Gout Nursing Care Plans Diagnosis and Interventions
Gout NCLEX Review and Nursing Care Plans
Gout is one of the generally known but complicated forms of arthritis that cause inflammation to the joints.
It is a condition that features severe joint pain which is sudden in onset and is accompanied by tenderness and swelling.
It can affect any joint in the body such as in the elbows, knees, and ankles, but gout commonly involves the big toe.
Gout can affect anyone but it is usually seen in men above 40 years of age. Its symptoms may come and go, and attacks can happen abruptly.
In some cases, gout occurs in the middle of the night, causing sleep disturbance due to the sudden and painful sensation.
Signs and Symptoms of Gout
- Severe joint pain – the pain is at its worst during the first four to 12 hours after onset. It is often localized in the large joint of the big toe but it can also manifest in wrists, fingers, elbows, knees and ankles
- Recurring discomfort – gout attack often causes discomfort that lasts from a few days to a few weeks. Later episodes may also last longer than usual affecting more joints.
- Joint inflammation – the affected joint is swollen, feels warm and tender to the touch, with redness noted
- Limited range of motion – the progression of gout often causes difficulties in movement
Causes and Risk Factors of Gout
The body normally produces uric acid, a waste byproduct resulting from the breakdown of purine.
The uric acid then dissolves in the blood, passes through the kidneys and is finally excreted in the urine.
However, there are cases where the body produces excessive uric acid due to high intake of purine-rich foods like organ meats and foods that are high in uric acid such as sweetened drinks containing fructose, and alcoholic beverages like beer.
It can also be due to the inability of the kidneys to excrete uric acid.
Excessive amounts of uric acid begin to build up, causing the formation of sharp urate crystals in the joint and its surrounding tissues.
This leads to joint pain and inflammation.
These are the risk factors that increase the likelihood of developing gout:
- Family history of gout
- Age and Gender – gout commonly affects men between the ages of 30 to 50 and post-menopausal women
- Certain medication like thiazide diuretics and low-dose aspirin
- Diet -consuming foods that are rich in purine and uric acid
- Alcohol consumption
- Obesity -uric acid production increases with weight and may cause difficulties in the filtration of kidneys
- Certain medical conditions such as untreated hypertension, diabetes, metabolic diseases and disorders of the kidney
- Recent surgery or trauma
Complications of Gout
- Permanent joint damage. Chronic gout can cause complications and increases the risk for permanent joint damage. Recurrent gout can lead to joint erosion and destruction if not treated promptly.
- Kidney stones. Gout may also lead to the development of kidney stones due to the accumulation of urate crystals in the urinary tract.
- Tophi. If not treated gout can cause tophi, a condition wherein urates crystallize under the skin in the form of nodules. Joint pain and swelling worsen during gout attacks. The attacks vary per individual; some patients never experience severe symptoms while others can have recurrent attacks per year.
Diagnosis of Gout
- Joint fluid test -fluid from the joints is aspirated and examined to check for urine crystal
- Blood test- elevated uric acid and creatinine levels in the blood may indicate gout, but these are not confirmatory for diagnosis
- Imaging – X-ray of the joints; musculoskeletal ultrasound, which provides visualization of urate crystals in a tophus or a joint; dual energy CT scan, which detects urate crystal even in the absence of inflammation
Treatment of Gout
- Medications. Medication therapy is usually the most effective for the treatment of gout. These medications not only treat attacks but prevent it from recurring as well:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). It works by reducing inflammation and can be given at a higher dose during an acute attack. These drugs must always be taken with meals since they increase the risk for stomach ulcers.
- Analgesics. Pain relievers are specifically used to effectively relieve joint pain brought about by gout.
- Corticosteroids. These control joint pain and inflammation and are given for people unable to tolerate NSAIDs. They can be given orally or injected directly into the affected joint.
- Xanthine oxidase inhibitors (XOIs). These block and limit production of uric acid. The side effects include low blood counts and rash.
