A 52-year-old obese Caucasian male presents to the clinic with a 2-day history of fever, chills,

and right great toe pain that has gotten worse. Patient states this is the first time that this
has happened, and nothing has made it better and walking on his right foot makes it worse. He
has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which
did give him a bit of relief.
 Past medical history positive or hypertension treated with hydrochlorothiazide and kidney
stones.
Social history negative for tobacco use but admits to drinking “a fair amount of red wine” every
week.
 General appearance: Ill appearing male who sits with his right foot elevated.
Physical exam remarkable for a temp of 101.2, pulse 108, respirations 18 and BP 160/88. Right
great toe (first metatarsal phalangeal [MTP]) noticeably swollen and red. Unable to palpate to
assess range of motion due to extreme pain.
CBC and Complete metabolic profile revealed WBC 14,000 mm3 and uric acid 8.9 mg/dl.
 
Patient diagnosis: Acute Gout.
 
Questions:

1. Develop a case analysis based from the given scenario. 10Points

TARLAC STATE UNIVERSITY

COLLEGE OF SCIENCE
DEPARTMENT OF NURSING
Awarded Level III Status by the Accrediting Agency of Chartered Colleges and Universities in the
Philippines

CLINICAL CASE ANALYSIS

Name of Patient Patient X Age: 52 Gender: M

Address n/a Date June 16,
Admitted: 2021
Diagnosis Acute gout

NURSING HISTORY:
A 52-year-old obese Caucasian male presents to the clinic with a 2-day history of fever, chills,
and right great toe pain that has gotten worse. Patient states this is the first time that this
has happened, and nothing has made it better and walking on his right foot makes it worse. He
has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which
did give him a bit of relief.
 Past medical history positive or hypertension treated with hydrochlorothiazide and kidney
stones.
PATHOPHYSIOLOGY:

DIAGNOSTIC PROCEDURES:
 Synovial Fluid Test. 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.
 Blood test. Your doctor may recommend a blood test to measure the levels of uric acid
in your blood. Blood test results can be misleading, though. Some people have high
uric acid levels, but never experience gout. And some people have signs and symptoms
of gout, but do not have unusual levels of uric acid in their blood.
 X-ray imaging. Joint X-rays can be helpful to rule out other causes of joint
inflammation.
 Ultrasound. This test uses sound waves to detect urate crystals in joints or in tophi.
 Dual-energy computerized tomography (DECT). This test combines X-ray images
taken from many different angles to visualize urate crystals in joints.

MEDICAL MANAGEMENT:
 Hyperuricemic therapy should be initiated in patients with frequent gout attacks, tophi
or urate nephropathy.
 Uricosuric agents, such as probenecid, correct hyperuricemia and dissolve deposited
urate
 Colchicine (oral or parenteral) or a NSAIDs, such as indomethacin is used to relieve
acute attacks
 Allopurinol is effective, but use is limited because of the risk of toxicity
 Aspiration and intra-articular corticosteroids are used to treat large-joint acute attacks
 Ibuprufen, Hydrochlorothiazide, acetaminophen

Name of TABERNA, Catherine T. (D4)

Student:
Date June 16, 2021 C.I.’s Signature
Submitted:

2. Explain why a patient with gout is more likely to develop renal calculi. 5points

 Individuals with gout typically have persistently acidic urine due to a

defect in the renal production of ammonia, which may be inherent or
secondary to tubular damage from urate crystal deposition. Individuals
with gout have a higher risk for uric acid stone formation due to the low
urine pH, which creates an environment favorable for uric
acid precipitation. Gout may also increase the risk for calcium
 oxalate stone formation, the most common type of kidney stones. The
precipitation of uric acid in the presence of a low urine pH may create
heterogeneous nuclei for calcium oxalate crystallization, and reducing
urinary uric acid excretion with allopurinol has been shown to decrease
the risk of calcium oxalate stone formation.

 The association between gout and kidney stone disease has been
demonstrated in several previous cross-sectional studies. Among 1258
patients with primary gout, 22% reported a history of kidney stones, a
prevalence substantially higher than the 12% lifetime risk reported in
the general population. Using data from the third National Health
and Nutrition Examination Survey, we noted a substantially higher
prevalence of kidney stone disease among individuals with physician-
diagnosed gout compared to the general population (14% vs. 6%). Even
after controlling for age, gender, race, and thiazide use, individuals with
gout were 49% more likely to report a history of kidney stone disease
compared to those without gout.

3. Identify one nursing problem and develop your NCP. 25points

 4. Make a drug study. Identify at least 3 medications that are given to patient with gouty arthritis. 15points

DRUG NAME DOSAGE AND ADVERSE NURSING

ACTION INDICATION CONTRAINDICATION
ROUTE EFFECTS RESPONSIBILITY
Ibuprofen Rheumatoid Unknown. May Ibuprofen contains the CNS  Contraindicated in  Tell patient to take
arthritis, inhibit active ingredient  Headache, patients hypersensitive to with meals or milk to
 Advil, Apo- osteoarthritis, prostaglandin ibuprofen, which dizziness, drug and in those with reduce adverse GI
Ibuprofen, arthritis synthesis, to belongs to a group of nervousness, angioedema, syndrome of reactions.
Motrin,  Adult: 300 to produce anti- medicines called non- aseptic nasal polyps, or  Note: Drug is available
Excedrin IB, 800 mg P.O. inflammatory, steroidal anti- meningitis. bronchospastic reaction to at OTC. Instruct patient
Genpril, t.i.d. or q.i.d. analgesic, and inflammatory drugs CV aspirin or other NSAIDs. not to exceed 1.2 g
Haltran, Ibu- Maximum antipyretic (NSAIDs).  Peripheral  Contraindicated in daily, not to give to
tab, daily dose is effects. It works by blocking edema, fluid pregnant women. chidren younger than
Medipren, 3.2 g. the action of a retention, edema.  Use cautiously in patients age 12, and not to take
Menadol, Mild to moderate substance in the body EENT with GI disorders, history for extended periods
Midol IB, pain, called cyclo-oxygenase.  Tinnitus of peptic ulcer disease, ( longer than 3 days for
Motrin, dysmenorrheal Cyclo-oxygenase is GI cardiac decompensation, fever or longer than 10
Rufen,  Adult: 400 mg involved in the  Epigastric hypertension, asthma, or days for pain) without
Trendar. P.O. q 4 to 6 production of various distress, nausea, intrinsic coagulation consulting presciber.
hours, p.r.n. chemicals in the body, occult blood defects.  Tell patient that full
Fever some of which are loss, peptic therapeutic effect for
 Adults: 200 to known as ulceration, arthritis may be
400 mg. P.O. prostaglandins. diarrhea, delayed for 2 to 4
q 4 to 6 hours, Prostaglandins are constipation, weeks. Although pain
for no longer produced in response to abdominal pain, relief occurs at low
than 3 days. injury or certain bloating, GI dosage levels,
Maximum diseases and would fullness, inflammation doesn’t
daily dose otherwise go on to dyspepsia, improve at dosages less
is1.2 g. cause pain, swelling flatulence, than 400 mg q.i.d.
 Children ages and inflammation. heartburn,  Teach patient to watch
6 months to 12 Ibuprofen is therefore decreased for and report to
years; If used to relieve pain and appetite. prescriber immediately
child’s inflammation. GU signs and symptoms of
temperature is All the medicines in  Acute renal GI bleeding, including
below 102.5º F this group (NSAIDs) failure, azotemia, blood in vomit, urine,
(39.2 ºC), give reduce inflammation cystitis, or stool or coffee
5 mg/kg P.O. q caused by the body's hematuria. ground vomit, and
6 to 8 hours. own immune system, HEMATOLOGIC black, tarry stool.
Treat higher and are effective pain  Plonged bleeding  Warn patient to avoid
temperatures killers. Ibuprofen can time, anemia, hazardous activities
with 10mg/kg be used to relieve pain neutropenia, that require mental
 q to 6 hours. such as muscular pancytopenia, alertness until effects
Maximum aches and pains, period thrombocytopeni on CNS are known.
daily dose in pains, headache, a, aplastic  Advise patient to wear
40mg/kg. backache, rheumatic anemia, sunscreen to avoid
Juvenile arthritis pain, dental pain and leucopenia, hypersensitivity to
 Children: 30 to neuralgia. It can also agranulocystocis. sunlight.
40 mg/kg daily reduce feverishness and METABOLIC
P.O. in three the symptoms of colds  Hypoglycemia,
or four divided and flu. hyperkalemia.
doses. RESPIRATORY:
Maximum  Bronchospasm
daily dose is SKIN
50 mg/kg.  Pruritus, rash,
urticaria, stevens
Johnson
syndrome.

