Gout

Ø A disorder of purine metabolism; causes high levels of uric acid in the blood & the precipitation of urate crystals in the joints

Ø Inflammation of the joints caused by deposition of urate crystals in articular tissue

Incident Rate

1.   Occurs most often in males

2.   Familial tendency

CAUSES:

1. Primary gout- disorder of Purine metabolism

2. Secondary gout- excessive uric acid in the blood like leukemia

S/sx

1.   Joint pain

2.   Redness

3.   Heat

4.   Swelling

5.   Joints of foot (especially great toe) & ankle most commonly affected (acute gouty arthritis stage)

6.   Headache

7.   Malaise

8.   Anorexia

9.   Tachycardia

10.                Fever

11.                Tophi  yellowish-whitish, irregular deposits in the skin that break open and reveal a gritty appearance

Dx

1.   CBC: uric acid elevated 

Medical Management

1.   Drug therapy

a.   Acute attack:

§  Colchicine IV or PO: discontinue if diarrhea occurs

§  NSAID: Indomethacin (Indocin)

§  Naproxen (Naprosyn)

§  Phenylbutazone (Butazolidin)

b.   Prevention of attacks

§  Uricosuric agents: increase renal excretion of uric acid

§  Probenecid (Benemid)

§  Sulfinpyrazone (Anturanel)

§  Allopurinal (Zyloprim): inhibits uric acid formation

2.   Low-purine diet may be recommended

3.   Joint rest & protection

4.   Heat or cold therapy

Nursing Interventions

1.   Assess joints for pain, motion & appearance.

2.   Provide bed rest & joint immobilization as ordered.

3.   Administer anti-gout medications as ordered.

4.   Administer analgesics as ordered: for pain

5.   Increased fluid intake to 2000-3000 ml/day: to prevent formation of renal calculi.

6.   Apply local heat or cold as ordered: to reduce pain

7.   Apply bed cradle: to keep pressure of sheets off joints.

8.   Provide client teaching and discharge planning concerning

a.   Medications & their side effects

b.   Modifications for low-purine diet: avoidance of shellfish, liver, kidney, brains, sweetbreads, sardines, anchovies

c.   Limitation of alcohol use

d.   Increased in fluid intake

e.   Weight reduction if necessary

f.    Importance of regular exercise