DEFINITION TYPES/CLASSIFICATION ASSESSMENT SIGNS AND SYMPTOMS ANATOMY AND PHYSIOLOGY

-is a type of arthritis 4 STAGES OF GOUT -Inspection -painful condition of the big
due to accumulation of 1.Asymptomatic Hyperuricemia- -Palpation toe (podagra- feeling like toe
uric acid in the blood There are no symptoms, but uric acid on fire)
that causes needle like levels are high and crystals are forming -intense joint pain
crystals that form in in the joints. -joint swelling and tenderness
the joints 2.Acute Gout- happens when Affected part: -joint redness
-inflammatory disease something (such as a night of drinking) -Toe- most common for an -heat/warm on the affected
in which monosodium causes uric acid levels to spike the attack area
urate crystals deposits crystals that have formed in a joint, -ankles -limited range of motion
into the joints making it triggering the attack. -knees -tophi-large clumps of uric
red, hot, swollen and - inflammation and pain usually strike -wrists acid can form which
tender ( when this at night and intensify over the next -fingers permanently damage and
happens it’s called eight to 12 hours. -elbows disfigure joints.
GOUTY ATTACKS - The symptoms ease after a few days
most common type of and likely go away in 10 days. Some
inflammatory arthritis.  people never experience a second
attack, but many people will have a
second attack within a year. 
3. Interval Gout- condition that occurs
after the acute attack has resolved and
the patient has become asymptomatic.
4. Chronic Gout- develops in people
with gout whose uric acid levels remain
high over a number of years.
–Attacks become more frequent and
the pain may not go away as it used to.
-Joint damage may occur.
-presence of tophi (white, yellowish,
nodules found in under the skin (ear,
fingers, elbows, toes))
 DIAGNOSTIC STUDIES

Laboratory Procedure/Diagnostic Procedure Normal Values Significance

Complete Blood Count(WBC) -4.5-11.0x10/L -higher than normal means there is an infection

Erythrocyte Sedimentation Rate (ESR) Age Male Female -measures the degree of inflammation in the body
0-50 <15mm/h <20mm/h
51-85 <20mm/h <30mm/h
>85 <30mm/h <42mm/h
- Joint X-rays can be helpful to rule out other causes of
joint inflammation.
X-ray imaging
-can detect urate crystals in a joint or in a tophus
Musculoskeletal Ultrasound
-can detect presence of urate crystals in a joint, even
Dual Energy CT Scan when it is not inflamed.

Arthrocentesis /Synovial Fluid Aspiration or Joint NORMAL ABNORMAL -Can be performed either diagnostically (for
Aspiration SYNOVIAL FLUID Viscous Less viscous may indicate
identification of the etiology of acute arthritis) or
inflammation
therapeutically (for pain relief, drainage of effusion, or
COLOR&CLARITY Clear, Colorless, Cloudy, opaque
injection of medications)
Straw Colored Pink/red-indicate blood cells
VOLUME 0.15-40mL(depends increase or decrease volume may - Joint aspiration is most often done on the knee.
on size of joint) indicate inflammation
CRYSTALS Not Present Indicate gout
WBC higher than normal may indicate
infectious arthritis, gout, or
rheumatoid arthritis
Microorganism Not present Indicate infection

2.4-6.0 mg/dL (female) and 3.4-7.0 mg/dL (male).

Uric Acid Blood Test/serum uric acid test
-measures how much uric acid you have in your blood.
The test can help determine how well your body
produces and removes uric acid.
250 to 750 milligrams per 24 hours.
Uric acid urine test (measures the amount of uric
acid in a sample of urine collected over 24 hours) Determine if the nephrons functioning properly and
excreting body waste like uric acid.
 MEDICAL MANAGEMENT
-treat the underlying cause of
hyperuricemia
-pharmacologic management
 NSAIDS (Ibuprofen, Naproxen) -
help reduce pain and swelling in
the joints during a gout attack
 Corticosteroids (Prednisone)-
control gout inflammation and
pain
 Colchicine-helps prevent gout
attacks and provides relief from
inflammation and pain
 Allopurinol- prevent of future
gout attack
-reduces uric acid production
-does not relieve acute attack
-in combination with colchicine
 Uricosuric drugs (Probenecid)-
decrease reabsorption and
increase excretion of uric acid.
-collaborative management
 Asses laboratory findings
NURSING MANAGEMENT
-assess the joints (for swelling, warm,
redness)
-assess the pain and where it is located
-assess health history
-educate the patient in avoiding high
purine foods like sea foods, red meat
and internal organs
-watch the medications they’re taking
especially aspirin and thiazide diuretics
(can increase uric acid level)
-apply warm compress
-advise the patient to increase fluid
intake 2-3 L per day (keep uric acid
from elevating)
-promote bed rest
SURGICAL MANAGEMENT
Surgical removal of tophi-large tophi is
removed
Tophi- deposit of crystalline uric acid
and other substances at the surface of
joints or in skin or cartilage
Joint fusion surgery-aka “arthrodesis”
-permanently hold a joint in a fixed
position and allow the bone to cross
the joint
Joint replacement-parts of arthritic or
damaged joint are removed and
replaced with a metal, plastic or
ceramic device called “prosthesis”
NURSING RESPONSIBILITY
Before:
- secure informed consent
-explain the procedure to the patient
and to the significant others
-gather all supplies needed for the
operation
During:
-monitor patient’s vital signs to detect
anomalies
After:
-proper wound care
-monitor closely the vital signs and
report any abnormalities to the
physician
 PHARMACOLOGIC MANAGEMENT

