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.