Exam 4: Gout

Question 1

Gout

Answer 1

Most common inflammatory arthritis, disruption of purine metabolism

Uric acid crystals deposited in joints and body tissues

Primary: Most common, uric acid production is greater than excretion. Chronic = 3 episodes per year or chronic joint changes

Secondary: Another disease causing excessive uric acid in blood (CKD, cancer, diuretic). Address underlying cause and gout flare

Question 2

Risk factors for gout

Answer 2

Hereditary, males and post menopause
Trauma
CV disease, chronic kidney disease

Modifiable: Diet (High purine = shellfish, red meat, high fructose drinks), alcohol, obesity, diuretic use

Question 3

Symptoms of gout

Answer 3

Severe joint pain
Redness, swelling, warmth of affected joint
May cause mild fever
Joint of the big toe most common
Tophi (small white nodules under joints and on ear)
Kidney stones

Question 4

Diagnosing gout

Answer 4

ESR
Serum uric acid level (6.5 or greater)
Renal function
Aspiration of synovial fluid for uric acid crystals

Question 5

Colchicine

Answer 5

Treatment of acute gout

For inflammation, reduces uric acid build-up
Diarrhea first sign of toxicity, renal impairment

Question 6

Allopurinol

Answer 6

Treatment of chronic gout, xanthine oxidase inhibitor

Promotes uric acid excretion and decreases production
May trigger gout flare

Take after meals with full glass of water, increase fluids

Question 7

Nursing interventions for gout

Answer 7

Dietary teaching: Increase fluids, low purine diet, limit alcohol intake, avoid starvation diets, avoid soft drinks/seafood/liver

Bed cradle
Open shoes
Cool compresses
Monitor pain