CASE

PRESENTATION
 M E M B E R S O F T H E G RO U P

CONSTA DELICO DEPORK

ARCA CASILAC DUEY
BLE NA AN
01 02 03 04 05 06
MEMBERS OF THE GROUP

GARILL
GALIZA PLETE REYES VISTA
OS
07 08 09 10 05
 GROUP 4

GOUTY ARTHRITIS

03-21-2023
 I. INTRODUCTION

II OBJECTIVES OF CARE

III PATIENTS DATA

IV FAMILY BACKGROUND/ HEALTH HISTORY

V. DEVELOPMENTAL DATA

VI. PHYSICAL ASSESSMENT

CONTENTS VII. ANATOMY AND PHYSIOLOGY
VIII
ETIOLOGY AND SYMPATOLOGY
.
IX. SURGICAL PROCEDURE

X. NURSING THERORIES

XII. DISCHARGE PLAN

XIII
RECOMMENDATION
.
 I N T RO DU C T I ON
Gout is a common form of inflammatory arthritis that is very painful. It usually affects one joint at a time (often the big
toe joint). There are times when symptoms get worse, known as flares, and times when there are no symptoms,
known as remission. Gout is caused by a robust inflammatory response to uric acid crystals which occurs in the
setting of hyperuricemia (high uric acid levels in the blood). The body makes uric acid when it breaks down purines,
which are found in your body and the foods you eat. Men are three times more likely than women to develop gout. It

01
tends to affect men after age 40 and women after menopause, when they lose the protective effects of estrogen.

As a matter of fact, in the global setting according to Frontiers Public Health Gout is the most common inflammatory
arthritis worldwide, with an incidence of 0.6 to 2.9 per 1,000 people-years and a prevalence ranging from <1 to 6.8%
reported in population-based studies. Furthermore, these epidemiological data seem to be steadily increasing
globally. Gout results from persistently elevated serum uric acid levels (hyperuricemia) which leads to the deposition
of monosodium urate (MSU) crystals in joints, tendons and other tissues, triggering recurrent episodes of apparent
acute inflammation known as gout flares. Many factors contributing to hyperuricemia are also risk factors for gout
incidence, including genetic, age, gender, and social and economic factors greater consumption of purine-rich foods
such as red meat, seafood, alcohol, and sugary beverages; and multiple other metabolic syndromes such as
hypertension, abnormal lipid/glucose metabolism, and chronic kidney disease.
 I N T RO DU C T I ON
In the national setting, according to Philippine Rheumatology Association (PRA), Philippines Gout is a growing
problem and the most common inflammatory arthritis, with an overall prevalence of 1.6%. It is primarily a disease of
males but may also affect females, especially in the postmenopausal age group when uricosuric protection from
estrogen wanes. Males who experience high serum uric acid levels for more extended periods increase their
predisposition to uric acid deposition and, ultimately, gout disease. Despite the availability of effective treatment,
gout is often managed poorly.

01 In local setting, six hundred sixty-nine records of patients with gout were reviewed; 101 (15%) fulfilled the young-
onset gout criteria. The mean age of onset was 25±4.40 years (range 14-30), and the mean disease duration before
diagnosis was 12.64±11.91 years. All of the patients were male and most were married; 76% were alcoholic
beverage drinkers and 38% were smokers. A family history of gout was noted in 47%. Most patients (66%) were
already on nonsteroidal anti-inflammatory drugs (NSAIDs), 24% on colchicine, and 14% on urate-lowering therapy
before consult at the rheumatology clinic. By history, at onset, the most common pattern of joint involvement was
monoarthritis (95%), affecting the ankles (60%), knees (52%), and 1st metatarsophalangeal (MTP) joint (51%).

The purpose of this paper is to present a case study of Gouty Arthritis. We as student nurses did our best in
comprehending this case that we encountered during our hospital duty. This will help the student nurses develop
their assessment and analytical skills in caring for patients. In addition, it will guide student nurses in providing
quality of care to the patients.
 OB JEC TI V ES OF C ARE
A.General Objectives
In this case study, our fundamental goal is to be able to know the

