The patient has a history of substance abuse and was found unresponsive with improvement related to Narcan administration

The patient has a history of substance abuse and was found unresponsive with improvement related to Narcan administration

The patient has a history of substance abuse and was found unresponsive with improvement related to Narcan administration 150 150 Peter

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The patient has a history of substance abuse and was found unresponsive with improvement related to Narcan administration. Genetics is a high ranking factor when it comes to substance abuse as individuals can be genetically predisposed to addictions. Addictions are to some extent tied together by shared genetic and environmental etiological factors and having knowledge of genetic factors in etiology and treatment response may enable the individualization of prevention and patient treatment (Bevilacqua & Goldman, 2009). Narcan is administered to reverse respiratory and CNS depression caused by opioids (Rosenthal & Burcham, pg. 867). Narcan acts as a competitive antagonist at opioid receptors which blocks opioid actions (Rosenthal & Burcham, pg.190). Opioid reversal involves several tissues (depending on the route of administration) which can include epithelia, subcutaneous, muscular, and neural (McCance & Huether, pg. 41).

The patient is also suffering from hyperkalemia most likely related to hypoxia which is caused by diminishing the efficiency of the cell membrane active transport and results in the escape of potassium to the extracellular fluid (McCance & Huether, pg. 117). Severe hyperkalemia (potassium greater than 6 mEq/L) dpresses the ST segment, prolongs the PR interval, and widens the QRS complex (which is a loss of atrial activity). All of these dysrhythmias together can cause cardiac arrest (McCance & Huether, pg 117).

Most likely related to IV drug use the patient also exhibits signs of necrotizing fasciitis which is a rare and rapidly spreading infection that is commonly caused by Streptococcus pyogenes which resists phagocytocis, and also releases toxins. The infection begins in the fascia, muscles, and subcutaneous fat to the overlying skin. This infection can progress quickly to sepsis and death and must be recognized, diagnosed, and treated early. Patients that participate in IV drug use are at an increased risk of this infection and must be treated with antibiotics and often surgical debridement. (McCance & Huether, pg.1513) Genetics is not a factor for this disease, as it is directly a result from a bacterial infection. The patient presents with the described symptoms because cell death related to the infection leaves painful skin wounds, often originating from the site of injection. This disease process will not respond to the treatment rendered in the scenario, as Narcan is not an antibiotic and has no antimicrobial properties.

Nothing would change the response to these disease process or treatment plans related to age or genetics, however, an extensive medical history would need to be completed and thoroughly evaluated to explore all possible causes of the hyperkalemia and rule out any comorbidities such as kidney disease or cardiac disease.

References:

Bevilacqua, L., & Goldman, D. (2009). Genes and addictions. Clinical pharmacology and therapeutics, 85(4), 359–361. https://doi.org/10.1038/clpt.2009.6

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier pgs. 41, 117, & 1513.

Rosenthal, L.D., & Burchum, J.R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). St. Louis, MO: Elsevier pgs. 190 & 867.