Gout Flashcards
What is gout?
Type of arthritis characterized by hyperuricemia and deposition of uric acid crystals in one or more joints. Painful flares for days to weeks, then long asymptomatic periods.
What is the pathophysiology of gout?
Purines are molecules produced by damaged or dying cells. Purine is broken down into uric acid and excreted by kidneys. Gout occurs if kidneys can’t excrete enough or if too much is being made. As urate levels rise, they will saturate the synovial fluid or soft tissues, triggering inflammation. Crystallization and inflammation occur.
What causes gout?
Primary hyperuricemia: genetic. Secondary hyperuricemia: caused by conditions that increase uric acid production or decrease uric acid excretion. Can also be caused by drugs that inhibit uric acid excretion, loop diuretics and beta blockers. Organ transplant recipients receiving immunosuppressive agents are also at risk.
What are acute gout manifestations?
One or more joints affected (usually 4, great toe most common), discoloration (cyanotic or dusky), extremely tender, symptom onset occurs at night, sudden swelling and severe pain, sensitive to light touch, low grade fever, duration of 2-10 days with or without treatment.
What are acute gout manifestations?
Multiple joint involvement, hard deposits of sodium urate crystals called tophi.
What are complications of gout?
Joint deformity, limited mobility, cartilage destruction, tophaceous deposits tear skin and cause infection, excessive uric acid excretion, kidney stones and urinary tract stones, pyelonephritis
What diagnostic studies are used for gout?
Serum uric acid greater than 6, 24 hour urine check. Synovial fluid aspiration- gold standard, tells gout from septic arthritis. H&P- most common way to diagnose. X-ray of affected joint- may appear normal in early stage, tophi may appear as eroded in areas in bone with chronic gout.
What is colchicine?
Anti-inflammatory, pain relief in 12 hours, aids in diagnosis. Reduces inflammatory response to the deposit of urate crystals in joint tissue. Adverse effects include GI or GU bleeding.
What medications are used to prevent gout attacks?
Xanthine oxidase inhibitors (allopurinol or febuxostat)- decreases uric acid production.
Probenecid- uricosuric; increase urinary excretion of uric acid; avoid aspirin because it inactivates probenecid.
What nursing interventions are indicated for gout?
Monitor serum uric acid regularly, restrict foods high in purine, limit alcohol intake, encourage adequate fluid intake to increase urinary output, weight reduction, use footboard to protect painful lower extremity, bed rest.
