GOUTY ARTHRITIS PRESENTED BY, JISMI MATHEW LINCY K OUSEPH MEENUPRIYA OONNANAL SMITHA V CHACKO VINEETHA MARY MATHEW
INTRODUCTION
DEFINITION SYNDROME OF ACUTE ATTACKS OF ARTHRITIS CAUSED BY HYPERURICAEMIA. (Brown & Edwards, 2009)
CAUSES INCREASE URIC ACID PRODUCTION UNDER- EXCRETION OF URIC ACID BY THE KIDNEYS INCREASED INTAKE OF FOODS CONTAINING PURINES
TYPES OF GOUT PRIMARY GOUT SECONDARY GOUT
AETIOLOGY (Brown & Edwards, 2009) ACIDOSIS OR KETOSIS ALCOHOLISM DIABETES MELLITUS HYPERTENSION OBESITY OR STARVATION RENAL DISEASE SICKLE CELL ANAEMIA USE OF CERTAIN COMMON DRUGS MALIGNANT DISEASE
PATHOPHYSIOLOGY(Lehne, 2009) INCREASED PURINE SYNTHESIS DECREASED RENAL EXCRETION HYPERURICAEMIA CRYSTALLIZATION OF SODIUM URATE IN THE SYNOVIAL SPACE INFLAMMATION
CASE STUDY
PERSONAL DETAILS 57 YEAR OLD MAN RECENT IMMIGRANT FROM A FOREIGN COUNTRY
PAST HISTORY REPEATED ATTACKS OF JOINT PAIN
PRESENT HISTORY INCREASE IN SIZE OF A NODULE ON HIS ELBOW
CLINICAL MANIFESTATIONS GOUT CLIENT JOINT PAIN AFFECTED JOINTS; CLUSKY, CYANOTIC AND TENDER INFLAMMATION OF THE GREAT TOE DEPOSITS OF SODIUM URATE CRYSTALS CALLED TOPHI PRESENT ABSENT PRESENT
PHYSICAL EXAMINATION ARTHRITIS ON BOTH HANDS. TENDER AND RUBBERY SUBCUTANEOUS NODULE OVER THE ELBOW. SUBCUTANEOUS NODULE AT THE LEFT METATARSAL – PHALENGEAL JOINT AND LEFT METACARPAL – PHALENGEAL JOINT.
DIAGNOSTIC TESTS SERUM ACID LEVELS 24 HOUR URINE SPECIMEN SYNOVIAL FLUID ASPIRATION JOINT ASPIRATION X - RAY
X – RAY FINDINGS CLASSIC ‘ PUNCHED OUT ‘ LYTIC LESION AT DISTAL RIGHT FIRST METATARSAL. MARGINAL EROSIONS AND DECREASED JOINT SPACE AT META – CARPAL AND PHALENGEAL JOINTS. SUBCUTANEOUS NODULE (GOUTY TOPHUS ) AT FIRST METACARPAL – PHALENGEAL AND LEFT FIRST METATARSAL – PHALENGEAL JOINTS.
TREATMENT COLLABORATIVE CARE DRUG THERAPY NUTRITIONAL THERAPY
COLLABORATIVE CARE GOALS TERMINATION OF AN ACUTE ATTACK BY ANTI- INFLAMMATORY AGENTS PREVENTION OF FUTURE ATTACKS – USE OF ALLOPURINOL AVOIDANCE OF ALCOHOL AND FOOD HIGH IN PURINE PREVENTION OF COMPLICATIONS
COMPLICATIONS URIC ACID KIDNEY STONES HYPERTRIGLYCERIDAEMIA HYPERTENSION
COLLABORATIVE THERAPY JOINT IMMOBILISATION LOCAL APPLICATION OF HEAT OR COLD JOINT ASPIRATION INTRA – ARTICULAR CORTICOSTEROIDS
DRUG THERAPY NON – STEROIDAL AND ANTI – INFLAMMATORY DRUGS COLCHINE PROBENECID ALLOPURINOL
COLCHICINE
ACTION ANTI – INFLAMMATORY AGENT
SIDE EFFECTS NAUSEA ABDOMINAL PAIN VOMITING GI TOXICITY
CONTRA - INDICATIONS PREGNANCY CARDIAC, RENAL AND GI DISEASES
NURSING RESPONSIBILITIES WATCH FOR COMPLICATIONS; SEIZURES, BONE MARROW SUPPRESSION WATCH FOR GI TOXICITY
ALLOPURINOL
ACTION TREAT CHRONIC TOPHACEOUS GOUT PREVENT NEPHROPATHY
SIDE EFFECTS HYPERSENSTIVITY SYNDROME; RASH, FEVER, EOSINOPHILIA AND DYSFUNCTION OF THE LIVER AND KIDNEYS. GI REACTIONS NEUROLOGIC EFFECTS
CONTRA - INDICATION PREGENANCY
NURSING RESPONSIBILITY WATCH FOR ANY SIDE EFFECTS MONITOR SERUM URIC ACID LEVELS
PROBENECID
ACTION INHIBIT REABSORPTION OF URIC ACID
SIDE EFFECTS GI EFFECTS HYPERSENSTIVITY RECTIONS RENAL INJURY
CONTRA - INDICATIONS RENAL DISEASE PREGNANCY
NURSING MANAGEMENT WATCH FOR COMPLICATIONS AND SIDE EFFECTS.
NUTRITIONAL THERAPY WEIGHT REDUCTION PROGRAM DIETARY AVOIDANCE OF FOOD / FLUIDS WITH HIGH PURINE CONTENT eg; ANCHOVIES, LIVER, WINE, BEER ETC
NURSING MANAGEMENT NURSING INTERVENTION IMPLEMENTATION SUPPORTIVE CARE OF THE INFLAMED JOINTS AVOID CAUSING PAIN TO THE INFLAMMED JOINT HEALTH EDUCATION BED REST JOINT IMMOBILISATION USE OF BED CRADLES IMPORTANCE OF DRUG THERAPY AVOIDANCE OF PERCIPITATING FACTORS