Gout, a common and painful form of arthritis, is characterized by hyperuricemia or elevated uric acid levels and the accumulation of uric acid crystals in the joints. This type of arthritis is known for its painful flares that can last up to several weeks following periods without any symptoms.
This condition occurs more commonly in men than women between the ages of 30 to 50 years old. Women rarely develop this condition before menopause.
Gout primarily occurs when the kidneys are unable to eliminate uric acid or there is too much uric acid in the body for the kidneys to excrete effectively, leading to the development of hyperuricemia.
Hyperuricemia can develop due to:
- Metabolic syndromes
- Alcohol (especially beer)
- Renal impairment
- Hypertension
- Obesity
- Diet high in purines
- Certain medications
- Genetics
Not everyone with hyperuricemia develops gout as this condition requires two essential processes to develop – crystallization and inflammation. When uric acid levels become elevated, crystals will form in the joints, which will then trigger the inflammatory process.
Gout can occur in one or more joints including the great toe, wrists, ankles, knees, and midfoot. The affected joints often appear reddened and swollen and are sensitive to touch. The pain is described as a burning sensation. The development of acute gout is typically triggered by trauma, alcohol use, surgery, and systemic infection.
Chronic gout, on the other hand, is characterized by visible deposits of urate crystals (tophi) that form nodules and may be painful during gout attacks.
Synovial fluid aspiration can diagnose gout, as uric acid crystals are visualized under a microscope. Gout is often easily diagnosed based on symptom assessment and physical examination.
Nursing Process
Gout can be effectively managed through medications, joint protection, and lifestyle modifications. The plan of care focuses on decreasing pain, reducing inflammation, and preventing the recurrence of attacks. Patient education is important to help patients prevent complications and reduce the possibility of flare-ups.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for gout, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for gout.
Acute Pain
Sudden and severe pain occurring in one or more joints, usually in the big toe, is the classic symptom of gout. This occurs due to the accumulation of uric acid, forming sharp crystals in the joints.
Nursing Diagnosis: Acute Pain
Related to:
- Disease process
- Inflammatory process
As evidenced by:
- Reddened, swollen joints
- Distraction behavior
- Expressive behavior
- Guarding behavior
- Positioning to ease pain
- Limited range of motion
- Reports pain characteristics and intensity
Expected outcomes:
- The patient will verbalize pain relief and perform activities of daily living without discomfort
- The patient will display an absence of redness, swelling, and warmth to the affected joints
Assessment:
1. Assess pain characteristics and location.
Gout can be diagnosed during a flare when the joint is painful and swollen. It is important to identify which joints are affected to optimize the treatment plan.
2. Assess laboratory and diagnostic studies.
While the result of a physical examination can diagnose gout, laboratory values and diagnostic studies can help determine the extent of the condition. Blood tests to measure uric acid levels and x-rays can help rule out other possible causes of joint inflammation.
Interventions:
1. Administer pain medications as indicated.
NSAIDs are usually prescribed to help relieve pain and reduce joint inflammation in patients with gout. Steroids can also help reduce damage to the joints.
2. Elevate the limb.
Elevating the affected joint can help reduce inflammation.
3. Apply cool compresses.
Nonpharmacologic interventions such as the application of cool compresses and ice can reduce inflammation and soothe burning sensations.
4. Adjust lifestyle behaviors.
Gout attacks can be minimized by reducing risk factors such as the intake of alcoholic beverages, sugary drinks, and high-purine foods such as red meats and some seafood.
Deficient Knowledge
If diagnosed and managed early, patients with gout can live without constant pain, joint swelling, and sudden flare-ups. The patient’s willingness to learn about the disease condition and ways in which flare-ups and complications can be prevented is vital in the management of gout.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Misinformation
- Inadequate participation in care planning
- Inadequate access to resources
- Inadequate awareness of resources
- Inadequate commitment to learning
- Inadequate information
- Inadequate interest in learning
- Lack of information provided
As evidenced by:
- Inaccurate follow-through of instructions
- Inaccurate statements about a topic
- Nonadherence to the treatment plan
- Recurrent gout attacks
Expected outcomes:
- The patient will be able to explain the disease process and the importance of compliance with the treatment regimen
- The patient will specify two diet recommendations to prevent gout
- The patient will verbalize their medication regimen to treat gout
Assessment:
1. Assess the patient’s understanding of the current condition.
Determining the patient’s knowledge about gout can help assess learning needs about the condition, its prognosis, and interventions.
