Gout

Question 1

Gout

Answer 1

• Recurrent attacks of acute arthritis associated with increased levels of serum uric acid
• Uric acid crystals are deposited in and around joints. This causes inflammation and pain

Question 2

Contributing Factors

Answer 2

1. Primary gout is hereditary
2. Results from increased purine sythesis, decreased renal excretion, or both
3. Accounts for 90% of cases
4. Secondary gout is related to conditions that cause hyperuricemia: acidosis, alcoholism, DM, HTN, hyperlipidemia, obesity

Question 3

Assessment Acute Phase

Answer 3

1. Affects 1 or more joints
2. Affected joints may appear dusky or cyanotic and are extremely tender
3. Inflammation of the great toe is most common

Question 4

Assessment Chronic Phase

Answer 4

Multiple joint involvement with development of tophi (deposits of uric acid crystals)

Question 5

Diagnostic Studies

Answer 5

• Synovial fluid analysis
• Serum uric acid levels
• 24 hour urine uric acid levels

Question 6

Allopurinol

Answer 6

Antihyperuricemic

Decreases uric acid synthesis and serum uric acid level

Side Effects: rash, flu like symptoms, cataracts (minimize ultraviolet exposure), bone marrow supression, drowsiness, liver and renal toxicity

Nursing Implications: May potentiate action of oral hypoglycemic, anticoagulants and therophylline. Continue taking drug during acute attacks.

• Daily fluid intake of at least 2-3 liters
• Take with meals to avoid gastric irritation
• Avoid use of alcohol
• teach client:
  
  • may increase frequency of gout attacks during first 6-12 months
  • attacks become less severe and of shorter duration
  • may be given for hyperuricemia caused by condiditons other than gout

Question 7

Colchicine

Answer 7

Antiinflammatory, antigout

Reduces inflammatory response to urate crystals

• Rash
• Hives
• Nausea
• Aplastic anemia
• Respiratory failure
• Toxicity: weakness, abdominal pain, nausea, vomiting, diarrhea

TNI:

1. Causes vitamin B12 deficiency
2. Oversedation common with antidepressants, narcotics, sedatives and antihistamines
3. daily fluid intake of at least 2-3 liters
4. take with meals
5. avoid use of alcohol
6. may be given prophylactically before surgery
7. keep supply on hand to take at first sign of acute attack of gout - the earlier it is started the more effective it is
8. freq ordered: give a dose hourly until abdominal pain or diarrhea appear, then reduce to q8h until acute attack subsides

Question 8

Probenecid

Answer 8

Uricosuric

Increases uric acid excretion and decreases serum uric acid level

• Rash
• Pruritus
• Painful urination
• Hematuria
• Hypotension
• Blood dyscrasis

TNI:

1. May potentiate action of oral hypoglycemic.
2. do not start during acute attack but may be continued if an attack flares up and client is already on it
3. ASA interferes with effect of probenecid
4. daily fluid intake of at least 2-3 liters
5. take with meals
6. avoid use of alcohol
7. Teach: may increase freq of gout attacks during firest 6-12 months but attacks become less severe and of shorter duration
8. also used to inhibit renal excretion of penicillin-type antibiotics

Question 9

How would gout be explained to a patient?

Answer 9

Gout is a condition caused by an excess of uric acid crystals depositing in tissues of the body. Excess leads to the formation of uric acid crystals in and around the joints causing pain and inflammation. Gout may be primary or secondary