Cellular Biology and Function

[EMT B]

As I pursue my career in Critical Care Nursing and Paramedicine, I can’t help but wonder something.

I am having the hardest time understanding cellular function. Thanks to EMT school and EMT CMEs I fully understand the different parts of the cell and how they function. I understand what carrier proteins and channel proteins et al. do. What I don’t understand is the process as to how they work at the CHEMICAL level. I don’t understand the chemical reactions that helps these proteins function.

So I pose the question- does it even matter? Does anyone actually look at their patient and say this patient is in metabolic acidosis because these proteins are not working due to this lipid’s carbon rings not forming properly due to this disease/disease process, or do you look at the patient and say this patient is in metabolic acidosis because of this disease/disease process?

 

[Clipper1]

This will all become clearer as you take college level A&P, microbiology, pathophysiolog and chemistry courses. EMTs courses are written around the 8th to 10th grade level and really do not cover very much at all except at a very elementary level. It is also a very extensive topic and until you get into the college level courses for nursing, it would be very difficult to go into such a topic on a forum such as this or most any forum without you having more of an educational basis.

 

[EMT B]

Im currently in my Freshman A&P right now and this is currently the topic we are covering and its a real struggle for me. Im just trying to figure out how much I really need to stress over not getting this chapter.

 

[Clipper1]

So I pose the question- does it even matter? Does anyone actually look at their patient and say this patient is in metabolic acidosis because these proteins are not working due to this lipid’s carbon rings not forming properly due to this disease/disease process, or do you look at the patient and say this patient is in metabolic acidosis because of this disease/disease process?

As a nurse it will absolutely matter. Your patient might be on lipids or have meds which may or may not be sparing on the kidneys. You will also be watching labs to know if the kidneys are functioning. What about ventilation's compensation?

Acid-base management is the foundation of most patient management. This includes fluids, ventilation and just about every aspect of care. You fail to recognize your patient is in metabolic acidosis and you could end up with a dead patient real fast. Blood pressure will drop and kidneys may fail totally which then leads to heart not working which then also drops the oxygenation/ventilation component.. As an RN you are the go between for patient and doctor. The doctor can not be at the bedside 24/7 or watch every minute all 30 - 50 patients he or she is seeing that day.

All RNs who want to work ICU or any unit in the hospital MUST understand acid-base. Many things you do as an RN can affect the acid-base status of a patient.

 

[JPINFV]

It's all about building your fund of knowledge. The thing about a good fund of knowledge is that you eventually end up using it without even thinking about it. It's like the difference between learning a second language and speaking your native language. In your second language you end up obsessing over the finer points because you need those finer points to speak properly. In your native language, you simply use the finer points without thinking about it.

 

[Carlos Danger]

Does anyone actually look at their patient and say this patient is in metabolic acidosis because these proteins are not working due to this lipid’s carbon rings not forming properly due to this disease/disease process

No, probably not.

However, you'll have a more thorough understanding of the disease process, why it causes metabolic acidosis, and why it is treated the way it is if you understand the underlying cellular physiology.

It is much easier to understand, learn, and remember pathophysiology and pharmacology if you have a solid understanding of cellular function.

 

[Clipper1]

No, probably not.

.

Wouldn't you consider a few things when hanging propofol or giving something similar? What about the interactions with various organs and medications? The RN can not always just blindly follow a doctor's order. The RN might have the latest lab results to know about certain failing organs and realize the meds ordered are not appropriate because of lipids or proteins even if they don't know the exact chemical formula structure.

 

[ThadeusJ]

I don't know how many conversations I have had about molecular biology while in the midst of a code and I know far too many clinicians who can tell me in great detail why a patient is deteriorating on a molecular level but fails to recognize a rapidly dropping BP, or act upon it when brought to their attention. However, when armed with this knowledge, you will have the ability to understand why certain things happen, and (as stated above) why certain things didn't happen.

A very simple example is drugs and old people, or people with renal insufficiency...because they don't break down the drugs in a timely fashion, the metabolites continue to circulate around and around and around. Someone who practices recipe medicine will give the "standard" dose. Someone who can put the pieces together understands that there is an art which should be practiced.

Knowledge is like pieces of a jigsaw puzzle. You may be able to get the picture with just a few pieces, enough to do what it needed. But if you have more pieces, it may allow you see a better view and act differently to provide better care. Some of the pieces are necessary and some are extraneous bits that don't add value...but that's up to you to decide. If you are unaware of what some pieces mean...it could limit your abilities.

 

[Carlos Danger]

Wouldn't you consider a few things when hanging propofol or giving something similar? What about the interactions with various organs and medications?

Do I consider "a few things" when I'm giving an anesthetic, or transporting a sick patients on multiple infusions? Of course. But they mostly have to do with how the pharmacokinetics of the drug are affected by the patient's condition and pathophysiology or other drugs, not usually the molecular basis for those pharmacokinetics.

The RN can not always just blindly follow a doctor's order. The RN might have the latest lab results to know about certain failing organs and realize the meds ordered are not appropriate because of lipids or proteins even if they don't know the exact chemical formula structure.

I don't think you'll find too many RN's who have much of a grasp on molecular biology. For instance, simply recognizing low albumin levels on a lab report and considering how that might affect certain medications doesn't necessarily require a lot of knowledge of physiology. They've all had A&P, but that's just an overview, and most I've known don't remember much about cellular processes or consider on a daily basis how they affect drugs or disease processes.