Salvan, Sarah Jane G.

BSN 3 - E
Fractures
What is a fracture?
A fracture is a break in the continuity
of a bone.
Other structures may be involved.
There might be soft tissue edema,
hemorrhage into muscles and joints,
joint dislocations, ruptured tendons ,
severed nerves, damaged blood
vessels and injury to body organs.
Classifications of Fractures
Complete - fracture involving the
entire cross section of the bone;
usually displaced.
Incomplete fracture involving only
a portion of the cross section of
bone; usually undisplaced.
Open break in the skin and
underlying soft tissue leading directly
into fracture or its hematoma.
Closed Fracture does not
communicated with outside area.
Specific Types of Fractures
Greenstick one side of a bone is
broken, and the other side is bent.
Transverse fracture straight
across the bone.
Oblique fracture occurring at an
angle across the bone.
Comminuted bone has splintered
into several fragments.
Clinical Manifestations
Pain
Loss of function; inability to use the
part
Localized swelling and discoloration
of the skin
Deformity (visible or palplable)
False motion; abdominal mobility at
fracture site
Crepitation (grating sensation)
Bone might be visible through skin
TYPES OF FRACTURE
1. Complete fracture - Involves a
break across the entire cross-section
2. Incomplete fracture - The break
occurs through only a part of the crosssection
3. Closed fracture - The fracture that
does not cause a break in the skin
4. Open fracture - The fracture that
involves a break in the skin
5. Comminuted fracture - A fracture
that involves production of several bone
fragments

6. Simple fracture - A fracture that

involves break of bone into two parts or
one
ASSESSMENT FINDINGS
1. Pain or tenderness over the involved
area
2. Loss of function
3. Deformity
4. Shortening
5. Crepitus
6. Swelling and discoloration
ASSESSMENT FINDINGS
1. Pain
Continuous and increases in severity
Muscles spasm accompanies the
fracture is a reaction of the body to
immobilize the fractured bone
2. Loss of function
Abnormal movement and pain can
result to this manifestation
3. Deformity
Displacement, angulations or
rotation of the fragments Causes
deformity
4. Crepitus
A grating sensation produced when
the bone fragments rub each other
Fracture
DIAGNOSTIC TEST
X-ray
EMERGENCY MANAGEMENT OF
FRACTURE
1. Immobilize any suspected
fracture
2. Support the extremity above and
below when moving the affected part
from a vehicle
3. Suggested temporary splints- hard
board, stick, rolled sheets
4. Apply sling if forearm fracture is
suspected or the suspected fractured
arm maybe bandaged to the chest
5. Open fracture is managed by
covering a clean/sterile gauze to
prevent contamination
6. DO NOT attempt to reduce the
facture
MEDICAL MANAGEMENT
1. Reduction of fracture either open or
closed, Immobilization and Restoration
of function
2. Antibiotics, Muscle relaxants such as
METHOCARBAMOL and Pain
medications

Salvan, Sarah Jane G.

BSN 3 - E
General Nursing MANAGEMENT for
CLOSED FRACTURE
1. Assist in reduction and
immobilization
2. Administer pain medication and
muscle relaxants
3. Teach patient to care for the cast
4. Teach patient about potential
complication of fracture and to report
infection, poor alignment and
continuous pain
General Nursing MANAGEMENT for OPEN
FRACTURE
1. Prevent wound and bone infection
Administer prescribed antibiotics
Administer tetanus prophylaxis
Assist in serial wound debridement
2. Elevate the extremity to prevent
edema formation
3. Administer care of traction and cast
FRACTURE COMPLICATIONS
Early
1. Shock
2. Fat embolism
3. Compartment syndrome
4. Infection
5. DVT
Late
1. Delayed union
2. Avascular necrosis
3. Delayed reaction to fixation devices
4. Complex regional syndrome
FRACTURE COMPLICATIONS: Fat
Embolism
Occurs usually in fractures of the
long bones
Fat globules may move into the blood
stream because the marrow pressure
is greater than capillary pressure
Fat globules occlude the small blood
vessels of the lungs, brain kidneys
and other organs
Onset is rapid, within 24-72
hours
ASSESSMENT FINDINGS
1. Sudden dyspnea and respiratory
distress
2. Tachycardia
3. Chest pain
4. Crackles, wheezes and cough
5. Petechial rashes over the chest,
axilla and hard palate
Nursing Management
1. Support the respiratory function

2.

3.

