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Please respond to discussion below using current APA edition and 2 scholarly references. Must be 150 words. This past week has been wonderful, and I think it’s because I’m starting to realize that the semester is almost over. After completing this clinical rotation, I not only feel more prepared but also a lot more confidence in my ability to analyze patients. I had the good fortune to have an incredible preceptor who had faith in me and gave me opportunities to practice my abilities.This past week, we saw a male patient who was 53 years old and complained of a great deal of pain as well as redness reported to his big toe on his right foot when he presented himself to the clinic. His blood pressure is 135/85, his heart rate is 85, his respiratory rate is 18, his oral temperature is 98.8 degrees Fahrenheit, and he is 5 feet 8 inches tall and weighs 211 pounds. According to him, the pain started one day ago. He states that the pain lessens when he raises his foot and rests, but he continues to have some degree of discomfort. When he is moving around, the agony, according to him, is an 8 out of 10. He reported that the pain first started in his right big toe, but it has now spread to his ankle as well. He is currently in a lot of discomfort. Since yesterday, the patient has been taking 400 milligrams of ibuprofen orally to treat discomfort. This has been going on since yesterday. He claims that it does assist to ease some of the pain, but that it is not effective enough to fully treat it. The patient insists that he is not taking any other medications and claims that he has not damaged his foot. He also claims that he does not recall ever experiencing numbness or loss of sensation in that foot. Standard laboratory tests, including the serum uric acid level, were performed. A complete bilateral examination of his joints was performed to assess for symmetry, appearance, and range of motion (Dunphy, Winland-Brown, Porter, & Thomas, 2019).The patient’s right big toe was warm to touch, painful on palpation, and the range of motion was limited.After the assessment it appears the patient’s primary diagnosis is gout. Initial testing for gout includes a serum uric acid level. Most patients will have an elevated serum urate level in the absence of elevated blood urea nitrogen because serum urate is above 7.5mg/dL in up to 95% of persons with gout (Dunphy, Winland-Brown, Porter, & Thomas, 2019, p. 949). Some differential diagnosis for gout would include arthritides, cellulitis, acute joint trauma, and a fracture.According to Singh & Gaffo (2020), gout is the most common inflammatory arthritis in adults worldwide, with a disproportionate burden of disease in men, the elderly and racial/ethnic minorities. Comorbidities in gout are very common and add further to the disease morbidity and make its management challenging. It is critical to devise a treatment strategy for the patient that they can stick to in order to get rid of the acute episode of gout and prevent any attacks in the future. Lab work, such as a complete blood count, serum uric acid levels, and a radiograph are the first steps in the treatment strategy for this patient. In addition, he has the option of continuing to treat the pain with nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids. First-line treatment for acute gout pain often consists of nonsteroidal anti-inflammatory drugs (NSAIDs). He was instructed to take an initial dose of 750 milligrams of Naproxen, followed by a dosage of 250 milligrams every 8 hours for a period of 5 to 8 days. Colchicine treatment begins with a loading dose of 1.2 milligrams, which is then followed by 0.6 milligrams one hour later. After that, the patient takes 0.6 milligrams once or twice every 12 hours until the gout episode subsides. The patient was given the directive to apply ice to the affected area whenever it was necessary, to continue eating healthily, and finally to formulate a strategy to control the weight increase that he had experienced. He was also instructed on the significance of increasing the amount of vegetables and low-fat goods he consumed, as well as the amount of water he drank to prevent becoming dehydrated, the amount of physical activity he engaged in, and the value of avoiding meats that were high in purine content, such as liver, kidney, and sweetbreads. Additionally, he ought to cut back on his consumption of alcohol and stay away from carbonated beverages.Because I had never seen anything remotely similar to this situation before this week, I considered myself really fortunate to be able to observe it. I was familiar with gout from what I had read about it, but I had never observed a patient who was experiencing an acute episode of gout. It was helpful to obtain a clear concept of what the patient presents with and how to manage their treatment in order to lessen swelling and pain in the patient.
