Nursing Care Plan (NCP) for Gout / Gouty Arthritis

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Outline

Pathophysiology

Gout is a common and painful form of arthritis that causes swollen, hot, and stiff joints. When uric acid crystallizes, it settles into the joints and body tissues, most frequently affecting the big toe and, if not treated, progresses to the ankles, heels, wrists, and hands. This results in severe pain, stiffness, and redness at the joint. Gout attacks often occur in the middle of the night when the joint is immobile. Once the initial pain has subsided, the general discomfort of the area can last for several weeks.

Etiology

Excessive amounts of uric acid in the blood is the primary cause of gout. Other factors include genetics, dietary factors, use of diuretics, and the inability of the kidneys to excrete uric acid. As the uric acid accumulates, crystals of monosodium urate form in the joints and tissues. 90% of cases are caused by the underexcretion of uric acid. Dietary factors as a cause for gout only comprise about 12% of cases, but changes to the diet help reduce the risk.

Desired Outcome

Relieve acute attack, prevent future attacks, promote optimal excretion of urates

Gout / Gouty Arthritis Nursing Care Plan

Subjective Data:

  • Sudden pain in joints, often the big toe
  • Stiffness in joint
  • Tenderness of the joint
  • Limited range of motion
  • Itching

Objective Data:

  • Tophi (nodules in the skin)
  • Renal calculi
  • Joint inflammation
  • Joint edema
  • Erythema

Nursing Interventions and Rationales

  • Assess and manage pain
    • Administer medications
    • Apply cool cloths as tolerable
    • Assist with positioning to avoid pressure on the affected joint
  An acute attack can cause intense pain for the first 36 hours. Offer options to help manage pain.
  • Assist with mobility
  Due to pain and inflammation, patients may require assistance with mobility for safe ambulation and transfer.
  • Monitor signs of joint inflammation
  Evaluate erythema and joint edema to determine if interventions are effective at reducing inflammation.
  • Administer medications
    • NSAIDs / Corticosteroids
    • Colchicine
    • Xanthine Oxidase Inhibitors (XOIs)
    • Uricosurics

  Medications can help relieve the immediate symptoms while others are for long term management and prevention of flare-up recurrence.

  • NSAIDs and corticosteroids help reduce swelling and can relieve immediate pain
  • Colchicine can be given for acute pain specific to gout attacks
  • XOI (allopurinol)- medications that block the production of uric acid and help prevent future attacks
  • Uricosurics (probenecid)- help the kidneys more effectively excrete uric acid
  • Promote hydration and increase fluid intake
  Prevents dehydration and helps the kidneys excrete uric acid
  • Assist with AROM or PROM
  Prevents joint stiffness and increases mobility
  • Nutrition Education
    • Limit or avoid animal proteins (liver, kidney, beef, lamb, and pork)
    • Limit intake of seafood, especially those high in purine such as shellfish, sardines, and tuna
    • Avoid alcohol as it greatly increases the risk of gout attacks
    • Encourage foods that reduce the risk of attacks including coffee, cherries, and foods high in vitamin C
    • Limit or avoid foods/drinks sweetened with fructose
  Dietary changes reduce the risk of recurrent gout attacks and lessen the severity of future attacks. Patients should avoid foods high in purines as these will cause a buildup of uric acid within the body.

Writing a Nursing Care Plan (NCP) for Gout / Gouty Arthritis

A Nursing Care Plan (NCP) for Gout / Gouty Arthritis starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

This is the nursing care plan for gout. Let’s work on it. So the pathophysiology behind gout is that it’s a common and painful form of arthritis that causes swollen, hot, stiff joints. What happens is uric acid crystallizes and settles into the joints and body tissues most frequently affecting the big toe. And if not treated progressive to the ankles, heels, wrist, and hands. This is also severe pain, stiffness and retinas at the joint. Gout attacks often occur in the middle of the night when the joint is a immobile. Once the initial pain subsides, the general discomfort of the area can last for several weeks. The nursing considerations, some things that we want to just be mindful of is this is painful. So we want to promote comfort. Okay. We want to optimize mobility. We want to educate the patient on exacerbating factors, and we want to make sure that we control their pain. 

The desired outcome of this is to relieve the acute attack, prevent future attacks and promote optimal excretion of the urines. So subjective, the patient is coming in. They have gout, this inflammation of the joints. What are they going to complain of? Well, the first thing is when it’s acute, they are going to complain of pain, sudden pain and joints. Okay. Now let’s go down a little deeper. There’s going to be limited range of motion because that pain, if you’re thinking of the joints, is going to be very tender and it is so great that you don’t want to move much. And there also may be some complaining of itching. 

Well, we’re going to observe as nurses, is we are going to notice, this is what is called tophi. And that is just pretty much nodules in the skin. There’s going to be some renal calculi or renal stones. There’s going to be some joint inflammation, some redness, some edema, those joints are going to be swollen, red and hot. So what are some things that we can do as nurses? We want to assess and manage their pain. Again, they are in a lot of pain. So we want to assess and manage pain. We want to administer any medications. So we want to administer medications And we want to apply cool cloth And assist with positioning to avoid pressure on the affected joint. And the acute attack can cause intense pain for the first 36 hours. Imagine being in pain for 36 hours, it’s not good. We want to offer options to help manage pain. Next thing we want to do is we want to look at some of the medications that we’re going to give. So, what can help? Well, let’s start with the swelling

Steroids help with swelling. We have colchicine. So let’s write that here. And that is a prescription gout medication. And that helps with gout pain. We have allopurinol that blocks your acid production and acute attack again, lasting for 36 hours. So any medications that we can give to help them either with a pain, with NSAIDS or corticosteroids, or to block that we can really help that patient along. We want to promote hydration and increased fluid intake, increased fluid intake. Remember it is all about the uric acid buildup in the body that settles into the joints. It prevents dehydration with the increased fluid intake, but it also is going to help flush out those uric acid crystals via the kidneys. So we want to flush your acid. Okay. The next thing we’re going to do is we’re going to give them some nutrition education. Remember a lot of this can be managed with diet. We want to tell our patients to avoid alcohol. We want to decrease animal proteins. We want to increase their vitamin C. So, we want to increase vitamin c, decrease alcohol , and decrease animal protein. And we want to limit high purine food as purine puree converts to acid in the body. So we want to decrease high pure rain foods. Hyperion foods include shellfish, tuna sardines. And finally, we want to assess and assist with range of motion exercises. This is going to prevent joint stiffness. 

And pain. Let’s take a look at the key points. The pathophysiology of gout, it’s a painful form of arthritis. It comes because of the increased uric acid in the blood. Some subjective data that we’re going to have. These patients are going to complain of joint pain, redness, usually in the big toe tenderness and stiffness. Some things that we’re going to see, is we’re going to see those nodules on the skin called tophi. We’re going to also see joint swelling and redness. The diet considerations are number one for this patient, because we want to make sure that these patients know what causes gout because of the uric acid. We want these patients to avoid alcohol. We want them to decrease animal protein, increase vitamin C and limit high purine. Remember those come to form a lot of foods like shellfish preserved foods, such as sardines. We want to have some medication management again, they’re in pain. So NSAIDS and steroids are important. We also have allopurinol, which is going to block the production of uric acid. We love you guys; go out and be your best self today. And, as always, happy nursing.

 

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