Case Study: Management of Gout in a 71-year-old African American Male, Exams of Nursing

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NR 324 Adult Health I RUA Case Study of a 71-year-old African American male with Gout {Chamberlain College of Nursing} TG is a 71-year-old African American male retired construction worker that is divorced with 3 children (2 girls & 1 boy). TG is overweight at 100.7 kg and 5’9 and says that he always feels stiff and has trouble exercising. He has no known allergies and is a full code. He has a history of gout, high blood pressure, and diabetes. His past surgeries include a kidney stone removal, a left hip replacement, and a right knee replacement. TG is on numerous medications including, but not limited to Aspirin, Simvastatin, Humalog, Gabapentin, Lopressor, and Allopurinol. He claims he misses his job and working and feels lonely. Claims he drinks about 1 pack of beer a day (6 or 12 cans). TG knows this isn’t a good lifestyle to have, but he feels okay about his way of life. Current Vital Signs Temp 99.0 degrees Fahrenheit orally Temp 97.8 - 99.1 degrees Fahrenheit BP 143/90 mmHg laying down BP 90/60 - 120/80 mmHg HR 75 bpm HR 60-100 bpm Resp 22 breaths/min Resp 12-18 breaths/min O2 96% on RA O2 91-100% Pain 8/10 Pain 0/

Current Lab Values and Normal Lab Values Uric Acid 4.0-8.5 mg/dL Uric Acid 8.2 mg/dL Cholesterol 125-200 mg/dL Cholesterol 300 mg/dL HDL <40 mg/dL HDL 40 mg/dL LDL <100 mg/dL LDL 143 mg/dL Triglycerides <150 mg/dL Triglycerides 170 mg/dL TG has current lab values and vital signs to show for his health. His vital signs of blood pressure(143/90) and respirations(22) are concerning as they are both higher than normal. He does have a history of HTN and is on medications for it, but his high respiration rate could be from nerves. With his lab values, they are all higher than normal limits except for his uric acid which is on the borderline of normal limits. With this, his lab values are most concerning, as his history of high blood pressure is being controlled by medication. With his history of HTN and being overweight, he is more susceptible to experiencing gout from limited exercise (Roddy & Doherty, 2010). At this time, the doctor has ordered an X-ray of the affected foot, Pts serum uric acid levels, BMP, CMP, 24-hour urine samples, wear compression stockings, and wound care of the affected foot. A comprehensive assessment of TG was completed on admission. He has stated that three nights ago, his big left toe was in an immense amount of pain when he woke up that morning. He claims that ibuprofen and aspirin provided little to no help from the irritation and pain since that date. It looks as if the left big toe is swollen, red, stiff, and sensitive to touch and movement. As of right now, no other joints of the affected foot and leg seem to be affected. Pt does have limited ROM in his left big toe. Gout is diagnosed based on physical attributes and laboratory values. A

gout is a form of inflammatory arthritis that can be very painful and tender in joints (Centers for Disease Control and Prevention, 2020). This tends to show redness, sores, and tenderness in an area such as the foot or sides of the ankles. Gout happens when excess uric acid crystallizes and deposits into surrounding joints (Roddy & Doherty, 2010). The excess uric acid builds up in one area and causes stiffness and redness in the joints in that area. TGs plan of care as follows per doctor's orders. Teach the patient the meals and drinks to stay away from. It is said in the article Gout: An old disease in New Perspective- A Review by three authors that Purine-rich foods, including organ meats like liver and kidney, game meats, anchovies, sardines, herring, and scallops, might make gout symptoms worse (Ragab, et al., 2017). Beyond that, alcoholic beverages are to be avoided. To prevent the accumulation of crystal acid, encourage the patient to drink a lot of water. In order to establish whether the patient's symptoms are getting better or worse, check joints for signs of inflammation. If necessary, collaborate with the provider to modify the treatment plan. If not contraindicated, the patient may use over-the-counter anti-inflammatory medication to help with joint swelling. Help with ROM exercises or give patient instructions. These exercises aid in avoiding joint stiffness. Measure your level of pain using the 0–10 scale. Identify the patient's tolerable degree of pain. Put pain management into action. This may occur both with and without medicine. Cold and warm compresses to the injured joint or joints, as well as moving as needed to reduce tightness and skin damage, can all be used as non-drug pain management techniques. Breathing exercises and other relaxation techniques to help manage stress and pain.

References Centers for Disease Control and Prevention. (2020, July 27). Gout. Centers for Disease Control and Prevention. Retrieved July 26, 2022, from https://www.cdc.gov/arthritis/basics/gout.html#:~:text=Gout%20is%20a%20common %20form,no%20symptoms%2C%20known%20as%20remission. Mayo Clinic. (2021, March 6). Gout. Retrieved July 26, 2022, from https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc- Ragab, G., Elshahaly, M., & Bardin, T. (2017, September). Gout: An old disease in New Perspective - A Review. Journal of advanced research. Retrieved July 26, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5512152/ Roddy, E., & Doherty, M. (2010, December 21). Gout. epidemiology of gout - arthritis research & therapy. BioMed Central. Retrieved July 26, 2022, from https://arthritis-research.biomedcentral.com/articles/10.1186/ar