NURSING CLIENT WITH MUCOSKELETAL AND AUTOIMMUNE DISORDER AND

GERONTOLOGY NURSING.

GOUT

INTRODUCTIONTo better understand gout, it helps to understand the anatomy of the joints

Joint

A joint is a union between two bones.

The joint allows the ends of the bones to move against one

another.

Have cartilage

Have a synovial fluid

Have a ligaments

WHAT IS GOUT???

Do you have experience of GOUT??? Or anybody at your family have this disease???

DEFINITIONIt is derived from the Latin word gutta,

meaning "a drop" (of liquid).

Gout is a metabolic disorder characterized by elevated serum uric acid levels and deposits of urate crystals in synovial fluids and surrounding tissues.

Gout also is a kind of arthritis that occurs when uric

acid builds up in blood and causes joint inflammation.

Acute

Chronic

RISK FACTOR

Lifestyle Medical conditions

Family HistoryAge and Sex

Clinical Manifestation

Severe pain at the joint

Itchy and peeling skin later

Redness and Inflammation

Fever

Less Flexibility

Becomes Nodules

ETIOLOGY

Classification causes of Gout

Primary Gout(Hereditary)

Secondary Gout(internal/external factors,

e.g. diet, kidney problems, obesity)

Etiology c0nt.Genetic tendency

Excessive urine acid in the blood

Over weight (Obese)

Overindulgence in alcohol

Medication

Kidney disease

increased purine synthesis, decreased

renal excretion

A high dietary intake of purine, alcohol

intake

Increase uric acid in the blood

(hyperuricemia)

Deposition of uric acid into the joints

PATHOPHYSIOLOGY

GOUT

Diagnostic Test

Medical History and Physical Examination

Test to measure levels of uric acid in blood

Diagnostic Test con’t

Test to measure levels of uric acid in urine

Extremity X-ray

Diagnostic Test con’t

Joint fluid analysis

Allopurinol

• Comes as a tablet to take by mouth, take it around the same time every day

• Side effect: Upset stomach, diarrhea and drowsiness

Medical treatmentColchicine(Colcrys)

•Side effect: Mild nausea, stomach pain and mild diarrhea

•Comes in a tablet to take by mouth.

Medical Treatment con’t

Probenecid

•Comes in a tablet to take by mouth.(taken two times a day)

•Side effect: Headache, Vomiting, Loss of appetite and Dizziness

Corticosteroid(Prednisone)

•Comes in a tablet to take by mouth.

•Side effect : Fluid retention, Increase BP, Mood Swings

Medical Treatment con’t

• Is recommended at 40 mg or 80 mg once daily (tablet)

• Side effect: nausea, diarrhea, headache and rash

Febuxostat(Uloric)

Surgical Treatment• If gout symptom have occurred off and on without treatment, uric acid

crystals may have built up in the joints to form gritty, chalky nodules called tophi.

Surgical Treatment con’t

This tophi can cause infection pain, pressure, and deformed joints.

Surgery will recommend by do the excision to remove the tophi

Complication

Recurrent gout Advanced gout

Kidney damage

Joint damage

Tophi

Kidney stone

NURSING CARE PLANNursing Diagnosis: Acute pain related to swelling joints

Goal: Pain will be relieved

Nursing Intervention:•The pain should be assessed on an ongoing basis using a scale of one to 10 to describe the severity.•Use cognitive therapy such as creative visualization to distract the patient from his pain.•Apply cold packs to inflamed joints to ease discomfort and reduce swelling.•Encourage the patient to perform techniques that promote rest and relaxation.

NURSING CARE PLAN con’t

Nursing Diagnosis: Activity Intolerance related to pain

Goal: Patient can do the activity daily living (ADL)

Nursing Intervention:•Evaluate orcontinuously monitor degree of joint inflammation or pain.•Assess the level of intolerance and assist the patient in activities she feels unable to perform.•Assist with activity passive rangeof motion.

NURSING CARE PLAN con’t

Nursing Diagnosis: Hyperthermia related to inflammatory process

Goal: Client will be maintain normal body temperature without complication

Nursing Intervention:•Monitor vital sign•Provide tepid sponge bath (if not contraindicated)•Promote client safety.

Health Education

Eats enough carbohydrate

Avoid or Limit alcohol consumption

Limit meat and seafood intake

Avoid fatty foods

Avoid or Limit alcohol consumption

Do the moderate daily exercise

Drink at least 6 to 8 glasses of water each day.

Take the prescribed medication and follow doctor`s order

As we already know, gout is a monosodium urate, monohydrate crystal deposit disease.

In teenagers gout also known as Rich Man’s Disease, because gout can be created by eating an abundance amount of seafood.

Clinical pharmacists need to be empowered with knowledge to assist prescribing clinicians in order to maximize therapeutic outcomes when treating gout.

To achieve this goal, a foundation of new insights into the pathogenesis of hyperuricemia and gout has been reviewed.

Both nonpharmacologic modalities and pharmacologic therapies have been discussed so that greater patient adherence through medication counseling can be achieved.

CONCLUSION

www.google.com www.mayoclinic.com

www.emedicine.comwww.wikipedia.com

www.ncbi.nlm.gov

www.medicinet.com

REFERENCES

ANY QUESTIO

NS?