NURSING CLIENT WITH MUCOSKELETAL

AND AUTOIMMUNE DISORDER AND

GERONTOLOGY NURSING.

GOUT

INTRODUCTION
To better understand gout, it helps to understand the anatomy of the joints

AA joint
joint isis aa union
union between
between two
two
bones.
bones.

Have
Have cartilage
cartilage

Joint
The
The joint
joint allows
allows the
the ends
ends of
of the
the
bones
bones to
to move
move against
against one
one
another.
another.

Have
Have aa synovial
synovial fluid
fluid

Have
Have aa ligaments
ligaments

WHAT IS GOUT???

Do you have experience of GOUT???

Or anybody at your family have this disease???

DEFINITION
It is derived from the Latin word gutta,
meaning "a drop" (of liquid).
Gout is a metabolic disorder characterized
by elevated serum uric acid levels and
deposits of urate crystals in synovial fluids
and surrounding tissues.

Gout also is a kind of arthritis

that occurs when uric
acid builds up in blood and
causes joint inflammation.

Acute
Chronic

Medical
conditions

Lifestyle

RISK
FACTOR
Age and Sex

Family History

Severe pain at the joint

Itchy and peeling skin later
Redness and Inflammation
Fever
Less Flexibility
Becomes Nodules

Clinical
Manifestation

ETIOLOGY
Primary Gout
(Hereditary)
Classification causes of
Gout

Secondary Gout
(internal/external factors,
e.g. diet, kidney
problems, obesity)

Etiology c0nt.
Genetic tendency
Overindulgence in
alcohol
Over weight
(Obese)
Excessive urine acid
in the blood
Medication
Kidney disease

A high dietary intake

of purine, alcohol
intake
increased purine
synthesis, decreased
renal excretion
Increase uric acid in
the blood
(hyperuricemia)

PATHOPHYSIOLOGY
Deposition of uric
acid into the joints

GOUT

Diagnostic Test
Medical History and
Physical Examination

Test to measure levels of

uric acid in blood

Diagnostic Test cont

Test to measure levels
of uric acid in urine

Extremity X-ray

Diagnostic Test cont

Joint fluid analysis

Medical treatment
Colchicine
(Colcrys)
Comes
Comes in
in aa tablet
tablet to
to take
take by
by mouth.
mouth.
Side
Side effect:
effect: Mild
Mild nausea,
nausea, stomach
stomach pain
pain and
and mild
mild diarrhea
diarrhea

Allopurinol
Comes
Comes as
as aa tablet
tablet to
to take
take by
by mouth,
mouth, take
take itit around
around the
the

same
same time
time every
every day
day

Side
Side effect:
effect: Upset
Upset stomach,
stomach, diarrhea
diarrhea and
and drowsiness
drowsiness

Medical Treatment cont

Probenecid
Comes
Comes in
in aa tablet
tablet to
to take
take by
by mouth.(taken
mouth.(taken two
two times
times aa day)
day)
Side
Side effect:
effect: Headache,
Headache, Vomiting,
Vomiting, Loss
Loss of
of appetite
appetite and
and
Dizziness
Dizziness

Corticosteroid
(Prednisone)
Comes
Comes in
in aa tablet
tablet to
to take
take by
by mouth.
mouth.
Side
Side effect
effect :: Fluid
Fluid retention,
retention, Increase
Increase BP,
BP, Mood
Mood Swings
Swings

Medical Treatment cont

Febuxostat
(Uloric)
Is
Is recommended
recommended at
at 40
40 mg
mg or
or 80
80 mg
mg once
once daily
daily (tablet)
(tablet)
Side
Side effect:
effect: nausea,
nausea, diarrhea,
diarrhea, headache
headache and
and rash
rash

Surgical Treatment
If gout symptom have occurred off and on without treatment, uric acid
crystals may have built up in the joints to form gritty, chalky nodules
called tophi.

Surgical Treatment cont

This tophi can cause infection pain, pressure, and
deformed joints.
Surgery will recommend by do the excision to remove the
tophi

Complication
Recurrent gout

Advanced gout

Tophi

Joint damage

Kidney damage

Kidney stone

NURSING CARE PLAN

Nursing Diagnosis: Acute pain related to swelling joints
Goal: Pain will be relieved
Nursing
Nursing Intervention:
Intervention:

The pain should be assessed on an ongoing basis using a scale of

one to 10 to describe the severity.
Use cognitive therapy such as creative visualization to distract the
patient from his pain.
Apply cold packs to inflamed joints to ease discomfort and reduce
swelling.
Encourage the patient to perform techniques that promote rest and
relaxation.

NURSING CARE PLAN cont

Nursing Diagnosis: Activity Intolerance related to pain
Goal: Patient can do the activity daily living (ADL)
Nursing Intervention:
Evaluate orcontinuously monitor degree of joint
inflammation or pain.
Assess the level of intolerance and assist the patient
in activities she feels unable to perform.
Assist with activity passive rangeof motion.

NURSING CARE PLAN cont

Nursing Diagnosis: Hyperthermia related to inflammatory process
Goal: Client will be maintain normal body temperature without
complication

Nursing Intervention:

Monitor vital sign

Provide tepid sponge bath (if not contraindicated)
Promote client safety.

Health Education
Avoid
Avoid or
or Limit
Limit alcohol
alcohol
consumption
consumption

Do
Do the
the moderate
moderate daily
daily exercise
exercise

Limit
Limit meat
meat and
and seafood
seafood intake
intake

Drink
Drink at
at least
least 66 to
to 88 glasses
glasses of
of
water
water each
each day.
day.

Avoid
Avoid fatty
fatty foods
foods

Take
Take the
the prescribed
prescribed medication
medication
and
and follow
follow doctor`s
doctor`s order
order

Eats
Eats enough
enough carbohydrate
carbohydrate

Avoid
Avoid or
or Limit
Limit alcohol
alcohol consumption
consumption

CONCLUSION
As
As we
we already
already know,
know, gout
gout isis aa monosodium
monosodium urate,
urate, monohydrate
monohydrate crystal
crystal deposit
deposit
disease.
disease.
In
In teenagers
teenagers gout
gout also
also known
known as
as Rich
Rich Mans
Mans Disease,
Disease, because
because gout
gout can
can be
be
created
created by
by eating
eating an
an abundance
abundance amount
amount of
of seafood.
seafood.
Clinical
Clinical pharmacists
pharmacists need
need to
to be
be empowered
empowered with
with knowledge
knowledge to
to assist
assist prescribing
prescribing
clinicians
clinicians in
in order
order to
to maximize
maximize therapeutic
therapeutic outcomes
outcomes when
when treating
treating gout.
gout.
To
To achieve
achieve this
this goal,
goal, aa foundation
foundation of
of new
new insights
insights into
into the
the pathogenesis
pathogenesis of
of
hyperuricemia
hyperuricemia and
and gout
gout has
has been
been reviewed.
reviewed.
Both
Both nonpharmacologic
nonpharmacologic modalities
modalities and
and pharmacologic
pharmacologic therapies
therapies have
have been
been
discussed
discussed so
so that
that greater
greater patient
patient adherence
adherence through
through medication
medication counseling
counseling can
can be
be
achieved.
achieved.

www.google.com

www.mayoclinic.com

www.ncbi.nlm.gov

REFERENCES
www.medicinet.com

www.wikipedia.com

www.emedicine.com

ANY
QUESTIO
NS?