ALTERATIONS IN CELLULAR PROCESSES

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Scenario:

An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of extremities and abdomen. History obtained from staff reveals the patient has a history of malabsorption syndrome and difficulty eating due to a lack of dentures. The patient has been diagnosed with protein malnutrition.

Post an explanation of the disease highlighted in the scenario you were provided. Include the following 5 points in your explanation, 3 references will support your points.

The role genetics plays in the disease. (May or may not be applicable to patient. For example, protein malabsorption in elders does not have a genetic basis in this case).
Why the patient is presenting with the specific symptoms described.
The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
The cells that are involved in this process.
How another characteristic (e.g., gender, genetics, age) would change your response. i.e. What might be a characteristic influencing your response?

Sample Solution

The scenario describes an 83-year-old resident with protein malnutrition presenting with generalized edema. Let’s delve into the details of this condition.

Genetics and Protein Malnutrition:

While some rare genetic disorders can cause protein deficiencies, protein malnutrition in the elderly, as seen in this case, is not typically caused by genetics [National Institutes of Health, 2020].

Symptoms and Physiological Response:

The patient exhibits generalized edema, which is swelling caused by excess fluid accumulation in tissues. Protein, particularly albumin, plays a crucial role in maintaining blood pressure within blood vessels. When protein levels are low (protein malnutrition), albumin levels decrease, leading to a decrease in osmotic pressure in the bloodstream. This decrease disrupts the normal fluid balance between blood vessels and tissues. Fluid leaks out of the blood vessels and accumulates in tissues, causing edema [National Institutes of Health, Office of Dietary Supplements, 2021].

Cells Involved:

All cells in the body require protein for various functions, including growth, repair, and enzyme production. In protein malnutrition, various cell types are affected. Muscle cells break down for protein, leading to muscle wasting. This can explain why the patient might have difficulty eating due to weakness. Additionally, protein deficiency can impair the function of immune cells, increasing susceptibility to infections.

Impact of Age:

Age is a significant characteristic influencing protein malnutrition in the elderly. Several factors contribute to this:

  • Decreased protein intake: Loss of appetite, chewing difficulties due to missing teeth (like in this case), and social isolation can lead to inadequate protein intake in older adults [Evans, 2000].
  • Increased protein needs: Even with adequate intake, the body’s ability to absorb and utilize protein may decline with age. Additionally, chronic health conditions common in elderly populations can further increase protein requirements for healing and recovery.

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