Friday, April 16, 2010

Gout also known as gouty arthritis is a metabolic disease marked by monosodium urate deposits that cause red, swollen, and acutely painful joints. Gout can affect any joint but mostly affects those in the feet, especially the great toe, ankle, and midfoot. Gout is a medical condition that usually presents with recurrent attacks of acute inflammatory arthritis (red, tender, hot, swollen joint). It is caused by elevated levels of uric acid in the blood. The uric acid crystallizes and deposits in joints, tendons, and surrounding tissues. Gout affects 1% of Western populations at some point in their lives. Gout is caused by an increased level of uric acid in the blood, salts of which are deposited in the joints. It mostly occurs in middle-aged men and almost always involves pain at the base of the great toe. Gout may result from a primary metabolic disturbance or may be a secondary effect of another disease, as of the kidneys.Gout is treated with drugs to suppress formation of uric acid or to increase elimination of uric acid. Patients who receive treatment for gout have a good prognosis. 
The final, unremitting stage of the disease (also known as tophaceous gout) is marked by persistent painful polyarthritis. An increased concentration of uric acid leads to urate deposits in cartilage, synovial membranes, tendons, and soft tissue, called Tophi/tophus . Tophi/tophus form in the fingers, hands, knees, feet, ulnar sides of the forearms, pinna of the ear, Achilles tendon and, rarely, in such internal organs as the kidneys and myocardium. Renal involvement may adversely affect renal function. 

Causes for Gout/Gouty Arthritis 
Hyperuricemia is the underlying problem of gout, Although the underlying cause of primary gout is unknown, it appears to be linked to a genetic defect in purine metabolism that causes overproduction of uric acid (Hyperuricemia), retention of uric acid, or both. 
Secondary gout develops during the course of another disease, such as obesity, diabetes mellitus, hypertension, polycythemia, leukemia, myeloma, sickle cell anemia, and renal disease. Secondary gout can also follow treatment with such drugs as hydrochlorothiazide or pyrazinamide. 

Complications for Gout/Gouty Arthritis 
Potential complications include: Renal disorders such as renal calculi Circulatory problems, such as atherosclerotic disease, cardiovascular lesions, stroke, coronary thrombosis, and hypertension Infection that develops when occur tophi ruptures and nerve entrapment. 

Treatment for Gout/Gouty Arthritis 
Gout/Gouty Arthritis management has three goals: Stop the acute attack. Treat hyperuricemia to reduce urine uric acid levels. Prevent recurrent gout and renal calculi. 
Treatment for an acute attack: 
Bed rest; immobilization and protection of the inflamed, painful joints; and local application of cold. Analgesics, such as acetaminophen, relieve the pain associated with mild attacks. Acute inflammation requires nonsteroidal anti-inflammatory drugs or intramuscular corticotropin. 
Treatment for chronic gout involves 
Decreasing the serum uric acid level. Adjunctive therapy emphasizes avoidance of alcohol and sparing use of purine-rich foods. Weight reduction program decreases uric acid levels and eases stress on painful joints. In some cases, surgery may be necessary excised and drained tophi to improve joint function or correct deformities. 

Nursing Assessment 
Patient history Reveal that the patient has a sedentary lifestyle and a history of hypertension or renal calculi. report waking with pain in toe or another location in the foot.He may complain that initially moderate pain has grown and He may report accompanying chills and a mild fever. 
Inspection a swollen, dusky red or purple joint with limited movement. Maybe found tophi, especially in the outer ears, hands, and feet, In chronic stage of gout, the skin over the tophi may ulcerate and release a chalky white exudate or pus. 
Palpation may reveal warmth over the joint and extreme tenderness. The vital signs assessment may disclose fever and hypertension. If the patient has a fever, possible occult infection must be investigated. 

Diagnostic tests for Gout/Gouty Arthritis 
Needle aspiration of synovial fluid (arthrocentesis) or tophaceous material Serum uric acid X-rays 

Nursing Diagnosis
Common nursing diagnosis found in Nursing care plans for Gout/Gouty Arthritis Acute pain Activity intolerance Anxiety Deficient knowledge (diagnosis and treatment) Disturbed sleep pattern Impaired physical mobility Ineffective coping Risk for injury

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