3 PathophysiologyDisease caused by the kidneys not clearing the uric acid out of the blood stream. Uric acid is the end product of purines in our diet. A large amount of purines in the diet are caused by the consumption of red meat products. This causes hyperuricemia (high levels of uric acid in the blood) which initiates an inflammatory response in the joints. Urate crystals deposit into the joints or subcutaneous tissues. The deposits and inflammation causes “gouty arthritis.” Gouty arthritis may appear the same as OA on X-ray. Urate crystal deposits can also cause kidney stones as deposits build up in the kidneys. Renal stones are 1,000x more common in PTs with gout.
4 Assessment Pain assessment, Check vitals Orthostatic hypotension Check labselevated WBCscalciumuric acid levelsCapillary refillNutritional statusSESAllergiesMedication & supplements are you currently on?
5 Diagnosis Top 5 nursing diagnoses, prioritized Acute pain Risk for infectionRisk for skin integrityRisk for immobilityDistorted body imageKnowledge deficit
6 Interventions Part 1Teach pt about the medications he/she is receiving and potential side effectsTeach pt about foods known to increase the incidence of gout episodes – including cheeses, wine, alcohol, sardines, organ meat, etc.Encourage client to notify physician if treatments are not working or if an increase in acute episodes of painMonitor for s/s of complications
7 Interventions Part 2Monitor for pain, pain scale 1-10, pain radiating, what brings the pain, what relieves the pain. Use of distraction props (IE: TV, books, guided image).Monitor lab values, edema, swelling, erythema (redness and swelling) Tophi on great toe?Rotate patient Q2hrs, use lift sheet, make sure skin is dry and intact,Monitor vitals signs for orthostartic hypotension, fall precautions, assist to bathroom (use call light), use assist devices.
8 Expected OutcomesPt will report minimal pain 1 hour after pain medication is administered,Pt verbalizes understanding and treatment of condition at discharge.Pt will verbalize specific gout nutrition and diet at discharge.Pt will walk successfully with crutches before discharge; pt will perform active ROM a week after discharge
9 EvaluationsGoal met for acute pain: pt claims minimal pain, with PO medsGoal met for infection: pt took ATB and no infection was acquired.Goal met for skin integrity: pt is aware of S&S of skin breakdownGoal is met for immobility: pt is able to withstand ambulating with little or no assisted devicesGoal is met for body image: pt will not demonstrate depressionover diagnosis and Is enrolled in gout counseling.
10 ReferencesWissmann, Jeanne. (2007). Adult Medical- Surgical Nursing RN Edition 7.1.Assessment Technologies Institute, LLC.Ignatavicius, Donna D., & Workman, M. Linda, (2010) Medical-Surgical Nursing, St. Louis, Missouri: Saunders, Elsevier Inc.