Respiratory failure is the most

common cause of death
Administer O2 in high concentration
Prepare for possible intubation and
ventilator support
Administer drugs
Corticosteroids
Dopamine
Morphine
Institute preventive measures
Immediate immobilization of
fracture
Minimal fracture manipulation
Adequate support for fractured
bone during turning and
positioning
Maintain adequate hydration and
electrolyte balance

Early complication: Compartment

syndrome
This results from fractures of arms or
legs where closed compartment are
present.
Compartment contains blood vessels,
nerves, muscles which are enclosed
by fascia.
A complication that develops when
tissue perfusion in the muscles is
less than required for tissue viability
ASSESSMENT FINDINGS
1. Pain- Deep, throbbing and
UNRELIEVED pain by opiods
Pain is due to reduction in the size of
the muscle compartment by tight
cast
Pain is due to increased mass in the
compartment by edema, swelling or
hemorrhage
2. Paresthesia- burning or tingling
sensation
3. Numbness
4. Motor weakness
5. Pulselessness, impaired capillary
refill time and cyanotic skin
Medical and Nursing management
1. Assess frequently the neurovascular
status of the casted extremity
2. Elevate the extremity above the
level of the heart
3. Assist in cast removal and
FASCIOTOMY
Open Reduction Internal Fixation
(ORIF)

Salvan, Sarah Jane G.

BSN 3 - E
Surgical insertion of internal fixation
devices like metal pins, wires or
screws to keep bone fragment in
position.
PRE-OPERATIVE CARE:
1. Immobilize the affected bone
2. Handle the affected bone gently
3. Cover open fractures with sterile
gauze.
POST-OPERATIVE CARE
1. Monitor neuromascular status
2. Monitor for signs of nerve damage
5Ps
3. Monitor for complications: DVT
(Homans sign), thromboplebitis,
infection
CARPAL TUNNEL SYNDROME:
Compression of the median nerve of
the wrist.
Most common in women 30-50 years
of age.
Usually associated with job-related
tasks (typists, computer operators,
assembly line workers, truck drivers,
carpenters)
Initial manifestations:
Paresthesia
Clumsiness when using the hands
Other manifestations;
1. Numbness
2. Pain
3. Paresthesia
4. Pain radiating to forearm, shoulder and
chest
5. Loss of fine motor movement of the
hand.
LABORATORY DATA:
(+) Tinels Sign tapping the median
nerve at the wrist produces the
symptoms
(+) Phalens test holding the wrist in
acute flexion for 60 s produces the
symptoms
Splint the wrist
Administer steroids as ordered
Prepare the client for surgical
intervention: (decompression of the
median nerve)
Prepare the client for occupation and
job counselling
Post-operatively, elevate the hand
and arm 24h
Encourage the client to handle
normal activities of daily living, 2-3
days following surgery
-

Strains
Excessive stretching of a muscle or
tendon
Nursing management
1. Immobilize affected part
2. Apply cold packs initially, then heat
packs
3. Limit joint activity
4. Administer NSAIDs and muscle
relaxants
Sprains
Excessive stretching of the
ligaments
Nursing management
1. Immobilize extremity and advise rest
2. Apply cold packs initially then heat
packs
3. Compression bandage may be applied
to relieve edema
4. Assist in cast application
5. Administer NSAIDS
Herniated disk
Occurs when all or part of the
nucleus pulposus forces through the
weakened or torn outer ring (annulus
pulposus)
Impingement on the spinal nerves
will result to BACK PAIN
Treatment
Reduction setting the bone; restoration
of fracture fragments into anatomical
position and alignment.
Methods:
Closed reduction
Traction
Open reduction
Closed Reduction
Bringing the bony fragments into
opposition by manipulation and
manual traction
Usually done under anesthesia to
relieve pain and relax muscles
Cast is usually applied to immobilize
extremity and maintain reduction
Open Reduction
Operative intervention to achieve
fracture reduction
Bone fragments are repositioned
under direct visualization
Internal fixation devices(metallic
pins, wires, screws, plates, nails,
rods) may be used to hold bone
fragments in position
After closure of wound, cast may be
applied

Salvan, Sarah Jane G.