DRUG NAME DOSAGE AND ADVERSE NURSING

ACTION INDICATION CONTRAINDICATION
ROUTE EFFECTS RESPONSIBILITY
Hydrochlorothiazi Hydrochlorothiazid Inhibits Indications CNS: Dizziness,  Assess improvement in
de e 12.5 mg 1 tab OD reabsorption of  Adjunctive vertigo,  Contraindicated with CVP q8h
PO sodium and therapy in paresthesias, allergy to thiazides,  Check for rashes and
chloride in distal edema weakness, sulfonamides; fluid or temperature elevation
renal tubule, associated headache, electrolyte imbalance; daily
increasing the with CHF, drowsiness, renal disease (can lead to  Assess for confusion
excretion of cirrhosis, fatigue azotemia); liver disease  Monitor manifestations
sodium, chloride, corticosteroid, CV: Orthostatic (risk of hepatic coma); of hypokalemia: acidic
and water by the and estrogen hypotension, anuria. urine, reduced urine,
kidney. therapy; renal venous osmolality, nocturia,
dysfunction thrombosis, hypotension,
 Hypertension volume tachycardia, weak
as sole therapy depletion, pulse, weakness,
or in cardiac altered LOC
combination arrhythmias,  Monitor for
with other chest pain manifestations of
antihypertensi Dermatologic: hypomagnesemia:
ves Photosensitivity, agitation, muscle
 Unlabeled rash, purpura, twitching, paresthesias,
uses: Calcium exfoliative hyperactive reflexes,
nephrolithiasis dermatitis, hives, dysphagia, tetany,
alone or with alopecia nausea, vomiting,
amiloride or GI: Nausea, diarrhea
allopurinol to anorexia,  Monitor for
prevent vomiting, dry manifestations of
recurrences in mouth, diarrhea, hyponatremia:
hypercalciuric constipation, increased BP, cold,
or normal jaundice, clammy skin,
calciuric hepatitis, hypovolemia,
patients; pancreatitis abdominal cramps,
diabetes GU: Polyuria, lethargy
insipidus, nocturia,  Assess fluid volume
especially impotence, loss status
nephrogenic of libido  Monitor electrolytes
diabetes Hematologic:
insipidus; Leukopenia,
Precautions:
osteoporosis thrombocytopeni
gout (risk of attack);
a,
SLE; glucose tolerance
agranulocytosis,
abnormalities, diabetes
aplastic anemia,
mellitus;
neutropenia
hyperparathyroidism;
Other: Muscle
manic-depressive
cramps and
disorder (aggravated by
muscle spasms,
hypercalcemia);
fever, gouty
pregnancy; lactation,
attacks, flushing,
elevated triglyceride
weight loss,
levels.
rhinorrhea,
 electrolyte
imbalances,
hyperglycemia

DRUG NAME DOSAGE AND ADVERSE NURSING

ACTION INDICATION CONTRAINDICATION
ROUTE EFFECTS RESPONSIBILITY
acetaminophen ADULTS  Antipyretic:  Analgesic-  CNS: Headache  Contraindicated with allergy Assessment
(N-acetyl-p-  PO or PR Reduces antipyretic in  CV: Chest pain, to acetaminophen.  History: Allergy to
aminophenol)  By suppository, 325– fever by patients with dyspnea,  Use cautiously with acetaminophen, impaired
(a seet a min' a 650 mg q 4–6 hr or acting aspirin allergy, myocardial damage impaired hepatic function, hepatic function, chronic
fen) PO, 1,000 mg tid to directly on hemostatic when doses of 5–8 chronic alcoholism, alcoholism, pregnancy,
qid. Do not exceed 4 the disturbances, g/day are ingested pregnancy, lactation. lactation
Suppositories: g/day. hypothalami bleeding daily for several  Physical: Skin color,
Abenol (CAN), c heat- diatheses, upper weeks or when lesions; T; liver
Acephen PEDIATRIC regulating GI disease, gouty doses of 4 g/day evaluation; CBC, LFTs,
PATIENTS center to arthritis are ingested for 1 renal function tests
Oral: Aceta,  PO or PR cause  Arthritis and yr
Apacet, Atasol  Doses may be repeated vasodilation rheumatic  GI: Hepatic Interventions
(CAN), Genapap, 4–5 times/day; do not and disorders toxicity and failure,  Do not exceed the
Genebs, exceed five doses in 24 sweating, involving jaundice recommended dosage.
Liquiprin, hr; give PO or by which helps musculoskeletal  GU: Acute kidney  Consult physician if
Mapap, Panadol, suppository. dissipate pain (but lacks failure, renal needed for children < 3
Tapanol,  Dosage heat. clinically tubular necrosis yr; if needed for longer
Tempra,             Age  Analgesic: significant  Hematologic: than 10 days; if continued
(mg)
Tylenol Site and antirheumatic Methemoglobinemi fever, severe or recurrent
 0–3 mo  40
mechanism and anti- a—cyanosis; pain occurs (possible
Pregnancy  4–11 mo  80 of action inflammatory hemolytic anemia serious illness).
Category B unclear. effects) —hematuria,  Avoid using multiple
 12–23  Common cold,
 120 anuria; preparations containing
Drug classes mo flu, other viral neutropenia, acetaminophen. Carefully
 Antipyretic  2–3 yr  160 and bacterial leukopenia, check all OTC products.
 Analgesic  4–5 yr  240 infections with pancytopenia,  Give drug with food if GI
(nonopioid)  6–8 yr  320 pain and fever thrombocytopenia, upset occurs.
 Unlabeled use: hypoglycemia  Discontinue drug if
 9–10 yr  400 Prophylactic for  Hypersensitivity: hypersensitivity reactions
 11 yr  480 children Rash, fever occur.
receiving DPT  Treatment of overdose:
vaccination to Monitor serum levels
reduce incidence regularly, N-
of fever and pain acetylcysteine should be
available as a specific
antidote; basic life
support measures may be
necessary.

