Gout: Nursing process (ADPIE)

Hubert Symanski is a 49-year-old male client with a history of Type 2 diabetes mellitus who presents to the clinic today with severe pain in the big toe of his right foot.

He explains that when he woke up this morning his toe was red, swollen and felt like it was on fire. He denies any recent injury to his toe or foot.

Walking around the house and putting on shoes is very painful, and the only shoes he can comfortably put on are sandals.

He reports that he had an episode of gout a year ago, confirmed by joint aspiration, and he is concerned that this may be another episode.

Gout is an inflammatory disease in which urate crystals deposit in a joint and cause damage.

Typically, the underlying cause is hyperuricemia, or too much uric acid, also known as urate, in the blood.

Uric acid is a natural waste product of purines, which are one of the building blocks of DNA and RNA.

Once produced, uric acid circulates in the bloodstream before it is filtered out and excreted by the kidneys to the urine.

Now, hyperuricemia is associated with several risk factors.

An important risk factor is overproduction of purines, which is most common with increasing age, male sex, obesity, and alcohol use.

Overproduction of purines can also occur with increased consumption of purine-rich foods such as shellfish, alcohol, anchovies, and red meat, as well as high-fructose corn syrup containing beverages such as sodas.

Hyperuricemia can also result when cells die at a faster than normal rate, resulting in increased breakdown of purines into uric acid, for instance as a result of chemotherapy, radiation treatment, as well as recent trauma or surgery.

In addition, some individuals have a genetic predisposition to developing hyperuricemia, so an important risk factor is family history.

Finally, hyperuricemia can also occur when there’s reduced excretion of uric acid by the kidney, which can result from dehydration, diabetes, chronic kidney disease, and medications like thiazide diuretics or aspirin.