EVENT OUTREACH UNIT

GOUT ATHRITIS

Field Of Study: Family Nursing

Topic: Gout

Family Goals: Mrs.D

Venue: House of Mrs. D in the village of UNIMUS

Day/date: Thuesday, 28 desember, 2016

Time: 30 minutes

I. Background

Uric acid is one of the health problems related to joints and movement. Therefore if the affected
joints gout then the movement becomes limited, and gradually when the left will become tofi where
crystals buildup occurring around the network so that if viewed from the outside as it is meat that
stands out especially on the joints. This usually occurs in adults.

Excess uric acid can be caused due to the process of intake of foods that contain a lot of purin purin
spending process or due to the passing of urine. Based on the results of the study on Ny R family
obtained information that Ny R suffering from excess uric acid and sometimes complain of sore and feel
the sciatic-rheumatic pain in waist to bottom of feet when going to bed or rest at night.

II. Objectives General Instructional:

After being given counselling clients can afford and understand about gout.

III. Special Instructional Purposes:

After a 30-minute extension given the expected objectives can be:

1. mention understanding Gout

2. mention the causes of Gout

3. the mention of the signs and symptoms of Gout

4. mention stadium disease Gout

5. mention factors that affect the occurrence of increased uric acid

6. mention complications-complications of Gout

7. mention penatalaksaanaan uric acid

8. mention the prevention of Gout

9. mention how treatment of uric acid independently.

10. mention the food recommended for sufferers of gout.

11. mention foods to avoid for Gout sufferers.

12. the mention of a folk remedy for Gout sufferers.

IV. Objectives: the family of Mr. j. specifically Ny. R

V. Material:

1. Understanding Gout

2. The causes of Gout

3. Signs and symptoms of Gout

4. Stadium disease Gout

5. Factors affecting the occurrence of increased uric acid

6. Complications-complications of Gout

7. Uric Acid Penatalaksaanaan

8. The prevention of Gout

9. How to care of uric acid independently.

10. the recommended Foods for Gout sufferers.

11. Foods to avoid for Gout sufferers.

 12. Traditional medicine for Gout sufferers.

Vi. Methods:

1. Discussion

2. Frequently asked questions

Vii. Media: Leaflets

Viii. Evaluation Of Learning:

1. Procedure: Test Post

2. Types of tests: Verbal

3. Grain problem:

a. Mentioned the notion of uric acid?

b. State the causes of Gout?

c. State the signs and symptoms of Gout

d. Mention stadium disease Gout

e. State the factors that affect the occurrence of increased uric acid

f. Mentioned complications-complications of Gout

g. Mentioned penatalaksaanaan uric acid

h. mentioned the prevention of Gout

I Mentioned how the treatment of uric acid independently.

j. Mentioned the foods recommended for sufferers of gout.

k. Mentioned foods to avoid for Gout sufferers.

b. Mention the folk remedy for Gout sufferers.

IX. Public Awareness

No. Time Activity Counseling Activities Participants
1  Opening:
5-minute
• Pronounce salutation.  Answer the greeting.
• Introduce yourself. • Listening.
• Explain the purpose of the outreach activities. • Pay attention to.
• Mention of the material to be conveyed. • Pay attention to.
.
.
2 15
minute of implementation: 
• Pay attention to the
• Explain the sense of uric acid
• Pay attention to.
• Explain the causes of Gout
• Pay attention to.
• Describe the signs and symptoms of Gout
• Pay attention to.
• Explain the stadium disease Gout
• Ask and answer the
• Explain the factors that affect the occurrence of questions given by the
increased uric acid

• Explain the complications-complications of Gout

• Explain penatalaksaanaan uric acid

• Explain the prevention of Gout

• Describes how treatment of uric acid

independently.

• Explain the foods recommended for sufferers of

gout.

• Explain the foods that should be avoided for Gout

sufferers.

• Explain the folk remedy for Gout sufferers.

speaker.

3 5 minute evaluation:
Ask the client about the content that was submitted. . To answer the question.
4 5 menit Termination:
• Say Thank you for the time spent, the attention • Listen to and reply
and the active role of the client during the follow thanks.
public awareness. • Answer the greeting.
• Closing Greetings.

