NURSING CARE FOR ELDERLY PATIENTS Mrs.

A WITH GOUTH ARTRITIS AT

GALELA HEALTH CENTER, GALELA DISTRICT

Deis Natalies Me, Charles B. Turangan, S. Ked, MARS, and Ns. Dra. Santje P Mangare,. M.

Repro

Nursing study program

Makariwo Halmahera College of Health Sciences

(mdeis049@gmail.com)

ABSTRACT

According to the results of the Indonesian Basic Health Research, the prevalence of gout in

Indonesia has increased in 2018. This disease is common in all ages, some are not yet elderly and

some are elderly and gout is more common in the elderly. These elderly people are divided into

five parts: those aged 50-59 years are called pre-elderly, those aged 60-69 years are called young

elderly, those aged 70-79 years are called middle elderly, those aged 80-89 are called complete

elderly, and those aged ≥ 90 years are full elderly. golden. The data found in Indonesia is that the

elderly who are most affected by gout are elderly women aged ≥ 75 years (54.8%). At the Galela

Community Health Center, based on 2022 data, there are 50 cases of gout, with the number being

men. as many as 32 cases and women 18 cases, and in 2023 there will be 27 cases and most of

them are aged 50-59 years, 21 people are outpatients and 6 people are hospitalized with the reason

that the patient experiences left knee pain according to the pain scale 7 (severe pain), dizziness,

weakness and heartburn for three days. Gout or commonly known as gout arthritis is a disease

caused by the accumulation of Monosodium Urate Crystals in a person's body. Objective: Describe

nursing care for elderly people with gout. Method: the type of research used is descriptive in
narrative form using a nursing process approach and explaining the management of nursing care.

Results: The first nursing diagnosis was found to be impaired comfort related to chronic pain. The

second diagnosis was impaired physical mobility related to pain and a diagnosis of fatigue. The

risk of falls was proven by age ≥60 years.

Key words: nursing care, elderly, gout.

INTRODUCTION affected by gout are young adults aged ≥ 75

years (54.8%). 1
According to the results of the Indonesian

Basic Health Research, it is stated that the Based on data from the Tobelo North

prevalence of gout in Indonesia has increased Halmahera Health Service in 2022, there

in 2018. Where this disease is common in all were 435 gout sufferers, with 235 men and

ages, some are not yet elderly and some are 200 women. And those most affected by gout

elderly and gout is more common in the and hypertension are elderly people aged 60-

elderly. These elderly people are divided into 69 years. Apart from that, uric acid is not only

five parts: those aged 50-59 years are called found in the elderly, but also in people who

pre-elderly, those aged 60-69 years are called have not reached old age. 2

young elderly, those aged 70-79 years are

At the Galela Community Health Center,
called middle elderly, those aged 80-89 are
based on data from 2022, there were 50 cases
called complete elderly, and those aged ≥ 90
of gout, with 32 cases of men and 18 cases of
years are complete elderly. golden. The data
women, and in 2023 there were 27 cases and
found in Indonesia is that the elderly most
most people were affected aged 50-59 years,

21 people were outpatients and 6 people were

hospitalized because the patient had left knee profession that can provide direct nursing

pain with a pain scale of 7 (severe pain), care with quality as a professional nurse.6

dizziness, weakness and heartburn for three

METHOD
days.3
The type of research used is descriptive in
Gout is a disease that arises from consuming
narrative form using a nursing process
too much food that contains high purines
approach and explaining the management of
such as nuts and decreased uric acid excretion
nursing care
due to impaired kidney function. Apart from
RESULTS
that, the cause of excessive uric acid

production in the body can occur due to Application About Case Description

genetic (congenital) factors, dietary factors Application of Nursing Care for Elderly

and disease factors.4 Patients Mrs. 2023.

