Sample Answer for NURS 6501 Neurological and Musculoskeletal Disorders Included After Question
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
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
By Day 7 of Week 7
Complete the Knowledge Check by Day 7 of Week 7.
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A Sample Answer For the Assignment: NURS 6501 Neurological and Musculoskeletal Disorders
Title: NURS 6501 Neurological and Musculoskeletal Disorders
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 a common chronic condition that arises from the deposition of monosodium urate crystals in the non-articular and articular structures. The pathophysiology of gout begins with hyperuricemia. Hyperuricemia refers to the accumulation of serum urates due to factors such as intake of high-purine diet and alcohol intake. The kidneys and gut regulate urate excretion. Any problem with the gut or kidneys results in urine buildup in serum. The accumulation of urates results in monosodium urate deposition in the small joints, which may progress to gout. The monosodium crystals have damage-associated molecules that stimulate innate inflammatory responses. For example, monosodium urate crystals active NLRP3 inflammasome in the monocytes and macrophages leading to the initiation of gout flares (Dalbeth et al., 2021; Narang &Dalbeth, 2020). There is also the activation of TLR2 and TLR4 inflammatory components that cause inflammation in gout.
The next phase in gout is the development of tophi, structural joint damage, and synovitis. Tophi represents the foreign-body inflammatory response to the deposited monosodium urate crystals. There is also the structural damage of the joints alongside bone erosion and cartilage damage in the advanced stages of the disease. The damage develops from the high number of bone-resorbing osteoclasts that accelerate bone and joint damage. The monosodium urate crystals also reduce the availability of the osteoclasts as well as their function. The reduction causes a shift in the functioning of the osteocytes to favor inflammatory processes and bone resorption (Dalbeth et al., 2021). The above processes contribute to the three stages of gout development. The stages include the asymptomatic stage where there are no gout symptoms, acute gouty arthritis, where symptoms appear and tophi stage.
References
Dalbeth, N., Gosling, A. L., Gaffo, A., & Abhishek, A. (2021). Gout. The Lancet, 397(10287), 1843–1855. https://doi.org/10.1016/S0140-6736(21)00569-9
Narang, R. K., &Dalbeth, N. (2020). Pathophysiology of Gout. Seminars in Nephrology, 40(6), 550–563. https://doi.org/10.1016/j.semnephrol.2020.12.001
A Sample Answer 2 For the Assignment: NURS 6501 Neurological and Musculoskeletal Disorders
Title: NURS 6501 Neurological and Musculoskeletal Disorders
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:
Patients with gout are highly likely to develop renal calculi and renal failure. Normally, kidneys excrete excess fluids and wastes from the body. The kidneys also excrete excess urates from the body, which is dissolved in the blood. Optimum renal function is essential for the elimination of excess urates from the body. Patients suffering from gout have hyperuricemia. The main mechanisms in which urates are regulated are through the kidneys and gout (Estiverne & Mount, 2020).
The buildup of urates in the body may affect the kidneys. Accordingly, the buildup of urates with reduced excretion through the kidneys results in the formation of urate crystals. The kidneys rare excrete large urate particles with urine, which results in the formation or kidney stones. Over time, the progressive kidney stones cause damage to the kidneys resulting in kidney disease and failure if responsive treatments for gout are not adopted (Wu et al., 2022).
The kidneys excrete the excess urates in the form or uric acid in the kidneys. Conditions such as gout result in elevated levels of uric acid that is be excreted through the kidneys. The filtration of blood in the kidneys coupled with the high levels of uric acid cause urate crystals formation, which cause renal stones and obstruction as urine is excreted (He et al., 2022). These mechanisms result in the development of renal complications such as stones and kidney disease and failure.
