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NURS6521-Module 5 Knowledge Checks-with latest solutions-
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NURS6521 -Module 5 Knowledge Checks -with 100% verified solutions -2023-2024 Neurological and Musculoskeletal Disorders Scenario: Gout A 52 -year -old obese Caucasian male presents to the clinic with a 2 -day history of fever, chills, and right great toe pain that has gotten worse. Patient states this is the first time that this has happened, and nothing has made it better and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief. Past medical history positive or hypertension treated with hydrochlorothiazide and kidney stones. Social history negative for tobacco use but admits to drinking “a fair amount of red wine” every week. General appearance: ill appearing male who sits with his right foot elevated. Physical exam remarkable for a temp of 101.2, pulse 108, resp 18 and bp 160 /88. Right great toe (first metatarsal phalangeal [MTP]) noticeable swollen and red. Unable to palpate to assess range of motion due to extreme pain. CBC and Complete metabolic profile revealed WBC 14,000 mm3 and uric acid 8.9 mg/dl. The APRN diagnoses the patient with acute gout. 1- Describe the pathophysiology of gout Gout is an inflammatory response to excessive quantities of uric acid in the blood (hyperuricemia) and in other body fluids, including synovial fluid. These elevated levels lead to the formation of monosodium urate (MSU) crystals in and around joints. When the uric acid concentration is >6.8 mg/dL in fluids, it crystallizes and forms insoluble precipitates of MSU that are deposited in connective tissues throughout the body. Crystallization in synovial fluid triggers TNF- a, causing the release of chemokines and interleukins. The result of crystallization in synovial fluid is acute, painful inflammation of the joint. This inflammatory response triggers macrophages. The pathoph ysiology of gout is closely linked to purine metabolism and kidney function. At the cellular level, purines are synthesized to purine nucleotides, which are used in the synthesis of nucleic acids, adenosine triphosphate, cyclic adenosine monophosphate (cAM P) , and cyclic guanosine monophosphate (cGMP). Gout is an inflammatory response to excessive quantities of uric acid in the blood and other body fluids including synovial fluid. The elevated level of uric acid lead to the formation of monosodium urate crystals in and around joints. When the uric acid levels exceed approximately 6.8 mg/dl, it crystallizes and forms an insoluble precipitate that are deposited into connective tissue through the body. When crystallization occurs in synovial fluid, it triggers Tumor Necrosis Factor (TNF) -a. Which causes the release of inflammatory cytokines and interleukins. The result is an acute inflammatory response within the joint. Gout is caused by a defect in purine metabolism and kidney function. Uric acid is a byproduct of purine nucleotides. People with gout may have an elevated level of purine syntheses accompanied by a rise in uric acid level. 2- Explain why a patient with gout is more likely to develop renal calculi. Most uric acid is eliminated from the body through the kidneys. Urate is filtered at the glomerulus and undergoes reabsorption and excretion within the proximal renal tubules. In primary gout, urate excretion by the kidneys is sluggish. This may be caused by a decrease in glomerular filtration or urate or acceleration in urate reabsorption. This allows for urate crystals to be deposited in the renal tubules. Scenario: Lyme Disease A 45 -year -old man presents to the clinic complaining of intermittent fevers, joint pain, myalgias, and generalized fatigue. He noticed a rash several days ago that seemed to appear and disappear on different parts of his abdomen. He noticed the les ion below this morning and decided to come in for evaluation. He denies recent international travel and the only difference in his usual routine was clearing some underbrush from his back yard about a week ago. Past medical history non -contributory with ex ception of severe allergy to penicillin resulting in hives and difficulty breathing. Physical exam: temp 101.1 f, BP 128/72, pulse 102 and regular, resp 18. Skin inspection revealed a 4 -inch diameter bull’s eye type red rash over the left flank area. The A PRN, based on history and physical exam, diagnoses the patient with Lyme Disease. She ordered appropriate labs to confirm diagnosis but felt it urgent to begin antibiotic therapy to prevent secondary complications. 1- What is lyme disease and what patient factors may have increased his risk developing LYME Disease? Lyme disease is a multisystem inflammatory disease caused by a spirochete that is transmitted by lxodes tick bites. It is the most frequently reported vector -born illness in the US. The microorganism is difficult to culture, escapes immune defenses through antigenic variation, blocks complement mediated killing, impedes release of antimicrobial peptides, leukocyte chemotaxis, and antimicrobial killing. It hides in tissue and is spread to other tissues by entering the capillary beds. The disease is characterized by flu-like symptoms in the early stages and many patients present with classic “target or bull’s eyes” lesion on the skin. If not treated early, there is disseminated infection with secondary rash with myalgias, arthralgias, fever and malaise. If left untreated, patients develop post Lyme disease syndrome or chronic Lyme Disease with can cause carditis, encephalitis, arthritis, polyneuropathy, and heart failure. The patient was likely bitten by an infected tick when he was clearing brush from his property. Scenario: Osteoporosis A 72-year -old female was walking her dog when the dog suddenly tried to chase a squirrel and pulled the woman down. She tried to break her fall by putting her hand out and she landed on her outstretched hand. She immediately felt severe pain in her right wrist and noticed her wrist looked deforme d. Her neighbor saw the fall and brought the woman to the local urgent care center for evaluation. Radiographs revealed a Colle’s fracture (distal radius with dorsal displacement of fragments) as well as radiographic evidence of osteoporosis. A closed redu ction of the fracture was successful, and she was placed in a posterior splint with ace bandage wrap and instructed to see an orthopedist for follow -up. 1- What is osteoporosis and how does it develop? Osteoporosis is considered a metabolic bone disease. Osteoporosis, also called porous bone, is the most common bone disease in humans. Its main features include low bone mineral density, impaired structural integrity of bone, decreased bone strength and increased risk for fractures. The two types of osteoporosis are primary and secondary. 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