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, general discomfort of the area can last for several weeks.
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.
Relieve acute attack, prevent future attacks, promote optimal excretion of urates
Gout / Gouty Arthritis Nursing Care Plan
- Sudden pain in joints, often the big toe
- Stiffness in joint
- Tenderness of the joint
- Limited range of motion
- Tophi (nodules in skin)
- Renal calculi
- Joint inflammation
- Joint edema
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.
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
- Xanthine Oxidase Inhibitors (XOIs)
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
- XOIs (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
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.
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
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