Physiological Principle for Health and Social Care - Essay Example

Assignment: LO1 Concept of Cellular Metabolism Every cell in our body utilizes the macronutrients like carbohydrates, fats and protein for the generation of ATP required for various cellular processes and doing mechanical work by aiding in muscle contraction. This process is called catabolism. There are also mechanisms by which these macromolecules can be generated within the cell and the process is called anabolism which takes place when energy requirement of the cell decreases. The basic concept is to generate acetyl CoA , formed from the catabolism of carbohydrates, fats, and proteins like glycolysis, deamination, fatty acid oxidations which enters the Tricarboxylic acid cycle or TCA cycle where it combines with oxaloacetic acid to form citrate and this is recycled back to oxaloacetate which continues the cycle again. There can be other intermediates of the TCA cycle which is derived from the breakdown products of carbohydrate , fats and proteins and thus it is not necessarily be acetyl CoA. In the TCA cycle, dehydrogenation takes place in the various molecules and carbon dioxide is liberated(which we finally breathe out). The removed hydrogen is taken up by NAD or FAD to form NADH and FADH2 . These molecules transfer the hydrogen atoms and the respected electrons through the electron transport chain which comprises of enzymatic complexes, that helps to transfer the electrons to the oxygen molecule ( which is inhaled and thus utilized un this fashion) with the formation of water. The hydrogen ions are pumped out of the inner mitochondrial matrix to the external space. This causes the hydrogen ion concentration to be more in external matrix than in the inner matrix. The hydrogen ions are pulled into the inner matrix due to passive diffusion through the half channels in the ATP synthase molecule that has a rotor-stator function. This means when the outside hydrogen atoms are pulled inside the ATP synthase causes a conformational change that puts the free ADP and Pi to its catalytic domain and thus ATP synthesis takes place.(Ganong, 2005)(Das,2009) Fig: The above concept is explained from the Fig 12-8 reproduced from Molecular Cell Biology, 6th edition, 2008 published and copyright of Freeman and Company 2. Whenever metabolism occurs in the body, there can be a change in the pH of the body which can hamper the action of various enzymes needed for completing other metabolic reactions therefore it is necessary to maintain an optimum pH or the acid base balance of the body to maintain homeostasis (keeping the internal environment of the body constant). This can be achieved by the compensatory mechanism which corrects alkalosis or acidosis under the changed conditions. The lungs help to correct acidosis by excreting increased carbon-di-oxide, so the HCO3- / H2CO3 ratio is increased and the body pH is revived which was lowered due to increased H2CO3. On the other hand the kidneys reabsorb more bicarbonate ions to compensate for this situation. Reverse occurs when the body is threatened by alkalosis, that is the ventilation or breathing is decreased and carbon dioxide elimination is reduced so the HCO3- / H2CO3 ratio is decreased and the pH is revived to normal which otherwise was increased due to alkalosis. On the other hand the kidneys excrete more bicarbonates by reducing its reabsorption which helps to bring down the HCO3- / H2CO3 to normal. The kidneys also excrete out the end products of nitrogen metabolism like urea, creatinine and hippuric acid and along with ketone bodies when there is increased beta oxidation of long chain fatty acids.(Ganong, 2005) (Das,2009) 3. The role of the endocrine system in cellular metabolism Adrenaline activates adenylate cyclase leading to the inactivation of the enzyme glycogen synthase. Adenylate cyclase changes ATP to cyclic AMP which allosterically activates protein kinase a which causes phosphorylation of glycogen synthase. This phosphorylated form is an inactive form. Hence, during exercise when adrenaline is released and glucose is utilized rather than being synthesized to glycogen. During Starvation, Glucagon is released and by the same mechanism as discussed above makes glucose available to tissues rather than storage as glycogen to fulfill the metabolic demands of the body. (Ganong, 2005)(Das,2009) 4. Obesity occurs due to the mutation in the leptin receptor which cannot bind to leptin released from fat cells and thus prevets satiety and cause overeating leading to overweight. In Marasmus, there is a deficiency of both calories and protein in the body which causes a child below the age of 1 year to be underweight. (Ganong, 2005)(Das,2009) Assignment:LO2 Anatomical and Physiological changes due to Exercise 1. Cardiovascular system: a. Increased heart rate: As exercise is a kind of stress there is an activation of the sympathetic nervous system and decreased vagal tone with the release of nor epinephrine by the post ganglionic neurons which acts on the beta 2 adrenoceptors to increase the heart rate and this mechanism is to increase the cardiac output because during exercise the muscles requires more oxygen which is delivered by increased cardiac output . (Cardiac Output= Stroke Volume * Heart Rate). b. Cardiac Output: Increases because the stroke volume( the amount of blood pumped out by the ventricles/beat) and the heart rate both increases. c. Increased Stroke Volume: when the heart rate rises there is less time for cardiac filling, hence according to the Frank Starlings hypothesis (force of contraction depends upon initial length of the cardiac muscle within physiological limits) the stroke volume would decrease. On the other hand due to the increased activity of the muscular pump the venous drainage increases which increases the end diastolic volume and this causes increased preload (initial length of cardiac muscle increases) which causes increased stroke volume. d. Increased Blood pressure: Systolic blood pressure (SBP) increases