A 56-year-old male was brought to the emergency room with a chief complaint was right flank pain.

History of present Illness:

One day prior to admission, the patient developed a change in the color of his urine from pale yellow to red in color. There was no associated fever, painful urination, or penile discharge. He decided to consult with his primary physician the following day.

One hour prior to admission, the patient developed severe right flank pain associated with nausea. Upon admission, the patient was noted by the ER physician to be in severe pain, with a pain scale of 9 from a visual analog pain scale from 1  to 10. On physical exam, patient had the following findings:

• Vital Signs BP: 140/90 mm Hg 
• Heart rate: 110 bpm  
• Respiration rate: 15 breaths per minute patient 
• Temperature: 98.6 deg C 
• All exam findings for the head, neck, heart, lungs, and abdomen were normal.  
• On examination of the back, patient had tenderness on the right flank upon palpation. 
• On examination of the genitalia, there was no penile discharge. 
• Note of a 1 x 1 cm tophus on right big toe. 

The following diagnostic exams were ordered

• CBC with WBC differential count  
• Urinalysis  
• Serum uric acid 
• KUB x-ray 
• MRI Scan abdominopelvic area 

Past Medical History:

• Diagnosed with gout one year prior to admission 
• On medication with allopurinol 
• No heart and lung disease 
• No diabetes or hypertension 

Click here to review the results of the diagnostic exam.

Questions and topics for discussion:

1. After considering his signs, symptoms, findings, and diagnostic exams, what would be the clinical diagnosis in this patient? (1 pt)
2. What is causing the hematuria to occur?  (1 pt)
3. Why are his vitals (BP, HR, breathing) elevated? (1 pt)
4. What is causing the severe right flank pain? (1 pt)
5. How are the elevated levels of serum uric acid and positive uric acid crystals in the urinalysis related to your diagnosis? (1 pts)
6. What pain medication would you provide to this patient? Why would you choose this medication? (2 pts)
7. What treatment would you recommend for removing the cause of his pain?  Explain your answer.  (3 pts)

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This week, you will write a mini-systematic literature review. It is mini because you will only be reviewing two sources.
For this literature review assignment, we are going to give you a choice of three topics to choose from. Choose one for this assignment.

1. Myasthenia Gravis
2. Hodgkin’s Lymphoma
3. HIV/AIDS

Remember, for a systematic review, focus your analysis on the treatments, causes, diagnosis, and prognosis presented in the literature.
Next, conduct your research of scholarly articles. Use the WCU Online Library databases. You will need to choose two sources to include in this mini-literature review.  
For this review, be sure to:

• Select two relevant and appropriate scholarly articles that address the topic you chose.
• Present a thorough literature review of both articles by summarizing, synthesizing, and evaluating the materials.
• Demonstrate understanding of the content presented in the articles.
• Include a critical assessment of the sources. Do not simply include a summary of what you have read.
• Incorporate citations into your body paragraphs; incorporate the essential and most relevant supporting evidence eloquently and appropriately.
• Present your writing in a clear, organized manner.
• Provide a strong introduction and conclusion, including further questions for research.
• Use proper APA format with proper citations. Review APA Citations Here


Your literature review should be 1–2 pages in length. Remember, you will need to use APA formatting in your literature review and include a title page and a reference page. 

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Discussion Prompt #1

• This week you spent some time in the interactive simulation as Dena Gray. You were asked to make some difficult decisions and you witnessed the results of those decisions. Take some time in this discussion forum to reflect on the experience with your classmates and instructor. How realistic were the situations and decisions compared to your professional experience? Did you feel the choices Dena was asked to face were choices that you have dealt with or expect to deal with in your career? Which decisions were most difficult for you to commit to? Which were easiest? Why? What impact, if any, will this exercise have on your own personal and professional decisions? Share any additional thoughts, questions, and learning insights here as well.

Discussion Prompt #2

• Regardless of your title or actual position, you’re always a leader in some way, and your decisions and actions will have an effect on other nurses, patients, family members, and visitors. Consider this statement as you respond to at least 2 of the following: 

1. In the positive outcome, how did Dena’s extra responsibilities reward her emotionally and professionally? What might she have sacrificed?
2. What kinds of decisions led to a positive outcome? What kinds of decisions led to a negative outcome?
3. How might previous reprimands affect Dena’s willingness to speak up? How much can leadership impact positive outcomes?
4. How did Dena need to change her approach with each of the different colleagues and situations? Have you made adjustments in your approach to achieve positive results at work?
5. How does the disposition of the physician affect a nurse’s ability to speak up? What would you do if the response was not as gracious as Dr. Green’s?
6. How much of your job involves customer service? Is that stressful?
7. What creative strategies do you use in dealing with difficult situations? Can you share an example?

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1. Identify concepts of health and disease
2. Differentiate between the basis of disease in relation to normal body function
3. Discuss interrelationships between pathophysiology, pharmacology, diagnostic testing, and management on health and disease
4. Explain the physiologic signs and symptoms of disease and their impact on functional health status
5. Delineate the risk factors highly correlated with specific health conditions
6. Identify the impact of specific diseases on the U.S. population and globally
7. Successfully critically consider current scholarly literature on a topic (write a literature review) using proper APA citations, references, and formatting

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Discuss characteristic findings for a stroke and how it affects the lives of patients and their families. Discuss the nurse’s role in supporting the patient’s psychological and emotional needs. Provide an example.

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