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

5. TYPES OF GOUT PRIMARY GOUT SECONDARY GOUT

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. CASE STUDY

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

10. PAST HISTORY REPEATED ATTACKS OF JOINT PAIN

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

12. 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

13. 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.

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

15. 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.

16. TREATMENT COLLABORATIVE CARE DRUG THERAPY NUTRITIONAL THERAPY

17. 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

18. COMPLICATIONS URIC ACID KIDNEY STONES HYPERTRIGLYCERIDAEMIA HYPERTENSION

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

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

21. COLCHICINE

22. ACTION ANTI – INFLAMMATORY AGENT

23. SIDE EFFECTS NAUSEA ABDOMINAL PAIN VOMITING GI TOXICITY

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

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

26. ALLOPURINOL

27. ACTION TREAT CHRONIC TOPHACEOUS GOUT PREVENT NEPHROPATHY

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

29. CONTRA - INDICATION PREGENANCY

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

31. PROBENECID

32. ACTION INHIBIT REABSORPTION OF URIC ACID

33. SIDE EFFECTS GI EFFECTS HYPERSENSTIVITY RECTIONS RENAL INJURY

34. CONTRA - INDICATIONS RENAL DISEASE PREGNANCY

35. NURSING MANAGEMENT WATCH FOR COMPLICATIONS AND SIDE EFFECTS.

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

37. 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