An understanding of the symptoms of alterations in neurological and musculoskeletal systems is a critical step in diagnosis and treatment. For APRNs this understanding can also help educate patients and guide them through their treatment plans.
Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following:
- Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
- Any racial/ethnic variables that may impact physiological functioning.
- How these processes interact to affect the patient.
Scenario: A 58-year-old obese white male presents to ED with chief complaint of fever, chills, pain, and swelling in the right great toe. He states the symptoms came on very suddenly and he cannot put any weight on his foot. Physical exam reveals exquisite pain on any attempt to assess the right first metatarsophalangeal (MTP) joint. Past medical history positive for hypertension and Type II diabetes mellitus. Current medications include hydrochlorothiazide 50 mg po q am, and metformin 500 mg po bid. CBC normal except for elevated sedimentation rate (ESR) of 33 mm/hr and C-reactive protein (CRP) 24 mg/L. Metabolic panel normal. Uric acid level 6.7 mg/dl.
All papers submitted must include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at All papers submitted must use this formatting.
Expert Solution Preview
Introduction:
Neurological and musculoskeletal alterations can result in a range of symptoms that require careful evaluation for diagnosis and treatment. In this case study analysis, we will examine the presentation of an obese white male with fever, chills, pain, and swelling in the right great toe, and explore the neurological and musculoskeletal pathophysiologic processes responsible for these symptoms. We will also consider any racial/ethnic variables that may impact physiological functioning, and how these processes interact to affect the patient.
Answer:
The presentation of fever, chills, pain, and swelling in the right great toe, along with exquisite pain on any attempt to assess the right first metatarsophalangeal joint, suggests the possibility of gout, a type of inflammatory arthritis. Gout occurs due to the deposition of uric acid crystals in joints, leading to inflammation and pain. Elevated uric acid levels, as seen in this patient, are a risk factor for gout.
The neurological pathophysiologic process that can explain the patient’s presentation is the activation of pain receptors and inflammation of nerve fibers in response to the deposition of uric acid crystals in the joint. The inflammation and pain can lead to dysfunction of the nerves, causing numbness, tingling, or weakness in the affected area.
The musculoskeletal pathophysiologic process that can explain the patient’s presentation is the inflammation of the synovial membrane, which surrounds the joint and produces synovial fluid. The inflammation can result in the accumulation of fluid and swelling of the joint, causing pain and discomfort. The activation of white blood cells in response to the presence of uric acid crystals also contributes to the inflammation.
Racial/ethnic variables can impact physiological functioning in gout. For instance, African Americans have a higher prevalence of gout than Caucasians, and they tend to develop gout at an earlier age and with more severe symptoms. This may be due in part to genetic factors that influence the metabolism of uric acid.
The neurological and musculoskeletal processes interact to affect the patient by causing pain, swelling, and dysfunction of the joint. The inflammation can also lead to damage of bone and cartilage, causing joint deformity and disability if left untreated. Therefore, prompt diagnosis and treatment are crucial to alleviate symptoms and prevent further complications.
