Gout

Gout Nursing Diagnosis Interventions and Care Plans

Gout NCLEX Review Care Plans

Nursing Study Guide on Gout

Gout is one of the generally known but complicated forms of arthritis that cause inflammation to the joints.

It is a condition that features severe joint pain which is sudden in onset and is accompanied by tenderness and swelling.

It can affect any joint in the body such as in the elbows, knees, and ankles, but gout commonly involves the big toe.

Gout can affect anyone but it is usually seen in men above 40 years of age. Its symptoms may come and go, and attacks can happen abruptly.

In some cases, gout occurs in the middle of the night, causing sleep disturbance due to the sudden and painful sensation.

Signs and Symptoms of Gout

  • Severe joint pain – the pain is at its worst during the first four to 12 hours after onset. It is often localized in the large joint of the big toe but it can also manifest in wrists, fingers, elbows, knees and ankles
  • Recurring discomfort – gout attack often causes discomfort that lasts from a few days to a few weeks. Later episodes may also last longer than usual affecting more joints.
  • Joint inflammation – the affected joint is swollen, feels warm and tender to the touch, with redness noted
  • Limited range of motion – the progression of gout often causes difficulties in movement

Causes and Risk Factors of Gout

The body normally produces uric acid, a waste byproduct resulting from the breakdown of purine.

The uric acid then dissolves in the blood, passes through the kidneys and is finally excreted in the urine.

However, there are cases where the body produces excessive uric acid due to high intake of purine-rich foods like organ meats and foods that are high in uric acid such as sweetened drinks containing fructose, and alcoholic beverages like beer.

It can also be due to the inability of the kidneys to excrete uric acid.

Excessive amounts of uric acid begin to build up, causing the formation of sharp urate crystals in the joint and its surrounding tissues.

This leads to joint pain and inflammation.

 These are the risk factors that increase the likelihood of developing gout:

  • Family history of gout
  • Age and Gender – gout commonly affects men between the ages of 30 to 50 and post-menopausal women
  • Certain medication like thiazide diuretics and low-dose aspirin
  • Diet -consuming foods that are rich in purine and uric acid
  • Alcohol consumption
  • Obesity -uric acid production increases with weight and may cause difficulties in the filtration of kidneys
  • Certain medical conditions such as untreated hypertension, diabetes, metabolic diseases and disorders of the kidney
  • Recent surgery or trauma

Complications of Gout

  1. Permanent joint damage. Chronic gout can cause complications and increases the risk for permanent joint damage. Recurrent gout can lead to joint erosion and destruction if not treated promptly.
  2. Kidney stones. Gout may also lead to the development of kidney stones due to the accumulation of urate crystals in the urinary tract.
  3. Tophi. If not treated gout can cause tophi, a condition wherein urates crystallize under the skin in the form of nodules. Joint pain and swelling worsen during gout attacks. The attacks vary per individual; some patients never experience severe symptoms while others can have recurrent attacks per year.

Diagnosis of Gout

  • Joint fluid test -fluid from the joints is aspirated and examined to check for urine crystal
  • Blood test- elevated uric acid and creatinine levels in the blood may indicate gout, but these are not confirmatory for diagnosis
  • Imaging – X-ray of the joints; musculoskeletal ultrasound, which provides visualization of urate crystals in a tophus or a joint; dual energy CT scan, which detects urate crystal even in the absence of inflammation

