1. GOUTY ARTHRITIS PRESENTED BY, JISMI MATHEW LINCY K OUSEPH MEENUPRIYA OONNANAL SMITHA V CHACKO VINEETHA MARY MATHEW

2. INTRODUCTION

3. DEFINITION SYNDROME OF ACUTE ATTACKS OF ARTHRITIS CAUSED BY HYPERURICAEMIA. (Brown & Edwards, 2009)

4. TYPES OF GOUT PRIMARY GOUT SECONDARY GOUT

5. CAUSES INCREASE URIC ACID PRODUCTION UNDER- EXCRETION OF URIC ACID BY THE KIDNEYS INCREASED INTAKE OF FOODS CONTAINING PURINES

6. 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

7. PATHOPHYSIOLOGY(Lehne, 2009) INCREASED PURINE SYNTHESIS DECREASED RENAL EXCRETION HYPERURICAEMIA CRYSTALLIZATION OF SODIUM URATE IN THE SYNOVIAL SPACE INFLAMMATION

8. PATHOPHYSIOLOGY

9. GOUT AND GOUTY ARTHRITIS

10. TOPHACEOUS GOUT

11. TOPHACEOUS GOUT - HANDS

12. TOPHACEOUS GOUT – GREAT TOE

13. DIAGNOSTIC TESTS SERUM ACID LEVELS 24 HOUR URINE SPECIMEN SYNOVIAL FLUID ASPIRATION JOINT ASPIRATION X - RAY

14. COMPLICATIONS URIC ACID KIDNEY STONES HYPERTRIGLYCERIDAEMIA HYPERTENSION

15. CASE STUDY

16. PERSONAL DETAILS 57 YEAR OLD MAN RECENT IMMIGRANT FROM A FOREIGN COUNTRY

17. PAST HISTORY REPEATED ATTACKS OF JOINT PAIN

18. PRESENT HISTORY INCREASE IN SIZE OF A NODULE ON HIS ELBOW

19. 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

20. 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.

21. 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.

22. CHRONIC GOUTY ARTHRITIS

23. COMPICATIONS RENAL NEUROPATHY

24. TREATMENT COLLABORATIVE CARE DRUG THERAPY NUTRITIONAL THERAPY

25. 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

26. COLLABORATIVE THERAPY JOINT IMMOBILISATION LOCAL APPLICATION OF HEAT OR COLD JOINT ASPIRATION INTRA – ARTICULAR CORTICOSTEROIDS

27. DRUG THERAPY NON – STEROIDAL AND ANTI – INFLAMMATORY DRUGS COLCHINE PROBENECID ALLOPURINOL

28. COLCHICINE

29. ACTION ANTI – INFLAMMATORY AGENT

30. SIDE EFFECTS NAUSEA ABDOMINAL PAIN VOMITING GI TOXICITY

31. CONTRA - INDICATIONS PREGNANCY CARDIAC, RENAL AND GI DISEASES

32. NURSING RESPONSIBILITIES WATCH FOR COMPLICATIONS; SEIZURES, BONE MARROW SUPPRESSION WATCH FOR GI TOXICITY

33. ALLOPURINOL

34. ACTION TREAT CHRONIC TOPHACEOUS GOUT PREVENT NEPHROPATHY

35. SIDE EFFECTS HYPERSENSTIVITY SYNDROME; RASH, FEVER, EOSINOPHILIA AND DYSFUNCTION OF THE LIVER AND KIDNEYS. GI REACTIONS NEUROLOGIC EFFECTS

36. CONTRA - INDICATION PREGENANCY

37. NURSING RESPONSIBILITY WATCH FOR ANY SIDE EFFECTS MONITOR SERUM URIC ACID LEVELS

38. PROBENECID

39. ACTION INHIBIT REABSORPTION OF URIC ACID

40. SIDE EFFECTS GI EFFECTS HYPERSENSTIVITY RECTIONS RENAL INJURY

41. CONTRA - INDICATIONS RENAL DISEASE PREGNANCY

42. NURSING MANAGEMENT WATCH FOR COMPLICATIONS AND SIDE EFFECTS.

43. ADVANCES IN TECHNOLOGY ALSO KNOWN AS ‘ ULORIC ‘ APPROVED IN 2009 ACTION SAME AS ALLOPURINOL FEBUXOSTAT

44. SIDE EFFECTS LIVER ABNOMALITIES NAUSEA ARTHRALGIA RASH

45. NUTRITIONAL THERAPY WEIGHT REDUCTION PROGRAM DIETARY AVOIDANCE OF FOOD / FLUIDS WITH HIGH PURINE CONTENT eg; ANCHOVIES, LIVER, WINE, BEER ETC

46. 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

47. HEALTH EDUCATION EDUCATE THE CLIENT AND FAMILY MEMBERS ABOUT DRUGS AND ITS SIDE EFFECTS. EDUCATE THE CLIENT TO AVOID ALCOHOL. EDUCATE THE CLIENT TO AVOID PURINE RICH DIET. EDUCATE THE CLIENT ABOUT THE IMPORTANCE OF MONITORING URIC ACID LEVELS.

48. REFERENCES Brown, D & Edwards, H. (2009). Medical – Surgical nursing: Assessment and management of clinical problems. Sydney: Elsevier. Lehne, R. (2009). Pharmacology for nursing care. Sydney: Elsevier.