1. The client/caregiver can define gout.
   1. It is a metabolic condition in which there is excess uric acid in the blood, causing sodium urate crystals to be deposited in or near the joints.
   2. The urate crystals form masses called tophi that cause irritation or inflammation of the joint.
   3. Deposits are found in joints and other body tissues such as ear, cartilage, and kidneys. The joint most often affected is first metatarsal joint of the great toe.
   4. Gout may be primary or secondary.
      1. Primary gout occurs because of an inherited defect in purine metabolism, resulting in excess uric acid.
      2. Secondary gout occurs because of increased uric acid secondary to lead poisoning, diuretics, renal disease, alcohol, surgery effects, and so forth.
   5. Gout may be acute or chronic.
2. The client/caregiver can list factors that may cause exacerbation.
   1. Prolonged fasting
   2. Stress
   3. Alcohol
   4. Certain medication such as aspirin or thiazide diuretics
3. The client/caregiver can recognize signs and symptoms.
   1. Intense pain
   2. Swelling and tenderness
   3. Limited motion of joint
   4. Increased heart rate and blood pressure
   5. Headache
   6. Fever and chills
   7. Malaise
   8. Tophi: crystallized deposits accumulating in articular tissues
4. The client/caregiver can list measures to prevent or control gout.
   1. Dietary measures
      1. Eat a high-fiber, low-fat diet.
      2. Reduce intake of refined sugars.
      3. Drink fluids such as water and herbal teas. Drink 8 to 12 glasses of fluid per day.
      4. Avoid foods high in purine such as glandular meats, shellfish, sardines, kid- ney, liver, lentils, mushrooms, and peas.
      5. Avoid alcoholic beverages.
   2. Check urine pH. If pH is less than six, increase fluids. Avoid high purine foods and eat alkaline foods such as potatoes or milk.
   3. Avoid stress.
   4. Avoid fasting.
   5. Protect nodular tophi areas to prevent skin breakdown.
   6. Use bed cradle to keep pressure off the affected part.
   7. Apply ice to inflamed joints.
   8. Obtain adequate rest (bedrest during acute stage).
   9. Achieve and maintain ideal weight.
   10. Take medications as ordered. Physician may want to avoid diuretics, aspirin, and nicotinic acid. Report nausea, rash, or constipation to physician.
   11. Perform range of motion exercise as instructed.
   12. Keep follow-up appointments with physician.
   13. Notify physician of symptoms of kidney stones (nausea, vomiting, urinary retention, flank pain, fever, etc.).
5. The client/caregiver is aware of possible complications.
   1. Permanent joint disability
   2. Kidney stones
   3. Hypertension
   4. Gouty arthritis
   5. Infection of ruptured deposits

Resource

National Institute of Arthritis and Musculoskeletal and Skin
Diseases
www.niams.nih.gov

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. Philadelphia: Mosby Inc.
Cohen, B. J., & Wood, D. L. (2000). Memmler’s the Human Body in Health and Disease (9th ed.). Philadelphia: Lippincott Williams & Wilkins.
Nutrition made incredibly easy. (2003). Springhouse: Lippincott, Williams & Wilkins.
Portable RN: The all-in-one nursing reference. (2002). Springhouse: Lippincott, Williams & Wilkins.
Taylor, C., Lillis, D., & LeMone, P. (2005). Fundamentals of nursing. Philadelphia: Lippincott Williams & Wilkins. Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott
Williams & Wilkins.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.
© 2008 Jones and Bartlett Publishers, Inc.
www.jbpub.com