- Uricosurics. These drugs work by increase the kidney’s ability to excrete uric acid but may cause elevated uric acid in the urine. They may cause the same effects with the xanthine oxidase inhibitors or XOIs.
- Lifestyle and dietary changes. Lifestyle modification, such as limiting alcohol consumption, also plays a huge role in treating gout. There are also recommended dietary choices like eating berries and consuming vitamin C supplements. However, it is best to observe caution when incorporating these into the diet and a referral to the dietitian is recommended.
Nursing Diagnosis for Gout
Nursing Care Plan for Gout 1
Nursing Diagnosis: Pain related to joint inflammation secondary to gout, as evidenced by pain score of 10 out of 10, guarding sign on the affected joints, restlessness, and irritability
Desired Outcome: The patient will report a pain score of 0 out of 10.
| Gout Nursing Interventions | Rationales |
| Assess the patient’s vital signs. Ask the patient to rate the pain from 0 to 10, and describe the pain he/she is experiencing. | To create a baseline set of observations for the patient. The 10-point pain scale is a globally recognized pain rating tool that is both accurate and effective. |
| Administer analgesics/ pain medications as prescribed. Administer other prescribed medications for gout. | To provide pain relief to the patient. The medications for gout include: Nonsteroidal anti-inflammatory drugs (NSAIDs) – to reduce inflammation and relieve pain Steroids – to slow down the damage of the joints, reducing inflammation and pain Xanthine oxidase inhibitors (XOIs) – block and limit production of uric acid. The side effects include low blood counts and rash Uricosurics – work by increase the kidney’s ability to excrete uric acid but may cause elevated uric acid in the urine |
| Ask the patient to re-rate his/her pain 30 minutes to an hour after administering the analgesic. | To assess the effectiveness of treatment. |
| Provide more analgesics at recommended/prescribed intervals. | To promote pain relief and patient comfort without the risk of overdose. |
| Reposition the patient in his/her comfortable/preferred position. Encourage pursed lip breathing and deep breathing exercises. | To promote optimal patient comfort and reduce anxiety/ restlessness. |
| Refer the patient to a pain specialist as required. | To enable to patient to receive more information and specialized care in pain management if needed. |
Nursing Care Plan for Gout 2
Nursing Diagnosis: Activity intolerance related to joint inflammation and pain secondary to gout, as evidenced by pain score of 8 to 10 out of 10, fatigue, disinterest in ADLs due to pain, verbalization of tiredness and generalized weakness
Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.
| Gout Nursing Interventions | Rationales |
| Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try. | To create a baseline of activity levels and mental status related to acute pain, fatigue and activity intolerance. |
| Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest. | To gradually increase the patient’s tolerance to physical activity. To prevent triggering of acute pain by allowing the patient to pace activity versus rest. |
| Administer analgesics as prescribed prior to exercise/ physical activity. Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room. | To provide pain relief before an exercise session. To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room. |
| Refer the patient to physiotherapy / occupational therapy team as required. | To provide a more specialized care for the patient in terms of helping him/ her build confidence in increasing daily physical activity. |
Nursing Care Plan for Gout 3
Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to decrease food intake secondary to acute pain as evidenced by weight loss, poor muscle tone and lack of appetite
Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices in relation to diagnosis.
| Gout Nursing Interventions | Rationale |
| Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term goals of weight gain. | To effectively monitory the patient’s daily nutritional intake and progress in weight goals. |
| Administer analgesics as prescribed. | To provide pain relief, as acute pain may result to disinterest in eating and eventual lack of proper nutrition. |
| Instruct the patient to avoid carbonated beverages and gas-producing food, and limit alcohol consumption. | To reduce abdominal distention which can worsen acute pain. Alcoholic drinks can worsen gout. |
| Encourage the patient to eat berries and take vitamin C supplements, if not contraindicated. | To lower serum uric acid levels. |
| Refer the patient to the dietitian. | To provide a more specialized care for the patient in terms of nutrition and diet. |
More Gout Nursing Diagnosis
- Risk for Fracture
- Risk for Fall
- Fatigue
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020).Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022).Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020).Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020).Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
Disclaimer:
Please follow your facilities guidelines and policies and procedures.
