Nursing Care Plan for Gout

Gout is a metabolic disorder that is due to abnormal metabolism of purines, a constituent of many foods. Gout occurs with the buildup of uric acid in the joints and kidneys. Essentially what happens is that the excretion of uric acid, which is the product of purine metabolism, does not keep pace with uric acid production. As a result there is abnormal accumulation of uric acid. As such it was also known as "The disease of the kings".

This situation is observed in cases where the kidneys become impaired and are incapable of excreting uric acid from the body in the normal way. The excess uric acid present in blood in such situations precipitates in the tissues.

Food and drinks that mostly contribute to gout attacks include seafood, red meat, organ meat, high-fructose corn syrup, sugar-sweetened items that are usually popular during the holidays and beer and liquor.

The typical early manifestations of gout are acute episodes of painful swollen joints. The usual sites of the first attacks are the big toe, the foot, and the ankle. If gout is not treated, uric acid accumulation worsens and other joints become inflamed and attacks become more frequent and debilitating. Besides being excruciatingly painful, the attacks also cause damage to joints and to internal organs such as the kidneys.

In the middle of the night, if you suddenly experience intolerable pain in any of your joints accompanied by inflammation, redness and stiffness of the joint, then you are experiencing a gout attack. Sometimes high fever may also be observed along with a gout attack. The skin surrounding the gout affected joint tends to peel off. Small pressure on the joint may aggravate the excruciating pain. As such walking or even standing up becomes an arduous task.

A number of studies have now identified the major contributing factors to gout. These include obesity, alcohol (especially beer), red meat, shellfish, and fructose containing beverages. The latter include both soft drinks as well as processed fruit juices.

Allopurinol is the pharmaceutical drug of choice used in long-term prevention of gout and decreases the body's production of uric acid. People experiencing gout attacks should, however, avoid medications containing aspirin as these can make gout worse. Pain relievers such as paracetamol or other more powerful analgesics, are often used to manage the pain. Anti-inflammatories, such as non-steroidal anti-inflammatory drugs (NSAIDs), are used to decrease joint inflammation and reduce the pain. If NSAIDs cannot be given because of an ulcer, your doctor may use colchicine may be used to settle an attack. I have found the homeopathic colchicines (30c) can be very useful for the gout patient instead of this drug. Do you take a "water tablet" or a diuretic? Pharmaceutical diuretics may cause gout in people who are genetically predisposed to gout by increasing the accumulation of uric acid within the body.

Nursing Diagnosis for Gout

1. Acute / Chronic Pain

2. Impaired Physical Mobility

3. Knowledge Deficit

Nursing Diagnosis and Interventions :

Acute / Chronic Pain

Goal : Comfortable feeling fulfilled or avoid pain

Nursing Interventions :

1. Provide a comfortable position, joint pain (leg) rested and given bearing. Rest can reduce local metabolism and reduce joint movement occurs.

2. Give warm or cold compresses can provide vasodilating effects, both have the effect of helping expenditure endorphins and cold can inhibit pain impulses.

3. Prevent to avoid irritation, such as avoiding the use of a narrow shoe, tripping over a hard object. If irritation persists it will be more painful, so take care if there is a sterile wound and drain care also attached to the wound.

4. Give the drugs according to the prescription and observe the side effects of these drugs.