Gout

Gout

Category / Primary Body System

• Musculoskeletal System

Problem

• Patient is at risk of complications due to gout.

Goal

• Patient will be free of signs and symptoms of acute gout flare-ups for the next 90 days.

Plan/Approach

1. Monitoring and Assessment

   • Monitor for signs and symptoms of gout including pain in the great toe (most common), difficulty with weight bearing, and swelling.

2. Medication Management

   • Administer medications as ordered to manage gout and prevent flare-ups.

3. Laboratory Tests

   • Check labs as ordered to monitor uric acid levels and kidney function.

4. Comfort and Positioning

   • Reposition for comfort as needed to alleviate pressure on affected joints.
   • Provide a foot cradle during acute flares to keep bed linens off the foot.

5. Pain Management

   • Actively intervene for pain during a gout flare and notify the MD if a flare is suspected.
   • Apply cool packs to affected joints as needed for pain relief.

6. Dietary Management

   • Encourage avoidance of high-purine foods including bullion, broth, gravies, meat extracts, organ meats, shrimp, mackerel, dried legumes, lentils, and baker’s or brewer’s yeast.

7. Education and Support

   • Provide patient and family with teaching and support regarding gout management and dietary modifications.

Rationale

1. Monitoring and Assessment

   • Early detection of symptoms allows for prompt intervention and management, reducing the risk of severe complications.

2. Medication Management

   • Proper administration of medications can help control uric acid levels and prevent gout flare-ups.

3. Laboratory Tests

   • Monitoring labs helps ensure effective management of gout and early detection of potential issues related to kidney function.

4. Comfort and Positioning

   • Proper positioning can alleviate pain and prevent further irritation of affected joints.

5. Pain Management

   • Effective pain management improves patient comfort and facilitates mobility.

6. Dietary Management

   • Avoiding high-purine foods helps reduce uric acid levels, thereby preventing gout flare-ups.

7. Education and Support

   • Providing information and support empowers the patient and family to effectively manage gout and adhere to treatment plans.

Actions

1. Monitoring and Assessment

   • Observe and document signs and symptoms of gout daily, focusing on pain, swelling, and difficulty with weight bearing.

2. Medication Management

   • Administer prescribed medications on schedule and monitor for effectiveness and side effects.

3. Laboratory Tests

   • Draw and monitor lab tests as ordered, reporting results to the healthcare team.

4. Comfort and Positioning

   • Reposition the patient as needed to ensure comfort and reduce joint pressure.
   • Use a foot cradle during acute flares to keep bed linens off the affected foot.

5. Pain Management

   • Apply cool packs to affected joints as needed for pain relief.
   • Notify the MD immediately if a flare is suspected and manage pain accordingly.

6. Dietary Management

   • Educate the patient on avoiding high-purine foods and provide dietary guidance to support adherence.

7. Education and Support

   • Offer teaching sessions for the patient and family on gout management, including lifestyle modifications and medication adherence.
   • Provide written materials and resources for further learning and support.