F - Wk9 Gout

Question 1

Whats gout?

Answer 1

1. inflammatory disease
2. where urate crystals deposit in a joint and cause damage

Question 2

What is the cause of gout?

Answer 2

1. Hyperuricemia = too much uric acid / urate in the blood.

Uric acid = natural waste product of purines
- one of the building blocks of DNA and RNA
- uric acid circulates in the bloodstream before being filtered out & excreted by the kidneys to urine

Question 3

What are the risk factors of hyperuricemia?

Answer 3

Risk factor: overproduction of purines
1. increasing age, obesity, alcohol

2. male
3. increased consumption of purine-rich foods like shellfish, alcohol, anchovies, & red meat
4. high-fructose corn syrup-containing beverages like sodas
5. After chemotherapy, radiation treatment, recent trauma or surgery
   - cells die at a faster than normal rate -> increased breakdown of purines into uric acid -> hyperuricemia
6. genetic predisposition to developing hyperuricemia -> family history
7. Reduced excretion of uric acid by the kidney - caused by:
   - dehydration, diabetes, chronic kidney disease,
   - medications like thiazide diuretics or aspirin.

Question 4

What are the symptoms of gout?

Answer 4

1. acute attacks: joint becomes red, warm, tender and swollen within hours
2. will wake up from sleep feeling like their big toe is on fire; even the weight of the sheets can be painful! -> podagra

• can affect many joints, such as those in the ankles, knees, wrists, and elbows,
• most often affects the first metatarsal joint of the foot / base of the big toe = podagra

3. pain is most severe in the hours immediately after the gout attack
   - generally lessens over time
   - but discomfort and swelling can last for a few days with treatment or weeks without treatment

Question 5

What are the complications of gout?

Answer 5

1. repeated gout attacks can cause chronic gout
   - a type of arthritis with permanent joint destruction and deformity
2. Chronic gout can eventually lead to:
   - permanent deposits of urate crystals = tophi along the bones just beneath the skin
3. Individuals with chronic gout:
   - increased risk for developing kidney stones made of uric acid
   - urate nephropathy = urate crystals deposit in kidney tubules

Question 6

How to diagnose gout?

Answer 6

Lab tests:
1. hyperuricemia = increased blood urate levels

2. Increased C reactive protein CRP
   & erythrocyte sedimentation rate ESR
   = ongoing inflammation.

Confirmed with:
3. Joint aspirate
- verify presence of urate crystals in synovial fluid

Chronic gout:
4. imaging techniques eg X-rays may detect tophi

Question 7

Whats the nursing management of patients with gout?

Answer 7

• address underlying risk factors

1. modify diet + reduce / eliminate soda, alcohol, red meat, and seafood
2. stay hydrated
3. manage underlying disorders
   - diabetes or chronic kidney disease
4. avoide some medications like thiazide diuretics.