Gout Nursing Care Plans Diagnosis and Interventions
Gout NCLEX Review and Nursing Care Plans
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
- 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.
- Kidney stones. Gout may also lead to the development of kidney stones due to the accumulation of urate crystals in the urinary tract.
- 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
- 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:
- 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.
- Analgesics. Pain relievers are specifically used to effectively relieve joint pain brought about by gout.
- 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.
- Xanthine oxidase inhibitors (XOIs). These block and limit production of uric acid. The side effects include low blood counts and rash.
- 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.
- 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 Diagnosis for Gout
Nursing Care Plan for Gout 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.
|Gout Nursing Interventions||Rationales|
|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 pain
Steroids – 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 rash
Uricosurics – 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 for Gout 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.
|Gout Nursing Interventions||Rationales|
|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 for Gout 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.
|Gout Nursing Interventions||Rationale|
|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.|
Nursing Care Plan for Gout 4
Nursing Diagnosis: Deficient Knowledge related to lack of exposure and misinterpretation of information secondary to gout as evidenced by the patient’s request for information and inaccurate follow-through of instructions and development of preventable complications.
- The patient will express understanding of the prognosis and potential complications of gout.
- The patient will express understanding of the therapeutic needs and regimens for gout.
- The patient will be able to develop a plan for self-care, which includes lifestyle modifications that include mobility and activity restrictions.
|Gout Nursing Interventions||Rationale|
|1. Ask the patient about his or her understanding of the disease process, prognosis, and what are the patient’s future expectations about the condition. Ask the patient about his or her definition of gout.||Asking about the patient’s understanding of the condition will help the nurse to assess the level of knowledge the patient has about gout.|
|2. Advise the patient about his or her role in managing gout through nutrition, medication, and a balanced program of rest and exercise.||The goal of disease control is to decrease the inflammation of joints and the tissues to maintain the function of the joints and prevent deformities.|
|3. Contribute to the patient in planning a realistic and integrated schedule of activities, rest, personal care, drug administration, physical therapy, and management of stress.||Planning a realistic and integrated schedule of activities will provide structure and decrease anxiety when managing a process of chronic disease.|
|4. Recognize individually appropriate exercise program components such as swimming, stationary bike, and non-impact aerobics.||Exercise will help the patient increase energy level, and mental alertness and minimize functional limits. Activities should be customized based on the involved joints and the general condition that will maximize effectiveness and reduce the risk of injury.|
|5. Explain the importance of therapeutic management to gout.||Drug therapy should be given in the correct dosage to maintain the therapeutic blood levels of the patient.|
|6. Advise the patient to take medications, such as NSAIDs with meals, milk products, or antacids at bedtime as prescribed by the physician, and ask the patient for any allergies to medications.||Taking the medications with food and with a full stomach will limit gastric irritation. Reduction of pain enhances sleep and will increase blood levels which will also cause a decrease in early morning stiffness.|
|7. Explain the possible adverse side effects of the medication such as tinnitus, gastric intolerance, GI bleeding, and purpuric rash.||Tinnitus may happen because of increased therapeutic blood levels. If tinnitus happens, the dosage of the medication may be decreased as discussed with the physician.|
|8. Explain to the patient the importance of a balanced diet such as foods high in vitamins, protein, and iron.||Vitamins, iron, and protein-rich foods will help in promoting tissue repair and regeneration.|
|9. If the patient is obese, encourage the patient to lose weight and supply reduction information for the patient as appropriate.||The stress on the joints, especially the hips, knees, ankles, and feet is reduced by weight loss.|
|10. Advise the patient about the information and resources for the use of assistive devices such as a wheeled dolly, pickup sticks, lightweight dishes, and pans, raised toilet seat, and safety handlebars.||This will reduce the force exerted on joints and enable the individual to participate comfortably in the desired activities.|
|11. Encourage the patient about energy-saving techniques such as sitting instead of standing when preparing meals or showering.||Energy-saving techniques will prevent fatigue and facilitate self-care and independence.|
|12. Encourage the patient to maintain correct body position and posture both at rest and during the activity like keeping the joints extended and not flexed, wearing splints, and avoiding remaining in a single position for extended periods.||To lessen joint stress and pain, good body mechanics must be practiced. Proper body mechanics allows the person to carry out the activities without excessive use of energy which will help in preventing injuries.|
|12. Explain to the patient the importance of medical follow-up, regular checking of laboratory studies, and nutrition.||Frequent assessment is needed for drug therapy. Refinement is also needed to ensure the optimal effect of the medication and to prevent dangerous side effects and drug overdose. Patients with gout should maintain proper nutrition to help decrease the occurrence of gout.|
Nursing Care Plan for Gout 5
Nursing Diagnosis: Impaired Physical Mobility related to pain, discomfort, and decreased muscle strength secondary to gout as evidenced by, the inability to purposely move within the physical environment and limited range of motion.
- The patient preserves a position of function with the absence of contractures.
- The patient will express increased strength and function of the affected body part.
