NRNP 6539 Week 5 CKD and Gout SOAP Note Example

Course	NRNP 6539 Advanced Primary Care of Adults
Week	Week 5
Paper type	Multi-problem SOAP note
Length	About 860 words, 6 pages
Format	APA 7 student paper
School	Walden University
Program	Master of Science in Nursing (MSN)
Updated	October 2026

Free sample paper for NRNP 6539 Week 5

SOAP Note: An Acute Gout Flare, Chronic Kidney Disease, and a Thiazide in a 61-Year-Old Man

Student Name

College of Nursing, Walden University

NRNP 6539: Advanced Nurse Practice in Primary Care Adult Gerontology I

Instructor Name

Month Day, Year

What this page is doingThe title lists three problems and one medication, because the note's value is in showing where they touch. A thiazide raises uric acid, and anti-inflammatory drugs harm the kidneys, so treating each problem alone would work against the others.

SOAP Note: An Acute Gout Flare, Chronic Kidney Disease, and a Thiazide in a 61-Year-Old Man

Subjective

Chief complaint: "My big toe woke me up and I can't even stand the sheet on it."

H.A. is a 61-year-old delivery route supervisor, a patient created for this note. Two nights ago, in the early morning hours, pain woke him: severe pain where his right big toe meets the foot, which swelled and turned red by morning. He has taken ibuprofen 800 mg three times daily, bought over the counter, for a week, since an ache that began before the flare, with partial relief. He had a similar episode in the same toe two years ago that resolved in about ten days without a diagnosis. He drinks four to six beers on weekend days. Hydrochlorothiazide was started for blood pressure eight months ago. He reports no fever, chills, recent injury, skin wound over the toe, or injection drug use. He has chronic kidney disease noted at his last visit, without diabetes.

Objective

Temperature 98.9 F, heart rate 84, blood pressure 144/88. Right first metatarsophalangeal joint: red, hot, swollen, and exquisitely tender, with limited motion; the redness extends slightly onto the dorsum of the foot. No break in the skin, no lymphangitic streaking. Other joints normal; no tophi on the ears, elbows, or hands.

Laboratory, today and six months ago: eGFR 51 today and 54 six months ago; urine albumin-to-creatinine ratio 96 mg/g today and 88 mg/g six months ago. Serum urate today 8.9 mg/dL, measured during the flare. Potassium and sodium normal.

Assessment

1. Acute gout flare, right first metatarsophalangeal joint. Sudden nocturnal onset, maximal within 24 hours, redness and exquisite tenderness in the first metatarsophalangeal joint, a prior similar episode, and a raised urate are classic. Septic arthritis must be addressed, because it can mimic gout and destroys a joint within days. Against infection: no fever, no skin break or injection risk, and a prior identical self-limited episode. Joint aspiration with crystal analysis, Gram stain, and culture is the definitive test and was discussed; because the small toe joint is hard to aspirate in the office and his presentation is typical, he preferred to defer it, with the agreement that fever, spreading redness, or failure to improve in 48 to 72 hours would prompt aspiration or referral the same day. A urate level measured during a flare can be falsely normal; his is elevated, which supports the diagnosis but does not prove it.

2. Chronic kidney disease, stage G3a A2. Staged by the KDIGO cause, glomerular filtration rate, and albuminuria framework: cause presumed hypertensive nephrosclerosis; filtration category G3a based on an eGFR of 45 to 59 on two occasions more than three months apart; albuminuria category A2 based on a ratio of 30 to 300 mg/g, also persistent (Kidney Disease: Improving Global Outcomes [KDIGO] CKD Work Group, 2024). Stable over six months.

3. Hypertension, above goal, on a drug that may be feeding the gout. Thiazide diuretics reduce renal urate excretion and raise serum urate, and hydrochlorothiazide was started months before this flare.

Plan by Problem

Gout flare: stop ibuprofen, because nonsteroidal anti-inflammatory drugs reduce kidney blood flow and are best avoided in chronic kidney disease. Treat with a short course of an oral glucocorticoid, one of the first-line options the American College of Rheumatology recommends for flares (FitzGerald et al., 2020); colchicine is an alternative but requires dose reduction for his kidney function. Rest, elevation, and ice.

Urate-lowering therapy: because he has had a second flare and has stage 3 chronic kidney disease, urate-lowering therapy is recommended, with allopurinol as the preferred first agent, started at a low dose adjusted for kidney function and increased gradually to a target serum urate below 6 mg/dL, with anti-inflammatory prophylaxis for the first months to prevent flares during initiation (FitzGerald et al., 2020). He will start it at the follow-up visit once this flare has settled, the option he preferred, although starting during a flare is also acceptable.

Chronic kidney disease: continue monitoring eGFR and albuminuria; add a renin-angiotensin blocker for albuminuria, as below; avoid nonsteroidal anti-inflammatory drugs going forward.

Hypertension: replace hydrochlorothiazide with losartan, which lowers blood pressure, reduces albuminuria, and has a modest uricosuric effect that lowers serum urate, unlike other drugs in its class (Rosenthal & Burchum, 2021). Recheck potassium and creatinine in one to two weeks.

Lifestyle: reduce beer, which raises urate; stay hydrated.

Where the Three Plans Touch

The three problems are one plan. The ibuprofen he chose for his toe threatened his kidneys, so the flare is treated with a glucocorticoid instead. The thiazide that controls his blood pressure raised his urate, so it is replaced with an agent that lowers blood pressure, protects his kidneys through its effect on albuminuria, and slightly lowers urate. His kidney function determines the starting dose of allopurinol and of colchicine if used. And the urate target is the same number whether the goal is fewer flares or, possibly, less strain on his kidneys. A single follow-up visit in two weeks will review all three together, with one set of laboratory tests serving all three problems.