2. Assess the patient’s motivation to learn.
The patient’s readiness to learn about the condition and motivation for improved symptoms can affect patient education efforts and outcomes.
Interventions:
1. Educate the patient about the importance of proper nutrition.
Since gout can be aggravated by food choices, provide the patient with verbal and written foods that should be avoided (red meat, bacon, organ meats, sardines) and foods that should be increased (water, vegetables, whole grains).
2. Refer to a rheumatologist.
Gout is a form of arthritis that is often managed by a rheumatologist. If a patient is struggling with controlling their gout, they may need the expertise of a specialist.
3. Explain the importance of pharmacologic treatment for gout.
Colchicine is a common medication for gout pain. Medications such as allopurinol block uric acid production. Educate the patient on how to safely administer OTC medications for pain.
4. Educate on chronic conditions.
Patients may not realize risk factors such as diabetes, heart disease, and renal disease contribute to the build-up of uric acid and gout. Discuss how controlling these conditions will reduce the incidence of gout attacks.
Impaired Physical Mobility
Patients with gout often find it difficult to walk or stand when they are having flare-ups in their feet, knees, or ankles because of severe and sudden pain and swelling. When there is joint swelling, the joints can become stiff, and painful when moved, and the range of motion will become more limited.
Nursing Diagnosis: Impaired Physical Mobility
Related to:
- Pain
- Inflammatory process
- Limited range of motion
- Joint tenderness
- Joint stiffness
As evidenced by:
- Altered gait
- Decreased range of motion
- Difficulty turning
- Expresses discomfort
- Postural instability
- Slowed movement
- Spastic movement
- Uncoordinated movement
- Hesitancy to move
Expected outcomes:
- The patient will be able to ambulate with minimal discomfort
- The patient will participate in activities to improve their range of motion
Assessment:
1. Assess the extent of joint pain and inflammation.
It is critical to assess the extent of pain and inflammation of affected extremities and joints to help determine the effects on the patient’s quality of life and formulate a treatment plan for optimal results.
2. Assess diagnostic studies and their results.
A synovial fluid analysis may be indicated to help determine the presence of crystals in affected joints.
Interventions:
1. Encourage weight loss.
Obesity places extra stress on joints and also increases the incidence of diabetes, hypertension, and other chronic conditions that are risk factors for gout. Patients should work towards 150 minutes per week of moderate physical activity.
2. Encourage active and passive ROM exercises.
Range of motion exercise can help preserve the flexibility and mobility of affected joints. Gout causes joint stiffness and patients can be provided with exercises they can do themselves or with someone else to maintain their mobility.
3. Refer to PT or OT.
A physical therapist or occupational therapist can help evaluate the extent of impaired physical mobility in patients with gout. Also, they can formulate a plan that promotes strength training and gait training, placing special attention on the affected joints and extremities.
4. Encourage the use of mobility aids when necessary.
Mobility aids like handrails, canes, and shower benches promote patient safety during gout flare-ups and prevent accidental falls and other injuries.
5. Protect the joints.
Exercise is recommended but joint injuries can occur if they are overextended. Choose low-impact activities such as swimming and biking.
References
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- Gout. Arthritis. CDC: Centers for Disease Control and Prevention. Reviewed July 27, 2020. From: https://www.cdc.gov/arthritis/basics/gout.html
- Gout. Cleveland Clinic. Reviewed: November 15, 2020. From: https://my.clevelandclinic.org/health/diseases/4755-gout
- Gout. Mayo Clinic. Reviewed: March 6, 2021. From: https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897
- Gout. NHS. Reviewed: October 9, 2020. From: https://www.nhs.uk/conditions/gout/
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
