Page 2129 - Saunders Comprehensive Review For NCLEX-RN

4. Chronic: Results from repeated episodes of acute gout
a. Results in deposits of urate crystals
under the skin
b. Results in deposits of urate crystals
within major organs, such as the
kidneys, leading to organ dysfunction
C. Assessment

1. Swelling and inflammation of the joints,

leading to excruciating pain
2. Tophi: Hard, irregularly shaped nodules in the skin
containing chalky deposits of sodium urate
3. Low-grade fever, malaise, and headache
4. Pruritus from urate crystals in the skin
5. Presence of renal stones from elevated uric acid levels
D. Interventions
1. Provide a low-purine diet as prescribed, avoiding
foods such as organ meats, wines, and aged cheese.
2. Encourage a high fluid intake of 2000 mL/day to
prevent stone formation.
3. Encourage a weight reduction diet if required.
4. Instruct the client to avoid alcohol and starvation
diets, because they may precipitate a gout attack.
5. Increase urinary pH (above 6) by eating alkaline ash
foods (i.e., green beans, broccoli).
6. Provide bed rest during acute attacks, with the
affected extremity elevated.
7. Monitor joint range-of-motion ability and appearance
of joints.
8. Position the joint in mild flexion during acute attack.
9. Protect the affected joint from excessive movement or
direct contact with sheets or blankets.
10. Provide heat or cold for local treatments to affected
joint as prescribed.
11. Administer medications such as analgesic,
antiinflammatory, and uricosuric agents as
prescribed.

Table 60-1

Types of Joints

Type Description
Amphiarthrosis Cartilaginous joint
Slightly movable
Diarthrosis Synovial joint
Ball-and-socket joint
Permit free movement
Synarthrosis Fibrous or fixed joint

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