• Embed Doc
  • Copy Link
  • Readcast
  • Collections
  • CommentGo Back
Download
 
GOUTY ARTHRITISDefinition
A heterogeneous group of conditions related to a genetic defect of purinemetabolism and fresulting hyperuricemia
A metabolic bone disorder in which purine (protein) metabolism is alteredand the by-product, uric acid, accumulates
Also Known As
Disease Of Kings
Incidence
Primary gout has 85% incidence of all cases, of which 95% are men
Risk / Predisposing Factors
Lifestyle factors.
Choices you make in your everyday life may increaseyour risk of gout. Excessive alcohol use — generally more than two drinksa day for men and more than one for women — increases the risk of gout.
Diet.
Excessive intake of foods high in purine such as shellfish, organmeats, red meats, increases uric production in the body
Medical conditions.
Certain diseases and conditions make it more likelythat you'll develop gout. These include untreated high blood pressure(hypertension) and chronic conditions, such as diabetes, high levels of fatand cholesterol in the blood (hyperlipidemia), and narrowing of the arteries(arteriosclerosis).
Certain medications.
The use of thiazide diuretics — commonly used totreat hypertension — and low-dose aspirin also can increase uric acidlevels. So can the use of anti-rejection drugs prescribed for people whohave undergone an organ transplant.
Family history of gout.
If other members of your family have had gout,you're more likely to develop the disease.
Age and sex.
Gout occurs more often in men than it does in women,primarily because women tend to have lower uric acid levels than men do.After menopause, however, women's uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually betweenthe ages of 40 and 50 — whereas women generally develop signs andsymptoms after menopause.
 
Manifestation
4 stages
I.
Asymptomatic hyperuricemia
II.
Acute attack accompanied by redness, swelling, and exquisite tendernessin one join (toes, fingers, wrist, ankles, knees, or other joints). Great toe ismost common site. First attack develops quickly, often overnight. Fever,tachycardia, malaise, and anorexia may be noted. Acute episode usuallysubsides within 1 week. As edema subsides, pruritus and localdesquamation (tissue loss) may be noted.
III.
A period of time between attacks during which affected joint returns tonormal and client may be asymptomatic for years. Eventually, other attacks occur 
IV.
Permanent changes in multiple joints with restrictions in movement. Trophimay be detected on ears, hands, elbows, feet and knees. Atherosclerosisoccurs in about 50% of all clients.
Types / Classification / Stage
Primary gout 
is caused by an inherited defect of purine metabolism
Secondary gout 
is an acquired condition that occurs followinghematopoietic (multiple myeloma, polycythemia vera, and leukemia) or renal disorders.
Pathophysiology
In the body, uric acid is made by enzymatic breakdown of tissue anddietary purines. Huperuricemia develops because of underexcretion or overproduction of uric acid. In addition to accumulation in the blood, uricacid is concentrated in the synovial fluid, myocardium, kidneys, and ears.When uric acid levels reach a certain level, they crystallize, and thecrystals (trophy) are deposited in connective tissue. Because the crystalsare deposited in connective tissue, gout is classified as a form of arthritis.
Diagnostic
Joint fluid test.
Your doctor may use a needle to draw fluid from your affected joint. When examined under the microscope, your joint fluid mayreveal urate crystals.
Blood test.
Your doctor may recommend a blood test to measure the uricacid level in your blood. Blood test results can be misleading, though.Some people have high uric acid levels, but never experience gout. Andsome people have signs and symptoms of gout, but don't have unusuallevels of uric acid in their blood.
 
Management
Hyperuricemia, trophi, joint destruction, and renal problems are treatedafter the acute inflammatory process has subside.
Uricosuric agents, such as [rpbemecid, correct hyperuricemia and dissolvedeposited urate.
Colchicines (oral or parenteral) or a nonsteroidal anti-inflammatory drug(NSAID), such as indomethacin, is used to relieve acute attack
Allopurinol is effective, but use is limited because of the risk of toxicity
Aspiration and intra-articular corticosteroids are used to treat large-jointacute attacks
Nursing Diagnosis
Pain
related to inflammation, increased disease activity, tissue damage,fatigue, and lowered tolerance
Fatigue
related to increased disease activity, pain, inadequate rest,deconditioning, inadequate nutrition, emotional stress, depression
Impaired physical mobility 
related to muscle weakness, pain onmovement, lack of or improper use of ambulatory devices
Self-care deficits
(feeding, bathing, dressing, toileting) related tocontractures, fatigue, or loss of motion
Disturbed sleep pattern
related to pain and fatigue
Disturbed body image
related to physical and psychological changes anddependency imposeb by chronic illness
Ineffective coping 
related to actual or perceived lifestyle or role changes
Nursing responsibilities
Relieving Pain And Discomfort
Reducing Fatigue
Increasing Mobility
Facilitating Self-Care
Improving Sleep
Improving Body Image
Monitoring and Managing Potential Complications
of 00

Leave a Comment

You must be to leave a comment.
Submit
Characters: ...
You must be to leave a comment.
Submit
Characters: ...