Gout or commonly known as gout arthritis is The patient's name is Mrs. A, female, 63

a disease caused by the accumulation of years old, Protestant Christian, elementary

monosodium urate crystals in a person's school education, occupation, housewife,

body. 5 social address, entry date, July 1 2023 with

registration number 012521

As per the data above, the author carried out

the study for 3 days, namely July 1 2023 at The main complaint was pain in the left knee

10:00 WIB at the Galela Community Health joint for about a year, dizziness and heartburn

Center. During this study the author provided for three days.

nursing care for elderly clients with gout. Physical examination, general condition is
Through this study, students are expected to good, composmentis consciousness, Blood
be able to develop skills to achieve a nursing
pressure: 130/80 mmHg, Pulse: 70x/m, Body falling was proven by age ≥60 years.

Temperature: 36.3oc, Respiration: 20x/m, Subjective data: The patient said that his

Body weight: 60 kilo grams, Height: 157cm. children helped him in his activities.

Objective data: The patient's age is 63 years.

Based on the results of the assessment, three
The patient walks with the help of his child.
diagnoses were obtained, namely first,
The patient walks slowly and is weak. The
disturbance of comfort related to chronic
patient has more than one secondary
pain, characterized by subjective data: the
diagnosis, namely gout and hypertension.
patient stated that he was unable to walk or

move because his left knee was painful. On a Action plan for diagnosis Identify location,

scale of 7 (0-10), it came and went like being characteristics, duration, frequency, quality,

pricked. Objective data The patient appears intensity of pain. Monitor uric acid levels.

to grimace when pain occurs Vital signs BP: Identify nonverbal pain responses. Teach

130/80 mmHg N: 70x/m, Sb: 36.3oc Rr: non-pharmacological techniques for deep

20x/m, Uric acid level 11g/dl, Redness and breathing relaxation, provide a comfortable

swelling around the left knee are visible . position, provide non-pharmacological

Second, physical mobility disorders related to techniques of warm water compresses to

pain are characterized by subjective data. The reduce pain. Collaborative administration of

patient states that it is difficult to move analgesics. For the second diagnosis Monitor

actively because the knee feels painful and blood pressure before ambulation begins,

swollen. Objective data: The patient appears Identify physical tolerance for ambulation,

to be walking slowly. The patient's knees Help the patient to perform active range of

showed tremors after returning from walking motion and passive range of motion in the

around the orphanage. The third risk of joints, Facilitate ambulation activities with a
cane or crutches, Facilitate physical mobility quality : stabbing, region: left knee, scale : 7,

if necessary, Provide motivation to improve timing: comes and goes. Objective Data: the

again activity. Third diagnosis: Identify risk patient appears to grimace when pain occurs,

factors for falling: for example balance there is visible redness around the knee.

disorders, vision problems, neuropathy. Nursing diagnoses are established based on

Identify behavior and factors that influence the data that is studied, starting with

the risk of falling. Identify environmental determining the cause of the problem and

factors that increase risk factors for falling, supporting data for the nursing problems

for example slippery floors, open stairs, use found, namely

walking aids, for example wheelchairs,

a. Disturbances in comfort are associated
walkers. , Monitor the ability to move from
with chronic pain
bed to chair and vice versa. Place patients at
b. Impaired physical mobility is associated
high risk of falling close to supervisors.
with pain
Encourage the use of non-slip footwear.

c. The risk of falls was demonstrated by age

Based on the data above, the author was able
≥60 years
to raise three diagnoses according to the

grouping of data from the patient assessment, The nursing care plan that is developed

the following nursing diagnosis emerged, according to theory includes observation of

namely disturbance of comfort related to independent actions, education and

chronic pain which is characterized by, collaboration with the health team.

subjective data: the patient said he was Intervention

unable to walk or move because the knee was
a) disturbance of comfort related to pain
painful, provocative : pain due to gout,
1. Identify the location, characteristics, 4. Facilitate ambulance activities with a cane

duration, frequency, quality and intensity of or crutches.

pain.
5. Facilitate physical mobility if necessary.

