Notes

MY NOTES ON GOUT FROM TEGRITY

Gout (slides 105-115)
Gout is a recurring acute arthritis caused by a deposit of uric acid crystals in one or more joints. Typically a small joint like the toes, foot, or hands.It is caused by an increase in uric acid production or an underexcretion of uric acid by the kidneys. Under excretion is the main cause. Uric acid is the major end product of purine metabolism.
There are two types of gout:
-Primary. A hereditary error of purine metabolism. That leads to the overproduction or retention of uric acid.
-Secondary. Caused by another disease like renal insuffiency or cancer, or drugs that increase the rate of cell death. other causes of secondary gout include alcohol use, sickle cell anemia, obesity or starvation, hyperlipidemia (high cholesterol), diabetes, hypertension

Risk Factors for gout
-male
-postmenopausal female
-older
-hypertension
-some drugs: diuretics, aspirin, cyclosporine
-having a transplant
-a diet high in purine-rich foods (beef, pork, shellfish, chicken, lentils, asparagus, and spinach)
-prolonged fasting

usually precipitated by some event like trauma or surgery, alcohol ingestion, or infection

Clinical Manifestations
-pain and inflammation in one or more small joints
-onset it typically at night with sudden swelling and excruciating pain which peaks in several hours
-often accompanied by low grade fever
-attacks last 2-10 days
-in between attacks, pt. is free of symptoms
-podagra (when gout involves great toe) (most common)
-visible deposits of uric acid (tophi)
-renal calculi (kidney stones)
-pylo nephritis which leads to kidney disease

severity varies from pt. to pt. some have very infrequent attacks while some have it practically all the time. generally, the higher the uric acid level, the earlier the tophi is seen and the more frequent/severe attacks are.

chronic inflammation can lead to joint deformity and cartilage destruction. it may predispose the patient to osteoarthritis.

The tophi may erode the skin from the inside out and produce draining sores. *risk for infection.

Diagnostic Tests
-Serum uric acid levels: elevated (hyperuricemia) (normal level is 2.5-6 in women and 2.5-7 in men)
-synovial fluid aspiration (arthrocentesis): usually not necessary for diagnosis because if they respond to medication, that's considered diagnostic. can provide relief. a sample is sometimes necessary to distinguish gout from other diseases. *needle stick=risk of infection* joint infections are hard to treat due to lack of circulation
-X-ray: shows tophi, eroded places in the bone

Goal: rapidly end acute flare ups and protect against future flare ups, to reduce the chance of crystal urate formation, to prevent disease progression, to lower the serum urate, and to correct the cause.

Drug Therapy
-Acute flare ups
-Colchicine (anti-inflammatory gout drug)
-also must take NSAID or pain med bc it does not treat pain. only inflammation in gout. generally gives dramatic relief of inflammation in 12-24 hours. if pt. responds to this, it is diagnostic. get baseline uric acid level and cvc before started. watch for myelosuppression (bone marrow activity is decreased) what does this mean? fewer RBCs, fewer WBCs, fewer platelets, which predisposes pt to anemias and infections. With long term use, the pt has to watch for neuromuscular toxicity and rhabdomyolysis (the breakdown of muscle tissue). teach pt to avoid grape fruit juice and breastfeeding women should not use colchicine.
-NSAIDs
-Corticosteroids (orally or injected into joint) only used orally if other therapies don't work.
-Chronic
-Allopurinol (Zyloprim) blocks production of uric acid. particularly useful in pt with uric acid stones or renal impairment.
-Probenicid (Benemid), Febuxostate (Uloric)
-increases the excretion of uric acid in urine. do not take aspirin if you are on one of these drugs
-pegloticase (Krystexxa) metabolizes uric acid into a harmless chemical that is excreted in the urine
-used if patient not respond to zyloprim and benemid
-Kozaar is good for pt. with both gout and high blood pressure

Check uric acid levels regularly regardless of which drug is used.

Diet Therapy
Pt. needs to be on a low-purine diet. Little protein. NO organ meats, shellfish, oily fish (sardines), and limit red meats.
also, alkinizing urine is helpful. in order to do that, pt must drink milk and eat potatoes, citrus fruits
Limit alcohol, a weight reduction plan if pt is obese, but fasting is a precipitant, so weight loss should be sensible. drink lots of fluids.

Nursing Interventions
-bedrest
-take meds and teach them how
-immobilization of the affected joint
-avoid careless handling of the joint
-teach diet
-assess limitation of motion and pain
-teach them the treatment plan

MS. MILLS END OF LECTURE NOTES ON GOUT
gout
uric acid crystals deposit in joint cause pain and deformity or tophi
risks
men, high blood pressure, diuretics,
preventative
avoid organ meats, shellfish, oily fish, lentils, spinach, asparagus,
add to
milk, potatoes, citrus fruits,
tx: colchicine (acute), NSAIDs (pain), probenecid (routinely), immobilize affected joint also helps pain,

QUESTIONS
1.) What is gout?
Gout is a recurring acute arthritis caused by a deposit of uric acid crystals in one or more joints. Typically a small joint like the toes, foot, or hands.

