Gout NCLEX Review

This NCLEX review will discuss gout.

As a nursing student, you must be familiar with gout along with how to care for patients who are experiencing this condition.

These type of questions may be found on NCLEX and definitely on nursing lecture exams.

Don’t forget to take the gout quiz.

You will learn the following from this NCLEX review:

• Definition of gout
• Causes
• Pathophysiology
• Signs and Symptoms
• Nursing Interventions
• Treatment

NCLEX Lecture on Gout

Gout NCLEX Review

What is gout? It’s a type of arthritis due to the accumulation of uric acid in the blood. This causes uric acid crystals to form in the joints and the patient will experience severe pain, inflammation, redness, and limited mobility.

Points to remember include:

The patient has issues with HIGH URIC ACID levels in the body because:

• The patient is producing too much uric acid or not excreting it normally.

Sharp needle-like urate crystals form around the joints causing intense inflammation along with pain and redness.

It tends to most commonly occur in the BIG TOE, but can affect the fingers, elbow, knee, small toes, wrist.

Diet management and losing weight plays a role in managing gout attacks.

What is uric acid? It is a waste product created from the purine breakdown during digestion. It enters the blood stream and is filtered through the kidneys and excreted out in the urine. The kidneys play a role in keeping the uric acid levels within normal range….therefore, if the kidneys are damaged there is a high risk of uric acid levels increasing.

What is purine? It’s a chemical compound used as a building block for nucleic acid (DNA and RNA) in our body. Foods that are rich in purine include:

NCLEX Tip: Remember these food categories

• internal organ meats (liver, kidneys, sweetbreads (thymus and pancreas)),
• other red meats
• alcohol (especially beer)
• seafood (anchovies, sardines, scallops)

What can cause Gout?

High consumption of:

• purine rich foods
• high fructose corn syrup drinks (fruit juice and soda drinks)
• alcohol…WHY? Alcohol and uric acid compete within the kidneys, and the kidneys choose to excrete alcohol rather than uric acid, which leads to the buildup of uric acid.

Kidney problems: kidneys are unable to filter out the uric acid in the blood so it accumulates in the blood as in conditions such as Chronic Kidney Disease.

Medications:

• aspirin (increases uric acid levels….EDUCATE patient to NOT take aspirin for pain)
• niacin
• cyclosporine (immune suppressor)
• loop and thiazide diuretics…WHY? They can cause dehydration and reduce the kidney’s ability to excrete urate, which is part of uric acid.

Dehydration: urine becomes concentrated allowing uric acid crystals to form

Overweight: increases uric acid levels…losing weight helps decrease level

Physical stress on the body: hospitalization due to an illness, surgery… stress increases uric acid levels

Signs and Symptoms of Gout

Acute gout attacks:

• Happen randomly…may only happen a few times or once in a person’s lifetime and lasts 1-2 weeks.
• The joints tend to not become damaged.
• Some patients may have several months or a year between attacks.
• Tends to start out in the big toe…may also affect the fingers, elbows, writs, knees, heel, toes.
• The sudden swelling, redness and pain in a joint tends to awake the patient from their sleep (middle of the night).
• Patient may have flu-like like symptoms…body aches.
• As the day progresses, the pain intensifies (4-24 hours), and the patient may have joint stiffness. The affected area is VERY sensitive and the slightest pressure on the joint causes intense pain.

Chronic attacks:

• Happens because uric high acid levels constantly stay elevated which leads to repeated acute attacks.
• Joints become permanently damaged because urate crystals start to form together in large masses called Tophi.
• Tophi are white/yellowish nodules that can be found under the skin on the helix ears, elbows, fingers, toes etc., joints, bursae, bones etc.

• Complications include itching and skin peeling and uric acid kidney stones.

Nursing Interventions for Gout

Assess patient joints, especially toes, fingers, elbows for warmth, redness, or pain

Assess for a history of gout (especially if hospitalized) because remember illness can cause a gout attack

Cold and warm compresses, if tolerated by the patient (alternate between cold and warm)

If gout is present:

• Assess events leading up to the flare-up to help patient avoid these type of events in the future (example: diet…did the patient recently consume an excessive amount of food rich in purine?)
• EDUCATE patient to determine what is causing their attacks so they can avoid future attacks. Every patient varies with the cause of gout. Some patients will only have a gout attack when they consume high amount of alcohol or seafood while others experience gout due to an illness where they become dehydrated.
• EDUCATE on low purine diet and to avoid foods rich in purine: red meats, internal organ meats, seafood, alcohol (beer)

Stay hydrated 2-3 liters per day, unless contraindicated : remember dehydration further increases uric acid levels. In addition, staying hydrated helps prevent uric acid crystals from forming within kidneys.

Bed rest with affected extremities in a foot board or cradle to keep area from pressure (bed linens and accidental bumps).

Weight loss

Medications prescribed by the physician to treat gout:

Meds that help with an acute attack by relieving signs and symptoms:

NSAIDs (to decrease inflammation)

Remember NO Aspirin…it increase uric acid level

Corticosteroids

Colchicine: Used for both acute attacks and prevention of further attacks

• It decreases swelling and lowers uric acid levels
• NURSE’S ROLE: Monitor for GI upset, neutropenia (sore throat, slow wound healing etc.), and toxicity muscle pain, tingling/numbness in finger or toe, gray lips, easy bleeding, bruising.
• NO grapefruit juice….increases risk of toxicity

Allopurinol (Zyloprim): Used for prevention of gout attacks doesn’t relieve an acute attacks

• Most commonly taken with colchicine or NSAIDs.
• Works by decreasing the production of uric acid, hence preventing gout attacks.
• NURSE’S ROLE: patient needs regular eye exams to monitor for vision changes and to avoid vitamin C supplements while taking due to risk for renal calculi formation.

References: