GOUT NURSING INTERVENTIONS

Gout is an inflammation in your joint resulting from an accumulation of urate crystals. Uric acid is a waste product formed from the breakdown of purines. These are substances found naturally in your body as well as in certain foods, especially organ meats — such as liver, brains, kidney and sweetbreads — and anchovies, herring, asparagus and mushrooms.
Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much or excretes too little of this acid. In that case, uric acid can build up, forming sharp, needle-like crystals (urate) in a joint or surrounding tissue that cause pain, inflammation and swelling.
Crystal deposits also cause another condition, known as false gout (pseudogout). But rather than being composed of uric acid, pseudogout crystals are made of calcium pyrophosphate dihydrate. And while pseudogout can affect the big toe, it's more likely to attack large joints such as your knees, wrists and ankles.
Risk factors
The following conditions or circumstances can increase the chances you'll develop high levels of uric acid that may lead to gout:
§ Lifestyle factors. Excess consumption of alcohol is a common lifestyle factor that increases the risk of gout. Excess alcohol generally means more than two drinks a day for men and more than one for women. Gaining 30 pounds or more than your ideal weight during adulthood also increases your risk.
§ Medical conditions. Certain diseases make it more likely that you'll develop gout. These include untreated high blood pressure (hypertension) and chronic conditions, such as diabetes, high levels of fat and cholesterol in the blood (hyperlipidemia), and narrowing of the arteries (arteriosclerosis).
§ Certain medications. The use of thiazide diuretics — used to treat hypertension — and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone a transplant.
§ Genetics. About one out of five people with gout has a family history of the condition.
§ Age and sex. Gout occurs more often in men than it does in women, primarily because women tend to have lower uric acid levels than men do. After menopause, however, women's uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually between the ages of 40 and 50 — whereas women generally develop symptoms after menopause.

Signs and symptoms
The signs and symptoms of gout are almost always acute, occurring suddenly — often at night — and without warning. They include:
§ Intense joint pain. Gout usually affects the large joint of your big toe but can occur in your feet, ankles, knees, hands and wrists. The pain typically lasts five to 10 days and then stops. The discomfort subsides gradually over one to two weeks, leaving the joint apparently normal and pain-free.
§ Inflammation and redness. The affected joint or joints become swollen, tender and red.

GOUT NURSING INTERVENTIONS

Advise change of lifestyle.
Encourage bed rest.
Encourage and facilitate drinking of plenty of fluids.
Record intake and output accurately.
Advise patient to avoid foods rich in purine
organ meats
shellfish
legumes
sardines
salted anchovies
mushrooms
herring
sweetbreads
consomme
beer / wine
Encourage weight loss after initial attack of gout.
Collaborative:
a) Acute attack – colchicines (discontinue if diarrhea or nausea and vomiting occur)
NSAIDS – indocin, butazolidin
b) Prevention – uricosuric agents
· Probenecid (Benemid), Sulfinpyrazone (Anturane), increase renal excretion
of uric acid.
· Allopurinol (Zyloprim) inhibits uric acid formation.
· Encourage fluids to 2,000 to 3,000 cc/day when giving antigout drugs to
Prevent formation of kidney stones.