Gout

Question 1

What happens in gout

Answer 1

It is an inflammatory disease due to urate crystal deposit in joint which causes damage/inflammatory response
(Conc is >4mg/dL, glows in X-ray & can cause kidney stones too)

Question 2

What are the underlying causes of gout

Answer 2

1. Overproduction of purine due to increased intake of purine rich food (seafood, red meat, alcohol, soda, anchovies)
2. Increased cell death due to chemotherapy & radiotherapy (increase in uric acid due to cell death causing kidney/gout disease)
3. Accumulation of uric acid due to lack of urease/CKD = uric acid cannot filter through and accumulate
4. Genetics

Question 3

What are the risk factors of gout

Answer 3

Increased age (>40), MALE, obese, alcohol use, HTN, HLD, DM

Question 4

What is acute gouty arthritis

Answer 4

Recurrent attacks of severe articular & periarticular inflammation

Question 5

What are the SS of gout

Answer 5

Can be asymptomatic after initial attack during early stages of gout
1. Monoarticular (usually 1st metatarsophalangeal joint/big toe [podagra])
2. Attack is precipitated by excessive exercise, certain meds/food, alcohol/diet
3. Abrupt pain onset, redness & swelling (*pain is most severe hrs following attack & lessen overtime; discomfort & swelling last for a few days with tx & wks w/o tx)

Question 6

What is chronic gout

Answer 6

Occurs after repeated gout attack which cause arthritis with permanent joint destruction & deformity

Question 7

What are the objectives of gout treatment

Answer 7

1. Terminate & prevent acute attacks
2. Correct hyperuricaemia

Question 8

What are the tx for gout

Answer 8

1. Exercise/maintain weight
2. Eat food low in purine & limit consumption of red meat, beer, soda & anchovies
3. Stay hydrated to help flush toxin out of body
4. Rest & elevate foot above heart to reduce pain & swelling
5. Medications (indometacin, Celecoxib, prednisolone, colchine, Allopurinol, Probenecid)

Question 9

What are the nursing diagnosis for gout

Answer 9

1. Acute pain from joint inflammation (intermittent)
2. Impaired physical ability related to MSK pain
3. Readiness for enhanced knowledge related to interest in health mgt & disease prevention

Question 10

What to assess for patients with gout

Answer 10

Pain and diet/lifestyle

Question 11

What is the nursing plan for gout

Answer 11

Decreased pain & increased mobility one week after tx
Commit to making lifestyle modifications

Question 12

What is the nursing management of gout

Answer 12

1. Decrease pain & inflammation
2. Encourage pt to elevate foot & keep toe open to air - no covering of sheets at night
3. Discuss importance of limiting food high in purine (seafood, red meat, alcohol, soda, aged cheese)
4. Stay hydrated for maintenance of gout
5. Manage underlying conditions (DM/CKD)
6. Avoid thiazide diuretics