NCLEX RN Practice Question # 483

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You shoul Know about Gout: (NCLEX Review)

 Description

  • Gout is a systemic disease in which urate crystals deposit in joints and other body tissues.
  • Gout results from abnormal amounts of uric acid in the body.
  • Primary gout results from a disorder of purine metabolism.
  • Secondary gout involves excessive uric acid in the blood caused by another disease.

Phases

  • Asymptomatic: Client has no symptoms but serum uric acid level is elevated.
  • Acute: Client has excruciating pain and inflammation of one or more small joints, especially the great toe.
  • Intermittent: Client has intermittent periods without symptoms between acute attacks.
  • Chronic: Results from repeated episodes of acute gout
    • Chronic gout results in deposits of urate crystals under the skin.
    • Chronic gout results in deposits of urate crystals within major organs, such as the kidneys, leading to organ dysfunction.

 Assessment

  • Swelling and inflammation of the joints, leading to excruciating pain
  • Tophi: Hard, irregularly shaped nodules in the skin containing chalky deposits of sodium urate
  • Low-grade fever, malaise, and headache
  • Pruritis from urate crystals in the skin
  • Presence of renal stones from elevated uric acid levels

 Interventions

  • Provide a low-purine diet as prescribed, avoiding foods such as organ meats, wines, and aged cheese.
  • Encourage a high fluid intake of 2000 mL/day to prevent stone formation.
  • Encourage weight reduction diet if required.
  • Instruct the client to avoid alcohol and starvation diets because they may precipitate a gout attack.
  • Increase urinary pH (above 6) by eating alkaline ash foods
  • Provide bed rest during the acute attacks with the affected extremity elevated.
  • Monitor joint range-of-motion ability and appearance of joints.
  • Position the joint in mild flexion during acute attack.
  • Protect the affected joint from excessive movement or direct contact with sheets or blankets.
  • Provide heat or cold for local treatments to affected joint as prescribed.
  • Administer medications such as analgesics, anti-inflammatory, and uricosuric agents as prescribed.

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