Respond on to  two different days who selected different immune disorders and/or factors than you, in the following ways:

Share insights on how the factor you selected impacts the pathophysiology of the immune disorder your colleague selected.

Expand on your colleague’s posting by providing additional insights or contrasting perspectives based on readings and evidence.

                                                    Main Post

                            Irritable Bowel Syndrome (IBS):

Irritable bowel syndrome is a problem of a bowel function of the gastrointestinal tract.  IBS is one of the most common reasons for gastroenterologist consultation (Hammer & McPhee, 2019).  Irritable bowel syndrome symptoms are persistent abdominal pain, gas, bloating and with bowel disturbance; there are four subtypes of IBS: constipation (IBS-C), diarrhea (IBS-D), mixed (IBS-M), or unsubtyped IBS (IBS-U) (Kosako et al., 2018).  The incidence of IBS is higher in women; it is 1.5 to 3 times higher than men; with greater incidence in youth and middle age (Huether & McCance, 2017).

There is no known pathophysiology of irritable bowel syndrome and no specific biomarker for the disease (Huether & McCance, 2017).  Increasing evidence showed due to the different types of symptoms presentation of IBS that there are possibilities of correlation to altered gut microflora, gut immune responses, neuroendocrine cell function, the brain-gut axis, genetic predisposition and epigenetic factor (Huether & McCance, 2017). Despite the global frequency and disease burden of IBS, its underlying pathophysiology remains unclear (Ng QX et al., 2018).  Inflammation may provide a pathogenic role in IBS; research has shown the occurrence of mucosal irritation at the microscopic and molecular degree in IBS (Ng QX et al., 2018).  It also been reported that considerable overlaps between IBS and inflammatory bowel disease (Ng QX, et al., 2018). 

Psoriasis:

Psoriasis is one of the common issues of chronic skin inflammation. The prevalence of psoriasis affects both sexes and in most ethnic groups (Huether & McCance, 2017).  Most common occurrences are in people in their 30s, but it can also happen soon after birth (Hammer & McPhee, 2019).  Familial history of psoriasis is common, and the genetic process is complicated (Huether & McCance, 2017). 

The inflammatory dynamic of psoriasis involves the multifaceted interaction between macrophages, fibroblasts, dendritic cells, natural killer cells, T helper cells, and regulatory T cells. The influence of these immune cells can signal the secretion of multiple inflammatory mediators such as interferon, tumor necrosis factor-alpha, and various cytokines including interleukin 12, 23 and 17 (Huether & McCance, 2017).  

Maladaptive consequences of IBS and psoriasis:

Skin diseases, including psoriasis, appeared to impact a substantial adverse effect on patients’ health-related quality of life (Jung et al., 2018).  Individuals with psoriasis report that the illness has various physical and mental implications, such as social isolation and stress, depression, shame, and anxiety (Jung et al., 2018).

Patients with irritable bowel syndrome (IBS) have been found to have a significant reduction in quality of life (Arluwaili, et al., 2018). People with IBS report that the disease broth substantial psychosocial consequences such as social lifestyle and activities, emotional, food, and diet interest (Arluwaili, et al., 2018).

Refences

Alruwaili, A. M. M., Albalawi, K. S. A., Alfuhigi, F. R. D., Alruwaili, A. F., Altaleb, B. A. A., & Aljarid, J. S. (2018). Effects of Irritable Bowel Syndrome (IBS) on the health-related quality of Life among Saudi Males at Al-Jouf, Kingdom of Saudi Arabia. Egyptian Journal of Hospital Medicine, 73(4), 6581–6585. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=a9h&AN=132302964&site=eds-live&scope=site

Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education.

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Jung, S., Lee, S.-M., Suh, D., Shin, H. T., & Suh, D.-C. (2018). The association of socioeconomic and clinical characteristics with health-related quality of life in patients with psoriasis: a cross-sectional study. Health And Quality Of Life Outcomes, 16(1), 180. https://doi-org.ezp.waldenulibrary.org/10.1186/s12955-018-1007-7

Kosako, M., Akiho, H., Miwa, H., Kanazawa, M., & Fukudo, S. (2018). Impact of symptoms by gender and age in Japanese subjects with irritable bowel syndrome with constipation (IBS-C): A large population-based internet survey. BioPsychoSocial Medicine, 12. https://doi-org.ezp.waldenulibrary.org/10.1186/s13030-018-0131-2

Ng QX, Soh AYS, Loke W, Lim DY, & Yeo WS. (2018). The role of inflammation in irritable bowel syndrome (IBS). Journal of Inflammation Research, 345. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edsdoj&AN=edsdoj.4b6f79137ef348099ec9533069da7bbb&site=eds-live&scope=site

