Scenario 1: Gout A 68-year-old obese male presents to the clinic with a 3-day history of fever with chills, and Lt. great toe pain that has gotten progressively worse. Patient states this is the first time that this has happened, and nothing has made it better and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief.

Scenario 1: Gout A 68-year-old obese male presents to the clinic with a 3-day history of fever with chills, and Lt. great toe pain that has gotten progressively worse. Patient states this is the first time that this has happened, and nothing has made it better and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief.

Scenario 1: Gout

A 68-year-old obese male presents to the clinic with a 3-day history of fever with chills, and Lt. great toe pain that has gotten progressively worse. Patient states this is the first time that this has happened, and nothing has made it better and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief.

HPI: hypertension treated with Lisinopril/HCTZ .

SH: Denies smoking. Drinking: “a fair amount of red wine” every week. General appearance: Ill appearing male who sits with his right foot elevated.

PE:  remarkable for a temp of 100.2, pulse 106, respirations 20 and BP 158/92. Right great toe (first metatarsal phalangeal [MTP]) noticeably swollen and red. Unable

to palpate to assess range of motion due to extreme pain. CBC and Complete metabolic profile revealed WBC 15,000 mm3 and uric acid 9.0 mg/dl.

Diagnoses the patient with acute gout.

Osteoporosis is a condition in which an individual’s bone is brittle. This is due to the bone unable to keep up with the process of new bone formation in balance with bone mineral removal. There are many risks involved with having this disease process such as easy fractures, and severe back issues like compression of vertebras. Risk factors for osteoporosis include family history, female, excessive alcohol, diet deficient in calcium and vitamin D, and many more. The nurse may educate patient on the disease process as well as screen the patient for complications. The nurse can educate the patient on a diet low in caffeine, alcohol, provide resources for exercises for bone strength as well as a diet that supports healthy bone.

Question:

Explain the pathophysiology of gout.
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Selected Answer:

Gout is an inflammatory response due to persistently excessive elevation of uric acid in the blood, and in other body fluids. The response of reaction results in the deposition of monosodium urate (MSU) crystals in the joints of patients. When the uric acid is elevated it crystallizes and the crystals are deposited on the joints, tendons, and surrounding tissues, resulting in a gout attack, Prolong accumulation of crystallizing results in joint damage and a condition known as gouty arthritis. crystal deposition in the subcutaneous tissues developed after a long time causing the formation of small, white nodules that are visible all over the body. Hyperuricemia is also associated with hypertension, heart disease, genetic, obesity, certain medications, alcoholism, kidney problem, eating foods that cause the build-up of uric acid such as red meat, sea food, foods rich purine -rich foods such asorgan meats, porks, More common in men that woman.The signs and symptoms severe pain in one or different joints, tenderness, swelling around the affectected area,reddness.
Correct Answer:

Correct 

Gout is an inflammatory response to excessive quantities of uric acid in the blood and other body fluids including synovial fluid. The elevated level of uric acid lea to the formation of monosodium urate crystals in and around joints. When the uric acid levels exceed approximately 6.8 mg/dl, it crystalizes and forms an insoluble precipitate that are deposited into connective tissue through the body. When crystallization occurs in synovial fluid, it triggers Tumor Necrosis Factor (TNF)-α, which causes the release of inflammatory cytokines and interleukins. The result is an acute inflammatory response within the joint.

Gout is caused by a defect in purine metabolism and kidney function. Uric acid is a byproduct of purine nucleotides. People with gout may have an elevated level of purine synthesis accompanied by a rise in uric acid level.
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