Gout

Question 1

Gout - Pathophysiology

Answer 1

• Urate crystal deposits in the joints and other body tissues & causes inflammation
• Primary: errors in curing metabolism
  > kidneys not able to excrete uric acid
  > makes more likely…
• Secondary: body makes too much uric acid
  > kidneys also can’t filter; but not the primary cause

Question 2

Gout - Risk Factors

Answer 2

• Renal insufficiency
• Diuretic therapy
• Some chemo
• Older adults
• CV problems (diabetes)
• Obesity
• Postmenopausal women

Question 3

Gout - Stages: Asymptomatic Hyperuricemia

Answer 3

• Pt usually unaware
• Elevated uric acid lvls
  > male: 4.0-8.5mg/dL
  > female: 2.7-7.3mg/dL
• No treatment
  > lifestyle changes

Question 4

Gout - Stages: Acute Gouty Arthritis

Answer 4

• Pain & inflammation
• Podagra: pain in great toe

Question 5

Gout - Stages: Chronic/Tophaceous Gout

Answer 5

• Repeated gout attacks
• Urate kidney stone formation

Question 6

Gout - CMs

Answer 6

• Joint pain
• Joint inflammation
• Hyperuricemia
• Uric acid lvls
• Elevated BUN (10-20mg/dL)
• Elevated Creatinine (0.6-1.3mg/dL)
• Kidney stones

Question 7

Gout - Treatment

Answer 7

• Medications
  > Indomethacin: for pain control; works in 12 hrs
  > Ibuprofen: pain relief, dcr inflamm; works quickly
  > Allopurinol: reduce uric acid lvl in body; for long term use - maintenance: prevent future attacks

Question 8

Gout - Nursing Interventions

Answer 8

• Strict low-purine diet
  > red meats, pork, shell-fish, organ meat, grain based (beers), alcohol
• Teach pt fad diets may cause attack
• Avoid Aspirin
  > b/c it reduces acidity lvl
• Avoid Diuretics
  > may not be able to…
• Stress reduction
• Assess for kidney stones

Question 9

Gout - Nursing Diagnosis

Answer 9

• Impaired physical mobility r/t musculoskeletal impairment
• Chronic pain r/t inflammation of affected joint
• Readiness for enhanced knowledge: expresses an interest in learning