{
  "name": "Gout",
  "slug": "gout",
  "url": "https://nursingplex.com/care-plans/gout",
  "category": "Musculoskeletal",
  "summary": "Uric acid crystal arthritis; acute flare relief, hydration and purine-limited diet.",
  "nursing_diagnoses": [
    "Acute pain",
    "Impaired physical mobility",
    "Deficient knowledge"
  ],
  "overview": [
    "Gout is inflammatory arthritis caused by monosodium urate crystals depositing in joints when serum uric acid stays supersaturated. The body either overproduces urate or, far more often, underexcretes it through the kidneys.",
    "An acute attack is unmistakable: sudden, severe pain that often wakes the patient at night, with a red, hot, exquisitely tender joint — classically the first metatarsophalangeal joint, called podagra. Even a bedsheet touching the joint is unbearable.",
    "Treatment splits into two distinct phases that patients frequently confuse. Acute attacks are treated with NSAIDs, colchicine or corticosteroids. Long-term urate lowering with allopurinol or febuxostat prevents future attacks but can trigger one if started during a flare, so it is begun after the attack settles and continued indefinitely with prophylaxis during the first months."
  ],
  "key_facts": [
    {
      "label": "Diagnostic gold standard",
      "text": "Needle-shaped, negatively birefringent urate crystals aspirated from the joint."
    },
    {
      "label": "Target uric acid",
      "text": "Below 6 mg/dL, and below 5 mg/dL when tophi are present."
    },
    {
      "label": "Do not start or stop urate-lowering therapy mid-flare",
      "text": "Starting allopurinol during an attack worsens it; if already taking it, continue it through the flare."
    },
    {
      "label": "Trigger foods",
      "text": "Organ meats, red meat, shellfish, sardines, anchovies, beer and high-fructose drinks."
    },
    {
      "label": "Hydration target",
      "text": "About 2–3 L of fluid daily, if not contraindicated, to reduce urate stone formation."
    },
    {
      "label": "Allopurinol warning",
      "text": "Report any rash immediately — Stevens-Johnson syndrome and DRESS are rare but severe."
    }
  ],
  "nursing_priorities": [
    "Relieve the severe pain of an acute attack quickly.",
    "Reduce joint inflammation and protect the joint from pressure.",
    "Lower serum uric acid to target over time.",
    "Prevent recurrent attacks, tophi and urate nephropathy.",
    "Teach dietary and medication self-management."
  ],
  "assessment": {
    "subjective": [
      "Onset, severity and location of joint pain; whether it woke the patient from sleep",
      "Number and pattern of previous attacks and their triggers",
      "Diet, alcohol intake, hydration and sugary drink consumption",
      "Medications including diuretics, low-dose aspirin and cyclosporine",
      "Family history and comorbid hypertension, obesity, diabetes and kidney disease"
    ],
    "objective": [
      "Affected joint: erythema, warmth, marked swelling and extreme tenderness",
      "Fever and elevated WBC during a severe attack",
      "Serum uric acid — may be normal or low during an acute flare",
      "Tophi over the helix of the ear, olecranon bursa, fingers and Achilles tendon",
      "Renal function, urine output and history of kidney stones",
      "Range of motion and functional limitation of the affected joint"
    ],
    "related_factors": [
      "Renal underexcretion or overproduction of uric acid",
      "Purine-rich diet, alcohol and fructose-sweetened beverages",
      "Thiazide and loop diuretics, low-dose aspirin",
      "Obesity, metabolic syndrome and chronic kidney disease",
      "Dehydration, trauma, surgery and rapid weight loss"
    ]
  },
  "goals": [
    "The client will report pain reduced to 3/10 or lower within 24–48 hours of treatment.",
    "The affected joint will show reduced swelling, warmth and redness with restored motion.",
    "The client will maintain a serum uric acid below 6 mg/dL on maintenance therapy.",
    "The client will remain free of further attacks and show no tophi progression.",
    "The client will describe the difference between acute and preventive medications."
  ],
  "interventions": [
    {
      "title": "Acute attack management",
      "points": [
        "Administer NSAIDs, colchicine or corticosteroids promptly — earlier treatment shortens the attack.",
        "Rest the joint, keep it elevated and use a bed cradle to keep linens off it.",
        "Apply cold packs to the joint for pain relief; avoid heat during an acute flare.",
        "Avoid weight bearing on the affected joint until inflammation subsides."
      ]
    },
    {
      "title": "Medication safety",
      "points": [
        "Monitor colchicine for diarrhea, nausea and abdominal cramping and adjust with renal impairment.",
        "Watch NSAIDs for GI bleeding, renal impairment and fluid retention, especially in older or hypertensive patients.",
        "Do not initiate allopurinol during an acute flare; if the patient already takes it, continue without interruption.",
        "Give low-dose colchicine or NSAID prophylaxis for the first 3–6 months of urate-lowering therapy as ordered."
      ]
    },
    {
      "title": "Long-term urate control",
      "points": [
        "Titrate allopurinol or febuxostat to a serum uric acid target with periodic level checks.",
        "Monitor CBC, liver enzymes and renal function on therapy and report rash immediately.",
        "Review medications that raise urate and discuss alternatives to thiazides with the prescriber.",
        "Encourage 2–3 L of fluid daily unless restricted, to reduce urate stone risk."
      ]
    },
    {
      "title": "Lifestyle and comorbidities",
      "points": [
        "Teach a low-purine pattern: limit organ meats, red meat, shellfish, oily fish, beer and sweetened drinks.",
        "Support gradual weight loss; crash dieting and fasting raise urate and can trigger attacks.",
        "Encourage low-fat dairy and cherries, which are associated with fewer attacks.",
        "Screen and manage hypertension, diabetes, dyslipidemia and kidney disease, which cluster with gout."
      ]
    }
  ],
  "patient_teaching": [
    "Start acute treatment at the first twinge — waiting makes the attack longer and worse.",
    "Understand the two medication roles: one stops an attack, the other prevents attacks and is taken every day, forever.",
    "Do not stop preventive medication when you feel well; that is when it is working.",
    "Report any rash on allopurinol immediately and stop the drug until evaluated.",
    "Drink 2–3 liters of fluid daily and limit beer, spirits and high-fructose sodas.",
    "Lose weight slowly and steadily; rapid fasting can trigger a flare."
  ]
}