NURS 6501 NEUROLOGICAL AND MUSCULOSKELETAL DISORDERS
Sample Answer for NURS 6501 NEUROLOGICAL AND MUSCULOSKELETAL DISORDERS Included After Question
NURS 6501 NEUROLOGICAL AND MUSCULOSKELETAL DISORDERS
NEUROLOGICAL AND MUSCULOSKELETAL DISORDERS
In this exercise, you will complete a 5-essay type question Knowledge Check to gauge your understanding of this module’s content.
Possible topics covered in this Knowledge Check include:
Stroke
Multiple sclerosis
Transient Ischemic Attack
Myasthenia gravis
Headache
Seizure disorders
Head injury
Spinal cord injury
Inflammatory diseases of the musculoskeletal system
Osteoporosis
Osteopenia
Bursitis
Tendinitis
Gout
Lyme Disease
Spondylosis
Fractures
Parkinson’s
Alzheimer’s
Three basic bone-formations:
Osteoblasts
Osteocytes
Osteoclasts
RESOURCES
NURS 6501 NEUROLOGICAL AND MUSCULOSKELETAL DISORDERS
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BY DAY 7 OF WEEK 7
Complete the Knowledge Check by Day 7 of Week 7.
This quiz was locked Apr 16 at 10:59pm.
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A Sample Answer For the Assignment: NURS 6501 NEUROLOGICAL AND MUSCULOSKELETAL DISORDERS
Title: NURS 6501 NEUROLOGICAL AND MUSCULOSKELETAL DISORDERS
Question 1
4 / 4 pts
Scenario 1: Gout
A 68-year-old obese male presents to the clinic with a 3-day history of fever with chills, and Lt. great toe pain that has gotten progressively 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.
HPI: hypertension treated with Lisinopril/HCTZ .
SH: Denies smoking. Drinking: “a fair amount of red wine” every week. General appearance: Ill appearing male who sits with his right foot elevated.
PE: remarkable for a temp of 100.2, pulse 106, respirations 20 and BP 158/92. 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 15,000 mm3 and uric acid 9.0 mg/dl.
Diagnoses the patient with acute gout.
Question:
Explain the pathophysiology of gout.
Your Answer:
Gout is caused by disorders of purine metabolism, increased uric acid production, and reduced uric acid excretion, causing increased serum uric acid (sUA) levels. This forms monosodium urate (MSU) crystals deposited in the joints, kidneys, and other tissues. Gout occurs following the precipitation of monosodium urate crystals in a joint space (Clebak et al., 2020). The deposition of the urate crystals elicits activation of the immune system, causing the release of various inflammatory cytokines and the recruitment of neutrophils. Over time, the joint space becomes irreversibly damaged, causing chronic pain and disability with grossly deformed joints. Tophi may also form at the joint space. These are subcutaneous nodules containing monosodium urate crystals in a matrix of lipids, proteins, and mucopolysaccharides (Clebak et al., 2020). The first metatarsophalangeal joint is mostly affected.
Reference
Clebak, K. T., Morrison, A., & Croad, J. R. (2020). Gout: Rapid evidence review. American family physician, 102(9), 533-538.
Question 2
2 / 4 pts
Scenario 1: Gout
A 68-year-old obese male presents to the clinic with a 3-day history of fever with chills, and Lt. great toe pain that has gotten progressively 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.
HPI: hypertension treated with Lisinopril/HCTZ .
SH: Denies smoking. Drinking: “a fair amount of red wine” every week. General appearance: Ill appearing male who sits with his right foot elevated.
PE: remarkable for a temp of 100.2, pulse 106, respirations 20 and BP 158/92. 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 15,000 mm3 and uric acid 9.0 mg/dl.
Diagnoses the patient with acute gout.
Question:
Explain why a patient with gout is more likely to develop renal calculi.
