NURS 6501 Week 8 Case Study Analysis

NURS 6501 Week 8 Case Study Analysis

A 52-year-old male with a history of hypertension and hyperlipidemia presents with left great toe pain despite not having an injury. He is currently taking hydrochlorothiazide 12.5 mg and simvastatin 20mg PO daily. Physical exam reveals the first metatarsal phalangeal joint is erythematous and edematous but with normal joint space and no erosion on X-ray. Uric acid and ESR levels are raised. The purpose of this assignment is to describe pathophysiologic processes related to the symptoms and racial/ethnic factors that can affect physiological functioning.

UnderlyingMusculoskeletal Pathophysiologic Processes

The patient’s presentation is typical in persons experiencing gouty arthritis. Gout is an inflammatory rheumatic disease that presents with arthritis resulting from abnormal uric acid metabolism (Murdoch et al., 2021). patients have increased uric acid levels resulting from increased formation or reduced excretion. Dietary intake of foods rich in triglycerides, starch, and proteins has been associated with increased uric acid production. On the other hand, diuretics such as hydrochlorothiazide and renal diseases have been associated with reduced uric acid excretion in the kidneys (Zhang et al., 2022). As a result, the increased uric acid concentration in blood is oxidized to urate.

The increased urate generates monosodium urate (MSU) crystals, which are deposited in and around the first metatarsophalangeal joint, knee, and fingers. The MSU crystals induce an inflammatory process leading to acute gouty inflammation and chronic long-term inflammatory consequences. A rise in ESR has been associated with the inflammatory cytokines released during the inflammation (Parisa et al., 2023). The cytokines and resultant inflammation sensitize surrounding pain receptors, resulting in pain around the joints affected alongside swelling.

Racial/Ethnic Variables That May Affect Physiological Functioning

Gout was previously considered a White man’s disease as they would overindulge in gamey meats and other rich foods. However, due to increased cases of obesity, the prevalence of gout is now seen in other demographics, including Black men and women and White women (Singh et al., 2020). However, gout may be more common in Black men and women compared with the White population. The increase may have resulted from socio-clinical factors such as excess BMI, poverty, chronic kidney disease, and poor diet (McCormick et al., 2022). Lastly, blacks are less likely to receive good quality gout care, leading to a disproportionate morbidity compared to the rest of the population.

How the Processes Interact to Affect the Patient

Inflammatory processes are characterized by pain, swelling, redness, increase in temperature, and loss of function at the site affected. The resultant inflammation is the hallmark of the clinical presentation of acute gouty arthritis in this patient’s right metatarsophalangeal joint (Parisa et al., 2023). As a result, the patient experiences joint pain associated with hotness around the joint affected. Patients also tend to have difficulty using the affected joints, resulting in symptoms such as pain while walking and inability to write (Cairns et al., 2020). In addition, oversaturation of the renal tubules with uric acid predisposes them to renal stone formation and resultant symptoms of urinary tract obstruction and infection.

Conclusion

Gouty arthritis is a condition that results from increased uric acid, leading to the deposition of urate crystals in and around joints, resulting in an inflammatory process. Gout has been associated with dietsrich in starch, proteins, and triglyceride. Additionally, some diuretics and renal failure have been associated with an increased risk of developing gout.

References

Cairns, I., Lindsay, K., Dalbeth, N., Díaz-Torné, C., AntòniaPou, M., Rodríguez Diez, B., Pujol-Ribera, E., Panter, C., Arbuckle, R., Tatlock, S., & Taylor, W. J. (2020). The impact of gout as described by patients, using the lens of The International Classification of Functioning, Disability and Health (ICF): a qualitative study. BMC rheumatology, 4, 50. https://doi.org/10.1186/s41927-020-00147-2

McCormick, N., Lu, N., Yokose, C., Joshi, A. D., Sheehy, S., Rosenberg, L., Warner, E. T., Dalbeth, N., Merriman, T. R., Saag, K. G., Zhang, Y., & Choi, H. K. (2022). Racial and Sex Disparities in Gout Prevalence Among US Adults. JAMA network open, 5(8), e2226804. https://doi.org/10.1001/jamanetworkopen.2022.26804