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NURS 6501: Advanced Pathophysiology

Arthritis

Lorie Valentin RN, BSN

Arthritis

            Osteoarthritis (OA) and Rheumatoid Arthritis (RA) are both diseases of the joints. Each is characterized by pain, swelling and stiffening of joints throughout the body (Huether & McCance, 2017). The most common joints affected are the hands, knees, hips and spine (Huether & McCance, 2017). In OA the breakdown of cartilage within the joints causes causing damage to the underlying bone and tissue. This breakdown causes a disruption of the fluid distribution mechanism within the joints allowing to much fluid into the cartilage, which in turn causes swelling in the joint and a weakening of the cartilage. As the cartilage weakens, breakdown occurs and causes further damage to the underlying boney structures, which leads to pain, inflammation and deformity of the joints. The most common cause of OA is repeated compression of the joints due to repetitive motion or constant pressure such as weight on the knees. In RA the causative factors are related to the increase of the synovial membrane comprised of pro-inflammatory cytokines (Hammer & McPhee, 2019). Where this increased lining comes in contact with out tissues such as cartilage and bone, it causes breakdown of those tissues.

Influencing Factors

            Though the rates for developing the disease are relatively equal in all parts of the world women are 30 percent more likely to develop RA than men (Hammer & McPhee, 2019). However, though the incidence rates are relatively equal between men and women, as they age women are typically more profoundly affected by OA (Huether & McCance, 2017). Ethnicity does not appear to play a major role in either disorder as it strikes individuals equally in different areas of the world (Hammer & McPhee, 2019).

Diagnosis and Treatment

            The diagnosis for OA is best achieved through thorough examination, in depth history, and radiological imaging to look for joint deformities (Huether & McCance, 2017).  The treatment for OA is based on the severity of the deterioration of the adjacent bone tissue in the joint. For mild to moderate disease physical therapy and exercise along with anti-inflammatory medications can improve mobility and pain. By improving muscle tone and flexibility many of the symptoms can be relieved. Possible addition of supplements and changes in diet can help decrease the inflammation characteristic of OA. More aggressive treatment for progressive disease might include steroid injections or surgery to replace the joint.

            The diagnosis for RA is much more complicated and is reliant on physical assessment, history and presentation. The most significant finding during evaluation that would point to RA is the swelling of the joints. Treatment should be immediate and aggressive to reduce the deterioration of the joint and the potential for damage to other organs within the body (Hammer & McPhee, 2019). Initial treatment for RA should be started with disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, sulfasalazine, or leflunomide (Huether & McCance, 2017). Like OA, RA treatment should also include physical and occupational therapy to improve muscle tone and flexibility as well as anti-inflammatory medications such as NSAIDS and steroids.

References

Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical

medicine (8th ed.). New York, NY: McGraw-Hill Education

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis,

MO: Mosby

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Topic: Health Issues for the Aging

As of 2014 health care expenditures in the United States are near 17% of our gross domestic product (GDP), with a major portion of Medicare funding goes towards chronic illness and care at the last 6 months of life. The Patient Protection and Affordable Care Act has made some initial legislative changes in our health system, but not sufficient to address our growing expenditures and caring for our large aging population. In this assignment, learners will synthesize issues in aging with health policy solutions by writing a paper on one health issue for older individuals addressed in the topic and offering a policy solution. Example of issue: In 2014, over 50% of the costs of institutional long-term care for older persons are paid for with public funds from Medicaid.

General Guidelines:

Use the following information to ensure successful completion of the assignment:

· Doctoral learners are required to use APA style for their writing assignments. 

· This assignment requires that at least three additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.

· You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Directions:

Write a 1,000-1,250 word paper that addresses a health issue for older individuals. Include the following:

