Gout

  1. General information
    1. A disorder of purine metabolism; causes high levels of uric acid in the blood and the precipitation of urate crystals in the joints
    2. Inflammation of the joints caused by deposition of urate crystals in articular tissue
    3. Occurs most often in males
    4. Familial tendency
  2. Medical management
    1. Drug therapy
      1. Acute attack: Colchicine IV or PO (discontinue if diarrhea occurs); NSAIDs such as indomethacin (Indocin), naproxen (Naprosyn), phenylbutazone (Butazolidin)
      2. Prevention of attacks
        1. uricosuric agents (probenecid [Benemid], sulfinpyrazone [Anturane]) increase renal excretion of uric acid
        2. allopurinal (Zyloprim) inhibits uric acid formation
    2. Low-purine diet may be recommended
    3. Joint rest and protection
    4. Heat or cold therapy
  3. Assessment findings
    1. Joint pain, redness, heat, swelling; joints of foot (especially great toe) and ankle most commonly affected (acute gouty arthritis stage)
    2. Headache, malaise, anorexia
    3. Tachycardia; fever; tophi in outer ear, hands, and feet (chronic tophaceous stage)
    4. Diagnostic test: uric acid elevated
  4. Nursing interventions
    1. Assess joints for pain, motion, appearance.
    2. Provide bed rest and joint immobilization as ordered.
    3. Administer antigout medications as ordered.
    4. Administer analgesics for pain as ordered.
    5. Increase fluid intake to 2000-3000 ml/day to prevent formation of renal calculi.
    6. Apply local heat or cold as ordered.
    7. Apply bed cradle to keep pressure of sheets off joints.
    8. Provide client teaching and discharge planning concerning
      1. Medications and their side effects
      2. Modifications for low-purine diet: avoidance of shellfish, liver, kidney, brains, sweetbreads, sardines, anchovies
      3. Limitation of alcohol use
      4. Increase in fluid intake
      5. Weight reduction if necessary
      6. Importance of regular exercise

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