02
assigned patient for our case and conduct a comprehensive case
study of Gouty Arthritis and most especially, to provide a holistic
and effective nursing care to the client by relating and putting to
use the knowledge that we have acquired.
B . S p e c i fi c O b j e c ti v e
COGNITIVE
• Define Gouty Arthritis.
• Determine the past and present health
history of the client.
• Review the Anatomy and Physiology of
the system involved.
• Identify and trace the pathophysiology
of the condition.
• Describe symptoms of Gouty Arthritis.
• Identify risk factors of Gouty Arthritis
• Determine specifically on the fast
treatment/interventions of the
condition.
• Formulate a drug study related to the
condition and explain its content.
• Apply nursing management through
nursing care plans.
PSYCHOMOTOR
• Perception: Obtain and analyze information
about the patient, including her medical
history, family medical history, medical history,
and current health state.
• Set: Student nurses will rely on the patient in
this situation.
• Guide Response: Follow the directions for
writing this paper from the clinical instructors
and is able to utilize the knowledge and
abilities obtained from the experiences.
• Mechanism: Organize the information
gathered and establish a program of events for
the General Assembly.
• Adaptation: Respond efficiently to
adjustments offered by the clinical teachers
during the case presentation.
• Origination: To execute the patient's needs,
carry out the right nursing care plan. Assist the
patient with primary care in order to maintain
excellent health by preventing sickness.
AFFECTIVE
• Receiving: Gain the patient's trust
and cooperation, cultivate a positive
relationship with them.
• Responding: Provide care and
attention to the patient indicates
respect, genuine concern, and empathy.
• Valuing: Deliver the best possible
care while maintaining the nurse-
patient relationship's ideals.
• Organizing: During the writing of this
paper, the student nurse must assume
obligations for the advancement of
skills and knowledge.
• Characterizing: Complete tasks alone
and participates in the group activities
cooperatively.
 PATI ENTS DATA
A. Biographical Data

Patient’s code name: Patient E. Vital signs upon admission:

Age: 45 years old ⮚BP – 140/90 mmHg
Nationality: Filipino ⮚T – 36.5

03 Civil status: Married (September 23, 2006)

Occupation: Farmer
Sex: Male
⮚PR – 68 bpm
⮚RR – 28 cpm
⮚SpO2 – 98%
Religion: Roman Catholic ⮚WT- 72kgs.
Educational attainment: High school Graduate ⮚HT- 170 cm
Bed number: Bed #1
Date of admission: March 6, 2023
 PATI ENTS DATA
Admitting/final diagnosis: Acute Gouty Arthritis inflare with effusion left
knee arthrocentesis left knee.
Surgical procedure (if any): Incision and drainage (3 times)
→ March 10, 2021 (First Time) Left knee
→ December 15, 2022 (Second time) Right knee

03 → March 06, 2023 (Third time) Left knee

Attending physician: Dr. Quilisadio (PC)

B.Chief complaints: Pain in left knee

FA M I LY B A C K G R O U N D / H E A LT H H I S T O R Y
A. Family health history
As patient verbalized “ni kalit ra gyud ni sa akoa ning arthritis, ika tulo
nako na admit. Ako rapud naay in ani sa tanan namong mag igsuon pati ako
mama ug papa wala gyud”

04
FA M I LY B A C K G R O U N D / H E A LT H H I S T O R Y
B. Client’s health history (past illnesses, present illnesses):

Past Illness:
→ Hypertension ( Diagnosed since 29 years old)
Medication : Amlodipine 10 mg Tab

04 → Kidney failure ( Diagnosed since 43 years old) - 12-02-22

Medication : Ketoanalogue 600 mg Tab
: Ural Sachet
→ Gouty Arthritis ( Diagnosed since 42 years old)
Medication: Febuxostat 40 mg tab

Present Illness:
2 days PTA, Patient accidentally out his balance and fell on the cemented road
hitting his left knee first, thus injuries sustained.
 D E V E L O P M E N TA L D ATA

