Gout

• Gout a disorder of purine metabolism, characterized by HIGH levels of uric acid in the blood and in the urine
• Gout

  Tophi - urate crystals in the joints
• Gout

  Occurs most often: males, familial
• Gout Clinical Manifestations

  • Joint pain, redness, heat, swelling; great/big toe and ankle are most commonly affected
  • Headache, malaise, anorexia
  • Tachycardia, fever, tophi in the great toe, outer ear, hands and feet
  • Complication: Renal Calculi
  • Podagra - gout of the foot especially big toe; attack notably cold at night; Mgt: bed cradle
• Acute Attack Gout Drug Therapy

  • DOC: Colchicine - discontinue if diarrhea or nausea and vomiting occur
  • or NSAIDS - Indocin, Butazolidin
• Prevention Gout Drug Therapy

  • Probenecid, Anturane - uricosuric agents, increase excretion of uric acid in the urine
  • Allopurinol - inhibits uric acid formation; WOF: Visual Changes
• Nursing Interventions in Antigout Medications

  Antigout medications should be used CAUTIOUSLY in clients with gastrointestinal, renal, cardiac or hepatic diseases
• Nursing Interventions in Antigout Medications

  Maintain a fluid intake of at least 2000 to 3000 ml a day to avoid kidney stones
• Nursing Interventions in Antigout Medications

  Instruct client to AVOID alcohol and caffeine as they can increase uric acid level
• Nursing Interventions in Antigout Medications

  AVOID purine - rich foods (caffeine, alcohol, organ meats, sardines, salmon, scallops and gravy)
• Nursing Interventions in Antigout Medications

  Instruct client to take medications with food to prevent GI irritation
• Nursing Interventions in Antigout Medications

  Instruct client to AVOID large doses of Vitamin C while taking Allopurinol to prevent kidney stones
• Nursing Interventions in Antigout Medications

  NEVER take ASA with antigout medications to prevent gout attack
• Nursing Interventions in Antigout Medications

  Allopurinol may increase the effect of Warfarin and OHA