GOUTY ARTHRITIS Definition A heterogeneous group of conditions related to a genetic defect of purine metabolism and fresulting hyperuricemia
A metabolic bone disorder in which purine (protein) metabolism is altered and the by-product, uric acid, accumulates
Also Known As Disease Of Kings Incidence Primary gout has 85% incidence of all cases, of which 95% are men Risk / Predisposing Factors Lifestyle Lifestyle factors. Choices you make in your everyday life may increase your risk of gout. Excessive alcohol use — generally generally more than two drinks a day for men and more than one for women — increases the risk of gout.
Diet. Excessiv Excessive e intake of foods high high in purine purine such such as shellfis shellfish, h, organ meats, red meats, increases uric production in the body
Medical conditions. Certain diseases and conditions make it more likely that you'll you'll develop develop gout. gout. These These include include untreated untreated high blood pressu pressure re (hypertension) (hypertension) and chronic conditions, such as diabetes, diabetes, high levels of fat and cholesterol in the blood (hyperlipidemia), and narrowing of the arteries (arteriosclerosis).
Certain medications. The use of thiazide diuretics — commonly used to treat hypertension — and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.
Family history of gout. If other members of your family have had gout, you're more likely to develop the disease.
Age and sex. Gout occurs more often in men than it does in women, primarily because women tend to have lower uric acid levels than men do. After menopause, however, women's uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually between the ages of 40 and 50 — whereas women generally develop signs and symptoms after menopause.
Manifestation 4 stages I. Asymptomatic hyperuricemia II. Acute attack accompanied by redness, swelling, and exquisite tenderness in one join (toes, fingers, wrist, ankles, knees, or other joints). Great toe is most common site. First attack develops quickly, often overnight. Fever, tachycardia, malaise, and anorexia may be noted. Acute episode usually subs subsid ides es with within in 1 week week.. As edem edema a subs subsid ides es,, prur prurit itus us and and loca locall desquamation (tissue loss) may be noted. III. A period of time between attacks during which affected joint returns to norm normal al and and client client may be asymp asymptom tomati atic c for for year years. s. Event Eventua ually lly,, other other attacks occur IV. IV. Permanent changes in multiple joints with restrictions in movement. Trophi may be detected on ears, hands, elbows, feet and knees. Atheroscler Atherosclerosis osis occurs in about 50% of all clients. Types / Classification / Stage Primary gout is caused by an inherited defect of purine metabolism
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Pathophysiology In the body, uric acid is made by enzymatic breakdown of tissue and dietary dietary purines purines.. Huperur Huperuricem icemia ia develop develops s because because of underexc underexcreti retion on or overproduction of uric acid. In addition to accumulation in the blood, uric acid is concentrated in the synovial fluid, myocardium, kidneys, and ears. When When uric uric acid acid levels levels reac reach h a certa certain in level, level, they they crysta crystalli llize ze,, and and the the crystals (trophy) are deposited in connective tissue. Because the crystals are deposited in connective tissue, gout is classified as a form of arthritis. Diagnostic Joint fluid test. Your doctor may use a needle to draw fluid from your affected joint. When examined under the microscope, your joint fluid may reveal urate crystals.
Blood test. Your doctor may recommend a blood test to measure the uric acid level in your blood. Blood test results can be misleading, though. Some people have high uric acid levels, but never experience gout. And some people have signs and symptoms of gout, but don't have unusual levels of uric acid in their blood.
Management Hyperuricemia, trophi, joint destruction, and renal problems are treated after the acute inflammatory process has subside.
Uricosuric agents, such as [rpbemecid, correct hyperuricemia and dissolve deposited urate.
Colchicines (oral or parenteral) or a nonsteroidal anti-inflammatory drug (NSAID), such as indomethacin, is used to relieve acute attack
Allopurinol is effective, but use is limited because of the risk of toxicity
Aspiration and intra-articular corticosteroids are used to treat large-joint acute attacks
Nursing Diagnosis Pain related to inflammation, increased disease activity, tissue damage, fatigue, and lowered tolerance
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relate ted d to musc muscle le weak weakne ness ss,, pain pain on Impair Impaired ed physic physical al mobili mobility ty rela movement, lack of or improper use of ambulatory devices
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Disturbed sleep pattern related to pain and fatigue
Disturbed body image related to physical and psychological changes and dependency imposeb by chronic illness
Ineffective coping related to actual or perceived lifestyle or role changes
Nursing responsibilities Relieving Pain And Discomfort Reducing Fatigue Increasing Mobility Facilitating Self-Care Improving Sleep Improving Body Image Monitoring and Managing Potential Complications
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Increasing Knowledge of Disease Management Promoting Home and Community-Based Care Health teaching Illustrations
Reference Medical Surgical Nursing by Black, 8 th ed. Textbook of Medical Surgical Nursing by Johnson 10 th ed. www.emedicine.com
