Nursing Care and Pathophysiology for Gout

In this lesson we’re going to talk about Gout. This is much more common than you think. In fact, just two days ago I had a patient in the ER who came in with a Gout flare. So let’s look at what Gout is and how we care for these patients.

So gout is mainly a disease of the joints, but it can actually affect any body tissues. It occurs when uric acid builds up in the body and causes these crystals to deposit in the joints and other areas of the body. These crystals are like splinters of ice off a popsicle, they’re super sharp and will cause a lot of pain and inflammation. You can see the swelling here on the toe and here on the ankle. It’s all due to this buildup of uric acid, or hyperuricemia. The most common cause is that the body has increased purine metabolism. Uric acid is a byproduct of purine breakdown, so the more we break it down, the more uric acid we end up with. We may also see that the kidneys aren’t excreting the uric acid like they should, causing it to build up in the system. The other thing that can cause hyperuricemia is increased dietary intake of purines, which is a protein - commonly found in organ meats, seafood, wine, and aged cheese. So we will have them avoid those kinds of foods, as well as alcohol which can lead to increased uric acid. It’s also possible that Gout has a hereditary component. But these two are going to be your main culprits - increased purine metabolism and decreased renal excretion of uric acid.

So, again, we’re going to see painful inflammation and swelling of the joints. And this can affect pretty much any joint - you can see here, this person’s elbow is affected. The classic sign of a gout flare is what are called Tophi. They are nodules that develop in the skin, usually near a joint. They’re usually pink and swollen, and may have a white crusty top. Again, these are super painful. We can also see pruritus, which is severe itching of the skin. Think purines, pruritus - they go together. And then, as we talked about in the Renal Calculi lesson, this high concentration of uric acid crystals can also cause stones to develop within the kidneys themselves.

For managing gout, we first want to make sure the patient is avoiding taking in too many purines. Remember these are a protein found in, well, really all meats, but especially organ meats and seafood, as well as wine and aged cheeses. They should also avoid alcohol and make sure they’re staying really well hydrated. This is going to help flush those crystals out of their system and protect their kidneys from getting stones from the uric acid. We also want to put them on bed rest when they are having an exacerbation or flare - this will help to decrease the irritation on the joints and improve their comfort while we work to flush the crystals out of their system. As far as medications, we’ll give anti-inflammatories like NSAIDs and Corticosteroids to decrease the inflammation, and we’ll give antihyperuricemics. So, just like the name says, it prevents hyperuricemia. The #1 med we give for gout is called Allopurinol. See the ‘purine’ in there? That’s give for long term control and management of gout. We could also give Colchicine, which is usually for flare ups to decrease the uric acid in the joints.

So, as you may have guess, our top priority nursing concepts for a patient with Gout are going to be comfort and mobility. We want to address their pain and decrease the inflammation, keep them on bedrest during exacerbations, and give them meds to help decrease the uric acid buildup.

So, just a quick recap. Gout is a disorder that occurs when uric acid builds up in the body and crystallizes, especially in the joints. It usually builds up because of increased purine metabolism or decreased renal excretion of uric acid. It causes painful, swollen, inflamed joints and patients can develop Tophi - these nodules on the skin near joints. We want to encourage them not to consume a lot of purines and to increase their fluid intake, put them on bedrest during an exacerbation, and give medications like anti-inflammatories and antihyperuricemics like Allopurinol.

So those are the basics of Gout. Make sure you check out the resources attached to this lesson, including the care plan and case study, to learn more. Now, go out and be your best selves today. And, as always, happy nursing!