Growth and Development

30 years old male, single

Erikson’s theory of Intimacy vs Isolation (18-40 years old)
Erikson has a theory which states that personality development goes through eight ordered
stages. And with each stage there is an associated psychosocial crisis that an individual
successfully resolves or fails to resolve, with failure resulting in stunted or incomplete
development of the personality and inhibits further development.

During this period of development, major conflicts center on forming intimate, loving
relationships with other people. During this period we begin to share ourselves more intimately
with other people, We explore relationships leading towards long-term commitments with
someone who isn’t a family member.

Successful attainment of this stage results in happy relationships and a sense of commitment
and safety, all within a relationship filled with love and care. Avoiding intimacy though, could
lead to isolation, loneliness, and sometimes depression and failure to attain this stage might
delay finding love.

Analysis and interpretation

The patient is single and is in the middle of the Intimacy and Isolation stage of
development, which poses issues such as possible inhibited personality growth and the lack of
progress in the current stage could pose a risk of further inhibited growth as a person.

He also risks development of negative traits with the failure to attain progress in this
developmental stage in his life and could live a life of isolation and loneliness.
Discharge plan

Final Diagnosis: Infected tophi, calcaneal area, Right Foot

Operation/s: Wound Debridement 4/3/19

Medications

Drug Dosage Frequency

Clindamycin 300 mg Q6 for 7 days

Trimoxazole 800 mg / 160 mg Q12 for 7 days

Febuxostat 40 g 1 tablet per day

Etoricoxib 90 mg Once daily for pain

Paracetamol + Tramadol 325 mg + 37.5 mg Q8 as needed for pain

Medication Teachings:

Clindamycin:

 Antibiotic and anti infective medication; inhibits, hinders, and/or kills bacteria to
control and cease infection.

Nursing Responsibility:

 Monitor renal, hepatic, and hematopoetic functions of patient during duration of

taking clindamycin.
 Assess patient’s state of infection before, during and after drug therapeutic
process

Trimoxazole:
 Antibiotic used to treat bacterial infections, including bone and joint infections
caused by susceptible organisms.
 Inhibits bacteria growth by inhibiting folic acid synthesis.

Nursing Responsibility:

 Assess symptoms
 Evaluate therapeutic response
 Advise to have regular CBC tests done for long term drug therapy.

Febuxostat:
  Xanthine oxidase inhibitor used in chronic management of hyperuricemia in
patients with gout. Achieves therapeutic effect by decreasing serum uric acid
levels

Nursing Responsibility:

 Monitor for signs and symptoms of MI, stroke, and hypersensitivity reactions
 Monitor serum uric acid at early as 2 weeks after starting drug therapy
 Advise patient on possible side effects of somnolence, dizziness, paraesthesia
and blurred vision. Discourage driving and operating heavy machinery during the
duration of  drug therapy.

Etoricoxib:

 COX-2 selective inhibitor normally prescribed for the management of gout.

Nursing Responsibility:

 Take without regards to meals unless instructed by physician

 Monitor BP when taking medication
 Monitor for hypersensitivity reactions which may cause swelling in the mouth,
tongue and throat. Which are risk factors for difficulty breathing, swallowing and
choking

Paracetamol + Tramadol:

 Indicated for moderate to severe pain.

 Increased sedative effect when taken with alcohol

Nursing Responsibility:

 Advise patient on sedative effects which may inhibit ability to drive and operate
heavy machinery.
 Monitor VS and drug tolerance.

Health Teaching:

 Patient was advised to increase fluid intake and decrease consumption of high purine
food and drinks such as: Alcoholic beverages, seafood, shellfish, bacon, liver.
 Rest while elevating affected areas with pillows
 Ice affected areas
  Informed that gout cannot be cured but can be managed with medication along with
proper diet

Physician Instructions:

 Come back every Monday for dressing

Diet:
 Diet as prescribed by physician or dietician to assist in management of symptoms and
current illness