References
Estiverne, C., & Mount, D. B. (2020). The Management of Gout in Renal Disease. Seminars in Nephrology, 40(6), 600–613. https://doi.org/10.1016/j.semnephrol.2020.12.007
He, Y., Xue, X., Terkeltaub, R., Dalbeth, N., Merriman, T. R., Mount, D. B., Feng, Z., Li, X., Cui, L., Liu, Z., Xu, Y., Chen, Y., Li, H., Ji, A., Ji, X., Wang, X., Lu, J., & Li, C. (2022). Association of acidic urine pH with impaired renal function in primary gout patients: A Chinese population-based cross-sectional study. Arthritis Research & Therapy, 24(1), 32. https://doi.org/10.1186/s13075-022-02725-w
Wu, B., Chen, L., Xu, Y., Duan, Q., Zheng, Z., Zheng, Z., & He, D. (2022). The Effect of Allopurinol on Renal Outcomes in Patients with Diabetic Kidney Disease: A Systematic Review and Meta-Analysis. Kidney and Blood Pressure Research, 47(5), 291–299. https://doi.org/10.1159/000522248
A Sample Answer 3 For the Assignment: NURS 6501 Neurological and Musculoskeletal Disorders
Title: NURS 6501 Neurological and Musculoskeletal Disorders
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 musculoskeletal disorder characterized by low bone mass and density and increase fragility of the skeleton. The affected patients have impaired quality of bones, propensity to fracture, and reduced bone mass. The rate of bone resorption in these patients is higher than bone formation, which leads to bone degeneration (Rosen, 2020). Osteoporosis has high prevalence in women as compared to males.
Several pathological processes contribute to osteoporosis. One of them is an increase in the level of osteoclastogenesis and osteoclasts. Osteoclasts are bone cells that are involved in bone loss. Patients with osteoporosis have an elevated number of osteoclasts that stimulate osteoclastogenesis. Ineffective bone repair and microdamage accumulation, which cause bone structural deterioration characterize osteoclastogenesis. The other pathogenesis contributing to osteoporosis is lack of estrogen. Decrease in estrogen levels as seen in postmenopausal increases the release of proinflammatory cytokines that signal the RANKL signaling pathways involved in bone resorption(Al Saedi et al., 2020). There is also the enhanced formation of osteoclasts, which accelerate bone resorption.
Osteoporosis also develops from reduced osteoblastogenesis and bone formation. Patients with osteoporosis have decreased number of osteoblasts, which are essential in bone formation. Reduction in osteoblastogenesis also lowers the maturation of osteoblasts, hence, increased bone loss than formation. Osteocytes also play a role in the development of osteoporosis. Osteocytes are crucial cells that regulate bone remodeling. A reduction of osteocytes and osteoblasts levels is prevalent in osteoporosis, which increase bone resorption rate. Bone formation is also largely dependent on supplementation of essential minerals such as calcium and vitamins, that include vitamin D. Dietary supplementation of these essential minerals and vitamins are crucial for bone health. However, inadequate intake of calcium and vitamin D affects the rate of bone formation. As a result, patients develop bones with low mass and density, leading to the formation of osteoporosis(Al Saedi et al., 2020; Rosen, 2020). Lifestyle factors such as smoking and dietary restriction as seen in athletes predispose patients to developing osteoporosis.
References
Al Saedi, A., Stupka, N., & Duque, G. (2020). Pathogenesis of Osteoporosis. Handbook of Experimental Pharmacology, 262, 353–367. https://doi.org/10.1007/164_2020_358
Rosen, C. J. (2020). The Epidemiology and Pathogenesis of Osteoporosis. In Endotext [Internet]. MDText.com, Inc. https://www.ncbi.nlm.nih.gov/books/NBK279134/
A Sample Answer 4 For the Assignment: NURS 6501 Neurological and Musculoskeletal Disorders
Title: NURS 6501 Neurological and Musculoskeletal Disorders
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:
The patient in the case study has been diagnosed with rheumatoid arthritis. Rheumatoid arthritis refers to an inflammatory disorder affecting mostly the joints and other regions of the body. The patient in the case study developed the disorder due to risk factors associated with rheumatoid arthritis such as genetics, hormonal imbalances with the advancing age, and diet. The patient reports that her grandmother had crippling arthritis. Genetics increase the risk of rheumatoid arthritis to individuals born to families with a history. The patient may be menopausal due to her age. As a result, she currently experiences estrogen imbalances, which predispose her to developing rheumatoid arthritis (Radu &Bungau, 2021). The additional risk factors that predispose her to the disease include dietary habits, obesity, and gender.
