b. Pathological changes include elevated serum uric acid levels and uric acid
crystals in the synovial fluid. Signs and symptoms of acute gout are sudden onset of
severe joint pain, accompanied by intense inflammation, swelling, and tenderness. The
first joint of the great toe is usually affected; and later, other joints of the foot become
affected. Attacks involving the same joints tend to recur. In chronic gout, there may be
development of renal calculi and deformity of the joints.
c. Patient care is directed toward decreasing the amount of sodium urate in the
extracellular fluid so that deposits do not form. This is done by modifying the diet to
decrease the amount of purine ingested and drug therapy to promote renal excretion of
urates. Drug therapy must be continued after the acute phase to decrease the
possibility of future attacks. Foods that should be limited are:
Liver, kidney, and brains.
Anchovies, sardines, and herring.
Bacon, goose, and mutton.
Salmon, turkey, and veal.
Yeast, beer, and meat broth.
d. Nursing care implications include administering medication as ordered,
documenting the patient's response, and observing the patient for side effects related to
a. Pain serves an important role. Pain can cause a person to allow injured parts
time to heal and to seek medical care for disease or tissue damage. However, pain
frequently persists long after its warning purpose has been achieved. Nursing care
should be directed toward reducing the perception of (and reaction to) pain and
b. Pain can be classified in various ways. It is often classified by intensity, such
as mild, moderate, or severe. Pain may be classified by its source as superficial,
visceral, or somatic. Superficial pain arises from the skin or mucous membranes.
Visceral pain has its origin in smooth muscles and organ systems. Somatic pain arises
from skeletal muscle, ligaments, vessels, or joints. Pain is also classified by the length
of time it persists.
(1) Acute. Acute pain is typically caused by tissue injury. It has a sudden
onset and it usually subsides with treatment. Acute pain generally lasts a few days.