CONTINUED

at work. Laboratory tests indicated a high level of uric acid. He was placed on a low purine diet and probenecid (Pro-cid) 0.25 g pc, twice daily, and colchicine (Colgout/Lengout) 0.5 mg 6 hourly was prescribed for 3 days, then 0.5 mg twice daily for 3 days, then 0.5 mg daily for 3 days. He was also instructed not to take aspirin because it prevents the excretion of uric acid.

NursiNg Care PlaNA Client with Hyperuricemia and Gout Taking Probenecid and ColchicineAhmed Kohler was a postal worker who came to the health care provider’s office complaining of pain in his feet. The pain was more pronounced in his right heel after standing all day

Chapter 13 Agents Used to Treat Hyperuricaemia and Gout

Assessment nursing diAgnosis PlAnning/goAls imPlementAtion evAluAtion

Pain on standing Acute pain: related to pain from deposition of urate crystals in body tissues.

Client will verbalise relief of pain within 1 week of starting colchicine.

Teach client to take colchicine at the first twinge of pain. Observe for nausea, vomiting, diarrhoea, or abdominal pain. Teach client to report gastrointestinal (GIT) problems.

Client verbalises relief of pain.

Increased uric acid level

Risk for impaired physical mobility related to pain secondary to increased serum levels of uric acid.

Client will have reduction of uric acid levels within 10 days of taking probenecid.

Give probenecid as prescribed to increase urinary excretion of uric acid. Do not take aspirin, as it interferes with excretion of uric acid. Observe for rash, headache, and gastrointestinal disturbances.

Laboratory tests show normal uric acid levels.

Pain in right heel, elevation of limbs prn

Activity intolerance related to pain secondary to urate crystals.

Client verbalises treat­ment plan during acute attacks prior to discharge.

Elevate affected joints and immobilise during acute attack. Ice can be used to relieve swelling in affected joint. Teach importance of maintaining joint function after acute attack subsides.

Client demonstrates mobility in all joints without pain following acute attack.

Knowledge of gout and its treatment

Deficient knowledge related to lack of exposure to gout.

Prior to discharge, client verbalises understanding of disease process and treatment regimen. Client develops a plan for self­care, including lifestyle modifications necessary to prevent acute attacks.

Teach client that gout is caused by uric acid crystals deposited in joints. Teach client to avoid alcohol, self­prescribed drugs, trauma, and certain foods. Teach client to use aceta minophen instead of aspirin to prevent inhibition of uricosuric effects of probenecid.

Client follows treatment plan and demonstrates a decrease in the occurrence of acute attacks.

Intake of foods high in uric acid content

Deficient knowledge related to lack of exposure to purine diet information.

Client will be able to verbalise dietary modifications to control uric acid levels prior to discharge.

Teach client to avoid foods high in purines, such as sardines, organ meats, and gravies. Maintain an alkaline ash diet by increasing foods, such as milk and fruits.

Client avoids foods high in purines and avoids alcohol. Client follows an alkaline ash diet.

Intake and output, check for presence of renal calculi (haematuria, pain)

Risk for impaired urinary elimination related to renal calculi.

Client will maintain adequate fluid intake by drinking 10–12 glasses of fluid daily by discharge.

Teach client to drink 200 mls of fluid 10–12 times a day to produce less concentrated urine and minimise the amount of urate in urine.

Client demonstrates urinary output of 2000–3000 mL/day and a specific gravity below 1.030.

13 BROYLES NCP 1ed SB 9780170193009 TXT 1pp.indd 1 8/17/12 10:25 AM

Assessment nursing diAgnosis PlAnning/goAls imPlementAtion evAluAtion

Check skin and joints for presence of tophi caused by uric acid crystals

Risk for impaired skin integrity related to urate crystals in body tissues.

Prior to discharge client verbalises a plan for skin care and signs and symptoms to report to a health care professional.

Teach good skin care to prevent infection. Teach client to observe for signs and symptoms of joint inflammation and to report these to health care provider.

Client has good hygiene practices and maintains skin integrity. Client reports signs and symptoms of tophi to a health care provider.

13 BROYLES NCP 1ed SB 9780170193009 TXT 1pp.indd 2 8/17/12 10:25 AM