Murdoch, R., Barry, M. J., Choi, H. K., Hernandez, D., Johnsen, B., Labrador, M., Reid, S., Singh, J. A., Terkeltaub, R., Vázquez Mellado, J., &Dalbeth, N. (2021). Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) common language definition of gout. RMD open, 7(2), e001623. https://doi.org/10.1136/rmdopen-2021-001623

Parisa, N., Kamaluddin, M. T., Saleh, M. I., &Sinaga, E. (2023). The inflammation process of gout arthritis and its treatment. Journal of advanced pharmaceutical technology & research, 14(3), 166–170. https://doi.org/10.4103/japtr.japtr_144_23

Singh, J. A., &Gaffo, A. (2020). Gout epidemiology and comorbidities. Seminars in arthritis and rheumatism, 50(3S), S11–S16. https://doi.org/10.1016/j.semarthrit.2020.04.008

Zhang, Y., Chen, S., Yuan, M., Xu, Y., & Xu, H. (2022). Gout and Diet: A Comprehensive Review of Mechanisms and Management. Nutrients, 14(17), 3525. https://doi.org/10.3390/nu14173525

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An understanding of the musculoskeletal systems is a critically important component of disease and disorder diagnosis and treatment. This importance is magnified by the impact that that this system may have on another. A variety of factors and circumstances affecting the emergence and severity of issues in one system can also have a role in the performance of the other.

Effective analysis often requires an understanding that goes beyond these systems and their mutual impact. For example, patient characteristics such as, racial and ethnic variables can play a role.

An understanding of the symptoms of alterations in musculoskeletal systems is a critical step in diagnosis and treatment. For APRNs this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.

Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

Learning Resources

Lecturio Resources

Review the following Video Resources and Content Pages in the Lecturio Platform by clicking button below labeled Load Week 8: Learning Resources in a new window.

• Rheumatology: Introduction and Overview (5:41 min)
• Osteoarthritis (OA): Pathogenesis (7:46 min)
• Crystalline Arthropathies: Gout/Pseudogout (7:03 min)
• Tick-Borne Disease, Lyme Disease, Rocky Mountain Spotted Fever (RMSF) & Ehrlichiosis (9:10 min)
• Spondyloarthritides (1:26 min)
• Growth and Development of the Infant (Nursing) (5:46 min)
• Growth and Development of the Toddler (Nursing) (7:21 min)
• Growth and Development of the Preschool-aged Child (Nursing) (5:21 min)
• Growth and Development of the School-aged Child (Nursing) (5:34 min)
• Growth and Development of the Adolescent (Nursing) (3:46 min)
• Growth and Development of the Infant: Motor and Cognitive Milestones (Nursing) (7:55 min)

If you have any technical issues, please contact the Customer Care Team at 1-800-925-3368.

Supplementary Resources

Note: These readings are intended to serve as supplementary to the Lecturio content provided in this course. Please refer/review these supplementary resources should you need help in reinforcing concepts and in preparation for completing this week’s Assessments.

• McCance, K. L. & Huether, S. E. (2019). Pathophysiology: the biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
  • Chapter 44: Structure and Function of the Musculoskeletal System (stop at Components of muscle function); Summary Review
  • Chapter 45: Alterations of Musculoskeletal Function (stop at Bone tumors); (start at Disorders of joints); Summary Review
  • Chapter 47: Structure, Function, and Disorders of the Integument (section on Lyme Disease)

Note: Although this resource page displays as an Assignment, it will not be counted towards your final grade. Your progress through the Lecturio resources will be reported as a percentage in the gradebook that will only be used as reference. 

To prepare:

By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Announcements” section of the classroom for your assignment from your Instructor.

The Assignment (1- to 2-page case study analysis)

In your Case Study Analysis related to the scenario provided, explain the following:

• The musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
• Any racial/ethnic variables that may impact physiological functioning.
• How these processes interact to affect the patient.

By day 7 of Week 8

Submit your Case Study Analysis Assignment by Day 7 of Week 8.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates

Links to an external site.). All papers submitted must use this formatting.

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

1. To submit your completed assignment, save your Assignment as WK8Assgn2_LastName_Firstinitial
2. Then, click on Start Assignment near the top of the page.
3. Next, click on Upload File and select Submit Assignment for review.

Rubric

NURS_6501_Week 8_Case Study_Assignment_Rubric