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Nursing Care Plan for Gout / Gouty Arthritis

Pathophysiology

Gout is a common and painful form of arthritis that causes swollen, hot and stiff joints. When uric acid crystallizes, it settles into the joints and body tissues, most frequently affecting the big toe and, if not treated,  progresses to the ankles, heels, wrists and hands. This results in severe pain, stiffness and redness at the joint. Gout attacks often occur in the middle of the night when the joint is immobile. Once the initial pain has subsided, general discomfort of the area can last for several weeks.

Etiology

Excessive amounts of uric acid in the blood is the primary cause of gout. Other factors include genetics, dietary factors, use of diuretics and the inability of the kidneys to excrete uric acid. As the uric acid accumulates, crystals of monosodium urate form in the joints and tissues. 90% of cases are caused by the underexcretion of uric acid. Dietary factors as a cause for gout only comprise about 12% of cases, but changes to the diet help reduce the risk.

Desired Outome

Relieve acute attack, prevent future attacks, promote optimal excretion of urates

Gout / Gouty Arthritis Nursing Care Plan

Subjective Data:

  • Sudden pain in joints, often the big toe
  • Stiffness in joint
  • Tenderness of the joint
  • Limited range of motion
  • Itching

Objective Data:

  • Tophi (nodules in skin)
  • Renal calculi
  • Joint inflammation
  • Joint edema
  • Erythema

Nursing Interventions and Rationales:

  1. Assess and manage pain: Administer medications, Apply cool cloths as tolerable, Assist with positioning to avoid pressure on the affected joint
    • An acute attack can cause intense pain for the first 36 hours. Offer options to help manage pain.
  2. Assist with mobility
    • Due to pain and inflammation, patients may require assistance with mobility for safe ambulation and transfer.
  3. Monitor signs of joint inflammation
    • Evaluate erythema and joint edema to determine if interventions are effective at reducing inflammation.
  4. Administer medications: NSAIDS / Corticosteroids, Colchicine, Xanthine, Oxidase, Inhibitors (XOIs), Uricosurics
    • Medications can help relieve the immediate symptoms while others are for long term management and prevention of flare-up recurrence.

      NSAIDS and corticosteroids help reduce swelling and can relieve immediate pain

      Colchicine can be given for acute pain specific to gout attacks

      XOIs (allopurinol)- medications that block the production of uric acid and help prevent future attacks

      Uricosurics (probenecid)- help the kidneys more effectively excrete uric acid
  5. Promote hydration and increase fluid intake
    • Prevents dehydration and helps the kidneys excrete uric acid
  6. Assist with AROM or PROM
    • Prevents joint stiffness and increases mobility
  7. Nutrition Education: Limit or avoid animal proteins (liver, kidney, beef, lamb and pork), Limit intake of seafood, especially those high in purine such as shellfish, sardines and tuna, Avoid alcohol as it greatly increases the risk of gout attacks, Encourage foods that reduce the risk of attacks including: coffee, cherries and foods high in vitamin C, Limit or avoid foods/drinks sweetened with fructose
    • Dietary changes reduce the risk of recurrent gout attacks and lessen the severity of future attacks.

      Patients should avoid foods high in purines as these will cause a buildup of uric acid within the body.

References

Date Published - Jun 2, 2017
Date Modified - Nov 12, 2018