The patient presents the hospital with a range of symptoms that include generalized joint pain, swelling, and stiffness. She also reports difficulty in grasping things and fatigue. These symptoms are attributable to the proinflammatory processes that affect different body joints making it difficult to move and engage in activities(Scherer et al., 2020). The inflammation also causes damage to the joints, lowering individual’s functioning abilities.
Rheumatoid arthritis differs from osteoarthritis. Rheumatoid arthritis is an autoimmune disease affecting the joints and other organs while osteoarthritis is a degenerative disease of the bones and joints. Rheumatoid arthritis has an early stage of development and rapid progression while osteoarthritis develops at the later stages of life with slow profession. Rheumatoid arthritis also affects joints of the writs, hands, and feet while osteoarthritis may affect any body joint and often seen at finger tips (Radu &Bungau, 2021; Scherer et al., 2020). Osteoarthritis also has asymmetrical pattern of affecting the joints while rheumatoid arthritis demonstrates a symmetrical pattern in affecting the joints.
References
Radu, A.-F., &Bungau, S. G. (2021). Management of Rheumatoid Arthritis: An Overview. Cells, 10(11), Article 11. https://doi.org/10.3390/cells10112857
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
A Sample Answer 5 For the Assignment: NURS 6501 Neurological and Musculoskeletal Disorders
Title: NURS 6501 Neurological and Musculoskeletal Disorders
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:
Multiple sclerosis is a neurological disorder that is characterized by central nervous system demyelination. The body produces immune cells that attack the central nervous system, cause inflammation, tissue damage, and neurodegeneration. The disease has the characteristic of myelin sheath degradation, which affect nerve impulse transmission. The nerves affected in the disease include those of the optic nerve, spinal cord, and the brain. The cells involved in multiple sclerosis include TH17 and TH1 that release cytokines for inflammation and destroy myelin antigens(Ward & Goldman, 2022).
The myelin sheath is responsible for insulating the axons and facilitating faster conduction of action potentials. Demyelination alters these processes resulting in the development of neurological symptoms. These symptoms include paresthesia, fatigue, optic neuritis, diplopia, ataxia, pain, dysarthria, constipation, psychological disturbances, and cognitive dysfunction. The patient in the case study already has some of these symptoms. She reports several weeks of blurred vision, which are attributed to optic neuritis. The patient also has difficulties in concentration and focusing, which arises from impaired nerve impulse transmission from the scar tissue formation in the axons. The patient also has tremors of hands, which are associated with altered nerve impulse transmission from the disease. She also reports difficulty in voiding due to impaired innervation of the bladder from the sclerosis(Faissner et al., 2019; Ward & Goldman, 2022). Cumulatively, the impaired transmission of action potentials from the demyelination contributes to the symptoms the patient demonstrates.
References
Faissner, S., Plemel, J. R., Gold, R., & Yong, V. W. (2019). Progressive multiple sclerosis: From pathophysiology to therapeutic strategies. Nature Reviews Drug Discovery, 18(12), Article 12. https://doi.org/10.1038/s41573-019-0035-2
Ward, M., & Goldman, M. D. (2022). Epidemiology and Pathophysiology of Multiple Sclerosis. Continuum (Minneapolis, Minn.), 28(4), 988–1005. https://doi.org/10.1212/CON.0000000000001136
A Sample Answer 6 For the Assignment: NURS 6501 Neurological and Musculoskeletal Disorders
Title: NURS 6501 Neurological and Musculoskeletal Disorders
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