X. Organizing.

a. Speaker / Facilitator: S. S.Kep Sapto adi assistants. (STIKES MB stase nursing student community)

XI. The evaluation criteria

a. Evaluation of the structure:

Clients participate in extension activities.

Counseling implementation done in-house Mr. J

b. Evaluation process:

Clients enthusiastic about the extension materials.

Clients directly involved in extension activities (discussion).

c. Evaluation of the results:

Clients understand about hypertension and are able to explain the about:

1. Understanding Gout

2. Causes Gout

3. Signs and symptoms Gout

4. Staging Uric Acid

5. Factors affecting the increase in uric acid

6. complications Uric Acid

7. Penatalaksaanaan Uric Acid

8. Prevention of Gout
9. How Uric Acid treatment independently.

10. Foods that are recommended for patients with uric acid.

11. The food that should be avoided for patients with uric acid.

12. Traditional medicine for Gout patients.

MATERIALS

( Uric acid )

A. DEFINITIONS

According Mutia Sari (2010: 5) uric acid is due to high levels of uric acid in the body. Silvia S. (2009: 10)
argues that uric acid is the acid crystals that were the end product of purine metabolism (derivative
form nucleoprotein) is one of the components of nucleic acids contained in the nucleus of body cells.

Khomsan A. S. Harlinawati Y. (2008: 4) says gout is the accumulation of uric acid crystals in the joint
area.

From the above opinion can be concluded uric acid is part of purine metabolism. In normal
circumstances and if it is not a normal place of uric acid will accumulate in the body tissues. As a result,
there is accumulation of uric acid crystals in the joint area, causing tremendous pain.

B. CAUSES

Abnormalities of metabolism in the body namely inflammation reaction against chain formation of uric
crystals of monosodium monohidrat related to hiperurisemia (the expenditure of uric acid through
excessive urine).

Some of the factors that lead to high uric acid levels are:

1. Hereditary factors

2. Diabetes Mellitus

3. The presence of kidney disorders and hypertension

4. The high intake of foods containing purin.

5. excess body weight (obesity)

6. The amount of alcohol consumed

7. The use of chemical drugs are diuretics/analgetik in a long time.

C. SIGNS AND SYMPTOMS

According to Sari Meutia (2010:33) normally gout about the thumb joint, but it can also on the heel,
ankle and hand or it. Most gout emerges as a recurrent attack. These diseases arise from conditions of
hiperurikemi, i.e. the State in which the level of uric acid in the blood is above normal.

Normal uric acid levels in men ranged from 3.5-7 mg/dL, while the ladies of the 2.6-6 mg/dL. Attacks of
gout usually arose suddenly/acute, most attacking at night. If the gout attack, joints that stricken look
red, swollen, shiny, skin it feels heat accompanied by pain, the joints and hard digerakan. The first attack
of gout is generally in the form of acute attacks that occur at the base of the hallux, and often only one
joint attack. However, these symptoms can also occur in other joints such as the knee, on the heels,
elbows and others.

The excess uric acid will then be accumulated in the joints causing pain or swelling. Sometimes, we often
feel painful or achy and the like. You can verify whether you are exposed to a gout or no way of knowing
the symptoms of gout. As for the symptoms, namely:

1) tingling and rheumatic pain.

2) Pain mainly evenings or mornings when waking up.

3) affected Joints of uric acid will look swollen, redness, heat, and pain in the night and morning.

4) Feels pain in joints occur over and over again.

5) who was attacked is usually the joints of the toes, fingers, 2.4, heels, elbows and wrists.

6) On the incidence of severe cases, joints feels very ill at the moment will move.

7) in addition to joint pain, high uric acid can cause kidney stones and in a prolonged period of time, will
damage the kidneys permanently until the required washing the blood of a lifetime. High uric acid levels
are also associated with the incidence of diabetes mellitus (diabetes) and hypertension.

8) in addition, the symptoms of gout can also be seen from the unhealthy state of the body such as
fever, chills, and a sense of malaise. Symptoms of uric acid as a very fast heart rate can also occur.
Symptoms of gout will generally appear in the middle age for men, whereas in women symptoms of uric
acid will begin to appear after menopause. Attack of gout in the form of early symptoms are felt in joints
will usually last for a few days and then disappear until the next attack. Symptoms of gout should really
look out for to avoid gout attacks are more severe.