Human development occurs continuously throughout the life span, from

05
conception to death. Every individual undergoes continual transformation.
Physical development, psychological development, cognitive development,
and spiritual development all take place at each developmental stage that
is directly related to health condition.
 A. Erick Erickson’s “Theory of Psychosocial Development” believed that personality developed in a series of stages. This described the
impact of social experiences across the whole lifespan. Erickson was interested in how social interaction and relationships played a role in the
development and growth of human beings.
STAGES NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION
Stages: 1Birth-18 During this stage, the infant is uncertain about the According to the patient, he remembers that his mother is ACHIEVEDThe baby (our patient) developed a sense of trust
months (Infancy) Trust world in which they live, and look towards their attending his needs. Taking care of him in their everyday given by significant others especially his mother.
vs. Mistrust primary caregiver for stability and consistency of living and gave him the best affection.
care.
Stages: 218 months-3 During this stage, children are focusing on According to the patient, during this stage, his mother allows ACHIEVED The baby (our patient) increased his
years (Early developing a sense of personal control over him to do some activities that can determine his abilities such independence, he becomes more confident and secure in his
Childhood)Autonomy vs. physical skills and a sense of independence. putting or picking of clothes, shoes and toys. own ability to survive in the world with the help of those
Shame and Doubt certain activity.
Stages: 3 3-5 years This stage provides the baby (the patient) with the According to the patient, his mother told him that when he ACHIEVEDThe patient involved in the interacting with other
(Preschool) Initiative vs. opportunity to explore her interpersonal skills was 3-4 years old, he used to share his toys and food to his children at their community and he has the opportunity to
Guilt through initiating activities and develop a sense friends and by that, he would ask them to play with him explore his interpersonal skills through initiating activities.
of initiative and feel secure in their ability to lead engaging with other children in their community.
others and make decisions.
Stages: 4 6-11 years This stage provides our patient develop a sense of As stated by the patient, during this stage, he was eager to try ACHIEVED The patient feel competent and confident in their
(School Age)Industry vs pride and accomplishment in their schoolwork, making his school works alone, but when he find it hard he ability to achieve goals.
Inferiority sports, and social activities life through the ask for help on his mother. Most of the time he was on his
helping hands of her family. pace on learning but there are still little moments that his not
giving any attention to his school works.
Stages: 5 12-18 years During this stage adolescents search for a sense The patient stated that during this stage, he met a girl and find ACHIEVED The patient is in longer- term commitments and
(Adolescence)Identity vs. of self and personal identity, through an intense her really attractive. Also, he started to join activities in their begin to look at the future in terms of career and relationships.
Role Confusion exploration of personal values, beliefs, and goals. community such basketball league where he got friends and Patient belongs to a society and fit in.
staring to feel comfortable.
Stages: 619-40 years During this stage, patient begin to share his self Patient stated that he is more on dealing with people, likes ACHIEVEDThe patient is in happy relationship and a sense of
(YoungAdulthood)Intima intimately with others. Explore relationships socializing and interacting. He also got married during this commitment, safety, and care within a relationship.
cy vs. Isolation leading toward longer-term commitments with stage.
someone other than a family member.
Stage: 7 40 to 65 (Middle In this stage, Adults must develop or nurture He was active in serving in their community making or ACHIEVEDThe patient nurture things that will outlast them,
Adulthood) something that will outlast them, which they helping in decision making for activities that can be often having mentees or creating positive changes that will
Generativity vs. frequently do by having children or by making a beneficial to their families and surroundings. benefit other people.
Stagnation beneficial change that benefits others.
B. Jean Piaget’s “Theory of Cognitive Development” this theory includes four periods and recognizes that children move through these specific
periods at different rates but in the same sequence or order. The four general periods of intellectual development according to Piaget are as follows:
Sensorimotor (birth to 2 years), Preoperational (2 to 7 years) Concrete Operational (7 to 11 years); Formal Operational (11 to years to adulthood).

STAGES NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION

Stage: 1(Birth to 2 years old) During this stage the infant focuses on physical Patient stated that his mother verbalized that he ACHIEVED The patient able to
Sensorimotor sensations and on learning to co-ordinate with manifested the typical actions such sucking and communicate through basic reflex actions.
his body. shaking his head.

Stages 2:(2-7 years old)
Preoperational
Stages: 3(7-11 years
old)Concrete Operational
> During this stage our patient build on object
permanence and continue to develop abstract
mental processes.
During this stage, the child can use operations (a
set of logical rules) so he can conserve
quantities, he realizes that people see the world
in a different way than he does (decentring) and
he has improved in inclusion tasks.
When he was 6 years old he always visualizing
scenarios and draw objects, even people related to
him and starting understand their purpose.
As stated by the patient, during this stage he used to
sort his toys according to their sizes. In addition, he
is able to recite the multiplication table when he is
10 years old.
ACHIEVEDPatient is able to make use of
logical principles in involving the physical
world.
ACHIEVEDPatient has able to perform
mental operations at this stage

