Please respond to discussion below using current APA edition and 2 scholarly references. Must be at least 150 words.
Everything went really well this week! Once more, I consider myself lucky to have an excellent preceptor. She does a great job going over pharmaceutical side effects and diagnosis explanations. This has shown to be very beneficial in determining the cause of a patient’s complaint, in my experience. The majority of the time, it’s because a new drug was added to their existing regimen.
This week at my clinical, we encountered a male patient who was 71 years old and had a history of excessive cholesterol. The patient reports that he is in excruciating pain and that his right big toe is swollen and red. He states that the pain was limited to his great toe and that it started a day ago. He now reports that the discomfort is also present in his ankle. After looking over his prescriptions, none of them seem to be the source of this problem right now.
Serum uric acid levels, complete blood count (CBC), and radiography are part of the patient’s care plan to confirm the diagnosis and rule out the existence of a competing diagnosis. The presence of hyperlipidemia prompted the drawing of a lipid panel as well. Gout, a metabolic disease characterized by a pathology involving uric acid levels over 7 mg/dL in men and 6 mg/dL in women, is the primary diagnosis. Urate deposits form in cartilage, soft tissues, and joints as a result of the high uric acid level. Reduced renal clearance, enzyme abnormalities, consuming too many purine-rich foods, obesity, dehydration, hunger, alcohol consumption, and diabetes are a few risk factors for gout (Dunphy, Winland-Brown, Porter & Thomas, 2019). The patient exhibits characteristic symptoms and indicators of the acute phase of the disease, including pain, elevated body temperature in the affected area, edema, and redness that would be indicative of gout.
He has been administered 750 mg of Naproxen, 250 mg every eight hours for five to eight days, and 1.2 mg of Colchicine as a loading dosage, followed by 0.6 mg one hour later, and 0.6 mg once or twice daily for the next twelve hours, or until the gout episode goes away. An additional component of the gout treatment was non-pharmacologic therapy. The patient was told to use topical ice whenever necessary. This patient’s information sources for anticipatory counsel and preventative care were reviewed. He received education on the value of maintaining a nutritious, well-balanced diet to prevent weight gain. Additionally, he received crucial information about limiting the intake of beef, lamb, pork, seafood, and low-fat products; increasing the consumption of vegetables; staying hydrated; adhering to a suitable exercise regimen; and avoiding meats high in purines, such as liver, kidney, and sweetbreads.
As to the American College of Physicians (ACP), the major clinical diagnosis for gout illness is as follows. Urate crystals in the aspirated fluid from the afflicted location, however, confirm the diagnosis. For individuals who may have acute gout, the American College of Physicians (ACP) advises using synovial fluid analysis when clinical judgment dictates that diagnostic testing is required. For the diagnosis of gout, synovial fluid analysis has been the gold standard. Acute gout misdiagnosed or misdiagnosed can lead to needless surgery, hospital stays, insufficient care (antibiotics for infected joints, for example), and overprescription of long-term medication. In the event that these standards are not met, the physician should either apply their professional judgment or refer the patient to a resource that can fulfill them.
After examining this patient, I could see how his care plan may incorporate a differential diagnosis like great toe cellulitis. I am also aware of how crucial it is to place the appropriate lab orders in order to rule out differential diagnosis and determine the root of the issue so that it may be appropriately treated. Seeing this patient made me feel at ease, especially since I was able to diagnose them using my prior knowledge because I had encountered a similar circumstance during my last clinical rotation.