with isotonic exercise and the diastolic blood pressure(DBP) falls but the mean blood pressure does not change to much. This is because SBP is a function of the cardiac output and the DBP is a function of the peripheral resistance, which actually falls during exercise.The decreased peripheral vascular resistance is due to a vasodilatation which occurs to supply more blood to the working muscles. e. Increased Coronary Ciculation: This is due to local oxygen lack in the myocardium which acts as a potent vasodilatator due to ADP accumulation. f. Increased capillary recruitment in skeletal muscles: The capillaries generally closed in the skeletal muscles opens up during severe exercise to supply oxygen through increased blood flow to the working muscles. Respiratory system: With exercise both the rate and the depth of respiration rises.During exercise the movements of the joints causes reflex rise of respiration. The main explanation is that during exercise oxygen lack takes place and this signal stimulates the carotid body chemoreceptors which will remain excited and depolarized due to the inhibition of the potassium efflux through the oxygen sensitive potassium channels ( as oxygen is less, so the channels do not open). This releases dopamine from the rceptors which stimulates the rostral ventrolateral medulla(RVLM) through the nucleus tractus solitarius. The RVLM sends impulses to the Retrotrapezoid Nucleus in the medulla which stimulates the respiratory pacemaker cells called the pre bottzinger complex which increases the rate and depth of respiration. Then due to accumulation of lactic acid and carbon dioxide the central chemoreceptors situated in the RVLM are also stimulated directly and also the RTN which similarly increases the ventilatory drive. Musculo-Skeletal Changes: 1. The fuels of the mucscles changes during various bouts of exercise. During light or endurance exercise the fuel is fats because there is no need of faster ATP generation and the slow twitch muscle fibres are involved to generate power. On the other hand when the exercise intensity becomes strenuous there is faster need of ATP generation and hence the fuel required is glucose which is used by the fast glycolytic twitch fibres as they are capable of generating faster ATP through anerobic glycolysis. 2. There is increased circulation in the skeletal muscles due to the process of capillary recruitment which increases and opens the otherwise closed capillaries to supply blood and oxygen to the working muscles. 3. With the increase in exercise intensity there is accumulation of lactic acid in the muscles and upon a certain concentration it starts to accumulate in the blood and this condition is called the onset of blood lactic acid (OBLA) which causes the increased ventilatory drive through the central chemoreceptors as discussed due to the actions of hydrogen ions and carbon dioxide. 4. The muscle pump becomes excited and this increases the venous drainage to the heart to increase the end diastolic volume which finally increases the stroke volume. (Chaudhuri,2002) Assignment: LO3 The BMI of the patient calculates out to be 33 ( BMI= Weight in kg/ Height in m2) as well as extrapolated from the following table below. Table: BMI chart for Men. This data suggests that this person is suffering from obesity because BMI >30 is classified as overweight and the waist circumference in this civil servant suggests that he is suffering from central obesity. Routine anthropometric measurements like BMI, weight indicates the metabolic status of an individual and will serve as a yardstick to plan intervention measures. There can also be measurements of blood pressure in a routine health check up to indicate whether the patient is suffering from hypertension or not. Then heart rate check ups also indicate the level of stress or anxiety in a person due to the work related stress or stress from personal life. These evaluations indicate that this civil servant should be encouraged to perform routine physical exercises and be guided to take less fatty foods because in obese persons although the fatty tissues generates a hormone called leptin which normally acts on the hypothalamus to reduce food intake, but in obese persons the leptin receptor is mutated so the leptin feedback mechanism does not works and the person reverts to overeating which causes increased calorie intake than desired as per the evaluation of his physical activity levels.Hence the performance of physical exercise will cause the person to burn out extra calories and prevent him to gain weight further. He should also take the advice of a dietitian to prepare his diet chart and consume food accordingly. The increased obesity in this person predisposes him to dyslipidemia or abnormality of the bad and good lipids in the body. This is due to the fact that LDL cholesterol will carry cholesterol from the liver and deposit it into the extra hepatic tissues like the endothelium of the blood vessels . However if the HDL cholesterol is more it will carry cholesterol from the extrahepatic tissues to the liver for metabolism. Therefore if his LDL/HDL ratio is increased there can be a chance of dyslipidemia and can increase his chance of atherosclerosis which can be an independent risk factor for cardiovascular diseases. He should be advised to have a lipid profile test to measure his LDL, HDL and total cholesterol. He should also be advised to have a blood sugar test because the incidence of obesity, stress and dyslipidemia can cause diabetes mellitus which will cause increased blood sugar levels and the glucose will not be utilized by the cells. Therefore while he will be doing strenuous exercise, he will not be able to cope up with the job, in spite of increased body weight, and will feel fatigued due to lack of energy. There can be further problems if he do not perform physical exercise, because sedentary lifestyle will cause diabetes to aggravate and cause neuropathic pain as the nerve cells will become devoid of glucose. During exercise