Your Answer:
Gout patients commonly present with nephrolithiasis. The development of renal calculi in patients with gout is primarily related to high levels of uric acid. The ionized forms of uric acid form salts like monosodium urate, disodium urate, or potassium urate (Bardin et al., 2021). Sodium is the main cation in the extracellular fluid. Urine acidifies along the renal tubules, causing a portion of urate to convert to uric acid. The solubility of uric acid in an aqueous solution is lesser than that of urate, but the saturation increases markedly with the increase in the pH value of urine (Bardin et al., 2021). Gout patients with long-term high uric acid levels have increased urinary uric acid concentration and form crystals after surpassing the solubility, which gradually enlarges to shape calculus.
References
Bardin, T., Nguyen, Q. D., Tran, K. M., Le, N. H., Do, M. D., Richette, P., Letavernier, E., Correas, J. M., & Resche-Rigon, M. (2021). A cross-sectional study of 502 patients found a diffuse hyperechoic kidney medulla pattern in patients with severe gout. Kidney international, 99(1), 218–226. https://doi.org/10.1016/j.kint.2020.08.024
Jia, E., Zhu, H., Geng, H., Wang, Y., Zhong, L., Liu, S., Lin, F., & Zhang, J. (2021). Effect of alkalized urine on renal calculi in patients with gout: a protocol for a placebo-controlled, double-blinded randomized controlled trial. Trials, 22(1), 743. https://doi.org/10.1186/s13063-021-05721-8
Partial credit, I did not see Jia as an intext citation. Let me know if I overlooked this.
Question 3
4 / 4 pts
Scenario 2: Osteoporosis
A 78-year-old female was out walking her small dog when her dog suddenly tried to chase a rabbit and made her fall. She attempted to try and 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 ER 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:
Discuss what is osteoporosis and how does it develop pathologically?
Your Answer:
Osteoporosis is a chronic metabolic disorder that presents with bone loss, causing a decreased bone density and increasing the risk of fracture. The commonly affected bones are the spine, hip, and wrist. Osteoporosis is diagnosed in a patient with a T-score at or below −2.5 (Akkawi & Zmerly, 2018). Common osteoporosis manifestations are loss of height, back pain with bending, lifting, or stooping, and fractures. Osteoporosis develops when bone resorption exceeds bone building, resulting in decreased bone mineral density (BMD). BMD decreases more rapidly in postmenopausal females due to decreased serum estrogen levels. Estrogen helps in preventing bone loss.
Reference
Akkawi, I., & Zmerly, H. (2018). Osteoporosis: Current Concepts. Joints, 6(2), 122–127. https://doi.org/10.1055/s-0038-1660790
Question 4
3.9 / 4 pts
Scenario 3: Rheumatoid Arthritis
A 48-year-old woman presents with a five-month history of generalized joint pain, stiffness, and swelling, especially in her hands. She states that these symptoms have made it difficult to grasp objects and has made caring for her grandchildren problematic. She admits to increased fatigue, but she thought it was due to her stressful job.
FH: Grandmothers had “crippling” arthritis.
PE: remarkable for bilateral ulnar deviation of her hands as well as soft, boggy proximal interphalangeal joints. The metatarsals of both of her feet also exhibited swelling and warmth.
Diagnosis: rheumatoid arthritis.
Question:
The pt. had various symptoms, explain how these factors are associated with RA and what is the difference between RA and OA?
Your Answer:
RA is a chronic, gradual, systemic inflammatory autoimmune disorder affecting synovial joints. It is characterized by inflammation of connective tissue in the synovial joint. It is a systemic disease that affects the body system and usually involves several joints and other tissues. Rheumatoid factors (RFs) are formed and attack healthy tissues, particularly synovium, causing inflammation (Scherer et al., 2020). The disease then involves the articular cartilage, joint capsule, and surrounding ligaments and tendons. This explains the patient’s symptoms of generalized joint pain, stiffness, and swelling, in her hands as well as boggy proximal interphalangeal joints and swelling and warmth of the metatarsals in her feet also exhibited swelling and warmth.