The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.
This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.
FAQs
What is a nursing diagnosis in nursing care plan? ›
The nursing diagnosis is the nurse's clinical judgment about the client's response to actual or potential health conditions or needs.
What are 5 nursing diagnosis? ›- Anxiety.
- Constipation.
- Pain.
- Activity Intolerance.
- Impaired Gas Exchange.
- Excessive Fluid Volume.
- Caregiver Role Strain.
- Ineffective Coping.
Instruct the patient to avoid carbonated beverages and gas-producing food, and limit alcohol consumption. To reduce abdominal distention which can worsen acute pain. Alcoholic drinks can worsen gout. Encourage the patient to eat berries and take vitamin C supplements, if not contraindicated.
How do you write a nursing diagnosis for Nanda? ›A nursing diagnosis has typically three components: (1) the problem and its definition, (2) the etiology, and (3) the defining characteristics or risk factors (for risk diagnosis). BUILDING BLOCKS OF A DIAGNOSTIC STATEMENT. Components of an NDx may include problem, etiology, risk factors, and defining characteristics.
Which is the best example of a nursing diagnosis? ›Which is the best example of a nursing diagnosis? Ineffective Breastfeeding related to latching as evidenced by non-sustained suckling at the breast. The formulation of nursing diagnoses is unique to the nursing profession.
What are the 3 types of nursing diagnosis? ›There are 4 types of nursing diagnoses: risk-focused, problem-focused, health promotion-focused, or syndrome-focused.
How do you write a nursing diagnosis risk? ›The correct statement for a NANDA-I nursing diagnosis would be: Risk for _____________ as evidenced by __________________________ (Risk Factors). Risk Diagnosis Example: Risk for infection as evidenced by inadequate vaccination and immunosuppression (risk factors).
What is potential nursing diagnosis? ›PES = Problem related to the Etiology (cause) as evidenced/manifested by the Signs and Symptoms (defining characteristics). Potential Nursing Diagnosis/Risk (2-part) PE = Potential problem related to the Etiology (cause). There are no signs and symptoms, because the problem has not occurred yet.
What are complications of gout? ›When you have chronic gout, you have swelling in your joints regularly. Chronic inflammation and tophi can lead to permanent joint damage, deformity, and stiffness. In the worst cases of chronic gout, you may need surgery to fix joint damage, or replace joints.
What kind of disease is gout? ›Gout is a common and complex form of arthritis that can affect anyone. It's characterized by sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints, most often in the big toe.
What symptoms does gout cause? ›
Symptoms of gout
the joint feeling hot and very tender, to the point of being unable to bear anything touching it. swelling in and around the affected joint. red, shiny skin over the affected joint. peeling, itchy and flaky skin as the swelling goes down.
NANDA-I recognizes four categories of nursing diagnoses: problem focused diagnosis, risk diagnosis, health promotion diagnosis, and syndrome.
What is Priority nursing diagnosis? ›Any nursing diagnoses that directly relate to survival or a threat to the patient's mortality should be prioritized first. This may be related to the patient's access to air, water, or food, defined as the necessities of survival.
When developing a nursing diagnosis for a client what should the nurse do first? ›Step 1: Data Collection or Assessment
A client database includes all the health information gathered. In this step, the nurse can identify the related or risk factors and defining characteristics that can be used to formulate a nursing diagnosis.
Diagnoses. Commonly used NANDA-I nursing diagnoses for pain include Acute Pain (duration less than 3 months) and Chronic Pain.
Can a nurse diagnose a patient? ›A nurse making a diagnosis must be working under strict protocol or direct supervision of a physician. Any other diagnosis made by a nurse constitutes the unauthorized practice of medicine. The term nursing diagnosis is often used as the title of a nursing care plan.