BSN 3 - E
Cast Types and Maintenance
Instructions
Musculoskeletal Modalities
Traction
Cast
Traction
A method of fracture immobilization
by applying equipments to align
bone fragments
Used for immobilization, bone
alignment and relief of muscle spasm
- Skin traction- Buck, Bryant
- Skeletal traction
- Balanced Suspension traction
- Running/Straight traction
Pulling force exerted on bones to
reduce or immobilize fractures,
reduce muscle spasm, correct or
prevent deformities
TO decrease muscle spasms
TO reduce, align and immobilize
fractures
To correct deformities
Nursing Management
Traction: General principles
1. ALWAYS ensure that the weights
hang freely and do not touch the
floor
2. NEVER remove the weights
3. Maintain proper body alignment
4. Ensure that the pulleys and ropes are
properly functioning and fastened by
tying square knot
5. Observe and prevent foot drop
Provide foot plate
6. Observe for DVT, skin irritation and
breakdown
7. Provide pin care for clients in skeletal
traction- use of hydrogen peroxide
8. Promote skin integrity
Use special mattress if possible
Provide frequent skin care
Assess pin entrance and cleanse the
pin with hydrogen peroxide solution
Turn and reposition within the limits
of traction
Use the trapeze
Cast
Immobilizing tool made of plaster of
Paris or fiberglass
Provides immobilization of the
fracture
Cast types:

1. Long arm
2. Short arm
3. Short leg
4. Long leg
5. Spica
6. Body cast
Casting Materials
Plaster of Paris
Drying takes 1-3 days
If dry, it is SHINY, WHITE, hard
and resistant
Fiberglass
Lightweight and dries in 20-30
minutes
Water resistant
Cast application
1.
TO immobilize a body part in a
specific position
2.
TO exert uniform compression to
the tissue
3.
TO provide early mobilization of
UNAFFECTED body part
4.
TO correct deformities
5.
TO stabilize and support unstable
joints
Nursing Management
CAST: General Nursing Care
1. Allow the cast to air dry (usually 24-72
hours)
2. Handle a wet cast with the PALMS not
the fingertips
3. Keep the casted extremity ELEVATED
using a pillow
4. Turn the extremity for equal drying.
DO NOT USE DRYER for plaster cast
Encourage mobility and range of
motion exercises
5. Petal the edges of the cast to prevent
crumbling of the edges
6. Examine the skin for pressure areas
and regularly check the pulses and skin
7. Instruct the patient not to place sticks
or small objects inside the cast
8. Monitor for the following: pain,
swelling, discoloration, coolness,
tingling or lack of sensation and
diminished pulses

Hot spots occurring along the cast

may indicate infection under the cast

Common Musculoskeletal
conditions
What is a cast?

Salvan, Sarah Jane G.

BSN 3 - E
A cast holds a broken bone in place
as it heals. Casts also help to prevent
or decrease muscle contractions, and
are effective at providing
immobilization, especially after
surgery.
Casts immobilize the joint above and
the joint below the area that is to be
kept straight and without motion. For
example, a child with a forearm
fracture will have a long arm cast to
immobilize the wrist and elbow
joints.
What are casts made of?
The outside, or hard part of the cast,
is made from two different kinds of
casting materials.
plaster - white in color
fiberglass - comes in a variety of
colors, patterns, and designs
Cotton and other synthetic materials
are used to line the inside of the cast
to make it soft and to provide
padding around bony areas, such as
the wrist or elbow.
Special waterproof cast liners may be
used under a fiberglass cast,
allowing the child to get the cast wet.
Consult your child's physician for
special cast care instructions for this
type of cast.
What are the different types of casts?
Short arm cast: Applied below the
elbow to the hand. Use: Forearm or
wrist fractures. Also used to hold the
forearm or wrist muscles and
tendons in place after surgery.
Long arm cast: Applied from the
upper arm to the hand. Use: Upper
arm, elbow, or forearm fractures.
Also used to hold the arm or elbow
muscles and tendons in place after
surgery.
Arm cylinder cast: Applied from the
upper arm to the wrist. Use: To hold
the elbow muscles and tendons in
place after a dislocation or surgery.
Shoulder spica cast: Applied
around the trunk of the body to the
shoulder, arm, and hand. Use:
Shoulder dislocations or after surgery
on the shoulder area
Minerva cast: Applied around the
neck and trunk of the body. Use:

