ACUTE GOUTNursing care plan & interventions

Katie Lehman, Michael Felix, Sheeva Morgan, Noemia Pinheiro, Joyce Lee, Hilary Delamater, Braden Nguyen

Acute Gout Pathophysiology Assessment Diagnosis Interventions Outcomes Evaluations

Pathophysiology Disease caused by the kidneys not clearing the uric acid out

of the blood stream. Uric acid is the end product of purines in our diet. A large amount of purines in the diet are caused by the consumption of red meat products. This causes hyperuricemia (high levels of uric acid in the blood) which initiates an inflammatory response in the joints. Urate crystals deposit into the joints or subcutaneous tissues. The deposits and inflammation causes “gouty arthritis.” Gouty arthritis may appear the same as OA on X-ray. Urate crystal deposits can also cause kidney stones as deposits build up in the kidneys. Renal stones are 1,000x more common in PTs with gout.

Assessment Pain assessment, Check vitals Orthostatic hypotension Check labs

elevated WBCs calcium uric acid levels

Capillary refill Nutritional status SES Allergies Medication & supplements are you currently on?

Diagnosis Top 5 nursing diagnoses, prioritized

Acute painRisk for infectionRisk for skin integrity Risk for immobilityDistorted body image Knowledge deficit

Interventions Part 1

Teach pt about the medications he/she is receiving and potential side effects

Teach pt about foods known to increase the incidence of gout episodes – including cheeses, wine, alcohol, sardines, organ meat, etc.

Encourage client to notify physician if treatments are not working or if an increase in acute episodes of pain

Monitor for s/s of complications

Interventions Part 2 Monitor for pain, pain scale 1-10, pain

radiating, what brings the pain, what relieves the pain. Use of distraction props (IE: TV, books, guided image).

Monitor lab values, edema, swelling, erythema (redness and swelling) Tophi on great toe?

Rotate patient Q2hrs, use lift sheet, make sure skin is dry and intact,

Monitor vitals signs for orthostartic hypotension, fall precautions, assist to bathroom (use call light), use assist devices.

Expected Outcomes Pt will report minimal pain 1 hour after

pain medication is administered, Pt verbalizes understanding and

treatment of condition at discharge. Pt will verbalize specific gout nutrition

and diet at discharge. Pt will walk successfully with crutches

before discharge; pt will perform active ROM a week after discharge

Evaluations Goal met for acute pain: pt claims minimal pain,

with PO meds Goal met for infection: pt took ATB and no

infection was acquired. Goal met for skin integrity: pt is aware of S&S of

skin breakdown Goal is met for immobility: pt is able to withstand

ambulating with little or no assisted devices Goal is met for body image: pt will not

demonstrate depressionover diagnosis and Is enrolled in gout counseling.

References

Wissmann, Jeanne. (2007). Adult Medical- Surgical Nursing RN Edition 7.1.Assessment Technologies Institute, LLC.

Ignatavicius, Donna D., & Workman, M. Linda, (2010) Medical-Surgical Nursing, St. Louis, Missouri: Saunders, Elsevier Inc.