Osteoarthritis (OA) presents with deep joint pain secondary to extensive joint use. It manifests with a reduced range of motion (ROM) in affected joints and Heberden nodes. Joint stiffness in OA occurs during rest, and it also has joint stiffness in the morning that lasts less than 30 minutes (Yunus et al., 2020). On the other hand, RA presents with morning joint stiffness lasting more than an hour. RA presents with systemic symptoms, like a low-grade fever, anorexia, fatigue, and weight loss, which do not occur in OA.
References
Scherer, H. U., Häupl, T., & Burmester, G. R. (2020). The etiology of rheumatoid arthritis. Journal of autoimmunity, 110, 102400. https://doi.org/10.1016/j.jaut.2019.102400
Yunus, M., Nordin, A., & Kamal, H. (2020). Pathophysiological Perspective of Osteoarthritis. Medicina (Kaunas, Lithuania), 56(11), 614. https://doi.org/10.3390/medicina56110614
As posted, RA …..spell out when first introduced as content.
Question 5
3.9 / 4 pts
Scenario5: Multiple Sclerosis (MS)
A 28-year-old obese, female presents today with complaints for several weeks of vision problems (blurry) and difficulty with concentration and focusing. She is an administrative para-legal for a law firm and notes her symptoms have become worse over the course of the addition of more attorneys and demands for work. Today, she noticed that her symptoms were worse and were accompanied by some fine tremors in her hands. She has been having difficulty concentrating and has difficulty voiding. She went to the optometrist who recommended reading glasses with small prism to correct double vision. She admits to some weakness as well. No other complaints of fevers, chills, URI or UTI
PMH: non-contributory
PE: CN-IV palsy. The fundoscopic exam reveals edema of right optic nerve causing optic neuritis. Positive nystagmus on positional maneuvers. There are left visual field deficits. There was short term memory loss with listing of familiar objects.
DIAGNOSIS: multiple sclerosis (MS).
Question:
Describe what is MS and how did it cause the above patient’s symptoms?
Your Answer:
MS is a chronic demyelinating disorder of the central nervous system (CNS). It is an autoimmune disorder that affects the myelin sheath and CNS conduction pathway. It is characterized by central areas of inflammation, demyelination, proliferation and activation of glial cells, and degeneration caused by immune-mediated attacks (Fernández et al., 2020). The clinical manifestations of MS include muscle weakness and spasticity, intention tremors, fatigue, inability to direct or limit movement, reduced sensitivity to pain, paresthesia, and decreased motor coordination. In addition, MS is characterized by changes in peripheral vision, reduced visual and hearing acuity, bowel and bladder dysfunction, altered sexual function, and cognitive changes.
Optic nerve and brainstem involvement can be attributed to the patient’s vision problems with blurred vision. The difficulty in voiding is due to a loss of neural control. Besides, demyelination in the cerebral cortex causes difficulties in concentration and focusing, which are present in the patient (Fernández et al., 2020). Demyelination in the cerebellum causes imbalance, incoordination, vertigo, and tremors, which explains the patient’s fine hand tremors and weakness. The difficulty in voiding can be attributed to the involvement of the spinal cord because the peripheral and spinal connections control the voiding reflex (Preziosi et al., 2018).
References
Fernández, Ó., Costa-Frossard, L., Martínez-Ginés, M., Montero, P., Prieto, J. M., & Ramió, L. (2020). The Broad Concept of “Spasticity-Plus Syndrome” in Multiple Sclerosis: A Possible New Concept in the Management of Multiple Sclerosis Symptoms. Frontiers in neurology, 11, 152. https://doi.org/10.3389/fneur.2020.00152
Preziosi, G., Gordon-Dixon, A., & Emmanuel, A. (2018). Neurogenic bowel dysfunction in patients with multiple sclerosis: prevalence, impact, and management strategies. Degenerative neurological and neuromuscular disease, 8, 79–90. https://doi.org/10.2147/DNND.S138835
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