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NR 508 Week 6 TD, NR 508 ADVANCED PHARMACOLOGY, Chamberlain College of Nursing
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NR 508 Week 6 TD, NR 508 ADVANCED PHARMACOLOGY, Chamberlain College of Nursing
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NR 508 Week 6 TD, Quiz and Summary, NR 508 Week 6 TD, Quiz and Summary
PART 1:
Jonathon is a 56 year-old retired automobile mechanic who has not been to
the doctor in approximately 6-7 years. He presents to your office
complaining that three weeks ago he was awoken with severe pain and
inflammation in his knee, which has been consistent since that initial night.
Upon physical examination of his knee, it appears swollen and erythematous
with periarticular involvement. Upon physical examination and laboratory
results you notice the following:
Physical examination:
GEN: well nourished, obese male (310 pounds)
VS: BP 191/112 HR 75 RR 15 T 98.6, HT 5’8”
EXT: Knee joint inflammation
Laboratory (fasting):
Na 139 mEq/L
K 3.8 mEq/L
Ca 9.1 mg/dL (9-10) Low Normal
CL 102 mmol/L (98-106)
HCO3 22 mEq/L
BUN 10 mg/dL
SCr 0.9 mg/dL
Serum Uric Acid 6.5 mg/dL (4-8.5) (>6.5 hyperuricemia)
Alb 4.1 g/dL (3.5-5)
Cholesterol 300 mg/dL (<200) H
UA: pH 6.8 (4.6-8) , uric acid 250 mg/24h (250-750)
What problems can be identified in this patient? Please provide a list of
differential diagnoses, as well as indication of your primary diagnosis.
What is your pharmacological plan for your primary diagnosis including the
medication, dose, and mechanism of action?
Probs = HTN, Obesity, High Cholesterol
Poss Dx = Pseudogout (calcium pyrophosphate dz), monoarthritis, septic
joint
, Pseudogout. Pseudogout, also referred to as acute calcium pyrophosphate
crystal arthritis, is an inflammatory disease process that belongs to a class of
diseases called calcium pyrophosphate deposition diseases (CPPDs) (Rho,
Zhu, Zhang, Reginato, & Choi, 2012). The two prevalent crystal-induced
arthropathies are gout and pseudogout (Rothschild, 2017). Sometimes,
pseudogout and its symptoms can be indistinguishable from gout
(Rothschild, 2017). Symptoms of both diseases include crippling pain in one
or more joints as well as erythema, warmness, tenderness, and swelling
(Rothschild, 2017). These symptoms generally effect the larger joints, such
as the knees and wrists (Papadakis & McPhee, 2017). When the affected
joint is examined via diagnostic imaging, chondrocalcinosis is almost always
present (Papadakis & McPhee, 2017). If the patient presents with the
symptoms above plus a fever, an infection of the joint should be investigated
(Rothschild, 2017).
There are some studies that can be useful in diagnosing, which include urine
and serum uric acid levels (even though these labs are not considered
diagnostic) and blood work such as a CBC to evaluate WBCs, a cholesterol
panel, a renal panel, liver enzymes, and glucose levels (Rothschild, 2017).
An ultrasound can be used to visualize the joint and examine for crystals,
tophaceous materials, and erosions that have overhanging edges (Rothschild,
2017). However, the best way to distinguish between gout and pseudogout is
to aspirate the synovial joint fluid; calcium pyrophosphate crystals indicate
pseudogout while monosodium urate monohydrate crystals indicate gout
(Rothschild, 2017).
Gout and pseudogout are treated similarly; both aim at reducing pain and
preventing flares via medications and/or decreasing urate levels (Rothschild,
2017). Before making a decision on the treatment plan, the provider needs a
baseline of renal functioning, to make sure the diagnosis is not septic
arthritis, and to know if the patient has a history of GI complications,
especially bleeding (PDR, 2017). Once crystal deposits are confirmed, relief
of pain and inflammation can be treated with NSAIDs, adrenocorticotropic
hormone (ACTH), colchicine, or a combination of meds including
intraarticular glucocorticoid (Rothschild, 2017).
For Jonathon, he is experiencing symptoms that could be either gout or
pseudogout. Based on the information given, I chose pseudogout because,
even though uric acid levels are not considered a diagnostic tool, his serum
and urine levels are within normal limits. Assuming he is afebrile and the
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