BRAND DOSAGE/ROUTE CLASSIFICATION INDICATION ADVERSE REACTION NURSING RESPONSIBILITY

NAME/GENRIC NAME
Generic Name: Dosage: 750mg PO, Non-steroidal Anti- -  reducing hormones that -indigestion BEFORE:
Naproxen Sodium then 250mg every 8 Inflammatory Drug cause inflammation and pain -epigastric pain -Check the physician’s order
hours until attack in the body. -diarrhea -observe 10 rights of drug
Brand Name: subsides OR -reduces pain, swelling, and -heart burn administration
Flanax 825mg then 275mg joint stiffness caused by -nausea DURING:
every 8 hours until conditions such as headache, -headache --advise the patient to take drug
attack subsides muscle aches, tendonitis, -Dizziness with or milk to minimize GI upset
dental pain, and menstrual -drowsiness -check properly if the patient take
Route: Oral cramps. arthritis, bursitis, the medication properly
and gout attacks.  AFTER:
-observe for allergic reactions
-document and record
-drug may cause drowsiness, tell
patient not to drive or perform
hazardous task requiring mental
alertness
Generic Name: Dosage: initially, 0.5- Anti-gout Agent -Symptomatic treatment of -nausea and vomiting BEFORE:
Colchicine 1.2mg PO, then 0.5- acute attack of gouty arthritis -abdominal pain -Check the physician’s order
1.2 every 1-2 hours -work by decreasing swelling -diarrhea -observe 10 rights of drug
Brand Name: and lessening the build up of administration
until pain is relieved
uric acid crystals that cause DURING:
Mitigare
pain in the affected joints -give drug with meals to reduce GI
Route: Oral effects
- check properly if the patient take
the medication properly
AFTER:
-tell the patient to report adverse
reactions of acute overdose
-tell patient with gout to limit
intake of foods high in purine
Generic Name: Dosage: Mild Gout, Xanthine Oxidase -reducing the production of -drowsiness BEFORE:
Allopurinol 200-300mg PO daily Inhibitor uric acid in the body -headache -Check the physician’s order
Severe Gout with -paresthesia -observe 10 rights of drug
Brand Name: large tophi, 40- -nausea administration
Zyloprim 600mg PO daily -vomiting -
-diarrhea DURING:
- to minimized GI adverse
-abdominal pain
reactions, tell patient to take drug
with or immediately after meals
- check properly if the patient take
the medication properly
AFTER:
-monitor uric acid levels to
evaluate drug’s effectiveness
-monitor fluid intake and output
-drug may cause drowsiness, tell
patient not to drive or perform
hazardous task requiring mental
alertness
-advise patient to avoid alcohol
during therapy
Generic Name: Dosage: 250mg PO Uricosuric Drug -Lowers level of uric acid in -nausea BEFORE:
Probenecid b.i.d to maximum of the body by helping the -vomiting - observe 10 rights of drug
2-3g daily kidneys to get rid of the excess -diarrhea administration
Brand Name: uric acid peptic ulcer or renal impairment
-headache
-inhibition of a renal tubular DURING:
Benemid -dizziness
transporter thereby - to minimized GI stress , give drug
facilitating the excretion of the -flushing with milk, food or antacids
uric acid by blocking reuptake -use cautiously in patients with
- check properly if the patient take
the medication properly
AFTER:
- tell the patient to report adverse
reactions of acute overdose
-document and record
-instruct patient and family that
when prescribed as treatment for
gout, drug must be taken regularly