Nurs-6501 Case Study Wk8 M5 Assgn ALL ANSWERS 100% CORRECT Latest Fall 2021/2022 GUARANTEED GRADE A+

Case Study A 58-year-old obese white male presents to ED with chief complaint of fever, chills, pain, and swelling in the right great toe. He states the symptoms came on very suddenly and he cannot put any weight on his foot. Physical exam reveals exquisite pain on any attempt to assess the right first metatarsophalangeal (MTP) joint. Past medical history positive for hypertension and Type II diabetes mellitus. Current medications include hydrochlorothiazide 50 mg po q am, and metformin 500 mg po bid. CBC normal except for elevated sedimentation rate (ESR) of 33 mm/hr and C-reactive protein (CRP) 24 mg/L. Metabolic panel normal. Uric acid level 6.7 mg/dl. Introduction Having a clear understanding of the neurological and musculoskeletal system is very important for Advanced Practice Registered Nurses to properly diagnose and treat individuals presenting with disorders pertaining to these body systems. These two systems work closely together, therefore, what may affect one might cause symptoms in the other system as well. There are many factors that can impact these two systems such as race, and ethnic variables. Educating is a key factor in making sure patients stick to the desired treatment plan made for them. The purpose of this paper is to analyze the symptoms presented in this case study, identify elements that may be factors in the diagnosis, and explain how these processes interact to affect the patient. Neurological and Musculoskeletal Pathophysiologic processes of Gout Gout is an inflammatory disease where high levels of uric acid is produced in the blood leading to the formation of monosodium urate crystals which deposit in and around joints (McCance et al., 2019). The formation of crystals in the synovial fluid triggers a response that releases chemokines and interleukins which results in pain and inflammation in and around joints (McCance et al., 2019). These inflammatory mediators signal other cells such as macrophages which phagocytize or engulf these crystals producing a protein know as inflammasome, over time the continual production of this protein results in joint damage better known as gouty arthritis (McCance et al., 2019). When these crystals deposits in subcutaneous tissue they develop white nodules or tophi, other pre-existing disease is also linked to the formation of tophi such as high blood pressure and diabetes and this patient has a history of both conditions, these nodules can also cause deformity of the hands and feet when deposited around those areas (McCance et al., 2019). The release of these interleukins which have pyrogenic properties are the cause of fever, chills, and pain at the site of inflammation which is the cause of this patient’s symptoms (McCance et al., 2019). Increased crystal production most likely accumulated in the joint of this patient’s big toe leading to the swelling and pain he’s experiencing. When an area is inflamed and swollen, it can be very painful trying to put pressure on that area, I take it that’s the reason why he experienced so much pain when trying to ambulate or allow the clinician to examine his great toe. High levels of uric acid can also cause neurological alterations such as dystonia, chorea, and ballismus which are seen in individuals with a deficiency in the enzyme called HGPRT (McCance et al., 2019). Racial/ethnic variables that may impact physiological functioning of gout According to the article Racial/Ethnic Variation and Risk Factors for Allopurinol- Associated Severe Cutaneous Adverse Reactions, individuals of Black, Asian, Native Hawaiian/ Pacific Islander descent have a higher chance of developing gout as opposed to individuals of Caucasian descent (Keller et al., 2018). Research has also determined that men develop gout more often than woman, the majority of the women who develop gout is post-menopausal, they are usually older (60 years old or older), and they have a higher prevalence of comorbid disease (Harrold et al., 2016). Some other variables that increased this patient’s odds of developing gout was his diabetes, high blood pressure, and the fact that he’s taking a thiazide medication