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1-56. GOUT
a. Gout is a disease manifested by an acute inflammation of a joint. It occurs most often in men over 40. Primary gout is a metabolic disorder in which the body is unable to properly metabolize purines. Purines are end products of the digestion of certain proteins. This inability results in deposit of urate crystals (a salt of uric acid) in the joint and connective tissues. Secondary gout is an acquired disease resulting in underexcretion of uric acid. It occurs because of impaired renal function precipitated by trauma or prolonged use of diuretic agents, aspirin, or alcohol.
b. Pathological changes include elevated serum uric acid levels and uric acid crystals in the synovial fluid. Signs and symptoms of acute gout are sudden onset of severe joint pain, accompanied by intense inflammation, swelling, and tenderness. The first joint of the great toe is usually affected; and later, other joints of the foot become affected. Attacks involving the same joints tend to recur. In chronic gout, there may be development of renal calculi and deformity of the joints.
c. Patient care is directed toward decreasing the amount of sodium urate in the extracellular fluid so that deposits do not form. This is done by modifying the diet to decrease the amount of purine ingested and drug therapy to promote renal excretion of urates. Drug therapy must be continued after the acute phase to decrease the possibility of future attacks. Foods that should be limited are:
(1) Liver, kidney, and brains.
(2) Anchovies, sardines, and herring.
(3) Bacon, goose, and mutton.
(4) Salmon, turkey, and veal.
(5) Yeast, beer, and meat broth.
d. Nursing care implications include administering medication as ordered, documenting the patient's response, and observing the patient for side effects related to the medication.
