gout nursing assignment help

gout nursing assignment help

Gout: Causes, Symptoms, and Treatment

1. Introduction to Gout

In the United States, gout is becoming very common. Between the years 2015 and 2016, 9.2 million Americans dealt with it. This type of arthritis arises when uric acid levels in the blood become elevated. Uric acid is an end product of the metabolism of a class of molecules called purines. Most of the uric acid made in the body dissolves in the blood and travels to the kidneys. From here, it travels through the urinary tract and exits the body in urine. However, things can go wrong at any point along this route, leading to unwanted crystals of the molecule being deposited inside joints or other tissues. When that happens, an excessive inflammatory response is triggered by our immune system. The result is the redness, heat, swelling, and pain that characterizes an acute attack of gout. Gout has been known to healthcare professionals for hundreds of years. Throughout most of that time, it was viewed as a disease afflicting the wealthy. This was due to the fact that a diet excessively high in rich foods and alcohol – which was only affordable to the rich in the past – is a risk factor for triggering an attack. Now we know that a genetic feature in the way that purines are metabolized is present in many people who have gout. So, currently, the condition is not seen in the same light as a mark of gluttony and intemperance. However, the idea that diet is one of the crucial factors still persists in society.

2. Causes and Risk Factors

Some evidence suggests a genetic component may also be involved in the causes of gout. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, abnormally high levels of uric acid in the body can increase a person’s likelihood of developing gout. In some cases, the body may produce too much uric acid; in other cases, the kidneys may not be efficient in removing enough uric acid – resulting in the condition hyperuricemia. Uric acid levels can become so high that it no longer remains soluble and instead solidifies to form crystals, which may accumulate around the joints and in the kidneys. Other medical conditions can also lead to hyperuricemia, which increases the person’s risk of developing gout. Some of these conditions include high blood pressure, abnormal kidney function, obesity, insulin resistance, metabolic syndrome, and type 2 diabetes. The medical journalist Lori Smith points out that the consumption of certain types of food can contribute to high levels of uric acid and may act as triggers for gout attacks. These are foods that are high in purines – which can be broken down by the body into uric acid. Foods that are particularly high in purines include red and organ meats, certain types of seafood and fish, as well as drinks that are high in fructose. Smith also notes that alcohol is known to both raise the levels of uric acid in the body – affecting the liver’s ability to remove uric acid from the blood – as well as dehydrate the body and reduce its ability to excrete uric acid through the kidneys. It is important to point out that although men are more susceptible to developing gout, particularly at a younger age, post-menopausal women also face a higher risk of developing the condition if they have had a hysterectomy. In general, women are more likely to develop gout after the age of 60, and men are more prone to suffer from the condition between the ages of 30-60.

3. Symptoms and Diagnosis

Although gout usually appears as attacks of arthritis, the symptoms of gout can be more generalized than that. This is especially true in people with a familial tendency towards high levels of uric acid. In these people, the presence of a gout attack can sometimes be a useful early clue for the future development of tophaceous gout. However, quite often in these early stages, the attacks of arthritis caused by deposition of monosodium urate crystals occur without hyperuricemia. The most useful diagnostic symptom is the presence of tiny uric acid crystals in the joint fluid. This is the only place one can see the crystals and without this, the diagnosis of gout becomes more difficult and relies more on the symptoms. By U.S. population standards, Hispanics have an intermediate risk for gout, African Americans have an intermediate-high risk and, although Caucasians have the lowest risk, it is much higher than that for people from countries where gout is uncommon. Native Americans have the lowest risk in the US. In general, gout seems to be more related to lifestyle and the foods available in a given geographic region, although genetics is also a factor. Gout is most commonly seen in people over the age of 30. For many years, it was regarded as a disease of overindulgence in rich food and drink. Today, we know that its onset is more likely a result of the body’s own physiology. However, certain foods and alcohols act as precipitating factors in an individual who is genetically predisposed to having gout attacks. For example, there is evidence that drinking large amounts of alcohol over a relatively short period of time and consuming large, protein-rich meals can both precipitate attacks of acute gout. We also know that taking aspirin can be a factor since it can interfere with the kidneys’ ability to excrete uric acid. The same is true for niacin, which is also found in some vitamin supplements. Some of the many treatment options for gout attacks include pain and anti-inflammatory medicines (NSAIDs) such as naproxen or indomethacin, colchicine, corticosteroids, and adrenocorticotropic hormone (ACTH). Other long term treatments are aimed at reducing the levels of uric acid in the blood and thereby preventing future attacks, usually through a lifetime of medication. The more common medications used for this purpose are allopurinol, probenecid, and febuxostat. Newer medications include pegloticase and lesinurad.

4. Treatment Options

The goal of the treatment of gout is to reduce the acute attack and to control the serum uric acid level, and gout medications are the important but not the only way to do so. Gout medications can be classified into those that treat the acute attacks, and those that prevent attacks. Colchicine is an alkaloid medication used to treat acute gout flares. First, it can alter the inflammatory reaction to the uric acid crystals, and it can also decrease the uric acid crystal deposit in the joint. However, the major problem for using colchicine is the gastrointestinal side effects such as nausea, vomiting, and diarrhea. NSAIDs, nonsteroidal anti-inflammatory drugs, can also be used to treat and relieve the acute gout attacks. By inhibiting the cyclooxygenase, it can reduce the production of prostaglandins which are important in the inflammation. However, NSAIDs can cause potential stomach bleeding, ulcers, and gastritis. Glucocorticoids can be used when the above treatments either do not work or cannot be used, such as the people who have kidney disease or gastrointestinal problem. They can be taken by the oral pill in a tapering dose or be injected into the muscle or into the affected joint directly. And it has a quicker and more powerful effect than the oral medication. Uricosurics increase the excretion of uric acid by the kidney, and it is suitable for those people who underproduce uric acid. It should not be used during an acute attack. However, uricosurics should be adopted with the alkalinization which means to increase the alkaline property of the body fluid such as the urine and the blood. This can increase the solubility of uric acid and help to dissolve the uric acid crystal. However, only people who have the uric acid overproduction can benefit from the uric acid lowering therapy. Most people who have gout need some uric acid level reduction and it is needed for at least 6 months. The target serum uric acid level for traditional gout management is 6.0 mg/dL or less. With the development of the understanding of the molecular genetics of gout, new therapeutic strategies, such as the recombinant enzyme therapy and the gene therapy may become available. However, at the moment, such treatments usually are only limited to the research environment.

5. Prevention and Management Strategies

Gout sufferers have a large amount of trouble with their disease. Because of the pain involved, most patients find it hard to move. This can lead to other health issues. As gout attacks become more frequent, joints can become increasingly more damaged and deformed. It is very important that you find a gout cure that works, or else you could be facing long-term negative effects on the body. Many people are now turning to natural health for their remedies and it is no different for gout. Using simple physical rehabilitation techniques can increase the blood flow in the body and help to reduce the frequency and severity of gout attacks. The disease will spread faster in one area of the body if you do not move a specific joint very often. This joint can become more damaged and painful. By giving special attention to joint mobility each day, you may actually decrease pain and other gout symptoms in the future. Also, some research has clearly shown that increasing the body’s natural production of crucial alkaline minerals can help alleviate the cause of gout. You should also make sure that you drink more water to help remove uric acid from the body. Reducing the amount of alcohol and high purine foods that you eat will help to alleviate gout symptoms. Devastating on joints, although advancement in medical research has given many victims hope. Regular physical examinations by a qualified doctor, alongside a well-managed gout cure, can help the sufferer maintain a more normal lifestyle.