1. Anna Pardue NS Methodist University

2.  As we known “Rich man’s disease.”  Inflammatory arthritis, a metabolic disorder that causes the deposition of uric acid crystals within joints and other tissues. (Pellico, 2013) Gillray, J. (2010, June 8). Punch Cures the Gout. [Web Photo] Retrieved from Pegs and 'Tails: https://pegsandtails.wordpress.com/2010/06/08/making-a-gout-stool-part-one/, (2015, April 26)

3.  Uric acid produces when body breaks down purines  Normally, uric acid dissolves in blood and passes through kidneys into urine  Uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue (Mayo Clinic, 2015)

4.  Metabolic syndrome  Dyslipidemia  Drugs (Diuretics, cyclosporine)  Foods in high in purine  Alcohol  High sugar contain foods (Pellico, 2013)  Hyperuricemia  Male  Age (between 40-60)  Chronic renal failure  HTN  Obesity  Diabetes (Pellico, 2013)

5.  Uric acid urinary  Gouty nephropathy  Tophi  Gouty arthritis  Excruciating pain  Inflammation  Redness, swelling (Pellico, 2013) Healthcare. (2015, April 26). What Causes Gout? [Web Photo] Retrieved from Healthcare-Online: http://www.healthcare-online.org/What- Causes-Gout.html, (2015, April 26)

6.  Inflammatory episodes: Ibuprofen or indomethacin with colchicine Corticosteroids or adrenocorticotropic hormone  Tophi formation: Allopurinol or Xanthine oxidase inhibitors  Hyperuricemia and urate: Probenecid (Benemid) or Sulfinpyrazone (Anturane) (Pellico, 2013)

7.  High concentration: Organ meats (Liver, kidney, brains, heart) sardines, herring, anchovies, sweetbreads, brains  Moderate amounts: Lentils, Asparagus, cauliflower, mushrooms, spinach  Very small amounts: Milk, cheese, eggs, butter, fats, nuts, peanut butter, coffee, tea, chocolate, sugars and sweets, refined cereals, spaghetti, macaroni, carbonated beverage, tapioca (Carroll Lutz et al., 2015)

8. BreakfastLunchDinner 1 cup whole grain unsweetened cereal or two pieces of whole grain toast with spread ½ cup skim or low fat milk 1 cup of strawberries 1 cup of coffee or fruit juice or 8oz water 2oz roasted or grilled chicken breast 1 pieces of whole grain roll with mustard 1 cup mixed green salad with balsamic vinegar and olive oil dressing ½ cup skim or low fat milk 8oz glass of water 3oz roasted or grilled salmon 1 cup roasted or steamed green beans ½ cup whole grain pasta with olive oil, lemon and pepper ½ cup low fat yogurt or 1 cup fresh melon 1 cup caffeine-free tea or 8oz glass of water (Mayo Clinic, 2015)

9.  Educate patient to avoid alcohol and foods that trigger gout  Educate patient to lose weight  Educate patient to drink plenty water (64 oz) to help flush uric acid  Rest the painful joint  Raise the painful joint so it’s at a level higher than patient’s heat (Pellico, 2013)

11.  Carroll Lutz, Erin Mazur, Nancy Litch. (2015). Nutrition and Diet Therapy. Philadelphia: F.A. Davis Company.  Linda Honan Pellico. (2013). Adult Health Medical-Surgical Nursing. Philadelphia: Lippincott Williams & Wilkins.  Mayo Clinic Staff. (April 11, 2015). Gout diet: What's allowed, what's not. Retrieved from: http://www.mayoclinic.org/healthy-lifestyle/nutrition- and-healthy-eating/in-depth/gout-diet/art-20048524