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NURSING 6501 Module 5 Knowledge Check Jean Baptiste
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NURS 6501Christine Jean-Baptiste
Knowledge Check: Module 5
Student Response
Scenario 1: 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, respirations 18 and
BP 160/88. Right great toe (first metatarsal phalangeal [MTP]) noticeably 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 of 2 Questions:
Describe the pathophysiology of gout.
Gout is an inflammatory response to excessive quantities of uric acid in the blood and in other
body fluids, including synovial fluid. Individuals with gout may have an accelerated rate of
purine synthesis accompanied by an overproduction of uric acid. A deficiency of the enzyme
HGPRT can lead to an increased production of uric acid. At the cellular level, purines are
synthesized to purine nucleotides, which are used in the synthesis of nucleic acids, adenosine
triphosphate, cAMP, and cGMP. Uric acid is a breakdown of product of purine nucleotides.
2 of 2 Questions:
Explain why a patient with gout is more likely to develop renal calculi.
Uric acid is mostly eliminated from the body through the renal system. 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; due to a decrease in glomerular
filtration of urate acid or acceleration in urate reabsorption leading to the development of renal
calculi.
Scenario 2: Lyme Disease
Stan is a 45-year-old man who presents to the clinic complaining of intermittent fevers,
joint pain, myalgias, and generalized fatigue. He noticed a rash several days ago that
1
, seemed to appear and disappear on different parts of his abdomen. He noticed the
lesion 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 exception of severe allergy to penicillin resulting in hives and difficulty breathing.
Physical exam: Temp 101.1 ˚F, BP 128/72, pulse 102 and regular, respirations 18. Skin
inspection revealed a 4-inch diameter bull’s eye type red rash over the left flank
area. The APRN, 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.
Question:
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 the spirochete Borrelia
burgdoferi transmitted by Ixodes tick bites and is the most frequently reported vector-borne
illness. The risk factor that increased the risk of Lyme disease clearing underbrush from his
backyard around a week ago. Working outdoors makes a person more at risk. The hallmark
bull’s-eye rash commonly appears at the site of tick attachment.
Scenario 3: 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 deformed. Her neighbor saw the fall and brought the
woman to the local Urgent Care Center for evaluation. Radiographs revealed a Colles'
fracture (distal radius with dorsal displacement of fragments) as well as radiographic
evidence of osteoporosis. A closed reduction 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.
Question:
What is osteoporosis and how does it develop?
Osteoporosis or porous bone, is the most common bone disease in humans. It is characterized by
low bone mineral density, impaired structural integrity of the bone, decreased bone strength, and
high risk for fractures. Those with low BMD are at the most risk of fractures. Osteoporosis
develops when the remodeling cycle- the process of bone reabsorption and bone formation is
disrupted, leading to an imbalance in the coupling process.
Scenario 4: Rheumatoid Arthritis
A 42-year-old woman presents to the clinic with a four-month history of generalized joint
pain, stiffness, and swelling, especially in her hands. She states that these symptoms
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