Teaching points
 Do not exceed
recommended dose; do
not take for longer than
10 days.
 Take the drug only for
complaints indicated; it is
not an anti-inflammatory
agent.
 Avoid the use of other
over-the-counter
preparations. They may
contain acetaminophen,
and serious overdosage
 can occur. If you need an
over-the-counter
preparation, consult your
health care provider.
 Report rash, unusual
bleeding or bruising,
yellowing of skin or eyes,
changes in voiding
patterns.
 5. Formulate a health teaching to the patient. 10points

TARLAC STATE UNIVERSITY

COLLEGE OF SCIENCE
DEPARTMENT OF NURSING
Awarded Level III Status by the Accrediting Agency of Chartered Colleges and Universities in the Philippines

PATIENT EDUCATION FORM

TABERNA, Catherine T. ORTHO

Name Area
Inclusive dates
Year Level 3rd year RLE Group G2 JUNE 14, 2021
of Rotation
Name of
PATIENT X Age 52 Gender Male
Patient
Date JUNE 16,
Diagnosis ACUTE GOUT
Admitted 2021
Details of Patient Education Content:

 Exercise regularly. You need to get 150 to 300 minutes of moderate-intensity activity a week to
prevent weight gain. Moderately intense physical activities include fast walking and swimming.

 Follow a healthy-eating plan. Focus on low-calorie, nutrient-dense foods, such as fruits, vegetables

and whole grains. Avoid saturated fat and limit sweets and alcohol. Eat three regular meals a day with
limited snacking. You can still enjoy small amounts of high-fat, high-calorie foods as an infrequent
treat. Just be sure to choose foods that promote a healthy weight and good health most of the time.

 Know and avoid the food traps that cause you to eat. Identify situations that trigger out-of-control
eating. Try keeping a journal and write down what you eat, how much you eat, when you eat, how
you're feeling and how hungry you are. After a while, you should see patterns emerge. You can plan
ahead and develop strategies for handling these types of situations and stay in control of your eating
behaviors.

 Monitor your weight regularly. People who weigh themselves at least once a week are more
successful in keeping off excess pounds. Monitoring your weight can tell you whether your efforts are
working and can help you detect small weight gains before they become big problems.

 Be consistent. Sticking to your healthy-weight plan during the week, on the weekends, and amidst
vacation and holidays as much as possible increases your chances of long-term success.
Treatment
Gout is treated with medications to relieve pain and inflammation, such as non-steroidal anti-inflammatory drugs, colchi
medications to decrease uric acid production in your body or to help your body remove uric acid.  It may be helpful to li
avoid drinking alcohol.  It may be helpful to drink plenty of water to help the kidneys eliminate uric acid.

Prevention

You may help prevent gout by avoiding alcohol. 

Avoid eating foods that are high in purines and limit the amount of protein from meat that you eat to about 5

or 6 onces per day.

Foods to Avoid
Beer and grain liquors (like vodka and whiskey)
Red meat, lamb, and pork.
Organ meats, such as liver, kidneys, and glandular meats like the thymus or pancreas (you may hear them
called sweetbreads)
Seafood, especially shellfish like shrimp, lobster, mussels, anchovies, and sardines.
Treatment
Gout is treated with medications to relieve pain and inflammation, such as non-steroidal
anti-inflammatory drugs, colchicine, and steroids.  Your doctor may prescribe medications to
decrease uric acid production in your body or to help your body remove uric acid. 
It may be helpful to limit foods that contain purines, such as red meat, and avoid drinking alcohol. 
It may be helpful to drink plenty of water to help the kidneys eliminate uric acid.

Patient’s Signature / Significant Other’s Signature Pt. x