Gout

Question 1

Primary Gout

Answer 1

Most common

Occurs mostly in middle aged men

Effects joints in the feet

Hereditary error of purine metabolism leads to the over production or retention of uric acid

Question 2

Secondary Gout

Answer 2

Can be related to:

• acquired disorder
• result of drugs known to inhibits uric acid excretion ( even leukemia drugs, thiazides diuretics)
• post menopausal women
• organ transplant pt taking immunosuppressive drugs
• obesity in men increases risk
• purine rich food diet only if you’re susceptible to gout

Question 3

Gout is caused by**

Answer 3

1. Increase in uric acid production
2. Under excretion of uric acid by the kidneys
3. Increased intake of foods containing purines which are metabolized to uric acid by the body

Also prolonged fasting or excessive alcohol increases ketoacid production which inhibits uric acid secretion

Question 4

Clinical Manifestations: Acute Phase**

Answer 4

Occurs in less than four joints usually.
Joints appear dusky cyanogen and extremely tender
**Most common initial problem: inflammation of the great toe / podagar
Onset usually occurs at night with sudden swelling and extreme pain accompanied by low grade fever.

Peak in a few hours last 2-10 days treated or untreated

Joints return to normal until next attack

Question 5

Clinical Manifestations: Chronic Gout

Answer 5

Multiple joint involvement and visible deposits of sodium urate crystals/ TOPHI. Seen in synovium, sub handrail bone, olceranon burase and vertebrae, along tendons and in the skin and cartilage. Higher serum acid level = earlier TOPHI appears and greater severity of gout.

Chronic inflammation = joint deformity and cartilage destruction

Draining sinuses that often become infected

Kidney or urinary tract stone formation

Infrequent mild attacks or many severe episodes associate with slow debilitation

Question 6

Diagnostic Test**

Answer 6

History and physical exam
Family history of gout
Sodium urate crystals in synovial fluid
Elevated serum uric acid levels**
X-Ray of affected joints

Question 7

Collaborative Care goal

Answer 7

Termination of an acute attack using anti inflammatory agents (colchicine & NSAID)

Drug therapy is the primary therapy for acute and chronic gout

Question 8

Collaborative Care: What is recommended to aid in gout attack prevention?

Answer 8

Loose weight as needed

Possible avoid alcohol and foods high in purine ( red and organ meats)

Question 9

Acute Gout Episode Nursing interventions**

Answer 9

Supportive care of inflamed joints - avoid causing pain by careless handling of inflamed joints

Bed rest may be appropriate with affected joints. Properly immobilized use a cradle or footboard or lower joints. *** bed linens may aggravate so use old sheets

Asses limitation of motion and degree of pain. Then document rx effectiveness

Help the patient and family understand chronic problems that can be controlled with following the regimen

Teach the patient what to avoid to prevent attacks

Question 10

What is gout?

Answer 10

A type of recurring acute arthritis characterized by the accumulation of Uris acid crystals in one or more joints

Question 11

PURINE FOODS TO AVOID

Answer 11

High: Sardines, muscles, liver, goose, herring, venison, meat soups, sweet breads,

Moderate: chickens, salmon, crab, veil, mutton, bacon, all pork products, beef.