Transcript 34_Disorders of nucleotides metabolism-

NURSING CLIENT WITH MUCOSKELETAL
AND AUTOIMMUNE DISORDER AND
GERONTOLOGY NURSING.
GOUT
INTRODUCTION
To better understand gout, it helps to understand the anatomy of the joints
A joint is a union between two
bones.
Have cartilage
Joint
The joint allows the ends of the
bones to move against one
another.
Have a synovial fluid
Have a ligaments
WHAT IS GOUT???
Do you have experience of GOUT???
Or anybody at your family have this disease???
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
Medical
conditions
Lifestyle
RISK
FACTOR
Age and Sex
Family History
ETIOLOGY
Primary Gout
(Hereditary)
Classification causes of
Gout
Secondary Gout
(internal/external factors,
e.g. diet, kidney
problems, obesity)
Etiology c0nt.
Genetic tendency
Overindulgence in
alcohol
Over weight
(Obese)
Excessive urine acid
in the blood
Medication
Kidney disease
A high dietary intake
of purine, alcohol
intake
increased purine
synthesis, decreased
renal excretion
Increase uric acid in
the blood
(hyperuricemia)
PATHOPHYSIOLOGY
Deposition of uric
acid into the joints
GOUT
Diagnostic Test
Medical History and
Physical Examination
Test to measure levels
of uric acid in blood
Diagnostic Test con’t
Test to measure levels
of uric acid in urine
Extremity X-ray
Diagnostic Test con’t
Joint fluid analysis
Medical treatment
Colchicine
(Colcrys)
•Comes in a tablet to take by mouth.
•Side effect: Mild nausea, stomach pain and mild diarrhea
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 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
Medical Treatment con’t
Febuxostat
(Uloric)
• Is recommended at 40 mg or 80 mg once daily (tablet)
• Side effect: nausea, diarrhea, headache and rash
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.
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
Complication
Recurrent gout
Advanced gout
Tophi
Joint damage
Kidney damage
Kidney stone
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.
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.
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.
Health Education
Avoid or Limit alcohol
consumption
Do the moderate daily exercise
Limit meat and seafood intake
Drink at least 6 to 8 glasses of
water each day.
Avoid fatty foods
Take the prescribed medication
and follow doctor`s order
Eats enough carbohydrate
Avoid or Limit alcohol
consumption
CONCLUSION
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.