2. Monitor uric acid levels.

6. Provide motivation to increase activity

3. Identify nonverbal pain responses. again.

4. Teach non-pharmacological deep c) Risk of falling is proven by age ≥ 60 years.

breathing relaxation techniques. Identify risk factors for falling: for example

balance disorders, vision problems,

5. Provide a comfortable position
neuropathy. Identify behaviors and factors
6. Give non-pharmacological techniques of
that influence the risk of falling.
warm water compresses to reduce pain.
1. Identify environmental factors that
7. Collaborative administration of analgesics
increase the risk of falling, for example

b) Impaired Physical Mobility Associated slippery floors, open stairs.

with Pain
2. Use walking aids, for example a

1. Monitor blood pressure before ambulation wheelchair, walker.

begins.
3. Monitor the ability to move from bed, to

2. Identify physical tolerance for ambulation. chair and vice versa.

3. Help the patient to perform active range of 4. Place patients at high risk of falling close
motion and passive range of motion in the to supervisory monitors.

joints.
5. Recommend using non-slip footwear.
The purpose of implementation is to help 3. Help the patient to perform active

patients achieve the goals that have been set movements.

which include improving health, preventing

4. Encourage the patient to use a cane and
disease and restoring health. In its
walking aids.
implementation the author takes action.
5. Encourage patients to carry out activities
a) disturbance of comfort related to chronic
according to their abilities.

1. Ask about the pain the patient feels

6. Motivate the client to resume normal
including the location, characteristics,
activities, if the swelling and pain decrease.
duration, frequency and quality of the pain.
c) The risk of falling is proven by age ≥ 60
2. Check the uric acid level in the blood.
years

3. Look at nonverbal reactions to pain.

1. Look at the client's cognitive or physical

4. Teaching non-pharmacological deep deficits that may increase the potential for

breathing relaxation techniques. falls in certain environments.

5. Provide padding under the patient's knees. 2. Look at behavior and factors that influence

the risk of falling.

6. Warm compress on the painful knee.

3. Look at environmental characteristics that

7. Ketorolac injection 3x30 mg (iv)
can increase the potential for falls (for
b) Impaired Physical Mobility Associated
example slippery floors and open stairs).
with Pain
4. Give the patient a wheelchair.
1. Measuring blood pressure.
5. See the ability to transfer from bed to chair
2. Ask the patient the level of mobilization.
and vice versa.
6. Encourage patients to use safe footwear. patient's condition being good. Nursing care

will be carried out on 1-3 July 2023 for gout

Evaluation
with 3 diagnoses, namely
After providing nursing care for three days,
a. Chronic pain associated with chronic
the patient's needs can be met. The evaluation
conditions (gouth arthritis, risk of falls, N
carried out includes process evaluation and
VIII balance disorders
results evaluation. Process evaluation is

carried out at the end of each patient's nursing b. Impaired Physical Mobility Is Associated

action which focuses on changes in the With Pain

patient's behavior or health status.

c. The risk of falling is proven by age ≥ 65
Meanwhile, evaluation of results is carried
years
out continuously until the goal is achieved.
After implementing nursing for three days,
Evaluation is carried out by collecting data on
all three problem diagnoses were resolved,
the patient's progress or changes in the
the patient went home.
patient's condition and comparing the

situation before and after the action has been Suggestion

taken using the achievement evaluation
criteria that have been determined in the
nursing plan.
Conclusion
After carrying out nursing care for the elderly
patient Mrs. For 3 Days to Patients. Nursing
actions can be carried out well with the
By implementing nursing care for clients
with gout that can be provided, namely:
1. For STIKMAH
Maintaining the quality of guidance for
students in implementing nursing care.
2. For the Soasio Community Health Center
Maintaining the quality of guidance for

students in carrying out nursing care.

BIBLIOGRAPHY

3. For the Community

There needs to be education about gouty

arthritis from related parties 1 Pribadi, Teguh, Ainur

Rahma, And Rika

4. For STIKMAH Students
Yulendasari. "Pemberian
To Stikmah Students to Improve and Sharpen
Akupresur Untuk
Skills, Attitudes and Knowledge to Become
Menurunkan Nyeri Dan
Professional Nurses in Providing Nursing
Kadar Asam Urat Pada
Care with Optimal Nursing Processes.
Klien Asam Urat Di
5. For Patients Poncowarno Kecamatan

It is hoped that this can be used as a guide to Kalirejo Lampung

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Masyarakat (PKM). 2021;

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The results of the research create a learning

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2 Riskesdas . Laporan Hasil
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