This document discusses gout, which is a disorder caused by elevated uric acid levels and deposition of urate crystals in joints. It is caused by increased purine synthesis or decreased renal excretion leading to hyperuricemia. Gout causes pain, swelling, and warmth in joints like the big toe. It is diagnosed through medical history, physical exam, and blood tests showing elevated uric acid and inflammation. Treatment involves medications to reduce uric acid levels and inflammation as well as lifestyle changes like diet modification and exercise. Nursing care focuses on pain management, rest, local heat/cold therapy, and high fluid intake.

1. Gout
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2. Gout
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Gout-is a disorder of purine metabolism,
characterized by elevated uric acid levels and
deposition of urate (crystals) in joints and other
tissues.

3. Pathophysiology/etiology
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• Gout results from accumulation and subsequent
deposition of uric acid in the body.
The hyperuricemia may be the result of :
1. increased purine synthesis,
2. decreased renal excretion, or both
• Hyperuricemia – uric acid serum concentration > 7
mg/dl

4. Cont’d
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 With repeated attacks, accumulation of sodium
urate crystals, called tophi, are deposited in the
peripheral areas of the body such as the great toe,
the hands and the ear.

5. Cont’d
 Primary hyperuricemia may be due to severe
starvation, excessive intake of foods high in
purines (shellfish, organ meats), or heredity.
 In secondary hyperuricemia, the gout is a
clinical feature secondary to any of a number
of genetic or acquired processes, including
conditions with an increase in cell turnover
(leukemias, multiple myeloma) and an
increase in cell breakdown.
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7. Signs & symptoms
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 The big toe, joints, cartilage and soft tissues are mostly
affected by Tophi.
 Pain, warmth, erythema, and swelling of tissue
 Fever
 Elevated uric acid level may lead to nephropathy.

8. Diagnostic evaluation
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 History
 physical examination
 Family history of gout
 Elevated serum uric acid levels
 ESR elevated
 X-ray of the affected joint
 microscopy of the synovial fluid of the involved joint

9. Pharmacologic management
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 NSAIDs-for Pain management & control inflammatory
process.
 Probenecid -inhibit tubular re-absorption of urate and
increase urinal excretion of uric acid
 Allopurinol (zyloprim)- inhibit production of uric acid
 Colchicine- relieve acute pain attack of gout.

10. Nursing Management
 Encourage patient to restrict consumption of
foods high in purines, especially organ meats,
and to limit alcohol intake.
 Encourage patient to maintain normal body
weight.
 In an acute episode of gouty arthritis, pain
management is essential.
 Bed rest and joint immobility
 Local heat or cold application
 High fluid intake 2000-3000ml/d
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11. Complications
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Deformity
Skin perforation
Kidney stone formation

12. Bone tumor
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Bone tumor includes benign tumors and malignant
bone diseases.
1.Benign tumors:
 Are common than malignant tumors
Are slow growing and well circumscribed
Presents few symptoms and are not a cause of
death
Some have the potential to become malignant

13. Cont’d
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2. Malignant bone tumor
Are rare but rapidly growing
Bone tumor metastasis to the lung is common
Pain, swelling, limited motion and weight loss
are the commonest symptom
E.g: Osteosarcoma, Chondrosarcoma, etc

14. Cont’d
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 A tumor in the bone causes bone destruction
 Malignant bone tumors invade and destroy
adjacent bone tissue
 They may be primary tumors or metastatic
tumors from primary cancers elsewhere in the
body

15. Clinical manifestations
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 Pain in the involved bone
 Swelling and limitation of motion
 Physical examination shows
Palpable, tender, fixed bony mass
 Increase in skin temperature over mass
 Superficial veins dilated and prominent

16. Diagnostic evaluation
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 History and physical examination
 X-ray will usually reveal
 metastasis to the lungs and bone tumor
 CT, MRI and Arteriography demonstrates soft tissue
involvement and location of tumors
 Biopsy of bone to confirm suspected diagnosis.

17. Management
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 bone tumor treatment may be accomplished by
surgical excision such as:
 local excision
 amputation and
 radiation therapy and
 chemotherapy

18. Nursing intervention
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 Guard patient to avoid fall
 Assist patient in movement
 Support painful extremities on pillow
 Administer pain medications half an hour before
ambulation or other uncomfortable movement

19. Characteristics of benign and malignant neoplasm
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Benign Malignant
Cell
characteristics
Well differentiated
cells that resemble
normal cells
Cells have little
resemblance
to the normal cells
Mode of growth Localized and not
infiltrating the
surrounding tissue
Infiltration and
destruction
Rate of growth Slow
More rapid
Metastasis Does not spread Spread by metastasis
Ability to cause Doesn’t cause death Usually cause death