GOUTY ARTHRITIS PRESENTED BY, JISMI MATHEW LINCY K OUSEPH MEENUPRIYA OONNANAL SMITHA V CHACKO VINEETHA MARY MATHEW

INTRODUCTION

DEFINITION SYNDROME OF ACUTE ATTACKS OF ARTHRITIS CAUSED BY HYPERURICAEMIA. (Brown & Edwards, 2009)

CAUSES INCREASE URIC ACID PRODUCTION UNDER- EXCRETION OF URIC ACID BY THE KIDNEYS INCREASED INTAKE OF FOODS CONTAINING PURINES

TYPES OF GOUT PRIMARY GOUT SECONDARY GOUT

AETIOLOGY (Brown & Edwards, 2009) ACIDOSIS OR KETOSIS ALCOHOLISM DIABETES MELLITUS HYPERTENSION OBESITY OR STARVATION RENAL DISEASE SICKLE CELL ANAEMIA USE OF CERTAIN COMMON DRUGS MALIGNANT DISEASE

PATHOPHYSIOLOGY(Lehne, 2009) INCREASED PURINE SYNTHESIS DECREASED RENAL EXCRETION HYPERURICAEMIA CRYSTALLIZATION OF SODIUM URATE IN THE SYNOVIAL SPACE INFLAMMATION

CASE STUDY

PERSONAL DETAILS 57 YEAR OLD MAN RECENT IMMIGRANT FROM A FOREIGN COUNTRY

PAST HISTORY REPEATED ATTACKS OF JOINT PAIN

PRESENT HISTORY INCREASE IN SIZE OF A NODULE ON HIS ELBOW

CLINICAL MANIFESTATIONS GOUT CLIENT JOINT PAIN AFFECTED JOINTS; CLUSKY, CYANOTIC AND TENDER INFLAMMATION OF THE GREAT TOE DEPOSITS OF SODIUM URATE CRYSTALS CALLED TOPHI PRESENT ABSENT PRESENT

PHYSICAL EXAMINATION ARTHRITIS ON BOTH HANDS. TENDER AND RUBBERY SUBCUTANEOUS NODULE OVER THE ELBOW. SUBCUTANEOUS NODULE AT THE LEFT METATARSAL – PHALENGEAL JOINT AND LEFT METACARPAL – PHALENGEAL JOINT.

DIAGNOSTIC TESTS SERUM ACID LEVELS 24 HOUR URINE SPECIMEN SYNOVIAL FLUID ASPIRATION JOINT ASPIRATION X - RAY

X – RAY FINDINGS CLASSIC ‘ PUNCHED OUT ‘ LYTIC LESION AT DISTAL RIGHT FIRST METATARSAL. MARGINAL EROSIONS AND DECREASED JOINT SPACE AT META – CARPAL AND PHALENGEAL JOINTS. SUBCUTANEOUS NODULE (GOUTY TOPHUS ) AT FIRST METACARPAL – PHALENGEAL AND LEFT FIRST METATARSAL – PHALENGEAL JOINTS.

TREATMENT COLLABORATIVE CARE DRUG THERAPY NUTRITIONAL THERAPY

COLLABORATIVE CARE GOALS TERMINATION OF AN ACUTE ATTACK BY ANTI- INFLAMMATORY AGENTS PREVENTION OF FUTURE ATTACKS – USE OF ALLOPURINOL AVOIDANCE OF ALCOHOL AND FOOD HIGH IN PURINE PREVENTION OF COMPLICATIONS

COMPLICATIONS URIC ACID KIDNEY STONES HYPERTRIGLYCERIDAEMIA HYPERTENSION

COLLABORATIVE THERAPY JOINT IMMOBILISATION LOCAL APPLICATION OF HEAT OR COLD JOINT ASPIRATION INTRA – ARTICULAR CORTICOSTEROIDS

DRUG THERAPY NON – STEROIDAL AND ANTI – INFLAMMATORY DRUGS COLCHINE PROBENECID ALLOPURINOL

COLCHICINE

ACTION ANTI – INFLAMMATORY AGENT

SIDE EFFECTS NAUSEA ABDOMINAL PAIN VOMITING GI TOXICITY

CONTRA - INDICATIONS PREGNANCY CARDIAC, RENAL AND GI DISEASES

NURSING RESPONSIBILITIES WATCH FOR COMPLICATIONS; SEIZURES, BONE MARROW SUPPRESSION WATCH FOR GI TOXICITY

ALLOPURINOL

ACTION TREAT CHRONIC TOPHACEOUS GOUT PREVENT NEPHROPATHY

SIDE EFFECTS HYPERSENSTIVITY SYNDROME; RASH, FEVER, EOSINOPHILIA AND DYSFUNCTION OF THE LIVER AND KIDNEYS. GI REACTIONS NEUROLOGIC EFFECTS

CONTRA - INDICATION PREGENANCY

NURSING RESPONSIBILITY WATCH FOR ANY SIDE EFFECTS MONITOR SERUM URIC ACID LEVELS

PROBENECID

ACTION INHIBIT REABSORPTION OF URIC ACID

SIDE EFFECTS GI EFFECTS HYPERSENSTIVITY RECTIONS RENAL INJURY

CONTRA - INDICATIONS RENAL DISEASE PREGNANCY

NURSING MANAGEMENT WATCH FOR COMPLICATIONS AND SIDE EFFECTS.

NUTRITIONAL THERAPY WEIGHT REDUCTION PROGRAM DIETARY AVOIDANCE OF FOOD / FLUIDS WITH HIGH PURINE CONTENT eg; ANCHOVIES, LIVER, WINE, BEER ETC

NURSING MANAGEMENT NURSING INTERVENTION IMPLEMENTATION SUPPORTIVE CARE OF THE INFLAMED JOINTS AVOID CAUSING PAIN TO THE INFLAMMED JOINT HEALTH EDUCATION BED REST JOINT IMMOBILISATION USE OF BED CRADLES IMPORTANCE OF DRUG THERAPY AVOIDANCE OF PERCIPITATING FACTORS