A 47-year old man presents with severe pain in his right great toe. He is unable to bear weight on his right foot and there was no apparent trauma. He reports the pain started last night and continued to increase in severity. Based on his physical exam and laboratory findings he is diagnosed with gout. Gout can be caused by several different mechanisms and blood samples are drawn and urinalysis is performed. The results from this individual are listed below. Plasma Urate(mg/100 ml) Urinary Uric Acid(mg/24 hr)
Normal < 7.0 413 ± 78
Patient 10.5 215

What is the best explanation for the presentation of gout in this individual and please explain why the other choices are not consistent with the data or what additional information you may need to decide the root cause?

1. Overproduction of purines
2. Decreased salvage of purines
3. Decreased urinary excretion of uric acid

After further discussion with the patient, he tells you that he recently switched from diet soda to regular soda because he read that the 'fake sugar' diet soda was bad for him; he tells you he drinks between 4and 5 L of soda a day. What is the potential impact of this dietary modification on the presentation of gout?

Describe the effects and potential risks associated with pica. include lead poisoning in the discussion.

Harold, a fifty-eight year old grocery store manager, had recently been waking up in the middle of the night with abdominal pain. this was happening several nights a week. he was also experiencing occasional discomfort in the middle of the afternoon. harold decided to schedule an appointment with his physician. the doctor listened as harold described his symptoms and then asked harold some questions. he noted that harold's appetite had suffered as a result of the pain he was experiencing and as a result of the fear that what he was eating may be responsible for the pain. otherwise, harold seemed fine. the doctor referred harold to a physician that specialized in internal medicine and had harold make an appointment for a procedure called an endoscopy. the endoscopy was performed at a hospital later that week. during the procedure, a long, thin tube was inserted into harold's mouth and directed into his digestive tract. the end of the tube was equipped with a light source and a small camera which allowed the doctor to observe the interior of harold's stomach. the endoscope was also equipped with a small claw-like structure that the doctor could use in order to obtain a small tissue sample from the lining of harold's stomach, if required. the endoscopy revealed that harold had a peptic ulcer. analysis of a tissue sample taken from the site showed that harold also had an infection that was caused by helicobacterpylori bacteria. the doctor who performed the endoscopy gave harold prescriptions for two different antibiotics and a medication that would decrease the secretion of stomach acid. the doctor also instructed harold to schedule an appointment for another endoscopy procedure in 6 months. 1. list the subjective findings in this case study. 2. what is an endoscopy? (2 points) what is a biopsy? 3. how was a biopsy performed on harold? 4. differentiate between gastric and duodenal ulcers by location. 5. what role does h. pylori play in the formation of peptic ulcers? 6. define occult and frank blood. (4 points) what is a guaiac test? 7. how can peptic ulcers cause bleeding? 8. why were antibiotics prescribed? 9. why would a medication that would decrease the secretion of stomach acid be beneficial?

Anurse is caring for a client who has diabetes mellitus and is taking pioglitazone. the nurse should plan to monitor the client for which of the following adverse effects? a. tinnitus b. insomnia c. fluid retention d. orthostatic hypotension