Stages: 4(11 years – During this stage, adolescents enter this stage,
Adulthood)Formal they gain the ability to think in an abstract
Operational manner, the ability to combine and classify items
in a more sophisticated way, and the capacity for
higher-order reasoning.
He stated that during this stage he was in college he ACHIEVEDThis period matures and
has a good life, grab chances offered to experience adolescents or adulthood presumes the level
that wonderful youth life. Now he has a family that of awareness.
adds meaning in his life.
C. Sigmund Freud’s “Psychoanalytic Model of Personality Development” theory suggests that as children develop, they progress through a
series of “Psychosexual stages”. At each stage, the libido's pleasure-seeking energy is focused on a different part of the body.

STAGES NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION

The Oral Stage:Age During the oral stage, the infant's primary His mother told him that when he was a ACHIEVED The patient gets much
range:Birth to 1 year source of interaction occurs through the baby, he put his thumb on his mouth every satisfaction from putting all sorts of things in
mouth, so the rooting and sucking reflex time he is hungry its mouth to satisfy his needs, and thus it‘s in
is especially important. The mouth is vital demand.
for eating, and the infant derives pleasure.
The Anal StageAge >During the anal stage, Freud believed His mother told him, when he was at this ACHIEVED Patient’s toilet training is a
Range:1 to 3 years that the primary focus of the libido was on stage his mother taught him to urinate and major source of tension at this age the child
Erogenous Zone:Bowel controlling bladder and bowel eliminate on the toilet or in the proper must learn to control their bodily needs.
and Bladder Control movements. The major conflict at this place. Gaining control leads to a sense of
stage is toilet training the child has to accomplishment and self-sufficiency.
learn to control their bodily needs.
The Phallic StageAge Freud suggested that during the phallic As stated by the patient, he remember that ACHIEVED Children at this age start to
Range:3 to 6 Years stage, the primary focus of the libido is on he becomes more needy to his mother. He notice the differences between males and
Erogenous thegenitals. At this age, children also was interested and explorative on his females, recognized his self as boy.
Zone:Genitals begin to discover the differences between genitals.
males and females.
The Latent PeriodAge During this stage, the superego continues Patient stated that he starting to socialized ACHIEVED Patient interacts withsame sex
Range:6 to Puberty to develop while the id's energies are in their community, joining activities in peers,engaging in hobbiesand acquiring
Erogenous Zone:Sexual suppressed. Children develop social skills, different events. skills.
Feelings Are Inactive values and relationships with peers and
adults outside of the family.
The Genital StageAge This is the period of adolescent sexual Patient stated that they are sexually active ACHIEVED Patient develops a strong
Range:Puberty to death experimentation, the successful as married couple, living happy and sexual interest in the opposite sex.
Erogenous conclusion of which is to settle down in a contented with their lives.
Zone:Maturing Sexual loving one-on-one relationship with
Interest another person.
 DEFINITION OF COMPLETE
DIAGNOSIS
Gout is a type of arthritis. It occurs when uric acid builds up in
blood and causes inflammation in the joints. Acute gout is a painful
condition that often affects only one joint. Chronic gout is the
repeated episodes of pain and inflammation. More than one joint

05 may be affected.
 PHYSICAL ASSESSMENT
Physical examination follows a methodical head to toe format in the cephalocaudal
assessment. This is done systematically using the techniques of inspection, palpation,
percussion and auscultation with use of materials and investments such as the penlight,
thermometer, sphygmomanometer, tape measure and stethoscope and also the senses.
During the procedure, we made every effort to recognize and respect the patient’s
feelings as well as to provide comfort measures and follow appropriate safety

06 precautions.
A. General Physical Assessment
Received client on bed, awake, and coherent. He is sweating heavily, pale, breathing fast,
and his skin is cold to touch. The patient appears restless and anxious but responsive the
entire physical assessment. Client cannot move his lower extremities and can only
minimally move his hands due to pain.

Initial Vital Signs:

Temp : 36.3C
BP : 140/90 mmHg
PR : 68 bpm
RR : 28 cpm
SPO2 : 98%
Pain scale : 10/10
 PHYSICAL ASSESSMENT
ASSESSMENT NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION

INTEGUMENTARY
Skin (Inspect ion and Skin is uniform in color, unblemished and no Skin is cold to touch and pale in Skin is cold and pale in appearance
Palpation ) presence of any foul odor.No lesions, bruising and appearance.(+) Scab at left knee due to arthritis’ pain. Scab forms over
rashesTemperature, moisture and texture is in a cut or wound during healing.
normal limit.

