Discussion Part One\u00a0\t\u00a0\tJonathon is a 56 year-old retired automobile mechanic who has not been to the doctor in approximately 6-7 years. He presents to your office complaining that 3 weeks ago he was awoken with severe pain and inflammation in his knee, which has been consistent since that initial night. Upon physical examination of his knee, it appears swollen and erythematous with periarticular involvement. Upon physical examination and laboratory results you notice the following:\t\u00a0\tPhysical examination:\tGEN: well nourished, obese male (310 pounds)\tVS: BP 191\/112 HR 75 RR 15 T 98.6, HT 5’8″\ufffd\tEXT: Knee joint inflammation\tLaboratory (fasting):\tNa 139 mEq\/L\tK 3.8 mEq\/L\tCa 9.1 mg\/dL\tCL 102 mmol\/L\tHCO3 22 mEq\/L\tBUN 10 mg\/dL\tSCr 0.9 mg\/dL\tSerum Uric Acid 6.5 mg\/dL\tAlb 4.1 g\/dL\tCholesterol 300 mg\/dL\tUA: pH 6.8, uric acid 250 mg\/24h\tWhat problems can be identified in this patient? Please provide a list of differential diagnoses, as well as indication of your primary diagnosis.\t\u00a0\tWhat is your pharmacological plan for your primary diagnosis including the medication, dose, and mechanism of action?\t\u00a0\tDiscussion Part Two (graded)\t\u00a0\tHe returns to your clinic for follow-up blood work, and 4 values catch your attention:\t\u00a0\t\u00a0AST 430 U\/L\tALT 535 U\/L\tBilirubin 41 mg\/dl\tBG 60 mg\/dl\tHe admits to a history of moderate-to-high alcohol intake (>12 drinks\/week for >10 years). He is slightly febrile (99.7\u00b0F) and has abdominal tenderness. He also admits to taking several, different over-the-counter pain relievers of different brands daily and continuously to combat the pain in his knee, in addition to his prescription(s) in Part One. You decide to run a toxicology lab, and it reveals a blood acetaminophen concentration of 58 \u00b5g\/mL.\t\u00a0\tWhat is the diagnosis at this point in his case? Please explain the mechanism for how this occurs\/occurred, and the antidote’s mechanism of action.\tWhat is the subsequent management and treatment for this individual related to the diagnosis in Part One.\tDiscussion Part Three (graded)\t\u00a0\tThis is your third time seeing this patient, and he reports the NSAID that he has been prescribed is not addressing his pain. He reports his pain is a 10 out of 10, HR 108, talking extremely fast, he is diaphoretic, unshaved, his clothes are a bit wrinkled and he is requesting that you prescribe him Percocet because he doesn’t think Tramadol, that you are considering prescribing, will work.\t\u00a0\tWhat are the possible signs of prescription drug abuse?\tWhat should the NP do when a patient has continued to return?<\/p>\n","protected":false},"excerpt":{"rendered":"
Discussion Part One\u00a0 \u00a0 Jonathon is a 56 year-old retired automobile mechanic who has not been to the doctor in approximately 6-7 years. He presents to your office complaining that 3 weeks ago he was awoken with severe pain and Read More …<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[],"tags":[],"class_list":["post-230070","post","type-post","status-publish","format-standard","hentry"],"_links":{"self":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts\/230070","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/comments?post=230070"}],"version-history":[{"count":0,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts\/230070\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/media?parent=230070"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/categories?post=230070"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/tags?post=230070"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}