Medical-surgical Nursing Demystified

(Sean Pound) #1

CHAPTER 6 Musculoskeletal System^269


the kidneys. These patients may also develop kidney stones as the uric acid crys-
tallizes in the kidney.
A person may also develop secondary gout. This is due to another disease pro-
cess or use of medication, such as thiazide diuretics or some chemotherapeutic
agents.


PROGNOSIS


Gout is typically a chronic disorder. Patients need to understand the disease and its
treatment so that medications can be initiated at the earliest point during a painful
flare. Repeated flares in the same joint will ultimately cause joint damage. Chronic
elevation of serum uric acid is associated with progression of atherosclerosis.


HALLMARK SIGNS AND SYMPTOMS



  • Acute onset of excruciating pain in joint due to accumulation of uric acid
    within the joint

  • Redness due to inflammation around the joint

  • Nephrolithiasis (kidney stones) due to uric acid deposits in the kidney


INTERPRETING TEST RESULTS



  • Elevated erythrocyte sedimentation rate (ESR).

  • Elevated serum uric acid level—not seen in all patients with gout. Typical of
    primary gout patients prior to episode of acute joint pain.

  • Elevated urinary uric acid levels.

  • Arthrocentesis shows uric acid crystals within the joint fluid.


TREATMENT


Acute treatment is managed with colchicine and nonsteroidal anti-inflammatory
medications. These medications are continued until the pain is controlled. Chronic
gout is treated with allopurinol or an uricosuric agent to reduce the amount of
uricacid in the system. These medications are used in the long term to reduce the
amount of painful flares that occur.

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