Hair (Inspection) Thin or thick, black and evenly distributed (No Patient’s hair is black. No signs of No significant manifestation observed
evidences of Alopecia). No infection or infestation alopecia, infection and infestation. on the hair.
(such as lice, nits or sores) and dandruff in the scalp
and hair.

Nails (Inspection and Pinkish nail bed and has the shape of convex Patient’s nails are pale. Pale nails is a sign of decreased blood
Palpation) curve.Capillary refill is generally less than 2 supply to the nail bed.
seconds.
 PHYSICAL ASSESSMENT
HEAD, EYES, EARS, NOSE, THROAT
Head and Face Head is normocephalic. Face is symmetrical, Head and face are normal upon No significant manifestation
smooth and has uniform consistency and with no assessment. observed on the head and face.
presence of nodules or masses.

Eyelids Sclera Eyelids have no presence of discharges; no Normal eyelids noted and sclera is No manifestation of structural
discoloration and lids close symmetrically with white and intact. changes in eye.
involuntary blinks. White and intact.

External Ears The ear lobes are bean shaped, parallel, and Normal in shape and size. No No manifestation of structural
Hearing Test symmetrical. The ear canal has normally some discharges or lesions noted at the changes in external ear and no
cerumen of inspection. The patient should be able ear canal. Patient hear the sound significant manifestation observed in
to hear the sound of the tuning fork adjacent to of tuning fork upon assessment. hearing.
their ear.
External Nose Symmetric, center and uniform in color. Normal in shape and size Nose flaring is because of patient’s
(Inspection) No presence of discharge or flaring and (+) Flaring rapid breathing due to gout attack.
deformities.
 PHYSICAL ASSESSMENT
MOUTH
Lips (Inspection) Lips should be uniformly pink; moist, Symmetric, brown in color. Discolored, dark, hyperpigmented lips
symmetric and have a smooth texture. is due to excess melanin production.
This happens due to various reasons
including sun exposure, smoking,
pregnancy, certain medication or other
medical issues.

Tongue (Inspection) Tongue should be centrally positioned.Tongue No abnormalities noted No manifestation of structural changes
should be pink in color, moist and slightly in tongue problems
rough.
NECK
Neck (Inspection and Straight and symmetrical with no visible mass The neck is straight. No No manifestation of physiological
Palpation) or lumps. No lesions and cervical lymph nodes visible mass or lumps. and anatomical changes in the neck.
were impalpable. The thyroid is non palpable Symmetrical. No jugular
as well as the nodules. Neck has strength that venous distension
allows movements of flexion, extension, (suggestive of cardiac
bending and rotation. congestion).
 PHYSICAL ASSESSMENT
RESPIRATORY
Lungs and thoracic Chest expansion was bilaterally Chest expansion was Rapid breathing is due to
region symmetrical.No tenderness, lesions, masses bilaterally symmetrical. anxiety from experiencing
or crepitation. Respiratory Rate: 28 cpm intense pain.

CARDIOVASCULAR
Heart Cardiac rate: Regular and strong (Normal Blood pressure: 140/90 Patient blood pressure increases
range: 60-100bpm) mmHg due to pain.
PR: 68 bpm

GASTROINTESTINAL
Abdomen Abdomen is soft, symmetric, and non- Soft, symmetric and non- No manifestation of structural
tender without distention. There are no tender. Skin color is uniform, changes in abdomen.
visible lesions or scars. no lesions.
 PHYSICAL ASSESSMENT
UPPER AND LOWER EXTREMITIES
Lower extremities Complete sets of 5 digits on each hands and foot. Can able to Complete sets of 5 digits on each hands Tophi are a symptom of gout, a condition
flex, extend, hyper extend and rotate the hands and foot as well and foot. where uric acid crystallizes in joints like those
as opposition on the fingers. (+) Trophus on knee in the feet and hands.
(+) Trophus on metatarsal area and first
metatarsophalangeal joint
Unable to flex, extend, hyper extend and
rotate lower extremities due to intense
pain.