How long does it take to write a nursing care plan? ›average time to write up a careplan? 4 hours. It takes me what seems like forever. It takes me about 2 hours to do the prelabbing part of it (meds, labs, etc) and about 2 hours to write up the the other part (Gordon's, nursing dx, etc).
What is written in a care plan? ›Care plans explained: What they include and why they are important. If you need support, a care plan is a document that specifies your assessed unique individual needs and outlines what type of support you should get, how the support will be given, as well as who should provide it.
What are the 4 key steps to care planning? ›- Patient assessment. Patient identified goals (e.g. walking 5km per day, continue living at home) ...
- Planning with the patient. How can the patient achieve their goals? ( ...
- Implement. ...
- Monitor and review.
The three main components of a nursing diagnosis are: Problem and its definition. Etiology or risk factors. Defining characteristics or risk factors.
Which description correctly defines a nursing diagnosis? ›
The nursing diagnosis is the nurse's clinical judgment about the client's response to actual or potential health conditions or needs.
What is the purpose of establishing a nursing diagnosis? ›"a clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group or community. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability."
What is the difference between medical diagnosis and nursing diagnosis? ›What is the difference between a medical diagnosis and a nursing diagnosis? A medical diagnosis deals with disease or medical condition. A nursing diagnosis deals with human response to actual or potential health problems and life processes.
What is Priority nursing diagnosis? ›Any nursing diagnoses that directly relate to survival or a threat to the patient's mortality should be prioritized first. This may be related to the patient's access to air, water, or food, defined as the necessities of survival.
What are the 5 components of nursing care plan? ›The nursing process functions as a systematic guide to client-centered care with 5 sequential steps. These are assessment, diagnosis, planning, implementation, and evaluation.
What is as evidenced by for a nursing diagnosis? ›A risk nursing diagnosis should be supported by evidence of the patient's risk factors for developing that problem. Different experts recommend different phrasing. NANDA-I 2018-2020 recommends using the phrase “as evidenced by” to refer to the risk factors for developing that problem.
Can a nurse diagnose a patient? ›A nurse making a diagnosis must be working under strict protocol or direct supervision of a physician. Any other diagnosis made by a nurse constitutes the unauthorized practice of medicine. The term nursing diagnosis is often used as the title of a nursing care plan.
Is pain a priority nursing diagnosis? ›The 2nd priority needs include MAAUAR which is mental status, acute pain, acute impaired urinary elimination, unresolved and unaddressed needs, abnormal diagnostic test results, and risks.
Is pain a nursing diagnosis? ›Diagnoses. Commonly used NANDA-I nursing diagnoses for pain include Acute Pain (duration less than 3 months) and Chronic Pain.
When developing a nursing diagnosis for a client what should the nurse do first? ›Step 1: Data Collection or Assessment
A client database includes all the health information gathered. In this step, the nurse can identify the related or risk factors and defining characteristics that can be used to formulate a nursing diagnosis.
What are the 5 stages of the nursing process? ›
- Assessment phase.
- Diagnosis phase.
- Planning phase.
- Implementing phase.
- Evaluation phase.
A working definition of nursing diagnosis was adopted by the North American Nursing Diagnosis Association (NANDA) Biennial Business Meeting in March 1990.
What is an example of a medical diagnosis? ›For example, a definitive diagnosis of cancer is made via tissue examination by a pathologist. Principal diagnosis. The single medical diagnosis that is most relevant to the patient's chief complaint or need for treatment. Many patients have additional diagnoses.
What are the steps in making a clinical diagnosis? ›- taking an appropriate history of symptoms and collecting relevant data.
- physical examination.
- generating a provisional and differential diagnosis.
- testing (ordering, reviewing, and acting on test results)
- reaching a final diagnosis.
- consultation (referral to seek clarification if indicated)
The correct statement for a NANDA-I nursing diagnosis would be: Risk for _____________ as evidenced by __________________________ (Risk Factors). Risk Diagnosis Example: Risk for infection as evidenced by inadequate vaccination and immunosuppression (risk factors).