Mr. R, a 42-year-old, is seen in a primary care clinic for a painful and swollen...

Mr. R, a 42-year-old, is seen in a primary care clinic for a painful and swollen toe. The healthcare provider diagnoses Mr. R with gout after bloodwork reveals he has hyperuricemia. Mr. R has the following questions: Why do I have gout, and what is gout? Will I have this for the rest of my life? What is the treatment plan for gout? As the nurse, how will you respond appropriately to each of Mr. R’s questions? What type of education can you give him as the nurse in this situation? *Please provide reference(s)

Expert Solution

1. ANS: Gout is an inflammatory joint disease which develops as a result of high uric acid levels. This can be caused by a metabolic abnormality which causes the body to make too much uric acid, or prevents the body excreting uric acid. Diseases such as renal failure may also lead to the development of gout. Alternatively, the disease may be caused by a diet rich in foods that are high in purine, a component of nucleic acids. Gout is divided into two types. They are

A. Primary gout is an inborn error of metabolism due to overproduction of uric acid.It is mostly related in increase in synthesis of purine nucleotides.

B. secondary gout is due to various diseases causing increase or decrease excretion of uric acid.

2. ANS: Potentially - can mitigate risk of attacks, but always at risk for subsequent acts & eventually chronic gout

3. ANS: Treatment plan for gout:

The drug of choice for primary gout is allopurinol,which competitively inhibits the enzyme xanthine oxidase.this type of inhibition is referred as SUICIDE INHIBITION.

Inhibition of xanthine oxidase by allopurinol leads to accumulation of hypoxanthine and xanthine,which are more soluble than uric acid.

Besides the drug therapy,

Control and restriction of dietary intake of purines and alcohol.

Consumption of plenty of water.

4. ANS: Patient education in gout:

Diet - low purine (cause the highest: beer, meat, shellfish, sea food)hydration; weight loss. The patients with gout have a diet which is distinctive in quality or quantity a careful diet was mostly preffered. The average daily intake of most nutrients, including total purine nitrogen, was similar except that the patients with gout drank significantly more alcohol. Beer was the most popular beverage, and 25 (41%) of those with gout consumed more than 60 g alcohol daily. The heavy drinkers had a significantly higher intake of purine nitrogen, half of which was derived from beer. Though the effect of ingested purine on the blood uric acid is difficult to estimate, it probably was sufficient to have a clinical effect, augmenting the hyperuricaemic effect of alcohol itself.

References:

Khanna D, Khanna PP, Fitzgerald JD, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken) 2012; 64:1447.

Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken) 2012; 64:1431.

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