It is anticipated that the initial discussion post should be in the range of 250-300 words. Response posts to peers have no minimum word requirement but must demonstrate topic knowledge and scholarly engagement with peers. Substantive content is imperative for all posts. All discussion prompt elements for the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments unless specified in the instructions. All posts should be supported by a minimum of one scholarly resource, ideally within the last 5 years. Journals and websites must be cited appropriately. Citations and references must adhere to APA format.
Classroom Participation
Students are expected to address the initial discussion question by Wednesday of each week. Participation in the discussion forum requires a minimum of three (3) substantive postings (this includes your initial post and posting to two peers) on three (3) different days. Substantive means that you add something new to the discussion supported with citation(s) and reference(s), you are not just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion, however should be correlated to the literature.
All discussion boards will be evaluated utilizing rubric criterion inclusive of content, analysis, collaboration, writing and APA. If you fail to post an initial discussion or initial discussion is late, you will not receive points for content and analysis, you may however post to your peers for partial credit following the guidelines above.
Initial Response
Scenario
You are seeing a 58-year-old male in the clinic today for an acute visit related to joint pain and swelling.
• He has a past medical history of hypertension and hyperlipidemia and is currently taking hydrochlorothiazide 25mg daily and atorvastatin 20mg daily.
• He was seen last in your office for a routine physical 6 months ago and had lab work completed showing a normal CBC, CMP and lipid panel while on his current medications.
• He presents with pain and swelling of the right first metatarsophalangeal joint and he reports the site is red and feels hot to touch. He reports the pain is so bad he can hardly stand to have anything touch the foot and awakens at night with the pain.
• He reports the symptoms started suddenly about 2 days ago and he denies any injury to the foot
• He does not have any similar pain or swelling elsewhere.
• Upon examination today it is observed that the right metatarsophalangeal joint is mildly edematous, erythematous and warm to touch. There is no rash, no bruising, and no laceration on the site. The patient can move the joint through range of motion, but has pain with motion. His physical exam is otherwise unremarkable.
Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion post:
• Provide your diagnosis.
• Discuss how you would manage the patient’s current presentation and provide a rationale supported by scholarly reference for your treatment plan.
• Include your specific prescription(s) for the patient. (This must include the medication name, dose, route, and frequency as well as any special instructions that apply as you would include when writing a prescription).
• Describe the patient education you would provide in relation to your treatment plan.
• Provide your plan for follow-up and/or referral (if indicated)
Based on the patient’s presentation, the diagnosis is acute gouty arthritis, commonly referred to as gout. The classic signs and symptoms of acute gout include the sudden onset of severe pain, swelling, erythema, and warmth of a single joint, most commonly the first metatarsophalangeal (MTP) joint, as seen in this patient. The exquisite tenderness and pain with even light touch are highly characteristic. His medical history also provides a key contributing factor: his use of a thiazide diuretic (hydrochlorothiazide), which is a known risk factor for hyperuricemia and the development of gout flares (Becker et al., 2021). The absence of trauma and systemic symptoms further supports this diagnosis.
My management plan for this patient focuses on rapidly resolving the inflammation and pain of the acute flare. For this patient, given his comorbid conditions, I would opt for a targeted, non-NSAID approach to avoid potential renal and cardiovascular risks. My primary treatment choice would be colchicine, which is highly effective when initiated early in a gout flare.