NURSING CLIENT WITH MUCOSKELETAL AND AUTOIMMUNE DISORDER AND GERONTOLOGY NURSING.

GOUT

INTRODUCTION
To better understand gout, it helps to understand the anatomy of the joints
Have cartilage A joint is a union between two bones.

Joint
Have a synovial fluid The joint allows the ends of the bones to move against one another. Have a ligaments

WHAT IS GOUT???

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

DEFINITION
It 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

Lifestyle

Medical conditions

RISK FACTOR
Age and Sex Family History

ETIOLOGY
Primary Gout (Hereditary)
Classification causes of Gout

Secondary Gout
(internal/external factors, e.g. diet, kidney problems, obesity)

Etiology c0nt.
Genetic tendency Overindulgence in alcohol

Over weight (Obese)

Excessive urine acid in the blood Medication Kidney disease

A high dietary intake of purine, alcohol intake increased purine synthesis, decreased renal excretion

PATHOPHYSIOLOGY
Deposition of uric acid into the joints

Increase uric acid in the blood (hyperuricemia)

GOUT

Diagnostic Test
Medical History and Physical Examination

Test to measure levels of uric acid in blood

Diagnostic Test cont

Test to measure levels of uric acid in urine

Extremity X-ray

Diagnostic Test cont

Joint fluid analysis

Medical treatment
Colchicine (Colcrys)
Comes in a tablet to take by mouth. Side effect: Mild nausea, stomach pain and mild diarrhea

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 Treatment cont

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 cont

Febuxostat (Uloric)
Is recommended at 40 mg or 80 mg once daily (tablet) Side effect: nausea, diarrhea, headache and rash

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 cont

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 Joint damage

Tophi

Kidney damage

Kidney stone

NURSING CARE PLAN

Nursing 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 cont

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 cont

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
Avoid or Limit alcohol consumption

Do the moderate daily exercise

Limit meat and seafood intake

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

Avoid fatty foods

Take the prescribed medication and follow doctor`s order Avoid or Limit alcohol consumption

Eats enough carbohydrate

CONCLUSION
As we already know, gout is a monosodium urate, monohydrate crystal deposit disease. In teenagers gout also known as Rich Mans 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.

www.google.com

www.mayoclinic.com

www.ncbi.nlm.gov

REFERENCES
www.medicinet.com

www.wikipedia.com

www.emedicine.com

ANY QUESTIONS?