References

FitzGerald, J. D., Dalbeth, N., Mikuls, T., Brignardello-Petersen, R., Guyatt, G., Abeles, A. M., Gelber, A. C., Harrold, L. R., Khanna, D., King, C., Levy, G., Libbey, C., Mount, D., Pillinger, M. H., Rosenthal, A., Singh, J. A., Sims, J. E., Smith, B. J., Wenger, N. S., . . . Neogi, T. (2020). 2020 American College of Rheumatology guideline for the management of gout. Arthritis Care & Research, 72(6), 744-760. https://doi.org/10.1002/acr.24180

Kidney Disease: Improving Global Outcomes CKD Work Group. (2024). KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International, 105(4S), S117-S314. https://doi.org/10.1016/j.kint.2023.10.018

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.

The Walden NRNP 6539 Week 5 instructions

NRNP 6539 Week 5 typically brings a patient whose chronic conditions interact, plus one acute problem. You document each problem, stage chronic disease correctly, plan treatment for each, and reconcile the plans where they interact. Faculty grade reconciliation as a separate skill. Each condition needs its own guideline citation in APA 7. Drug choice should account for kidney function. Long-term management such as urate lowering may be addressed. Follow-up laboratory monitoring belongs in the plan. NRNP 6539 faculty want the KDIGO stage written as both a G and an A category. Explain the flare treatment you chose and why others were set aside. Address the thiazide directly with an alternative. State when urate lowering therapy starts and its target. Name the laboratory tests and when they will be repeated.

Inside the NRNP 6539 Week 5 example

The subjective section begins at the toe: overnight onset, a joint too tender for a bedsheet, and a week of full-strength ibuprofen bought over the counter. A prior flare two years ago is recorded, along with beer on weekends and a thiazide started for blood pressure. On exam the first metatarsophalangeal joint is red, hot, and swollen, and kidney function and urine albumin results from this visit and from one earlier draw are reported unchanged. Assessment comes in three parts. Gout is assessed with septic arthritis addressed, and joint aspiration is discussed. Kidney disease is staged by KDIGO's cause, filtration, and albuminuria categories. Hypertension is reviewed for the drug that may be feeding the gout. The plan answers each problem, then a reconciliation paragraph shows where the three plans touch.

Reading the NRNP 6539 Week 5 rubric

Reconciliation is what a multi-problem week is really testing, and three separate plans that never mention each other earn the parts of the grade tied to each condition while missing the integration credit. This note's reconciliation paragraph is where that credit lands. Kidney staging is examined for completeness; a stage given by filtration alone, without albuminuria or cause, reads as outdated to anyone who knows KDIGO. The anti-inflammatory he was already taking is a trap the case sets, and a plan that adds another one for the flare fails a safety check in a patient with reduced filtration. Urate-lowering therapy discussed during the acute visit is weighed for timing and cited to the ACR guideline. A single monitoring schedule is expected as well, and one scattered across three plans tends to lose organization marks.

NRNP 6539 Week 5 help from the desk

Multi-problem notes lose credit when three plans sit side by side without mentioning each other. Add a section that reconciles them. Another common error is choosing an NSAID for gout in kidney disease. Explain the safer choice. Writers also stage kidney disease by eGFR alone, though KDIGO includes albuminuria. Report both. Avoid stopping the thiazide without a replacement plan for blood pressure. Keep laboratory values consistent. Address when to start urate lowering therapy. Close with monitoring dates. Students also forget to check for joint infection when the presentation is atypical. Say why it is unlikely here. Another frequent slip is starting allopurinol at a dose too high for his kidney function. Note the need to start low. Writers sometimes leave out diet and alcohol counseling. Add brief advice.

Get a NRNP 6539 Week 5 example written to your instructions

Send the multi-problem case your Week 5 prompt describes, plus the rubric, and name any note template your section requires. A problem-oriented SOAP note is prepared for that case, carrying a reconciliation paragraph that shows where the conditions and their drugs interact. Delivery takes 24-48 hours, and a first custom sample costs you nothing.

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NRNP 6539 Week 5 questions, answered

What does KDIGO staging include beyond eGFR?

KDIGO classifies chronic kidney disease by cause, by filtration category, and by albuminuria category, and it requires the abnormality to persist rather than appear on a single result. The example reports all three elements and notes the earlier draw that establishes persistence. A stage written from filtration alone is incomplete under that framework, and rubrics that name KDIGO usually check for the albuminuria category.

Why is the blood pressure drug part of a gout note?

Thiazide diuretics can raise uric acid, and in a patient having flares that makes the drug part of the gout problem as well as the blood pressure one. The example raises the question, weighs an alternative class against his albuminuria, and records the choice with its source. Leaving the diuretic unmentioned is a common gap that multi-problem rubrics are built to catch.

What if my case pairs different conditions?

The reconciliation paragraph works for any combination, diabetes with heart failure, depression with chronic pain, or whatever your prompt supplies. Each problem is written on its own terms first, then the paragraph reads across them for drug interactions and conflicting targets. Written to your case, a sample keeps that order with your conditions in place of these, citing a guideline for each.

Where can I find a free NRNP 6539 Week 5 sample paper?

The gout, kidney disease and thiazide note is reproduced here with KDIGO staging, each problem's plan and the section showing where the plans meet.

How is the gout flare treated in NRNP 6539 Week 5?

With a choice that respects his chronic kidney disease, while the thiazide that raises uric acid is reviewed.