Summary
Highlights
Gout, also known as gouty arthritis, is characterized by painful inflammatory arthritis due to uric acid crystal deposits in the joints, primarily affecting the large toes. High levels of uric acid are often caused by consuming purine-rich foods.
Purine-rich foods to avoid include organ meats (like liver), red meats, and seafoods such as anchovies, sardines, and scallops. Alcohol, while not directly increasing uric acid, inhibits its excretion from the body, leading to elevated blood uric acid levels.
Assessment findings for gout include sudden severe joint pain, swelling, and itchiness (pruritus), with increased serum uric acid levels. Nursing interventions involve avoiding triggers like alcohol and high-purine foods, encouraging weight loss in obese patients, promoting hydration to prevent kidney stones, and administering medications like allopurinol for maintenance and colchicine or corticosteroids for acute attacks. Using a bed cradle can prevent pain from contact with linens.
Osteoporosis makes bones porous and fragile due to excess bone resorption. Healthy bone formation (osteoblast activity) and bone resorption (osteoclast activity) should be balanced, a process called bone remodeling. In osteoporosis, osteoclast activity is greater than osteoblast activity, leading to low bone density and increased fracture risk.
Risk factors include aging (higher osteoclast activity), being of White or Asian descent (lower peak bone mass), women with low estrogen (postmenopause, hysterectomy with oophorectomy), long-term corticosteroid use, hyperparathyroidism, inadequate calcium or vitamin D intake, smoking, excess alcohol, and diuretic use (except thiazides).
Common assessment findings include height loss (an early sign), back pain, kyphosis (dowager's hump), and pathologic fractures (fractures without major trauma) commonly in the hip, wrist, and spine.
Management includes promoting bone health through weight-bearing exercises (e.g., walking, not swimming), a diet rich in calcium and vitamin D (dairy, green leafy vegetables, salmon, eggs), and safe sun exposure. Pharmacological interventions include bisphosphonates (alendronate) to slow bone resorption and calcitonin to promote calcium transfer to bones.
To prevent falls and fractures, patients should use assistive devices, modify home environments by removing throw rugs and using non-slip mats, ensure adequate lighting, and raise bed rails in hospitals. Patients should avoid high-impact activities like running and horseback riding to prevent further risk to fragile bones.
Patients taking bisphosphonates should consume them with a full glass of water and remain upright for 30 minutes to prevent regurgitation and esophagitis. Regular bone mineral density testing (DEXA scan) is a confirmatory test for osteoporosis, and patients should remove all metal before the scan.