After surgery on the neck or upper

back area.
Short leg cast: Applied to the area
below the knee to the foot. Use:
Lower leg fractures, severe ankle
sprains/strains, or fractures. Also
used to hold the leg or foot muscles
and tendons in place after surgery to
allow healing.
Leg cylinder cast: Applied from the
upper thigh to the ankle. Use: Knee,
or lower leg fractures, knee
dislocations, or after surgery on the
leg or knee area.
Unilateral hip spica cast: Applied
from the chest to the foot on one leg.
Use: Thigh fractures. Also used to
hold the hip or thigh muscles and
tendons in place after surgery to
allow healing.
One and one-half hip spica cast:
Applied from the chest to the foot on
one leg to the knee of the other leg.
A bar is placed between both legs to
keep the hips and legs immobilized.
Use: Thigh fracture. Also used to
hold the hip or thigh muscles and
tendons in place after surgery to
allow healing.
Bilateral long leg hip spica cast:
Applied from the chest to the feet. A
bar is placed between both legs to
keep the hips and legs immobilized.
Use: Pelvis, hip, or thigh fractures.
Also used to hold the hip or thigh
muscles and tendons in place after
surgery to allow healing.
Short leg hip spica cast: Applied
from the chest to the thighs or
knees. Use: To hold the hip muscles
and tendons in place after surgery to
allow healing.
Abduction boot cast: Applied from
the upper thighs to the feet. A bar is
placed between both legs to keep
the hips and legs immobilized. Use:
To hold the hip muscles and tendons
in place after surgery to allow
healing.
How can my child move around while
in a cast?
Assistive devices for children with
casts include:

crutches

walkers

Salvan, Sarah Jane G.

BSN 3 - E

wagons

wheelchairs

reclining wheelchairs
Cast care instructions:
Keep the cast clean and dry.
Check for cracks or breaks in the
cast.
Rough edges can be padded to
protect the skin from scratches.
Do not scratch the skin under the
cast by inserting objects inside the
cast.
Can use a hairdryer placed on a cool
setting to blow air under the cast and
cool down the hot, itchy skin. Never
blow warm or hot air into the cast.
Do not put powders or lotion inside
the cast.
Cover the cast while your child is
eating to prevent food spills and
crumbs from entering the cast.
Prevent small toys or objects from
being put inside the cast.
Elevate the cast above the level of
the heart to decrease swelling.
Encourage your child to move his/her
fingers or toes to promote
circulation.
Do not use the abduction bar on the
cast to lift or carry the child.
Older children with body casts may
need to use a bedpan or urinal in
order to go to the bathroom. Tips to
keep body casts clean and dry and
prevent skin irritation around the
genital area include the following:
Use a diaper or sanitary napkin
around the genital area to
prevent leakage or splashing of
urine.
Place toilet paper inside the
bedpan to prevent urine from
splashing onto the cast or bed.
Keep the genital area as clean and
dry as possible to prevent skin
irritation.
When to call your child's physician:
Contact your child's physician or
healthcare provider if your child
develops one or more of the
following symptoms:
fever greater than 101 F
increased pain
increased swelling above or below
the cast

complaints of numbness or tingling

drainage or foul odor from the cast
cool or cold fingers or toes

METABOLIC BONE DISORDERS

Osteoporosis
A disease of the bone characterized
by a decrease in the bone mass and
density with a change in bone
structure
Pathophysiology
Normal homeostatic bone turnover is
altered rate of bone RESORPTION is
greater than bone FORMATION
reduction in total bone mass
reduction in bone mineral density
prone to FRACTURE
Types of Osteoporosis
1. Primary Osteoporosis- advanced
age, post-menopausal
2. Secondary osteoporosis- Steroid
overuse, Renal failure
RISK factors for the development of
Osteoporosis
1. Sedentary lifestyle
2. Age
3. Diet- caffeine, alcohol, low Ca and Vit
D
4. Post-menopausal
5. Genetics- caucasian and asian
6. Immobility
ASSESSMENT FINDINGS
1. Low stature
2. Fracture

Femur
3. Bone pain
LABORATORY FINDINGS
1. DEXA-scan
Provides information about bone
mineral density
T-score is at least 2.5 SD below the
young adult mean value
2. X-ray studies
Medical management
1. Diet therapy with calcium and
Vitamin D
2. Hormone replacement therapy
3. Biphosphonates- Alendronate,
risedronate produce increased bone
mass by inhibiting the OSTEOCLAST
4. Moderate weight bearing exercises
5. Management of fractures
Osteoporosis Nursing Interventions

Salvan, Sarah Jane G.