Upper extremities Presence of the ulnar and radial pulses noted.Can able to move Patient’s joints in hands are conspicuous. Producing too much uric acid can build up and
arm in pronation, supination and rotation and flex and extend (+) difficulty in moving his hands. cause tiny sharp crystals to form in and around
both elbow and shoulder. joints. These crystals can cause the joint to
become inflamed (red and swollen) and painful
which will affect moving.

NEUROLOGIC
Neurologic (Interview) Oriented to people, time, and place. Comprehensible. Speaks Client appears restless but oriented to It reveals normal mental status and speech.
clearly people, time and place. He speaks slowly
but clearly.
 A N ATO M Y A N D P H Y S I O L O G Y

Joints
A joint is defined as the juncture where bones and muscles come together, facilitating
movement and stability. Contraction of muscles crossing the joint can stabilize it or cause it

07
to move. Normal joint function is defined as a joint's ability to move throughout its range of
motion and bear weight.

Joints are the areas where 2 or more bones meet. Most joints are mobile, allowing the bones
to move. Joints consist of the following:
• Cartilage. This is a type of tissue that covers the surface of a bone at a joint. Cartilage helps
reduce the friction of movement within a joint.
• Synovial membrane. A tissue called the synovial membrane lines the joint and seals it into a
joint capsule. The synovial membrane secretes a clear, sticky fluid (synovial fluid) around
the joint to lubricate it. This lining (synovial membrane) becomes inflamed and swollen. The
disease process can eventually destroy cartilage and bone within the joint.
• Ligaments. Strong ligaments (tough, elastic bands of connective tissue) surround the joint to
give support and limit the joint's movement. Ligaments connect bones together.
• Tendons. Tendons (another type of tough connective tissue) on each side of a joint attach to
muscles that control movement of the joint. Tendons connect muscles to bones.
• Bursas. Fluid-filled sacs, called bursas, between bones, ligaments, or other
nearby structures. They help cushion the friction in a joint.
• Synovial fluid. A clear, thick fluid secreted by the synovial membrane.
• Meniscus. This is a curved part of cartilage in the knees and other joints.
Bones
• Bone, rigid body tissue consisting of cells embedded in an abundant hard intercellular
material. The two principal components of this material, collagen and calcium phosphate,
distinguish bone from such other hard tissues as chitin, enamel, and shell. 

The functions of bone include

(1) structural support for the mechanical action of soft tissues, such as the contraction of
muscles and the expansion of lungs
(2) protection of soft organs and tissues, as by the skull,
(3) provision of a protective site for specialized tissues such as the blood-forming system
(bone marrow), and
(4) a mineral reservoir, whereby the endocrine system regulates the level of calcium and
phosphate in the circulating body fluids.
Soft Tissue

Soft tissues connect and support other tissues and surround the organs in the body. They
include muscles (including the heart), fat, blood vessels, nerves, tendons, and tissues that
surround the bones and joints.

Soft tissues may be distinguished from other tissues like bones for their flexibility, their soft
mechanical properties. This concerns the connective tissues, the muscles, the organs and the
brain. A more accurate distinction may be made in considering their respective functions in the
organism.
 E T I O L O G Y A N D S Y M PATO L O G Y

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 SURGICAL PROCEDURE

09 Arthrocentesis is a procedure that is performed to obtain synovial fluid

from within a joint capsule, both for diagnostic and for therapeutic
purposes. It is used in multiple disease processes, including arthritis,
gout, and infectious processes such as septic arthritis. There are
numerous indications for joint fluid aspiration, the most important of
which includes the evaluation of synovial fluid for evidence of infection of
inflammation. While the procedure specifics vary depending on the joint
being aspirated, the general technique and steps remain consistent. The
procedure tends to be very safe overall with few complications if
performed correctly, and only a small number of contraindications exist.
 NURSING THEORIES
1. Dorothea E. Orem’s Self-care Deficit Theory
It focuses on each “individual’s ability to perform self-care, defined as ‘the practice of
activities that individuals initiate and perform on their own behalf in maintaining life, health,
and well-being.'” The Self-Care or Self-Care Deficit Theory of Nursing is composed of three
interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the

10
theory of nursing systems, which is further classified into wholly compensatory, partially
compensatory and supportive-educative.