Treatment of Gout

  1. Medications. Medication therapy is usually the most effective for the treatment of gout. These medications not only treat attacks but prevent it from recurring as well:
  2. Nonsteroidal anti-inflammatory drugs (NSAIDs). It works by reducing inflammation and can be given at a higher dose during an acute attack. These drugs must always be taken with meals since they increase the risk for stomach ulcers.
  3. Analgesics. Pain relievers are specifically used to effectively relieve joint pain brought about by gout.
  4. Corticosteroids. These control joint pain and inflammation and are given for people unable to tolerate NSAIDs. They can be given orally or injected directly into the affected joint.
  5. Xanthine oxidase inhibitors (XOIs). These block and limit production of uric acid. The side effects include low blood counts and rash.
  6. Uricosurics. These drugs work by increase the kidney’s ability to excrete uric acid but may cause elevated uric acid in the urine. They may cause the same effects with the xanthine oxidase inhibitors or XOIs.
  7. Lifestyle and dietary changes. Lifestyle modification, such as limiting alcohol consumption, also plays a huge role in treating gout. There are also recommended dietary choices like eating berries and consuming vitamin C supplements. However, it is best to observe caution when incorporating these into the diet and  a referral to the dietitian is recommended.

Nursing Care Plans for Gout

Nursing Care Plan 1

Nursing Diagnosis: Pain related to joint inflammation secondary to gout, as evidenced by pain score of 10 out of 10, guarding sign on the affected joints, restlessness, and irritability

Desired Outcome: The patient will report a pain score of 0 out of 10.

InterventionsRationales
Assess the patient’s vital signs. Ask the patient to rate the pain from 0 to 10, and describe the pain he/she is experiencing.To create a baseline set of observations for the patient. The 10-point pain scale is a globally recognized pain rating tool that is both accurate and effective.
Administer analgesics/ pain medications as prescribed. Administer other prescribed medications for gout.To provide pain relief to the patient. The medications for gout include: Nonsteroidal anti-inflammatory drugs (NSAIDs) – to reduce inflammation and relieve painSteroids – to slow down the damage of the joints, reducing inflammation and pain Xanthine oxidase inhibitors (XOIs) – block and limit production of uric acid. The side effects include low blood counts and rashUricosurics – work by increase the kidney’s ability to excrete uric acid but may cause elevated uric acid in the urine  
Ask the patient to re-rate his/her pain 30 minutes to an hour after administering the analgesic.To assess the effectiveness of treatment.
Provide more analgesics at recommended/prescribed intervals.To promote pain relief and patient comfort without the risk of overdose.
Reposition the patient in his/her comfortable/preferred position. Encourage pursed lip breathing and deep breathing exercises.To promote optimal patient comfort and reduce anxiety/ restlessness.
Refer the patient to a pain specialist as required.To enable to patient to receive more information and specialized care in pain management if needed.

Nursing Care Plan 2

Nursing Diagnosis: Activity intolerance related to joint inflammation and pain  secondary to gout, as evidenced by pain score of 8 to 10 out of 10, fatigue, disinterest in ADLs due to pain, verbalization of tiredness and generalized weakness

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

InterventionsRationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels and mental status related to acute pain, fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.To gradually increase the patient’s tolerance to physical activity. To prevent triggering of acute pain by allowing the patient to pace activity versus rest.
Administer analgesics as prescribed  prior to exercise/ physical activity. Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.To provide pain relief before an exercise session. To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/ her build confidence in increasing daily physical activity.

Nursing Care Plan 3

Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to decrease food intake secondary to acute pain as evidenced by weight loss, poor muscle tone and lack of appetite

          Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices in relation to diagnosis.

InterventionRationale
Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term goals of weight gain.To effectively monitory the patient’s daily nutritional intake and progress in weight goals.  
Administer analgesics as prescribed.To provide pain relief, as acute pain may result to disinterest in eating and eventual lack of proper nutrition.  
Instruct the patient to avoid carbonated beverages and gas-producing food, and limit alcohol consumption.To reduce abdominal distention which can worsen acute pain. Alcoholic drinks can worsen gout.
Encourage the patient to eat berries and take vitamin C supplements, if not contraindicated.To lower serum uric acid levels.
Refer the patient to the dietitian.To provide a more specialized care for the patient in terms of nutrition and diet.  

Other possible nursing diagnoses:

  • Risk for Fracture
  • Risk for Fall
  • Fatigue

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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