1. Evaluate what the literature suggests as a resolution to your chosen issue.

2. Discuss any attempts to incorporate the solution into public policy.

3. Determine the barriers to implementation of the solution.

4. Analyze the options being discussed for public and/or private funding.

5. Propose your own recommendation.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting.

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COLLAPSE

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Human Immunodeficiency disorder (HIV) is a viral infection.  The infection results from one of two similar retroviruses (HIV-1 and HIV-2) that destroy CD4+ lymphocytes and can impair cell-mediated immunity which increases the risk of certain infections and cancers (Cachay, 2019).  When cell-mediated immunity is impaired, the immune system weakens and makes the body more susceptible to any type of infection that sees opportunity.  HIV is spread through contact with infected body fluids such as saliva, blood, and semen.  The pathophysiology includes the HIV cells to attach and penetrate host T cells via the CD4+ molecules and chemokine receptors.  After the attachment process, HIV RNA and several HIV-encoded enzymes are released into the host cell (Cachay, 2019).  This process results in multiple replications of the infected host cell.  These mutations facilitate the generation of HIV which can resist control by the host’s immune systems and by antiretroviral drugs (Cachay, 2019).  Compensatory mechanisms are present throughout the human body and evolution is a key factor in the impairment of several disease processes.  RNAi is a novel target when directed at the viral TAR.  When this has been tested, HIV can not mutate the target site.  Instead several mutations indirectly compensated through upregulation.  The RNAi represents a novel compensatory mechanism by which viruses can tune viral transcriptional regulation as an indirect mechanism to compensate for viral suppression (Leonard, J. N., et al, 2008).  Depending on the infected host’s immune system, HIV can present as an acute febrile illness days to months after exposure to the virus.  Determination of HIV is based on the CD4+ count.  When the CD4+ count drops to <200/mcL nonspecific symptoms may worsen and succession of AIDS-defining illnesses will develop (Cachay, 2019).  Behavior seems to be the largest risk factor in the pathophysiology and diagnosis of this disease process.  Homosexual or bisexual men are at the highest risk of exposure to the infection.  Anal-receptive intercourse poses the highest risk because mucous membrane inflammation facilitates HIV transmission (Cachay, 2019).  

Systemic lupus erythematosus (SLE) is an autoimmune disease that results in multi-organ dysfunction.  SLE is characterized by a loss of self-tolerance with activation of autoreactive T and B cells which then leads to production of pathogenic autoantibodies and tissue injury (Choi, Kim, & Craft, 2012).  The kidneys are the primary targeted area that generates the initial dysfunction from this genetic pre-disposed disease.  Even though genetics is a predisposition to the development of SLE, the cause remains unknown.  The pathophysiology includes tissue injury through the release of inflammatory cytokines, as well as the aberrant activation of autoreactive T and B cells, which eventually leads to the pathogenic production of autoantibodies and then results in end-organ injury (Choi, Kim, & Croft, 2012).  End-organ injury in SLE can present as acute renal failure, spleenomegaly, and enlarged lymph nodes.  The cause of this presentation is based on an increased amount of circulating and activated basophils (Choi, Kim, & Craft, 2012).  To regulate this autoimmune disease process, CD4+ cells are present.  CD4+ T cells are critical players in the pathogenesis of SLE, they regulate B cell responses and also infiltrate target tissues, which eventually leads to tissue damage (Choi, Kim, & Craft, 2012).  

There are similarities and differences between SLE and HIV.  Each disease attacks the immune system which can cause an increased inflammatory response.  However in SLE, the immune system is overactive, where as in HIV, the immune system is underactive (2019).  Therefore, in SLE the body attacks healthy tissue and cells and in HIV, the body lacks an immune system to attack infections and the body becomes more susceptible to illness.  Both immune disorders are due to the qualitative CD4+ T cell dysfunction that occurs prior to CD4 cell depletion.  It is manifested by reduced responsiveness of CD4 cells to monocyte soluble antigens, which may include polyclonal B cell activation and reduced antibody response to specific immunogens (Fox & Isenburg, 2007).  

References

Cachay, E. R. (2019).  Human Immunodeficiency Virus (HIV) Infection – Infectious Diseases.  Retrieved from https://www.merckmanuals.com/professional/infectious-diseases/human-immunodeficiency-virus-hiv/human-immunodeficiency-virus-hiv-infection

Choi, J., Kim, S. T., & Craft, J. (2012).  Pathogensis of systemic lupus erythematosus update. Pathology, 44.  doi: 10.1016/s0031-3025(16)32688-5.  Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508331/

Fox, R. A>, & Isenberg, D. A. (2007).  Human immunodeficiency virus infection in systemic lupus srythematosus.  Arthritis & Rheumatism, 40(6), 1168-1172.   doi: 10.1002/art.1780400623.  Retrieved from https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.1780400623

Leonard, J. N., Shah, P. S., Burnett, J., C., & Schaffer, D. V. (2008).  HIV Ecades RNA Interference Directed at TAR by an Indirect Compensatory Mechanism.  Cell Host & Microbe, 4(5), 484-494. n doi:  10.1016/j.chom.2008.09.008.  Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742160/

What is lupus? (2019).  Retrieved from https://www.lupus.org/resources/what-is-lupus

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