Explanation:
The patient in this case needs an assistance especially when it comes to ADL since the patient
is experiencing severe pain and physical immobility. This theory gives full picture of everyday
living of well as well as sick clients and how dynamics of care giver affected by self-care
deficit by a client. Theory has a beauty of simplicity and language easy to understand if we
compare it to other theorists. This theory is comprehensible by providers that are not highly
educated and even they can implement this in day to day practice.
 NURSING THEORIES
2. Ida Jean Orlando’s Nursing Process Discipline Theory
The major dimensions of the model explain that the role of the nurse is to find out and meet
the patient’s immediate needs for help. The patient’s presenting behavior might be a cry for
help. However, the help the patient needs may not be what it appears to be. Because of this,
nurses have to use their own perception, thoughts about perception, or the feeling

10
engendered from their thoughts to explore the meaning of the patient’s behavior.

Explanation:
In our case, we utilize Orlando's Nursing Process Discipline Theory, which assists nurses in
determining the patient's primary need and providing the necessary assistance. Nursing,
according to Orlando, is responsive to individuals who are suffering or anticipate feeling
helpless. With that, this theory marks the purpose of nursing as providing the assistance a
patient requires in order for his needs to be met. That is, if the patient has an immediate need
for assistance and the nurse discovers and meets that need, the goal of nursing has been met.
 NURSING THEORIES
3. Dorothy Johnson Behavioral System Theory
Dorothy Johnson’s theory defined Nursing as “an external regulatory force which acts to
preserve the organization and integration of the patient’s behaviors at an optimum level
under those conditions in which the behavior constitutes a threat to the physical or social
health, or in which illness is found.” It also states that “each individual has patterned,

10
purposeful, repetitive ways of acting that comprises a behavioral system specific to that
individual.”

Explanation:
Johnson’s Behavioral System Model is a nursing care model that advocates the fostering of
efficient and effective behavioral functioning in the patient to prevent illness. The patient is
identified as a behavioral system composed of seven behavioral subsystems: affiliative,
dependency, ingestive, eliminative, sexual, aggressive, and achievement. Each subsystem’s
three functional requirements include protection from noxious influences, provision for a
nurturing environment, and stimulation for growth. An imbalance in any of the behavioral
subsystems results in disequilibrium. It is nursing’s role to assist the client in returning to a
state of equilibrium.
 DISCHARGE PLAN
Enter y Medication management:
The patient should continue taking any prescribed medications for gouty arthritis as directed by their
healthcare provider. They should also be advised to avoid medications that can trigger a gout attack, such as
diuretics.

Lifestyle modifications:
Patient is advised to make lifestyle modifications to manage their gout symptoms, such as:

-Limiting alcohol consumption

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-Maintaining a healthy weight
-Eating a low-purine diet (avoiding red meat, organ meats, and seafood)
-Drinking plenty of water to stay hydrated

Follow-up appointments:
The patient is scheduled for a follow-up appointment at Tagum medical city to monitor symptoms and adjust
treatment plan as needed.

Pain management:
The patient was provided with pain management strategies to help cope with the pain associated with acute
gouty arthritis, such as rest, ice, and elevation of the affected joint.

Education:
The patient was educated about gouty arthritis and its management, including the importance of adhering to
their treatment plan and making lifestyle modificationsour text here, or paste your text here.
 R E C O M M E N DAT I O N
This case study presented the results based on the student nurse’s response to the indicated
observations regarding the given case of a patient with Acute Gouty Arthritis in Flare with Effusion Left
Knee. In addition to taking responsibility for a patient's diagnosis, this has a big impact on the student
nurse's ability to understand the situation on Ward duty and other sections. As a result, they gain
valuable experience and knowledge.

A vital aspect of the patient's care is that the family, primary caregiver, and significant others provide

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accurate information about the patient's complaint to the medical staff so that they can provide an
accurate diagnosis, care, and nursing assessment; The faculty should strive to inspire, be an excellent
role model, and guide students in taking history and assessing to gather consistent, reliable data from
numerous sources; The healthcare team should successfully establish a relationship and obtain trust
and cooperation from multiple sources by taking their history and assessing; In order to identify any
problems as early as possible, we propose that the hospital enhance the medically-used technologies
and improve the facilities, so that problems can be detected earlier.

In addition, future nursing students can improve their understanding and provide more explanation
through the case study presented, which presents original ideas and a comprehensive understanding of
Acute Gouty Arthritis in Flare with Effusion Left Knee. Student nurses may find that the studies can give
them some fresh insights and ideas that will challenge them to work it out and explore the topic further.
THANK YOU