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GOUTGOUTSITI MEILAN SIMBOLONSITI MEILAN SIMBOLON

MEDICAL SURGICAL NURSING DEPARTMENTMEDICAL SURGICAL NURSING DEPARTMENT STIKES ST STIKES ST

ELISABETH MEDANELISABETH MEDAN

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DefinitionDefinition

Gout is characterized by recurrentGout is characterized by recurrentattacks of acute arthritis inattacks of acute arthritis inassociation with increased levels ofassociation with increased levels ofserum uric acid.serum uric acid.

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EtiologyEtiologyIncreasedIncreased purinepurine synthesissynthesis

Decreased renal excretionDecreased renal excretionBothBoth

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Clinical manifestationClinical manifestation Acute phase Acute phase maymay accuraccur in one or more joints but usually lessin one or more joints but usually lessthan fourthan four: :oo PainPainoo SwellingSwelling

oo FeverFever

Chronic phaseChronic phase : :oo Multiple jointMultiple joint deposits of sodiumdeposits of sodium urateurate crystalscrystals TophyTophy

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TOPHITOPHISolidSolid urateurate depositsdepositsin tissuesin tissues

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GOUT: A Chronic Disease of 4 stagesGOUT: A Chronic Disease of 4 stages

Asymptomatic Asymptomatic hyperuricemiahyperuricemia As. As. UratUrat tinggitinggi tapitapi belumbelummenunjukkan gejalamenunjukkan gejala

Acute Flares of crystallization Acute Flares of crystallization Sudah muncul gejalaSudah muncul gejala

bengkak yang nyeri di ibu jari kaki, lengan dsb dan ga bisabengkak yang nyeri di ibu jari kaki, lengan dsb dan ga bisauntuk jalan maupun aktivitasuntuk jalan maupun aktivitas

Intervals between flaresIntervals between flares Merupakan fase dimanaMerupakan fase dimana

setelah serangan akut dan dr memberi obat penurun asamsetelah serangan akut dan dr memberi obat penurun asamurat, kondisi pasien tenag dan tidak terjadi serangan,urat, kondisi pasien tenag dan tidak terjadi serangan,berlangsung lamaberlangsung lama

Advanced Gout & Complications Advanced Gout & Complications MerupakanMerupakan tahaptahapakhirakhir daridari GoutGout TThopushopus

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DIAGNOSING GOUTDIAGNOSING GOUT

LaboratoryLaboratory Blood routine, Uric acidBlood routine, Uric acidSynovial fluid analysisSynovial fluid analysis crystalscrystals

RadiologyRadiology inflamationinflamation

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ComplicationsComplicationsRenal FailureRenal Failure ARF can be caused ARF can be caused

byby hyperuricemiahyperuricemia, ,chronicchronic urateuratenephropathynephropathy

NephrolithiasisNephrolithiasis

Joint deformityJoint deformityRecurrent GoutRecurrent Gout

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MANAGEMENTMANAGEMENT

NonNon--farmakologik farmakologik Change the lifestyleChange the lifestyle dietdiet

Diet rendah purinDiet rendah purin Body weightBody weight painpain RestRest joint immobilization joint immobilization

Farmakologik Farmakologik ANALGESIC ANALGESIC

NSAID /CORTICOSTEROID/NSAID /CORTICOSTEROID/COLCHICINE,COLCHICINE, Allpurinol Allpurinol

URIC LOWERING DRUGSURIC LOWERING DRUGS

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NURSING MANAGEMENT : GOUTNURSING MANAGEMENT : GOUT

Prevented byPrevented by maintanancemaintanance of theof theserum acid at normal levelserum acid at normal levelNursing intervention is directed atNursing intervention is directed atsupportive care of the inflamed jointssupportive care of the inflamed jointsBed restBed rest

Avoid causing pain Avoid causing pain

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Re erencesRe erencesBulecheck Bulecheck G.M, Butcher H.K andG.M, Butcher H.K and DochtermanDochterman J.M.,J.M.,2008. Nursing Intervention Classification (NIC), fifth2008. Nursing Intervention Classification (NIC), fifthedition. USA : Mosbyedition. USA : MosbyBrunner andBrunner and SuddarthsSuddarths, 2000. Medical Surgical Nursing,, 2000. Medical Surgical Nursing,99 thth Edition, Unit 2. Philadelphia : LippincottEdition, Unit 2. Philadelphia : Lippincott

Lippincott., J.B., 1987. MedicalLippincott., J.B., 1987. Medical Surgical Nursing, SixthSurgical Nursing, SixthEdition. Philadelphia : MosbyEdition. Philadelphia : MosbyHerdmanHerdman, T.H, 2012. NANDA INTERNATIONAL Nursing, T.H, 2012. NANDA INTERNATIONAL NursingDiagnosis :Diagnosis : DefenitionDefenition & Classification 2012& Classification 2012- -2014.2014.Oxford : WileyOxford : Wiley- -BlackwellBlackwellLewis,Lewis, HeitkemperHeitkemper and Dirksen, 2000. MEDICALand Dirksen, 2000. MEDICALSURGICAL NURSING,SURGICAL NURSING, Assesment Assesment and Management ofand Management ofclinical problems, Fifth edition, Volume 2. USA : Mosbyclinical problems, Fifth edition, Volume 2. USA : MosbyMoorheadMoorhead dkk dkk., 2008. Nursing Outcomes Classification., 2008. Nursing Outcomes Classification

(NOC), Fourth Edition. USA : Mosby(NOC), Fourth Edition. USA : Mosby

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THANK YOUTHANK YOU