2. INTRODUCTION
It is derived from the Latin
word gutta, meaning "a drop"
(of liquid).
Earlier it was believed that an
acute attack of the disease
was the result of poison
dropping into a joint
Disease of the ‘KINGS’ (Rich foods have a
higher concentration of protein. This could
cause major problems for a person
afflicted with gout)
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4. The King of Pain
• Benjamin Franklin
• Thomas Jefferson
• Sir Isaac Newton
• Charles Darwin
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5. According to Brunner & Suddarth’s Text
book of Medical –Surgical Nursing, gout is
“A heterogeneous group of conditions related to a
genetic defect of purine metabolism resulting in
hyperuricemia. Over secretion of uric acid or a
renal defect resulting in decreased excretion of
uric acid, or a combination of both,
occurs”(2010).
Characterized by hyperuricaemia ,acute
arthritis, chronic to tophaceous arthritis
& gouty nephropathy.
DEFINITION
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9. INCIDENCE
• Prevalence is reported to be about 2%.
• Gout occurs more frequently in men than
women over 40yrs M:F= (9:1)
• The peak age of attack is 75 to 80 yrs
• The incidence of gout become approximately
equal b/t the sexes after 60yrs.
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17. Synovial fluid is a poor solvent for monosodium urate
than plasma, urates in the joint fluid become
supersaturated more easily ,particularly in the peripheral
joints(ankles, toes) which have low temperature. With
prolonged hyperuricemia,crystal & microtophi of urates
develop in the synovial & in the joint cartilage.
Crystal are released to synovial fluid & they are chemo-
attractant for neutrophils & macrophages which is the
hallmark of acute attack.
Repeated attacks of acute arthritis lead eventually to
chronic arthritis & formation of tophi in the inflamed
synovial membranes & periarticular tissue ,as well as
elsewhere.
In time, sever damage to the cartilage develops & the
function of the joints is compromised.
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18. increased purine
synthesis, decreased
renal excretion
A high dietary intake
of purine, alcohol
intake
Increase uric acid in
the blood
(hyperuricemia)
Deposition of uric
acid into the joints
GOUT
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22. Acute gouty arthritis
Severe pain, tenderness, warmth, redness
and swelling .
Acute Gout attacks- needle-like pains on
use of the joint affected.
First joint of the toes
(metatarsophalangeal), 90% patients
experience acute attacks in the great toe
24. Cont…
• Insteps - ankles, heels, knees, wrists, fingers,
and elbows.
• Commonly the first attacks - at night.
• Systemic signs - leukocytosis, fever, and
increase ESR
• Early attacks tend to subside spontaneously
over 3 to 10 days.
25. INTERVAL GOUT
• Complete remission of symptoms,
• most patients experience a second attack from
six months to two years later.
• If they are untreated, the attacks will increase
in frequency
26. CHRONIC GOUT
• Stage of Gout - reached after many years. Hard
or gritty (tophaceous) deposits - joint and
tendons.
• Chronic joint symptoms - permanent erosive
joint deformity appears.
• Limitation of motion, often involving multiple
joints of the hands, feet, or both.
27. CHRONIC GOUT
• Visible "tophi," deposits of monosodium urate
-cartilage, synovial membranes, tendons, and
soft tissues, after an average of about 12 years.
• Tophi visible - margin of the ear lobe (pinna),
fingers, hands, knees, and feet, and also the
ulnar surface of the forearm.
• Signs of renal involvement
34. For acute gout
ii.Colchicine: Lower the deposition of
uric acid & interferes with leukocyte
infiltration, thus reducing inflammation
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i.NSAIDs: Indomethacine, Naproxen,
Phenyl butazone
iii. Corticosteroid :may be used in pt. who have no response to other
therapy
35. For chronic gout
Probenecid: uricosuric agent;
inhibits renal reabsorption of
urates & increases the urinary
excretion of uric acid
Sulfinpyrazone: uric acid
synthesis inhibitor
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Allopurinol: uric acid
synthesis inhibitor
36. Surgical Treatment
• If gout symptom have occurred off and on without treatment,
uric acid crystals may have built up in the joints to form gritty,
chalky nodules called tophi.
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37. Surgical Treatment con’t
This tophi can cause infection pain, pressure, and
deformed joints.
Surgery will recommend by doing the excision to remove
the tophi
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39. NURSING CARE PLAN
Nursing Diagnosis: Acute pain related to swelling joints
Nursing Intervention:
•The pain should be assessed on an ongoing basis
using a scale of one to 10 to describe the severity.
•Use cognitive therapy such as creative visualization
to distract the patient from his pain.
•Apply cold packs to inflamed joints to ease
discomfort and reduce swelling.
•Encourage the patient to perform techniques that
promote rest and relaxation.
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40. NURSING CARE PLAN con’t
Nursing Diagnosis: Activity Intolerance related to pain
Nursing Intervention:
•Evaluate or continuously monitor degree of
joint inflammation or pain.
•Assess the level of intolerance and assist the
patient in activities she feels unable to perform.
•Assist with activity passive rangeof motion.
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41. NURSING CARE PLAN con’t
Nursing Diagnosis: Hyperthermia related to inflammatory process
Nursing Intervention:
•Monitor vital sign
•Provide tepid sponge bath (if not
contraindicated)
•Promote client safety.
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42. Health Education
Eats enough carbohydrate
Avoid or Limit alcohol
consumption
Limit meat and seafood intake
Avoid fatty foods
Avoid or Limit alcohol
consumption
Do the moderate daily exercise
Drink at least 6 to 8 glasses of
water each day.
Take the prescribed medication
and follow doctor`s order
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