According to the U.S. Khomsam Harliawati (2008) the symptoms of gout attacks is marked by pain and
swelling in the thumbs up to the other fingers. Typically, such great pain lasts for 24 hours. Furthermore,
the fade is reduced until it disappears within 3-7 days. If the levels of uric acid is not the first attack was
reduced to normal, the next attack will happen and is chronically.
Pain caused by uric acid resulting in the difficulties of motion so that interfere with daily activities.
Tirnbulnya second and subsequent attacks are difficult to predict. However, from a variety of research
put forward that the higher levels of uric acid, the more often the pain attacks also occur with various
complications. The attack was not just on the thumb, but spread to the ankles, knees, elbows, ears,
small joints of the hand, and another on the muscles. Will growing pains when the middle of the night.
The joints are afflicted by it will look red, swollen, shiny, skin on it feels hot, and hard-driven joints. In
addition, the Agency became a fever, head pain, reduced appetite, and heart pounding. (Silvia 2009).

D. STADIUM DISEASE GOUT

According to Sari Meutia (2010) as well as cancer, diseases of uric acid consists of several stages. The
case of uric acid level keparahannya consists of four stages/staging:

1. Asymptomatic Phase (stage I)

Signs of illness/uric acid gout at the stadium I or the beginning usually characterized by elevated levels
of uric acid but not felt by sufferers because it does not feel any pain at all and is not accompanied by
pain symptoms, arthritis, tofi/tofus or kidney stones of uric stones or in the urinary tract.

2. Acute Phase (stage II)

Gout usually attacks the II stage of arthritis is accompanied by pain, swollen, red and feels the heat at
the base of the thumb. Attacks usually appear in the middle of the night and by morning.

3. Interkritikal Stage (stage III)

Uric acid stage III is the interval between two stages of acute attacks. Selelah usually occurs one to two
years later.

4. Chronic Stage (stage IV)

Chronic stage is characterized by the formation of tofi and deformation or alteration of the form in the
joints that can not be changed into shape as before, this is called symptoms irreversibel chronic gout or
arthritis. In this state the frequency of relapse will be increasingly frequent and continuous pain
accompanied by a more excruciating body temperature and can be high. If so can cause the sufferer can
no way lame or because the joints become stiff stiff cannot be bent.

E. FACTORS AFFECTING THE OCCURRENCE OF ELEVATED LEVELS OF URIC ACID

According to Khosam a. s. Harlinawati (2008) the onset of disorders gout is triggered by a few things.
The following risk factors that make a person afflicted by gout.

1. excess purin Compounds

Purin is a compound that is converted into uric acid in the body. Uric acid levels rise because of higher
food intake purin. The types of foods that are high in purin, such as organ meats, seafood, canned food,
and meat broth.
2. Genetic

The presence of uric acid within the family history to make the risk of onset of gout is becoming
increasingly high.

3. excess alcohol consumption

Alcohol is a barrier to spending of uric acid from the body.

4. Excess body weight

The condition of excess body weight (FAT) can me nyebabkan uric acid. This is because there is a lot of
fat on the body fat people inhibiting spending uric acid through the urine.

5. certain Drugs

Certain types of drugs consumed in the long run it turns out can increase levels of uric acid in the body,
such as diuretic (urine deciduous) and aspirin (preventing a heart attack).

6. kidney function Disorders

Uric acid is issued along with the urine through kidneys. In case of disorders of the kidneys, uric acid also
is disturbed.

7. Age

Disease gout more often strikes men over 30 years. This is because men have the content of uric acid in
the blood is higher than women. The content of uric acid in women increased selelah new menopause.

8. Degenerative diseases (hypertension, heart, diabetes mellitus)

Some experts state that basically the uric acid is not the principal disease. He became a companion of
degenerative diseases. If high levels of uric acid, need to be suspected the existence of degenerative
diseases.

9. drink Less

Drinking less trigger the deposition of uric acid and impede spending on gout.

