Gout attack (acute or chronic) nursing lecture on the symptoms, treatment, diet, and pharmacology review for the NCLEX exam.

Gout is a type of arthritis due to the accumulation of uric acid in the blood. Symptoms of gout are due to uric acid crystals that form within the joint that leads to severe pain, redness, and limited mobility.

Acute gout attacks happen suddenly (often waking the patient in the middle of the night) and tends to affect the big toe (knee, elbow, fingers, toe can also be affected). The affected joint will present with swelling, inflammation, and severe pain. The site will also be warm to the touch, and the patient will be unable to tolerate even the slightest pressure on the site.

Chronic gout is due to constant elevated uric acid levels that leads to repeated acute gout attacks. In chronic gout, tophi tend to develop. Tophi are large masses of uric acid crystals that have formed into large clumps. They are white/yellowish nodules that can found under the skin (helix of the ear, fingers, elbow etc.), within the joints, or bones. Tophi can lead to bone deformity and joint damage.

Patients with gout are educated to follow a diet that is low in purines, alcohol, and high fructose corn syrup drinks. Food high in purines include seafood, organ meats, red meat, and alcohol (especially beer).

Nursing interventions for gout include: keeping the patient hydrated with 2-3 liter of fluid per day (prevent renal stones and keep uric acid level low), monitor joint's status of redness and swelling, cold/warm compresses as tolerated, administering anti-gout medications.

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