Acute gout

Nursing care plan & interventions
Katie Lehman, Michael Felix, Sheeva Morgan, Noemia
Pinheiro, Joyce Lee, Hilary Delamater, Braden Nguyen
 Assessment
 Diagnosis
 Interventions
 Outcomes
 Evaluations
Disease caused by the kidneys not clearing the uric acid out
of the blood stream. Uric acid is the end product of purines in
our diet. A large amount of purines in the diet are caused by
the consumption of red meat products. This causes
hyperuricemia (high levels of uric acid in the blood) which
initiates an inflammatory response in the joints. Urate crystals
deposit into the joints or subcutaneous tissues. The deposits
and inflammation causes “gouty arthritis.” Gouty arthritis may
appear the same as OA on X-ray. Urate crystal deposits can
also cause kidney stones as deposits build up in the kidneys.
Renal stones are 1,000x more common in PTs with gout.
Pain assessment,
Check vitals
Orthostatic hypotension
Check labs
 elevated WBCs
 calcium
 uric acid levels
Capillary refill
Nutritional status
Medication & supplements are you currently on?
Top 5 nursing diagnoses, prioritized
 Acute pain
 Risk for infection
 Risk for skin integrity
 Risk for immobility
 Distorted body image
 Knowledge deficit
Interventions Part 1
Teach pt about the medications he/she is
receiving and potential side effects
 Teach pt about foods known to increase
the incidence of gout episodes – including
cheeses, wine, alcohol, sardines, organ
meat, etc.
 Encourage client to notify physician if
treatments are not working or if an increase
in acute episodes of pain
 Monitor for s/s of complications
Interventions Part 2
Monitor for pain, pain scale 1-10, pain
radiating, what brings the pain, what relieves
the pain. Use of distraction props (IE: TV,
books, guided image).
Monitor lab values, edema, swelling, erythema
(redness and swelling) Tophi on great toe?
Rotate patient Q2hrs, use lift sheet, make sure
skin is dry and intact,
Monitor vitals signs for orthostartic
hypotension, fall precautions, assist to
bathroom (use call light), use assist devices.
Expected Outcomes
Pt will report minimal pain 1 hour after
pain medication is administered,
 Pt verbalizes understanding and
treatment of condition at discharge.
 Pt will verbalize specific gout nutrition
and diet at discharge.
 Pt will walk successfully with crutches
before discharge; pt will perform active
ROM a week after discharge
Goal met for acute pain: pt claims minimal
pain, with PO meds
Goal met for infection: pt took ATB and no
infection was acquired.
Goal met for skin integrity: pt is aware of S&S
of skin breakdown
Goal is met for immobility: pt is able to
withstand ambulating with little or no assisted
Goal is met for body image: pt will not
demonstrate depressionover diagnosis and Is
enrolled in gout counseling.
Wissmann, Jeanne. (2007). Adult
Medical- Surgical Nursing RN Edition
7.1.Assessment Technologies Institute,
 Ignatavicius, Donna D., & Workman, M.
Linda, (2010) Medical-Surgical Nursing,
St. Louis, Missouri: Saunders, Elsevier