Gout

gout

1. nursing client with mucoskeletal and autoimmune disorder and gerontology nursing. GOUT

2. INTRODUCTION To better understand gout, it helps to understand the anatomy of the joints Joint A joint is a union between two bones. The joint allows the ends of the bones to move against one another. Have cartilage Have a synovial fluid Have a ligaments

3. WHAT IS GOUT??? Do you have experience of GOUT??? Or anybody at your family have this disease???

4. DEFINITION It is derived from the Latin word gutta , meaning "a drop" (of liquid). Gout is a metabolic disorder characterized by elevated serum uric acid levels and deposits of urate crystals in synovial fluids and surrounding tissues. Gout also is a kind of arthritis that occurs when  uric acid  builds up in blood and causes joint inflammation. Acute Chronic

5. RISK FACTOR Lifestyle Medical conditions Family History Age and Sex

6. Clinical Manifestation Severe pain at the joint Itchy and peeling skin later Redness and Inflammation Fever Less Flexibility Becomes Nodules

7. ETIOLOGY Classification causes of Gout Primary Gout (Hereditary) Secondary Gout (internal/external factors, e.g. diet, kidney problems, obesity)

8. Etiology c0nt. Genetic tendency Excessive urine acid in the blood Over weight (Obese) Overindulgence in alcohol Medication Kidney disease

9. increased purine synthesis, decreased renal excretion A high dietary intake of purine, alcohol intake Increase uric acid in the blood (hyperuricemia) Deposition of uric acid into the joints PATHOPHYSIOLOGY GOUT

10. Diagnostic Test Medical History and Physical Examination Test to measure levels of uric acid in blood

11. Diagnostic Test con’t Test to measure levels of uric acid in urine Extremity X-ray

12. Diagnostic Test con’t Joint fluid analysis

13. Allopurinol Comes as a tablet to take by mouth, take it around the same time every day Side effect: Upset stomach, diarrhea and drowsiness Medical treatment Colchicine ( Colcrys ) Side effect: Mild nausea, stomach pain and mild diarrhea Comes in a tablet to take by mouth.

14. Medical Treatment con’t Probenecid Comes in a tablet to take by mouth .( taken two times a day) Side effect: Headache, Vomiting, Loss of appetite and Dizziness Corticosteroid (Prednisone) Comes in a tablet to take by mouth. Side effect : Fluid retention, Increase BP, Mood Swings

15. Medical Treatment con’t Is recommended at 40 mg or 80 mg once daily (tablet) Side effect: nausea, diarrhea, headache and rash Febuxostat ( Uloric )

16. Surgical Treatment If gout symptom have occurred off and on without treatment, uric acid crystals may have built up in the joints to form gritty, chalky nodules called   tophi .

17. Surgical Treatment con’t This tophi can cause infection pain, pressure, and deformed joints. Surgery will recommend by do the excision to remove the tophi

18. Complication Recurrent gout Advanced gout Kidney damage Joint damage Tophi Kidney stone

19. NURSING CARE PLAN Nursing Diagnosis: Acute pain related to swelling joints Goal: Pain will be relieved Nursing Intervention: The pain should be assessed on an ongoing basis using a scale of one to 10 to describe the severity. Use cognitive therapy such as creative visualization to distract the patient from his pain. Apply cold packs to inflamed joints to ease discomfort and reduce swelling. Encourage the patient to perform techniques that promote rest and relaxation.

20. NURSING CARE PLAN con’t Nursing Diagnosis: Activity Intolerance related to pain Goal: Patient can do the activity daily living (ADL) Nursing Intervention: Evaluate orcontinuously monitor degree of joint inflammation or pain. Assess the level of intolerance and assist the patient in activities she feels unable to perform. Assist with activity passive rangeof motion.

21. NURSING CARE PLAN con’t Nursing Diagnosis: Hyperthermia related to inflammatory process Goal: Client will be maintain normal body temperature without complication Nursing Intervention: Monitor vital sign Provide tepid sponge bath (if not contraindicated) Promote client safety.

22. Health Education Eats enough carbohydrate Avoid or Limit alcohol consumption Limit meat and seafood intake Avoid fatty foods Avoid or Limit alcohol consumption Do the moderate daily exercise Drink at least 6 to 8 glasses of water each day. Take the prescribed medication and follow doctor`s order

23. As we already know, gout is a monosodium urate , monohydrate crystal deposit disease. In teenagers gout also known as Rich Man’s Disease, because gout can be created by eating an abundance amount of seafood. Clinical pharmacists need to be empowered with knowledge to assist prescribing clinicians in order to maximize therapeutic outcomes when treating gout. To achieve this goal, a foundation of new insights into the pathogenesis of hyperuricemia and gout has been reviewed. Both nonpharmacologic modalities and pharmacologic therapies have been discussed so that greater patient adherence through medication counseling can be achieved. CONCLUSION

24. www.google.com www.mayoclinic.com www.emedicine.com www.wikipedia.com www.ncbi.nlm.gov www.medicinet.com REFERENCES

25. ANY QUESTIONS?