BSN 3 - E
1. Promote understanding of
osteoporosis and the treatment regimen
Provide adequate dietary supplement
of calcium and vitamin D
Instruct to employ a regular program
of moderate exercises and physical
activity
Manage the constipating side-effect
of calcium supplements
Take calcium supplements with
meals
Take alendronate with an EMPTY
stomach with water
Instruct on intake of Hormonal
replacement
2. Relieve the pain
Instruct the patient to rest on a
firm mattress
Suggest that knee flexion will cause
relaxation of back muscles
Heat application may provide
comfort
Encourage good posture and body
mechanics
Instruct to avoid twisting and heavy
lifting
3. Improve bowel elimination
Constipation is a problem of calcium
supplements and immobility
Advise intake of HIGH fiber diet and
increased fluids
4. Prevent injury
Instruct to use isometric exercise to
strengthen the trunk muscles
AVOID sudden jarring, bending and
strenuous lifting
Provide a safe environment
Juvenile rheumatoid Arthritis
AUTO-IMMUNE inflammatory joint
disorder of UNKNOWN cause
SYSTEMIC chronic disorder of
connective tissue
Diagnosed BEFORE age 16 years old
PATHOPHYSIOLOGY : unknown
Affected by stress, climate and
genetics
Common in girls 2-5 and 9-12 y.o.
Symptoms may decrease as child
enters adulthood
With periods of remissions and
exacerbations
Medical Management
1.
ASPIRIN and NSAIDs- mainstay
treatment
2.
Slow-acting anti-rheumatic drugs

3.
Corticosteroids
Nursing Management
1. Encourage normal performance of
daily activities
2. Assist child in ROM exercises
3. Administer medications
4. Encourage social and emotional
development
Nursing Management During acute
attack:
SPLINT the joints
NEUTRAL positioning
Warm or cold packs
OSTEOARTHRITIS
The most common form of
degenerative joint disorder
Chronic, NON-systemic disorder of
joints
OSTEOARTHRITIS: Pathophysiology
Injury, genetic, Previous joint
damage, Obesity, Advanced age
Stimulate the chondrocytes to
release chemicals
chemicals will cause cartilage
degeneration, reactive inflammation
of the synovial lining and bone
stiffening
OSTEOARTHRITIS: Risk factors
1. Increased age
2. Obesity
3. Repetitive use of joints with previous
joint damage
4. Anatomical deformity
5. Genetic susceptibility
OSTEOARTHRITIS: Assessment findings
1. Joint pain
Caused by:
Inflamed cartilage and
synovium
Stretching of the joint capsule
Irritation of nerve endings
2. Joint stiffness

Commonly occurs in the

morning after awakening

Lasts only for less than 30

minutes

DECREASES with movement,

but worsens after increased weight
bearing activitry

Crepitation may be elicited

3. Functional joint impairment
limitation
The joint involvement is
ASYMMETRICAL

Salvan, Sarah Jane G.

BSN 3 - E
This is not systemic, there is no
FEVER, no severe swelling
Atrophy of unused muscles
Usual joint are the WEIGHT
bearing joints
OSTEOARTHRITIS: Diagnostic findings
1. X-ray
Narrowing of joint space
Loss of cartilage
Osteophytes
2. Blood tests will show no evidence
of systemic inflammation and are not
useful
OSTEOARTHRITIS: Medical management
1. Weight reduction
2. Use of splinting devices to support
joints
3. Occupational and physical therapy
4. Pharmacologic management
Use of PARACETAMOL, NSAIDS
Use of Glucosamine and
chondroitin
Topical analgesics
Intra-articular steroids to decrease
inflam
OSTEOARTHRITIS: Nursing Interventions
1. Provide relief of PAIN
Administer prescribed analgesics
Application of heat modalities.
ICE PACKS may be used in the
early acute stage!!!
Plan daily activities when pain
is less severe
Pain meds before exercising
2. Advise patient to reduce weight
Aerobic exercise
Walking
3. Administer prescribed medications
NSAIDS
4. Position the client to prevent flexion
deformity
Use of foot board, splints, wedges
and pillows
Rheumatoid arthritis
A type of chronic systemic
inflammatory arthritis and
connective tissue disorder affecting
more women (ages 35-45) than
men
FACTORS:
Genetic
Auto-immune connective tissue
disorders
Fatigue, emotional stress, cold,
infection