F. COMPLICATIONS-COMPLICATIONS

Not infrequently, sufferers become depressed because of the quality and productivity decreased
drastically. Is to look out for complications later in life, like a bump on a certain body parts, bones and
joints so that the damage can be limping, inflammation damages the bone, ligaments and tendons
(muscle), kidney stones, kidney damage, and high blood pressure (hypertension).
G. MANAGEMENT

Purpose: to end the acute attacks as soon as possible, to prevent recurrent attacks, and prevention of
complications.

1. treatment of acute attack with Colchicine 0.6 mg (the giving of oral), Colchicine 1.0-3.0 mg (within
Naci intravenously), phenilbutazone, Indomethacin.

2. The joint ended (imobilisasi patients)

3. cold Compress

4. Diet low purin

5. pharmacological Therapy (Analgesic and antipyretic effects)

6. Colchicines (oral/IV) every 8 hours to prevent phagocytosis of Crystals of uric acid by netrofil until the
pain decreases.

7. the Nonsteroid anti-inflammatory drugs (NSAIDS) for pain and inflammation.

8. Allopurinol to suppress or control the level of uric acid and to prevent attacks.

9. Uricosuric (Probenecid and Sulfinpyrazone) to increase excretion of uric acid and impede the
accumulation of uric acid (the number is restricted to patients with renal failure).

10. the preventive therapy with increases the excretion of uric acid using probenezid 0.5 g/day or
sulfinpyrazone (Anturane) in patients who do not tolerate benemid or lower the formation of uric acid
with Allopurinol 100 mg 2 times/day.

H. PREVENTION

1) Restrictions purin: avoid foods containing purin: Offal (heart, liver, kidney, intestinal tongue),
sardines, clams, herring, beans, spinach, shrimp, leaf gnetum.

2) Calories according to your needs: the amount of caloric intake should be properly adapted to the
needs of the body based on height and weight. Sufferers of the disorder of uric acid that is overweight,
weight should be lowered by remaining mindful of the amount of calorie consumption. The intake of
calories too little can also increase the levels of uric acid due to the ketone bodies would reduce
spending on gout through urine.

3) high carbs: complex carbohydrates such as rice, cassava, sweet potato and bread good consumed by
sufferers of the disorder of uric acid as it will increase the expenditure of uric acid via the urine.

4) Low protein: Protein is mainly derived from animals can increase levels of uric acid in the blood. Food
sources that contain animal protein in high quantities, such as the liver, kidney, brain, lung and spleen.
5) low fat: Fat can hinder uric acid excretion through the urine. Fried foods, bersantan, as well as
margarine and butter is best avoided. Fat consumption we recommend as much as 15 percent of total
calories.

6) high fluid: aside from the drinks, liquid can be obtained through fresh fruits containing a lot of water.
Recommended fruits is melon, watermelon, cantaloupe, pineapple, star fruit, guava and sweet water. In
addition to fruits, other fruits that can also be consumed because very few fruits contain purin. Fruits
are best avoided is avocado and durian, because both have a high fat content.

7) Without alcohol: based on the research note that the levels of uric acid that they consume alcohol
than those who do not consume alcohol. This is because the alcohol will increase plasma lactic acid. This
lactic acid will inhibit spending uric acid from the body.

8) exercise: regular Exercise improve the condition of the power and flexibility of the joints as well as
minimize the risk of damage to the joints due to arthritis. In addition, the exercise effect warms the
body thereby reducing pain and preventing deposition of uric acid at the ends of the cold body due to
lack of blood supply. Walking, cycling and jogging can be used as an alternative sport for tackling
rheumatism and gout. In addition, sufficient and regular exercise strengthens blood circulation in the
body.

J. HOW TO CARE OF URIC ACID INDEPENDENTLY

Treatments can be done in the form of the action during the attacks, medical doctors and the care of his
own after acquiring the diagnosis.

If you have gout attacks suddenly, do the following: emergency action

1. Rest your articulations in order to heal faster. Give cold compress (ice contains plastic) for a few hours
once for 15 to 20 minutes at the joints to reduce pain pain due to inflammation. If necessary enter a
swollen foot into a bucket of water ice. A blanket or other fabric to stick to the joint pains, because
these locations are in the sensitive State.

2. Medication pain reliever (analgesic) to eliminate pain

3. Drink lots of water (more than 3.5 liters or 8-10 glasses a day) to help excrete uric acid from the body
through urine.

