NURS 6501
Christine 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
1
,intermittent fevers, joint pain, myalgias, and generalized fatigue. He noticed a
rash several days ago that
2
,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
3
, 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
4
Christine 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
1
,intermittent fevers, joint pain, myalgias, and generalized fatigue. He noticed a
rash several days ago that
2
,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
3
, 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
4
