GOUT
GOUT
Definition
This is a disorder of uric acid metabolism whereby
urate crystal deposits in the joints and other body tissues. It's usually
caused by excessive concentration of uric acid in the blood (hyper uricermia)
the disease affects toe, foot, ankle, knee, hand and elbow joints. It's common
in males than females.
Risk/Predisposing
Factors
Ø Obesity
Ø High
Alcohol intake
Ø Genetic
predisposition
Ø High
intake of foods rich in purines e.g sea foods
Ø Drugs
e.g diuretics
Ø Injury
to joints
Ø Long
standing kidney disease.
PATHOPHYSIOLOGY
Excessive concentration of uric acid in the blood
either due to over production or faulty disposal or elimination to the kidney
leads to accumulation and deposition of urate crystal within the joint tissues,
thereby setting up irritation and local inflammatory response causing pain,
tenderness and swelling of the affected joint.
Small masses of the urate crystals, called tophi are
also formed in the cartilage, kidneys and soft tissues of other parts of the
body resulting in systemic symptoms like anorexia, nausea and fever.
PATHOPHYSIOLOGY
FLOW CHART OF GOUT
Excessive concentration of uric acid in the blood
⬇
Accumulation and deposition of urate crystals within
the joint
⬇
Irritation and inflammation of the joint
⬇
Pain, tenderness swelling
⬇
Tophi (masses of urate crystals)
Deposited
in the kidneys and soft tissues
⬇
Systemic symptoms e.g Anorexia
CLINICAL
MANIFESTATION
Ø Severe
pain
Ø Tenderness
in the affected joint
Ø Swelling
of the affected joint
Ø Warm,
tight, shiny and red skin on the affected joint
Ø Nausea
Ø Anorexia
Ø Fever
Ø Headache
Ø Constipation
DIAGNOSTIC
EVALUATIONS
Ø Examination
of the joint and full medical history of severe pain, tenderness and swelling
Ø Blood
analysis will reveal Elevated uric acid level.
Ø Aspiration
of joint fluid to confirm the presence of uric acid crystals.
Ø X-ray
of affected areas may reveal joint damage
MEDICAL
MANAGEMENT
Ø Acute
treatment is managed with colchicine and NSAIDs. These medications are
continued until the pain is controlled.
Ø Chronic
gout is treated with ebuxostat, allopurinol, or a uricosuric agent to reduce
the amount of uric acid in the system. These
medications are used
in the long
term to reduce
the amount of painful flares that occur.
Ø Administer
colchicine during an acute episode to decrease the inflammatory response
resulting from uric acid deposits. This will help reduce pain.
Ø Administer
NSAID to decrease inflammation to aid in pain relief {indomethacin, ibuprofen,
naproxen} Aspirin should be avoided as it can reduce the amount of uric acid
excreted by the body.
Ø Administer
xanthine oxidase inhibitor medication to reduce total body uric acid. Given as long-term treatment to patients with
recurrent episodes of gout. Allopurinol, ebuxostat.
Ø Administer
uricosuric medications. when the total body
amount of urate needs to be decreased.
Not used in patients who are already
excreting a large amount of uric acid. Given to patients with chronic gout or recurrent episodes. probenecid,
sulfinpyrazone
Ø Low-fat
Ø Immobilize
the joint for comfort.
NURSING
MANAGEMENT
Ø On
admission, patient is placed on bed rest and the affected part Immobilize
Ø Hot
or cold applications to the affected joints will provide some relieve
Ø Nutrition:
Restrict food high in purines. Purines produce uric acid. Foods high in purines
include shellfish, organ meats(brain, liver, kidney), yeast extract as milk, Reduce
alcohol intake which can cause diuresis and increase the concentration of the
internal environment which encourages accumulation of uric acid.
Ø Have
the patient drink 3 liters of fluid
every day to avoid crystallization of uric acid in the kidneys. Increased fluids help flush the uric acid through the kidneys
Ø Maintain
body weight to reduce stress on the affected joints
NURSING
DIAGNOSIS
Ø Chronic
pain related to inflammatory response and irritation of the joints by uric acid
evidence by patients complain.
Ø Hyperthermia
related to inflammatory process evidence by temperature of 38oc
Ø Knowledge
deficit as regard management of the condition evidence by frequently
questioning and non compliance to the treatment plan.
COMPLICATIONS
Ø Permanent
damage to the joints
Ø Kidney
stones
Ø Deformity
Ø Loss
of function
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