NURS 6501 Module 5 Assignment: Case Study Analysis
NURS 6501 Module 5 Assignment: Case Study Analysis
Advanced pathophysiology
Hyperuricemia is a health condition known to be commonly caused by a decrease in renal excretion. Patients utilizing diuretics such as hydrochlorothiazide are at a higher risk of developing the disease. However, the disease might also be genetically passed from parents to children. An increase in the turnover of nucleoprotein in the hematologic condition may result to an increase in urate production (Singh & Gaffo, 2020). Nucleoprotein turnover occurring in conditions of high rate of cell death and cellular proliferation may also impact high production of urate. Obesity which is an abnormal body weight may also cause an increased urate production which correlates with surface area to volume ratio of body size.
Neurological processes
An acute gout flare is characterized by pain as the primary symptom. Several factors may account for the felt pain. Bradykinin and prostaglandins production may be one factor that might impact the pain. Nociceptors’s sensitization may also account for this pain. Stimulation of unmyelinated nerve fibres results to neuropeptides release (Mei et al., 2019). For instance substance P which is an example of neuropeptides might be released. A release of substance P results to production of cytokines and PGs. It is also characterized by processes such as leukocytes recruitment, vasodilation, mast cell degranulation and plasma extravasation.
Musculoskeletal process
Continuous and multiple flare-ups makes gout to become persistent and severe. Due to this reason deformity of
a joint is developed. As time goes by, one progressively develops difficulties in joint motions. The uric acid crystals accounts for the damage in these joints and tendons. Developing gout is characterized by urate precipitation that results in monosodium-urate crystals that are needle-shaped. These crystals are found as deposits in vascular tissues such as cartilage and in other avascular tissues such as walls of bursae, tendons, ligaments and tendon sheaths (Zhang et al., 2018). The crystals may also be deposited within the skin closer to tissues and cooler distal joints such as those of the ears.
Racial/ethnic variables that may impact physiological functioning.
African-American men are reported to have more cases of gout arthritis compared to white men. From previous research studies, it has been found out that several differences exist in the genetic constituents of renal urate between African-American and white men. These differences account for the difference in number of gout Hyperuricemia cases. The higher prevalence of co-morbidities such as renal failure, hypertension and obesity also cause an increased burden of gout to the African-American men (Singh & Gaffo, 2020). Furthermore, delays in diagnosis and treatments as well as utilization of medications that are predisposing such as diuretics account for the higher number of gout patients among African-American men.
How these processes interact to affect the patient.
Having a history of diabetes mellitus and hypertension pose high possibilities of the patient developing gout. Increased uric acid also forms a higher risk of developing gouty arthritis. The patient’s obese condition and a recent history of hydrochlorothiazide intake also form a crucial role in gout pathogenesis. A sterile auto-inflammatory response to the crystals of monosodium-urate represents the gout flare. The auto-inflammatory response is characterized by erythema, heat, pain, swelling and loss of joint movement (Zhang et al., 2018). These are the exact signs and symptoms that the patient complains about. Moreover, the patient complains of having problems in the movement of the right first metatarsophalangeal which is the primary location where gout is known to attack. Although the patient is a white male who is less prevalent to gout attacks, his medical history suggest a higher chance of Hyperuricemia which is a primary cause of gouty arthritis.
References
Mei, J., Zhou, F., Qiao, H., Li, H., & Tang, T. (2019). Nerve modulation therapy in gouty
arthritis: targeting increased sFRP2 expression in dorsal root ganglion regulates
macrophage polarization and alleviates endothelial damage. Theranostics, 9(13), 3707.
https://doi: 10.7150/thno.33908
Singh, J. A., & Gaffo, A. (2020, June). Gout epidemiology and comorbidities. In Seminars in
arthritis and rheumatism (Vol. 50, No. 3, pp. S11-S16). WB Saunders.
https://doi.org/10.1016/j.semarthrit.2020.04.008
Zhang, Q., Gao, F., Sun, W., Ma, J., Cheng, L., & Li, Z. (2018). The diagnostic performance
of musculoskeletal ultrasound in gout: a systematic review and meta-analysis. PLoS
One, 13(7), e0199672. https://doi.org/10.1371/journal.pone.0199672