K. FOOD ON SUFFERERS OF GOUT

1. Consumption of foods containing high potassium such as potatoes, yogurt, and banana

2. Consumption of fruit that contain lots of vitamin C, such as oranges, papaya and strawberry
3. Examples of fruits and vegetables to treat diseases of uric acid: Dragon fruit, star fruit wuluh, ginger,
pumpkin, mustard greens, chicory, Lemongrass and tomato

4. Expand the consumption of complex carbohydrates such as rice, cassava, and Yam bread

5. reduce consumption of simple carbohydrates such as sugar, fructose are types of candy, sweet,
cotton candy and arum syrup

6. don't drink aspirin

7. don't overwork/fatigue

8. In people who are overweight (obesity), normally the levels of uric acid quickly up but spending a
little, then we recommend that you lose weight with exercise enough

9. adjust the body needs energy intake, based on height and weight

B. THE FOODS THAT SHOULD BE AVOIDED IN PEOPLE WITH GOUT

a. Offal: kidney, tripe, spleen, intestines, liver, lungs and brain.

b. Seafood: shrimp, squid, cuttlefish, clams, mussels, oysters, crab, anchovies, sardines.

c. meat Extracts such as mince and jerky.

d. food that's been pressure canned (example: corned beef, sardines).

e. mutton, beef, horse meat.

f. ducks, geese and turkeys.

g. beans: soya beans (including tempeh, douchi, fermented beans, soy milk), peanuts, green beans, bean
sprouts, gnetum gnemon, chips.

h. vegetables: cauliflower, spinach, asparagus, string beans, ear fungus, cassava leaves, papaya leaves,
Ipomoea aquatica.

i. cheese, eggs, cream, ice cream, broth or gravy is thick.

certain Fruits such as j. durian, pineapples and coconut water.

k. fried foods or bersantan or cooked using margarine/butter.

l. Foods rich in protein and fat.

m. in addition to the restrictions above, some sufferers of gout disease also should always drink plenty
of water especially for those who have the disease of kidney stones. By drinking lots of water will help
the kidneys to excrete uric acid crystals from the body through urine.
M. FOLK REMEDY FOR GOUT SUFFERERS

. Folk remedy for gout, among others:

1. Tomato juice and carrots

The tool and the material is 1 piece 1 piece of carrot, tomato, lemon 1/3 tablespoon of white water, and
1/3 cup of star fruit, knife and a blender.

How to make it: namely, wash clean all the ingredients, slice carrots and tomatoes, masukkkan into a
blender, then add 1/2 tablespoon of lime juice and 1/3 water glasses of white and then blended until
smooth.

Usage: is drinking this juice in the morning before eating or 2 x per day if needed

2. The Cat's Whiskers

Boil 30-60 grams of dry cat whiskers or 90-120 gr fresh cat whiskers, and then drink the water
rebusannya. Whiskers cat fresh or dried can also be brewed and then drunk as tea.

3. Ginger Compress

Ginger compresses, because ginger contains gingerol, asiri oils and oleoresin which is warmed. Ginger
compresses well used for gout sufferers who have been experiencing swelling which serves to widen
blood vessels and improve blood flow, so the swelling and pain can be reduced or lost. Tools and
materials: segment 3-5 ginger, grated, and suspended a cloth bandage. How to make it clean i.e. ginger,
then grate the ginger and place in a bowl, stir until it's like porridge. Usage is balurkan the ginger grater
in the joints are sore, and then the rest of the grated ginger, banking on the swollen joints.
 BIBLIOGRAPHY

Khomsun A. S. Halinawati. 2008. Juice Therapy for rheumatism and gout, prints V. Jakarta: Puspa Swara
IKAPI, Member

Mansjoer, A. .. 2004 Capita Selekta medicine. Third Edition, Volume One. Jakarta: Media Aeskulapius

Saraswati s., 2009. Healthy diet for uric acid Disease, Diabetes, hypertension and Stroke, Mold 1,
Jogjakarta: à Plus Books

Sari m. 2010. Healthy and fit without Gout, prints 1. November, Araska Publisher

Smeltzer, SC & Bare, BG, 2002, Medical Surgical Nursing Textbook Brunner & Suddarth,