GOUTY ARTHRITI

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Gout Overview

Gout is a disease characterized by an abnormal metabolism of uric acid, resulting in an excess of uric acid in the tissues and blood. People with gout either produce too much uric acid, or more commonly, their bodies have a problem in removing it. There are a number of possible consequences of this build-up of uric acid in the body, including acute and chronic gouty arthritis, kidney stones, and local deposits of uric acid (tophi) in the skin and other tissues. Gout may occur alone (primary gout) or may be associated with other medical conditions or medications (secondary gout).

Gout Overview

Gout is a disease characterized by an abnormal metabolism of uric acid, resulting in an excess of uric acid in the tissues and blood. People with gout either produce too much uric acid, or more commonly, their bodies have a problem in removing it. There are a number of possible consequences of this build-up of uric acid in the body, including acute and chronic gouty arthritis, kidney stones, and local deposits of uric acid (tophi) in the skin and other tissues. Gout may occur alone (primary gout) or may be associated with other medical conditions or medications (secondary gout).

The prevalence of gout appears to be increasing. It is currently estimated to be affecting over 6 million Americans.

Gouty arthritis is a common cause of a sudden onset of a painful, hot, red, swollen joint, particularly in the foot at the big toe. Gouty arthritis is reportedly the most common cause of inflammatory arthritis in men over the age of 40. It is definitively diagnosed by detecting uric acid (monosodium urate) crystals in an aspirated sample of the joint fluid. These uric acid crystals can accumulate in the joint and tissues around the joint over years, intermittently triggering repeated bouts of acute inflammation. Repeated "attacks" of gouty arthritis, or "flares," can damage the joint and lead to chronic arthritis. Fortunately, while gout is a progressive disease, there are effective medications to treat gout.  

Gout Causes:

> If your parents have gout, then you have a 20% chance of developing it. > British people are five times more likely to develop gout. > American blacks, but not African blacks, are more likely to have gout than other populations. > Intake of alcoholic beverages, especially beer, increases the risk for gout. > Diets rich in red meats, internal organs, yeast, and oily fish increase the risk for gout.

Attacks of gouty arthritis can be precipitated when there is a sudden change in uric acid levels, which may be caused by:

> overindulgence in alcohol and red meats, > trauma, > starvation and dehydration, > chemotherapy, > Medications: diuretics and some other anti-hypertensive medications, aspirin (Bayer, Ecotrin), nicotinic acid (B-3-50, B3-500-Gr, Niacin SR, Niacor, Niaspan ER, Slo-Niacin), cyclosporin A,

ANSWERS ON CASE ANALYSIS

1. Could the client’s minor accident have contributed to the precipitation of an acute gout attack?

Yes, the client’s minor accident contributed to the precipitation of an acute gout attack. As stated in the book one of the factors that may precipitate gout attack is INJURY including the following: dehydration, fever, heavy eating, heavy drinking of alcohol, and recent surgery, obesity, weight gain, high blood pressure, abnormal kidney function, and certain medications.

2. What may be the reason these symptoms have occurred and what alterations could be made to control them?

Uric acid crystals are the underlying problem causing gout pain and inflammation. When there is too much uric acid being produced in the body someone fit will form hard microscopic crystals which build up in joint areas. They are very sharp, like needles or small pieces of glass. Body will react to these crystals as foreign material and attempt to remove them. This is what actually causes the pain and swelling, rather than the crystals themselves.

To stop a gout attack, doctor can give a shot of corticosteroids, or prescribe a large daily dose of one or more medicines. To ease the pain during a gout attack, rest the joint that hurts. Taking ibuprofen or another anti-inflammatory medicine can also help you feel better. But don't take aspirin. It can make gout worse by raising the uric acid level in the blood.

Paying attention to what you eat may help you manage your gout. Avoid regular daily intake of meat, seafood, and alcohol (especially beer). Drink plenty of water and other fluids. Cut down on proteins that come from red meat, change to low fat dairy products, consume healthy carbs, and avoid both breads and alcohol products that contain brewer’s yeast.

 3. What Nursing measures could help relieve the client’s pain?

1. Give pain medication as needed especially during acute attacks.2. Apply cold packs to inflamed joints to ease discomfort and reduce swelling.3. Administer anti-inflammatory medication and other drugs, as ordered.4. To promote sleep, administer pain medication at times that allow maximum rest.5. Encourage bed rest, but use a bed cradle to keep bed linens off sensitive, in inflamed joints.6. Encourage the patient to perform techniques that promote rest and relaxation.

7. Provide nutritious diet. Avoid purine rich foods.8. Before and after surgery, administer colchicines to help prevent gout attacks as ordered.9. Urge the patient to perform as much self-care as his immobility and pain allow.10. Urge the patient to drink plenty if fluids 2 liters per day to prevent renal calculi.11. Discuss the principles of gradual weight reduction with an obese patient.12. Urge the patient to control hypertension, especially if he has tophaceous renal deposits.13. Provide emotional support during diagnostic test and procedures.

4. Would the use of probenecid with colchicines be a logical therapy to control client’s pain?

Colchicine alters the way your body responds to uric acid crystals. Too much uric acid in the body is what leads to the symptoms of gout (swelling and pain).

Probenecid reduces the amount of uric acid in your body by causing it to be passed in your urine.

The colchicine and probenecid combination is used to prevent gout attacks. This medication will not cure gout and it will not stop a gout attack that has already started. Thus this may be a logical therapy to control client’s pain.

5. What effect would the client’s use of aspirin have on the effectiveness of probenecid?

Aspirin products may affect the way the body responds to probenecid by further increasing the uric acid that’s why the aspirin prescribed to the patient is questionable. The aspirin should be discontinued and should be replace by NSAID.  

BY: GROUP C

Members:

Duran, AppleFranada, Vangie

Fronda, Audrey MaeGalutan, Kimberly

Garcia, JosephGerardo, Janine,Hobli, Michelle

Luluquisen, Maurence