Pathophysiology
Immune reaction in the synovium
attracts neutrophils releases
enzymes breakdown of collagen
irritates the synovial liningcausing
synovial inflammation edema and
pannus formation and joint erosions
and swelling
ASSESSMENT FINDINGS
1. PAIN
2. Joint swelling and stiffnessSYMMETRICAL, Bilateral
3. Warmth, erythema and lack of
function
4. Fever, weight loss, anemia,
fatigue
5. Palpation of join reveals spongy
tissue
6. Hesitancy in joint movement
ASSESSMENT FINDINGS

Joint involvement is
SYMMETRICAL and BILATERAL

Characteristically beginning in the

hands, wrist and feet

Joint stiffness occurs early

morning, lasts MORE than 30
minutes, not relieved by movement,
diminishes as the day progresses

Joints are swollen and warm

Painful when moved

Deformities are common in the

hands and feet causing misalignment

Rheumatoid nodules may be

found in the subcutaneous
tissues
Diagnostic test
1. X-ray
Shows bony erosion
2. Blood studies reveal (+)
rheumatoid factor, elevated ESR
and CRP and ANTI-nuclear
antibody
3. Arthrocentesis shows synovial fluid
that is cloudy, milky or dark yellow
containing numerous WBC and
inflammatory proteins
MEDICAL MANAGEMENT
1. Therapeutic dose of NSAIDS and
Aspirin to reduce inflammation
2. Chemotherapy with methotrexate,
antimalarials, gold therapy and
steroids
GOLD THERAPY:
IM or Oral preparation

Salvan, Sarah Jane G.

BSN 3 - E
Takes several months (3-6) before
effects can be seen
Can damage the kidney and causes
bone marrow depression
May NOT work for all individuals
3. For advanced cases- arthroplasty,
synovectomy
4. Nutritional therapy
Nursing MANAGEMENT
1. Relieve pain and discomfort
USE splints to immobilize the
affected extremity during acute
stage of the disease and
inflammation to REDUCE
DEFORMITY
Administer prescribed medications
Suggest application of COLD packs
during the acute phase of pain,
then HEAT application as the
inflammation subsides
2. Decrease patient fatigue
Schedule activity when pain is less
severe
Provide adequate periods of rests
3. Promote restorative sleep
4. Increase patient mobility
Advise proper posture and body
mechanics
Support joint in functional position
Advise ACTIVE ROME
Avoid direct pressure over the joint
5. Provide Diet therapy
Patients experience anorexia,
nausea and weight loss
Regular diet with caloric
restrictions because steroids may
increase appetite
Supplements of vitamins, iron and
PROTEIN
6. Increase Mobility and prevent
deformity:
Lie FLAT on a firm mattress
Lie PRONE several times to prevent
HIP FLEXION contracture
Use one pillow under the head
because of risk of dorsal kyphosis
NO Pillow under the joints because
this promotes flexion contractures
Capsaicin

Unknown mechanism,
probably Inhibits substance P

Reduces pain

Applied over the affected

area

Do NOT bandage the area

Side effect: burning

sensation
Wash hands after application

Hot versus Cold

OA versus RA
Gouty arthritis
A systemic disease caused by
deposition of uric acid crystals in the
joint and body tissues
CAUSES:
1. Primary gout- disorder of Purine
metabolism
2. Secondary gout- excessive uric
acid in the blood like leukemia
ASSESSMENT FINDINGS
1. Severe pain in the involved joints,
initially the big toe
2. Swelling and inflammation of the
joint
3. TOPHI- yellowish-whitish, irregular
deposits in the skin that break open
and reveal a gritty appearance
4. PODAGRA-big toe
5. Fever, malaise
6. Body weakness and headache
7. Renal stones
DIAGNOSTIC TEST
Elevated levels of uric acid in the
blood
Uric acid stones in the kidney
(+) urate crystals in the synovial
fluid
Medical management
1. Allupurinol- take it WITH FOOD

Rash
signifies allergic reaction
2. Colchicine

For acute attack

3. Probenecid

For uric acid

excretion in the kidney
Nursing Intervention
1. Provide a diet with LOW purine
Avoid Organ meats, aged and
processed foods
STRICT dietary restriction is NOT
necessary
2. Encourage an increased fluid intake
(2-3L/day) to prevent stone
formation
3. Instruct the patient to avoid
alcohol
4. Provide alkaline ash diet to
increase urinary pH

Salvan, Sarah Jane G.

BSN 3 - E
5. Provide bed rest during early attack
of gout
6. Position the affected extremity in
mild flexion

7. Administer anti-gout medication and

analgesics

10