Neuro Case Study

• Identify and select appropriate interventions including diagnostic tests and nursing interventions.(Neuro Case Study Example)
• Analyze physiological and psychological responses to illness and treatment modalities(Neuro Case Study Example)

Purpose: Examine case studies related to neurologic disease and answer the assigned questions. This assignment should help refine your clinical/critical thinking skills.

Assignment Description:

• Describe the pathophysiology of extradural and subdural hematomas.
• Identify the surgical emergency and provided rationale for the choice.
• Describe the most likely type of head injury and outline anappropriatetreatment plan.
• Your answer must follow APA 7th edition format.
• Submit the answer to this assignment area.(Neuro Case Study Example)

Patient 1 – Two individuals come to the emergency department with head injuries. One, 25 years old, has just been in a motor vehicle accident (MVA) and has a temporal lobe injury. The other, 65 years old, has increasing confusion after a fall that happened earlier in the week.

a. Differentiate the pathophysiology of extradural hematoma and subdural hematoma.

b. Identify the patient in the above scenario requiring immediate emergency surgical intervention and provide rationale for your choice.

Patient 2 – An 38 year old was driving his 1970 Chevy Corvette to a Milwaukee Brewers baseball game when a deer jumped out in front of him on the highway. He swerved his car and hit a telephone pole instead. His head hit the windshield and he suffered severe head trauma.(Neuro Case Study Example)

a. Describe the most likely specific type of head injury he suffered.

b. Outline the treatment plan for this patient.

Neuro Case Study Example-Solution

Gout is a form of inflammatory arthritis typically characterized by intense pain on one joint at a time, swelling, and stiffness of the joint. The patient’s symptoms hint on the occurrence of acute gout triggered by the patient’s medications as well as other risk factors such as hypertension and obesity. It is imperative to examine the neurological and musculoskeletal pathophysiologic processes that account for the symptoms, any variables that may verse physiological functioning, and how the process interactions affect the patient.(Neuro Case Study Example)

Gout symptoms manifest due to the formation of uric acid crystals in the joints and the body’s response to the accumulation of the crystals in tissues of the body (Singh, 2013). The deposits of uric acids on the joints cause inflammation of the joints leading to pain, heat (fever), and swelling. Typically, uric acid is a byproduct of purine protein break down. Hyperuricemia, too much uric acid in the body, leads to deposition on joints as assessed on the patient’s right first metatarsophalangeal (MTP) joint. Acute gout occurs when urate crystal deposits suddenly cause acute inflammation and intense pain. Labeled as ‘flares,’ acute gout takes up to 10 days to subside and can be triggered by stressful events, alcohol, and drugs, as well as cold weather (Williams, 2019).(Neuro Case Study Example)

Hydrochlorothiazide (HCTZ), one of the patient’s antihypertensive medications, is also known to increase uric acid levels and elevate the risk for gout (Ala-Mutka et al., 2018). HCTZ and uric acid use the same cell membrane transporter, organic anion transporter 1 (OAT1). Competition between the two organic acids partly contributes to the increase in uric acid levels, leading to an increased risk for gout (Ala-Mutka et al., 2018). Secondly, the patient is obese and has a history of Type 2 Diabetes Mellitus (T2DM) (Evans et al., 2018). T2DM is a chronic condition characterized by high levels of sugar in the blood due to insulin resistance. T2DM happens when the body’s cells resist insulin’s effect, which drives glucose in the blood into the cells. In the patient’s case, T2DM and hypertension increased the risk of gout, as the body creates more insulin, and the kidneys find it challenging to dispose of uric acid.(Neuro Case Study Example)

On a national scale, gout affects up to 4% of the American population. However, there are ethnic variables with African Africans having a 5.0% prevalence compared to whites 4.0% due to a high prevalence of hyperuricemia (Evans et al., 2018). Furthermore, gout is found to be more prevalent among males than females due to high serum urate levels in men across all ages. However, the difference decreases among men and women above 70 years (Singh, 2013).(Neuro Case Study Example)

The patient’s history and present medication, as well as obesity, led to acute gout. Obesity, hypertension, and T2DM increased the risk of gout by increasing serum urate levels and uric acid concentrations (Wilson, & Saseen, 2016). Consequently, HCTZ medication also increased uric acid and serum urate levels, elevating the risk of disease. The patient’s gender contributed but not ethnicity as minority groups are associated with high serum rates compared to whites with European ancestry. The increased levels of uric acid led to more the accumulation on the right first metatarsophalangeal (MTP) joint, leading to intense pain, inflammation on the right great toe and fever and chills.(Neuro Case Study Example)

For the patient, acute gout is manifested through intense pain and stiffness on the right first MTP joint. The patient’s antihypertensive medications are increasing the risk of disease, as well as hypertension, obesity, and T2DM. It is imperative to treat the patient by addressing the underlying causes of gout.(Neuro Case Study Example)

References

Ala-Mutka, E. M., Rimpelä, J. M., Fyhrquist, F., Kontula, K. K., & Hiltunen, T. P. (2018). Effect of hydrochlorothiazide on serum uric acid concentration: a genome-wide association study. Pharmacogenomics, 19(6), 517-527.

Evans, P. L., Prior, J. A., Belcher, J., Mallen, C. D., Hay, C. A., & Roddy, E. (2018). Obesity, hypertension and diuretic use as risk factors for incident gout: a systematic review and meta-analysis of cohort studies. Arthritis research & therapy, 20(1), 136.

Singh J. A. (2013). Racial and gender disparities among patients with gout. Current rheumatology reports, 15(2), 307. https://doi.org/10.1007/s11926-012-0307-x

Williams, L. A. (2019). The History, Symptoms, Causes, Risk Factors, Types, Diagnosis, Treatments, and Prevention of Gout, Part 2. International Journal of Pharmaceutical Compounding, 23(1), 14-21.

Wilson, L., & Saseen, J. J. (2016). Gouty arthritis: a review of acute management and prevention. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 36(8), 906-922.