Question

ullated skele disorders Chapter 16 Case study ga si left great toe at the metatarsal phalangeal joint. When Mr Segal's foot is ameng over hisoractice nurse, Stella Brent, she finds the great toe is erythematous, warm, welined by the pr to touch. He has had at least three other episodes of this type of pain, 62-year-old man who presents at his GP's surgery complaining of pain and s a swelling over his swollen and t lasting for it for 6 days. During the nodule der to 3 days, but he tells Nurse Brent that the pain is now worse and he has had e examination, Nurse Brent also notices a small rounded, subcutaneous der and rubbery to the touch. The patient has a history of type 2 diabetes wcontrolled by diet) and of hypertension (controlled with hydrochlorothiazide).A abou which is tender and rubber entative diagnosis of gout is made. ission to the ward the following vital signs were noted and recordec: Observation 38.0°C 88 beats per minute 14 breaths per minute 140/80 mmHg 98% Vital sign Temperature: Pulse Normal 36.1-38.0°C range 51-90 beats per minute 12-20 breaths per minute 111-219 mmHg (systolic) range <96% 495 Blood pressure: 0, saturation: Test Joint fluid test Serum uric acid Result +ve urate crystals 9 mg/dL 1.1 mg/dL Normal Values Clear 4.0-8.5 mg/dL 0.6-1.2 mg/dL ne ake some time to reflect on this case and then consider the following: 1. What information from the patient's subjective history may be required? 2. Why might joint fluid be taken from the affected joint and what might this reveal? 3. What treatment might be required in order to help Mr Segal with his condition? Me s enere any health promotion activities the nurse might wish to discuss with Mr Segal?

Answer 1

1. The information that is required from the patient are :-

- any history of disease in family

- any history of injury

- any history of Rheumatic Arthritis

- Does pain worsens in the morning from patient wakes up

2. Joint fluid test is the first and most important diagnosis method for gout .In this the doctor may use a needle to draw fluid from your affected joint. Urate crystals may be visible when the fluid is examined under a microscope.

3. Treatment :-

#. Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include over-the-counter options such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), as well as more-powerful prescription NSAIDs such as indomethacin (Indocin) or celecoxib (Celebrex).

# . Colchicine. Your doctor may recommend colchicine (Colcrys, Mitigare), a type of pain reliever that effectively reduces gout pain. The drug's effectiveness may be offset, however, by side effects such as nausea, vomiting and diarrhea, especially if taken in large doses.

After an acute gout attack resolves, your doctor may prescribe a low daily dose of colchicine to prevent future attacks.

#. Corticosteroids. Corticosteroid medications, such as the drug prednisone, may control gout inflammation and pain. Corticosteroids may be in pill form, or they can be injected into your joint.

Corticosteroids are generally used only in people with gout who can't take either NSAIDs or colchicine. Side effects of corticosteroids may include mood changes, increased blood sugar levels and elevated blood pressure.

4. Health promotion activities for gout :-

- weight reduction

- avoid alcohol

- avoid food having high purines like red and organ meat etc

- compliance to antigout therapy