- The patient will show techniques and behaviors that allow the continuation of activities.
|Gout Nursing Interventions||Rationale|
|1. Check and monitor continuously the degree of joint inflammation and pain. Ask the patient about the level of pain that affects the patient’s mobility.||The patient’s level of activity and exercise may be affected because of gout. The patient’s level of activity and exercise depends on the development of the inflammatory process.|
|2. Advise the patient to have bed rest or chair rest when needed. Activities should be scheduled and the nurse should encourage frequent rest periods and uninterrupted sleep at night.||It is mandatory to have systemic rest while there is a presence of acute exacerbations and this will also help to reduce the patient’s fatigue and will help improve the strength of the patient.|
|3. Advise and instruct the patient about the active and passive range of motion exercises and isometrics when capable.||Range of motion exercises will help to maintain and improve the function of the joints, and strength of muscles, and this improves the patient’s general stamina. When the patient has inadequate exercise it may lead to joint stiffening.|
|4. Advise the patient to maintain upright and maintain proper posture when sitting, standing, and walking.||Proper posture helps in maximizing joint function and will help in maintaining mobility. Proper posture helps keep the nerves and blood vessels healthy, and it also supports the muscles, ligaments, and tendons.|
|5. Encourage and assist the patient to perform the activities essential for daily living, such as practicing good hygiene, dressing, and feeding himself.||Performing the activities of daily living will help in maximizing the patient’s function.|
|6. Instruct the patient about the safety needs such as raised chairs and toilet seats, using handrails in the tub, shower, and toilet, and instruct the proper use of the mobility aids and the safety measures while using the wheelchair.||Mobility aids will help to prevent accidental injuries and falls. Mobility aids are devices that are designed to help people who are experiencing problems in moving and people that have disabilities and injuries.|
|7. Assist the patient when shifting position with the help of adequate personnel. Assist the patient when using the mobility aids such as a walker, cane, and trapeze.||Repositioning relieves pressure on the patient’s tissues and will also promote body circulation. Proper ways of transferring the patient will prevent abrasion of the skin.|
|8. Provide the patient joint support with splints and braces and position the patient comfortably with pillows, sandbags, and a trochanter roll.||Joint support will help reduce the risk of injury and will help to promote joint stability, and body alignment and will minimize the contractures.|
|9. Manage the pain of the patient by giving appropriate pain medications as prescribed by the physician.||The pain in the affected part of the patient will cause immobility. Pain medication may be given to the patient such as NSAIDs and other medications as prescribed by the physician.|
|10. Discuss with the patient the need for physiotherapy and occupational therapy that will help the patient’s mobility.||Specialized care from the physiotherapist and occupational therapist is needed to provide specialized care that will help the patient to build his or her confidence in increasing daily physical activity.|
|11. Advise the patient’s family to assist the patient when mobilizing.||Because of the patient’s mobility, the patient might be needing help from the family and the significant others. Support and encouragement from the family and significant others will increase the patient’s willingness to increase his or her mobility.|
Nursing Care Plan for Gout 6
Risk for Impaired Home Maintenance
Nursing Diagnosis: Risk for Impaired Home Maintenance related to the long-term degenerative disease process and inadequate support systems secondary to gout.
- The patient’s safety will be maintained as well as the patient’s growth-promoting environment.
- The patient will show the appropriate and effective use of the resources for the condition.
|Gout Nursing Interventions||Rationale|
|1. Assess the level of physical functioning by the use of functional level classification 0-4.||Classification of functional level will help the nurse to identify the degree of assistance and support required for the patient. for example, a level 0 patient is completely capable to do the usual activities of daily living such as self-care, vocational, and avocational, and the level 4 patient is completely unable to perform the usual activities of daily living.|
|2. Check the patient’s environment to check for the patient’s ability to care for himself or herself.||Assessing the patient’s environment determines the feasibility of the patient’s home to meet the patient’s needs.|
|3. Ask the patient about the financial resources that are available to meet the needs of an individual’s situation. Identify the available support systems available to help the patient such as extended family, friends, and neighbors.||The ability to problem-solve and choose a solution will be affected because of the available resources and support from the community. The financial resources of the family might be not enough to afford the needs of the patient. Community and government assistance can sometimes help the family to relieve financial strain.|
|4. Improve or make a plan that will help the patient in maintaining a clean and healthful environment such as sharing household repairs and tasks that involve the family members or the contract services.||The needs of the patient should be met on an ongoing basis.|
|5. Check for the sources of the necessary equipment that the patient can use such as lifts, elevated toilet seats, and wheelchairs.||The equipment should be provided before the patient’s discharge.|
|6. Check the patient’s family’s preparedness to care for the patient effectively.||The patient’s family members and other significant others do not receive adequate training in patient care. If the family and significant others do not have the training and support the situation can overwhelm them. Once the lacking skills are identified, adjustments can increase the patient’s quality of care.|
|7. Do home evaluation in coordination with the occupational therapist and the rehabilitation team.||To maintain the patient’s independence, the nurse should identify the adaptive equipment available at home that will help in modifying the task of the patient to maintain independence.|
|8. Evaluate the patient’s living situation with the family.||Valuable and unique information about the current situation and their concerns can be provided by the family. The family may have a different viewpoint of the problem and issues that the patient might not be aware of.|
|9. Teach the family and significant others about the importance of taking time off to recover.||The family member who is caring for the patient must be given time off because the family member might forget to take time for themselves while caring for the patient. Primary caregivers may be needing the help of other family members to alleviate the caregiver workload.|
|10. Introduce and encourage the family to seek the support groups available in the community.||Groups of caregivers can be helpful with emotional support to the family. Hearing similar experiences with the other will help the caregiver decompress and recharge by expressing their thoughts and feelings.|
|11. Evaluate the patient and the family of the patient’s understanding of the condition and as well as their understanding of the available resources that can help for home maintenance.||Assessing the level of understanding about the situation and the need for home maintenance is necessary. This will help the nurse to assess the effectiveness of the interventions and will help to assess if additional interventions should be done to help reduce the risk of home maintenance.|
More Gout Nursing Diagnosis
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. (2022). 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. (2020). 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
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