Nu623U6D#1peerresponseKimberly

Risk factors for developing gout

Risk factors for this man for developing gout include being over the age of 40 years, male gender, alcohol intake (most commonly beer), being hypertensive (BP 180/96), and having a medical history of hyperlipidemia. Other risk factors that may contribute to gout not in this patient’s history include dehydration, high intake of dietary fatty foods, and increased intake of red meat and seafood/fish (Fenstermacher & Hudson, 2019).

Contributing factors to be explored

Other contributing factors that should be explored in this patient include if he is taking any drugs that may alter uric acid production or excretion (Fenstermacher & Hudson, 2019). Certain medications that may alter this include thiazide diuretics, loop diuretics, niacin, and calcineurin inhibitors.

Physical assessment focus

On physical assessment focus on the presentation of your patient. Is there acute pain and tenderness in the first metatarsophalangeal joint, is the joint swollen, warm, and red, does this wake the patient from sleep due to intolerance of contact with bed linens? Was the onset of pain intense and acute often beginning in the early morning hours and rapidly progressing over the next 12 to 24 hours? Does the patient have a fever? Are there subcutaneous or intra-osseous nodules? Does the patient have pain with urination that would be secondary to uric acid renal stone formation? On the actual assessment of your patient’s complaints does his right large great toe look swollen, does it have a full range of motion, and are there any firm nodules known as tophi present?

Initial testing performed

CBC to assess for WBC elevation. Synovial fluid analysis to assess for uric crystals, cell count, and culture to rule out infection. Serum uric acid level. Other testing to consider would be a CMP to check electrolytes and sedimentation rate to check for inflammation. The gold standard is seeing urate crystals in joint fluid aspirate (usually done by a rheumatologist) (Fenstermacher & Hudson, 2019).

Differential diagnoses

Pseudogout
Cellulitis
Acute bursitis

Modifications the patient is to be instructed to make for treatment of the gout

Lifestyle modifications should include weight loss for obese patients, good hydration, and smoking cessation. Patients should be instructed to avoid organ meats that are high in purine such as liver, sweetbreads, and kidneys. Patients should also avoid high fructose corn syrup and sweetened drinks. Patients should avoid the overuse of alcohol and no alcohol during an acute gout attack. Other lifestyle recommendations are limiting servings of beef, lamb, seafood, sardines, shellfish, and pork. Patients should be instructed to a diet high in vegetables, and low-fat dairy products.

Initial treatment, follow-up plan, and full prescribing information.

Initial treatments include ice, rest, and elevation. Acute flares are most effective when treatment is started within several hours of symptoms (Fenstermacher & Hudson, 2019). For mild to moderate pain NSAIDS and intra-articular corticosteroids in combination. If the patient is unable to tolerate NSAIDs or has chronic renal impairment, then corticosteroids can be started. Colchicine can be used if the gout attack was less than 36 hours before initiation of any other treatments. Consider when prescribing these drugs, important factors to include pharmacokinetics, pharmacodynamics, population specifics, benefits, and contraindications (Quintana et al., 2023).

The follow-up plan includes serum uric acid level every two to five weeks while titrating uric lowering treatment, monitoring CBC, renal function, liver function tests, and urinalysis.

Prescription information includes Indomethacin capsule 50mg, one capsule PO TID, given with food if GI upset occurs, and taper as symptoms improve but continue until pain-free, #90, no refills. Colchicine 0.6 mg tablets take 2 tablets (1.2mg total) PO initially once, then one hour later take 1 tablet (0.6mg total) PO for a total dose on the first day of therapy of 1.8mg. Then reduce to 0.6mg PO BID daily until 48 hours after resolution of the flare. #63, no refills.

Are you struggling to create a sound and comprehensive nursing paper? Do you feel overwhelmed with the amount of time and effort it takes to write a good piece? Are you looking for the best nursing paper writing service that can assist you in your nursing paper needs? Look no further than our skilled team of professional writers who specialize in providing high-quality papers with the best nursing paper writing services reviews. Make your order at nursingpaperhelp.com