cells can actively utilize glucose and the chance of neuropathic pain will thus be decreased. He should also go for a blood pressure check up because obesity may increase the chances of dyslipidemia. This might causes deposition of cholesterol in the endothelium of the blood vessels to cause atherosclerosis. This condition may cause increased peripheral resistance leading to increased blood pressure which again is a risk factor for cardiovascular morbidity and mortality. Finally there should be electrocardiogram which should be performed to evaluate whether there is any deposition of atheroma, which might impair blood and oxygen supply through the coronary capillaries to the myocardium and this might be reflected if his ST segment in the ECG is elevated. There can also be chance of left ventricular hypertrophy as because deposition of cholesterol in the large blood vessels may increase the after load of the the heart which can be confirmed by the increased amplitude of the QRS complex in the electrocardiogram. Evaluating anthropometric profile, cardiovascular profile may help in diagnosis of metabolic dysfunctions at an early stage of life and with proper life style modifications and prophylactic medications cardiovascular morbidity and mortality can be minimized. (Ganong, 2005)(Das,2009) Assignment: LOC4 Osteoarthritis which is also known as a degenerative joint disease, is a group of mechanical abnormalities which involves degradation of the joints , including the articular cartilages and subchondral bone. A variety of causes involving hereditary, developemental, metabolic and mechanical processes leads to the loss of cartilage.When the bone surface becomes less protected by cartilage, bone will be exposed and damaged due to inflammation. As a person ages the water content of the cartilage decreases as a result of decreased proteoglycan content, thus causing the cartilage to become less resilient. As a result of decreased movement secondary to pain, regional muscles may atrophy also. The common symptoms include joint pain, tenderness, stiffness, locking and sometimes an effusion is also noted. Care giving steps: 1. Assessment and relief from pain: Helping the patient to take comfortable positions during sleeping (elevating the bed) or sitting. 2. Warm compression to be applied on the sore joints several times a day. 3. The patient should be assisted with a range of active and passive motion with the help of resistive and isometric exercise, if possible to reduce the stiffness of joints which might result from immobility. 4. Scheduling of activities to provide a rest period of continuous and uninterrupted night time sleep. 5. Providing safe environments, for example, raising the chair/ use of high grips/ mobility aids and wheelchairs should be used. 6. Collaborating with physical therapist and physician and overseeing that the patient adheres to management plan. Management Of Urinary Incontinence Urinary incontinence is a condition in which continuous urinary flow occurs by dribbling without identifiable micturition episodes. There is a loss of micturition reflex and the inhibition from higher centres of the brain on the periaqueductal grey neurons is lost. Care plan 1. assisting the patient to select and apply a urine containment device like absorptive pads, incontinent briefs, underpads for bedding and absorptive inserts that can be put inside the undergarments 2. Cleansing the skin with an incontinence cleansing product or plain water when changing the containment pads or devices. Using of soap and water on alternate days should be done. 3. applying skin moisturizers following cleansing will promote comfort and reduce the chance of skin breakdown. 4. applying a protective barrier or ointment to the skin when incontinence is severe during the risk of a pressure ulcer. 5. Usage of antifugal powders in consultation with the physician because these powders provide relief from monilial rash, however excess usage may lead to the retention of moisture and diminish its effectiveness. 6. maintaining the privacy and the self dignity of a patient should also be an important aspect of care giving. Management of Pneumonia Pneumonia is a disease of the respiratory system caused by infection of the lungs.It is caused by various species of bacteria which infects a patient depending upon the environment where the patient is admitted. The most common pathogen is Streptococcal species in the community, however other forms of bacteria like Legionella and Pseudomonas may be involved in atypical pneumonia or hospital acquired pneumonia respectively.The germs reach the alveoli by inhalation, aspiration of oropharyngeal bacteria. The signs and symptoms includes cough, fever, hyperventilation, tachycardia, nausea and shortness of breathe. Due to inadequate oxygenation the patient also feels tired and fatigued. Care Plan 1. After assessing the frequency and depth of breathing and chest movements, breathing exercises should be intervened frequently and pressing the chest for effective coughing with the patient sitted in the Fowler’s position. 2. stimulating the production of cough to mechanically clear the airways by giving fluids at least 2500ml/day. Offering warm water is preferable.This will mobilize and remove secretions and clear the airways for improved breathing. 3. Assisting to monitor the effects of treatment and physiotherapy with the help of nebulizations as ordered by the physician. 4. Giving the medications like mucolytics, expectorants, bronchodilators and analgesics in consultation with the physician.(Chintamani, 2010)(Ganong,2005) (Das, 2009) References Chaudhuri, S 2002, Concise Medical Physiology, Fourth Edition, New Central book Agency, Kolkata. Chintamani, 2010 , Lewiss’s , Medical –Surgical Nursing., First Edition, Assessment and Management of Clinical Problems, Elsevier Das, D 2009, Biochemistry, Twenty third Edition, Academic Publishers, Kolkata Ganong,W 2005, Review of Medical Physiology, Twenty Second edition, McGraw Hill,Boston. Read More