Primary Care of Adults Across the Lifespan (NRNP 6531)Wk 9 gout flare

(NRNP 6531)Primary Care of Adults Across the Lifespan (NRNP 6531)Le昀琀 knee pain, swelling, redness x 2 days HPI: Mr. Tod Gouseau is a 57yo Caucasian M presen琀椀ng with acute le昀琀 knee pain. He reports gradual onset of mild aching discomfort, redness, and swelling to le昀琀 knee 2 days ago. The pain is constant and has worsened to a 6-8 out of 10 throbbing super昀椀cial and deep pain. He denies radicular pain. He denies acute injury or trauma to a昀昀ected knee. Pain is exacerbated by weight bearing, bending, and walking. Pain is improved with rest but is not eliminated. Addi琀椀onal home therapies include OTC ibuprofen without relief. The pain makes walking and sleeping di昀케cult. He denies similar complaints with addi琀椀onal joints, fever, chills, fa琀椀gue, paresthesia, weakness, joint s琀椀昀昀ness, myalgia. He reports intermi琀琀ent episodes of le昀琀 great toe swelling and one previous episode of le昀琀 knee pain, swelling, and redness approximately 1 year ago. He has a history of osteoarthri琀椀s and HTN. His HTN is stable and is controlled by HCTZ 25mg po qday. He has a family history of rheumatoid arthri琀椀s. He denies a known history of gout. He drinks 3 beers 2 to 3 nights per week, follows a Mediterranean diet, a琀琀empts to walk 30 mins every day. ROS: General: Nega琀椀ve for fa琀椀gue, fever, chills, addi琀椀onal joint involvement, generalized weakness or s琀椀昀昀ness. CV: Posi琀椀ve for localized swelling to Le昀琀 knee Nega琀椀ve for CP, palpita琀椀ons, dizziness, syncope, orthopnea, exercise intolerance, cyanosis, claudica琀椀on, peripheral edema Resp: Posi琀椀ve for 25yr history of 0.5-1 PPD tobacco smoking, quit 15 yrs ago. Nega琀椀ve for SOB, dyspnea, cough, wheezing, sputum produc琀椀on GI: Denies N/V/D, cons琀椀pa琀椀on, abd pain, melena, hematochezia, hematemesis, dysphagia, dyspepsia, incon琀椀nence, or jaundice GU: Nega琀椀ve for dysuria, urgency, frequency, incon琀椀nence, or polyuria MS: Posi琀椀ve for Le昀琀 knee pain, swelling, and redness. Posi琀椀ve for family hx of RA. Posi琀椀ve for impaired gait. Nega琀椀ve for addi琀椀onal joint involvement, myalgia, trauma, hx of gout, muscle cramping or s琀椀昀昀ness, knee catching/popping/locking. Neuro: Nega琀椀ve for paresthesia, numbness, dizziness, syncope, decreased sensa琀椀on, ver琀椀go, generalized of unilateral weakness, tremors, or seizures. PMH: HTN: controlled by HCTZ 25mg po qd, diet, and exercise Osteoarthri琀椀s PSH: Lap Cholecystectomy: 8 yrs ago, no complica琀椀ons R shoulder arthroscopy for rotator cu昀昀 injury: 15yrs ago, no complica琀椀ons Downloaded by DANIEL NDAMBIRI () lOMoARcPSD| A++ Preventa琀椀ve: Colonoscopy: 6 yrs ago, normal results, no complica琀椀ons Dental exam: 2 yrs ago Immuniza琀椀ons: In昀氀uenza: UTD COVID-19: UTD + booster TDaP: UTD 6yrs ago Childhood schedule: UTD Medica琀椀ons: HCTZ 25mg po qday for HTN OTC Ibuprofen 400mg po qd prn pain Denies addi琀椀onal prescrip琀椀ons, OTC, supplements Allergies: Denies known allergies to medica琀椀ons, foods, latex, environmental allergens. Social History: Former Smoker: 0.5-1 PPD x 25 yrs, quit 15 yrs ago ETOH: 3 beers 2-3x/week, denies concerns for ETOH dependence Drugs: Denies use Ac琀椀vity: walks 30mins qd Diet: Mediterranean, Greek salads with sardines Ca昀昀eine: Denies ca昀昀einated drinks and chocolate intake Water: Reports good water intake, hydra琀椀on Housing: small apartment, lives with daughter Financial: has medical insurance, can a昀昀ord copays Occupa琀椀on: re琀椀red construc琀椀on worker Support System: lives with adult daughter Marital Status: widowed x 1 year Sexual Prac琀椀ces: 1 partner since death of wife, No contracep琀椀on/condom use. Denies hx of STI Family History: Mother: deceased at 71 from CVA, hx of RA Father: deceased at 64 from M