Ward Class

An Online Resource Site For Student Nurses

Welcome

Ward Class is an online resource for student nurses. Created with the aim of helping student nurses cope with the demands of nursing school and clinicals, it offers free downloads, notes, sample NCPs, sample drug studies, study aids, news and updates, and practical tips to its users.

Site Announcement

The December 2012 PRC Nursing Board Exam Result is already available here at Ward Class and at Pinoy R.N.




Musculoskeletal Disorders: Gout


  • also called metabolic arthritis
  • a disorder in purine metabolism; high levels of uric acid in the blood results in the formation of urate crystals that accumulate around joints
  • the presence of urate crystals around joints cause inflammation and intense pain
  • risk factors include:
    • lifestyle factors--> excessive alcohol use
    • medical conditions--> uncontrolled hypertension, hyperlipidemia (increased cholesterol levels), diabetes mellitus, and arteriosclerosis (narrowing of the arteries)
    • medications--> thiazide diuretics, anti-rejection drugs, aspirin
    • family history of gout
    • age and sex--> more common in men, between 40 t0 50 y.o;
Assessment Findings
  • joint pain, redness, heat, swelling--> usually affects joints of the foot (big toe) and ankles
  • intense pain that starts during the night
  • headache
  • malaise
  • anorexia
  • tophi in outer ear, hands, and feet (chronic tophaceous stage)
  • Diagnostic test--> joint fluid test (presence of urate crystals when examined under microscope), blood test (increased serum uric acid levels, more than 7.0mg/100ml)
Medical Management
  1. Non-steroidal anti-inflammatory drugs (NSAIDs)--> includes ibuprofen and naproxen may cause stomach pain, bleeding, and ulcers
  2. Colchicine--> effectively controls gout; may have side effects such as nausea, vomiting, and diarrhea
  3. corticosteroids--> may control gout inflammation and pain; side effects include thinning bones and poor wound healing
  4. Uricosuric agents (probenecid) and allopurinol---> prevents recurrent attacks
Nursing Management
  1. regularly assess joints (pain, motion, appearance)
  2. provide bed rest and joint immobilization as ordered
  3. administer medications as prescribed
  4. increase fluid intake (2 to 3 L/day) to prevent renal calculi formations
  5. apply bed cradle to minimize joint pain
  6. apply heat or cold to affected area as ordered
  7. provide health teachings on:
    • anti-gout and pain medications and their side effects
    • importance of low-purine diet--> avoid organ meats (sweetbreads, lover, brains), sardines, mackerel, herring, anchovies, and shellfish
    • limitation of alcohol consumption
    • increased fluid intake (2 to 3 L/day)
    • weight reduction as necessary
    • importance of exercise
Prognosis

Gout is severely restricting due to intense pain and inflammation. Effective gout treatment usually improves symptoms within hours. Even if left untreated, acute gout attacks resolve on its own. Affected areas return to normal without functional limitations.

Prevention

To reduce the risk of gout, it is important to make certain dietary and lifestyle changes. Intake of red meat, seafood, alcohol, and high-fat dairy products should be limited. Regular exercise is also encouraged to maintain healthy weight.


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