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Gout
Introduction
Gout is derived from the Latin word “gutta” and French word “gote".
Gout is a disorder of hyperuricemia.
Hyperuricemia is a disorder in which excessive amounts of uric acid
production or decrease excretion.
Definition
Gout is defined as the metabolic disorder in which abnormal
metabolism of purine and characterized by excessive uric acid crystal
accumulated in the blood.
Gout disorder mainly affects the greater toe.
Types
1. Primary gout - primary gout occurs due to abnormal metabolism
of purine.
2. Secondary gout - secondary gout occurs due to any pathological
disorder.
Eg. - Liver disease, renal failure etc.
Stage of gout - 4 stage -
1. Asymptomatic gout
2. Acute gout
3. Intercortical gout
4. Chronic gout.
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Asymptomatic gout
No sign symptoms occur.
But uric acid level is elevated.
Asymptomatic gout is only determined with the help of a physician.
Acute gout
Acute gout involves inflammation and pain of one or more small joints.
Joints are warm, red and tender.
Uric acid is elevated and shows signs and symptoms.
Intermittent - Client has intermittent periods without any sign and
symptoms between acute attacks.
Chronic gout - continuous or persistent gout disorder.
It is a repeated episode of acute gout disorder.
Causes
Hereditary
High purine rich diet
Excessive eating non veg diet
Renal and liver failure
Hyperuricemia
Obesity.
Clinical manifestation
Excessive joint pain ( toe pain )
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Sudden joint redness, tenderness and swelling
Low grade fever
Itching or pruritus
Headache and malaise
Renal calculi.
Burning urination
Tophi - hard irregular shape nodules.
Diagnosis
History collection and physical examination.
Serum uric acid.
Blood urea nitrogen and serum creatinine clearance test.
Synovial biopsy and synovial fluid analysis.
CBC
X-ray
WBC and ESR rate elevated.
Medical Management
Drug of choice of gout - allopurinol.
Allopurinol inhibits the synthesis of uric acid.
Allopurinol is a short acting competitive inhibitor.
Corticosteroid - for inflammation.
NSAID - pain relief.
Narcotics
Antibiotics
Uricosuria drugs - probenecid
Cold application.
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Complications
Joint deformity
Obstructive renal disease
Osteoarthritis
Renal calculi etc.
Nursing management
Nurses monitor patient diagnostic examinations and vital signs.
Nurse assesses serum uric acid level.
Nurses monitor the patient’s range of motion and daily routine activity.
Provide adequate rest during acute attack.
Provide a low purine diet and avoid a non-veg diet.
Provide weight reduction diet and mild exercise.
Provide prescribed medication and instruction to avoid alcohol and
smoking.
Nurses assist the client during activity and provide appropriate support.
Immobile the client in server condition.
Provide physiological and emotional support.
Educate about follow up care.
Key Points
1. Hyperuricemic disorder of joints - Gout.
2. Gout disorder is abnormal metabolism of - Purine.
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3. Gout disorder occurs due to pathological disorder -
Secondary gout.
4. Diet should be avoided in gout - Purine diet.
5. Drug of choice of gout - Allopurinol.
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