2.) What causes gout?
It is caused by an increase in uric acid production or an underexcretion of uric acid by the kidneys. Under excretion is the main cause. Uric acid is the major end product of purine metabolism.

3.) What are the two types of gout?
-Primary. A hereditary error of purine metabolism. That leads to the overproduction or retention of uric acid.
-Secondary. Caused by another disease like renal insuffiency or cancer, or drugs that increase the rate of cell death. other causes of secondary gout include alcohol use, sickle cell anemia, obesity or starvation, hyperlipidemia (high cholesterol), diabetes, hypertension

4.) What are the risk factors for gout?
-male
-postmenopausal female
-older
-hypertension
-some drugs: diuretics, aspirin, cyclosporine
-having a transplant
-a diet high in purine-rich foods (beef, pork, shellfish, chicken, lentils, asparagus, and spinach)
-prolonged fasting

5.) What usually brings about gout to those susceptible?
usually precipitated by some event like trauma or surgery, alcohol ingestion, or infection

6.)What are the clinical manifestations of gout?
-pain and inflammation in one or more small joints
-onset it typically at night with sudden swelling and excruciating pain which peaks in several hours
-often accompanied by low grade fever
-attacks last 2-10 days
-in between attacks, pt. is free of symptoms
-podagra (when gout involves great toe) (most common)
-visible deposits of uric acid (tophi)
-renal calculi (kidney stones)
-pylo nephritis which leads to kidney disease

7.) How severe are gout attacks?
severity varies from pt. to pt. some have very infrequent attacks while some have it practically all the time. generally, the higher the uric acid level, the earlier the tophi is seen and the more frequent/severe attacks are.

8.) What can chronic gout lead to?
chronic inflammation. chronic inflammation can lead to joint deformity and cartilage destruction. it may predispose the patient to osteoarthritis.

9.) What are the diagnostic tests for gout?
-Serum uric acid levels: elevated (hyperuricemia) (normal level is 2.5-6 in women and 2.5-7 in men)
-synovial fluid aspiration (arthrocentesis): usually not necessary for diagnosis because if they respond to medication, that's considered diagnostic. can provide relief. a sample is sometimes necessary to distinguish gout from other diseases. *needle stick=risk of infection* joint infections are hard to treat due to lack of circulation
-X-ray: shows tophi, eroded places in the bone

10.) What are the nursing goals for gout?
rapidly end acute flare ups and protect against future flare ups, to reduce the chance of crystal urate formation, to prevent disease progression, to lower the serum urate, and to correct the cause.

11.) What is the drug therapy for gout?
-Acute flare ups
-Colchicine
-NSAIDs
-Corticosteroids
-Chronic
-Allopurinol (Zyloprim)
-Probenicid (Benemid), Febuxostate (Uloric)
-pegloticase (Krystexxa)
-Kozaar

12.) What patient teaching is involved with the drug therapy?
-Colchicine (anti-inflammatory gout drug)
-also must take NSAID or pain med bc it does not treat pain. only inflammation in gout. generally gives dramatic relief of inflammation in 12-24 hours. if pt. responds to this, it is diagnostic. get baseline uric acid level and cvc before started. watch for myelosuppression (bone marrow activity is decreased) what does this mean? fewer RBCs, fewer WBCs, fewer platelets, which predisposes pt to anemias and infections. With long term use, the pt has to watch for neuromuscular toxicity and rhabdomyolysis (the breakdown of muscle tissue). teach pt to avoid grape fruit juice and breastfeeding women should not use colchicine.
-NSAIDs
-Corticosteroids (orally or injected into joint) only used orally if other therapies don't work.
-Chronic
-Allopurinol (Zyloprim) blocks production of uric acid. particularly useful in pt with uric acid stones or renal impairment.
-Probenicid (Benemid), Febuxostate (Uloric)
-increases the excretion of uric acid in urine. do not take aspirin if you are on one of these drugs
-pegloticase (Krystexxa) metabolizes uric acid into a harmless chemical that is excreted in the urine
-used if patient not respond to zyloprim and benemid
-Kozaar is good for pt. with both gout and high blood pressure

13.) What should the nurse remember to do related to drug therapy?
check uric acid levels regularly

14.) What should you teach a patient with gout about their diet?
Pt. needs to be on a low-purine diet. Little protein. NO organ meats, shellfish, oily fish (sardines), and limit red meats.
also, alkinizing urine is helpful. in order to do that, pt must drink milk and eat potatoes, citrus fruits
Limit alcohol, a weight reduction plan if pt is obese, but fasting is a precipitant, so weight loss should be sensible. drink lots of fluids.

15.) What are the nursing interventions for a patient with gout?
-bedrest
-take meds and teach them how
-immobilization of the affected joint
-avoid careless handling of the joint
-teach diet
-assess limitation of motion and pain
-teach them the treatment plan