NURSING CARE FOR ELDERLY PATIENTS Mrs.

A WITH GOUTH ARTRITIS AT

GALELA HEALTH CENTER, GALELA DISTRICT

Deis Natalies Me, Charles B. Turangan, S. Ked, MARS, and Ns. Dra. Santje P Mangare,. M.

Repro

Nursing study program

Makariwo Halmahera College of Health Sciences

(mdeis049@gmail.com)

ABSTRACT

According to the results of the Indonesian Basic Health Research, the prevalence of gout in

Indonesia has increased in 2018. This disease is common in all ages, some are not yet elderly and

some are elderly and gout is more common in the elderly. These elderly people are divided into

five parts: those aged 50-59 years are called pre-elderly, those aged 60-69 years are called young

elderly, those aged 70-79 years are called middle elderly, those aged 80-89 are called complete

elderly, and those aged ≥ 90 years are full elderly. golden. The data found in Indonesia is that the

elderly who are most affected by gout are elderly women aged ≥ 75 years (54.8%). At the Galela

Community Health Center, based on 2022 data, there are 50 cases of gout, with the number

being men. as many as 32 cases and women 18 cases, and in 2023 there will be 27 cases and

most of them are aged 50-59 years, 21 people are outpatients and 6 people are hospitalized with

the reason that the patient experiences left knee pain according to the pain scale 7 (severe pain),

dizziness, weakness and heartburn for three days. Gout or commonly known as gout arthritis is a

disease caused by the accumulation of Monosodium Urate Crystals in a person's body. Objective:

Describe nursing care for elderly people with gout. Method: the type of research used is
descriptive in narrative form using a nursing process approach and explaining the management

of nursing care. Results: The first nursing diagnosis was found to be impaired comfort related to

chronic pain. The second diagnosis was impaired physical mobility related to pain and a

diagnosis of fatigue. The risk of falls was proven by age ≥60 years.

Key words: nursing care, elderly, gout.

INTRODUCTION the elderly most affected by gout are young

adults aged ≥ 75 years (54.8%). 1

According to the results of the Indonesian

Basic Health Research, it is stated that the Based on data from the Tobelo North

prevalence of gout in Indonesia has Halmahera Health Service in 2022, there

increased in 2018. Where this disease is were 435 gout sufferers, with 235 men and

common in all ages, some are not yet elderly 200 women. And those most affected by

and some are elderly and gout is more gout and hypertension are elderly people

common in the elderly. These elderly people aged 60-69 years. Apart from that, uric acid

are divided into five parts: those aged 50-59 is not only found in the elderly, but also in

years are called pre-elderly, those aged 60- people who have not reached old age. 2

69 years are called young elderly, those aged

At the Galela Community Health Center,
70-79 years are called middle elderly, those
based on data from 2022, there were 50
aged 80-89 are called complete elderly, and
cases of gout, with 32 cases of men and 18
those aged ≥ 90 years are complete elderly.
cases of women, and in 2023 there were 27
golden. The data found in Indonesia is that
cases and most people were affected aged

50-59 years, 21 people were outpatients and

6 people were hospitalized because the achieve a nursing profession that can

patient had left knee pain with a pain scale provide direct nursing care with quality as a

of 7 (severe pain), dizziness, weakness and professional nurse.6

heartburn for three days.3

METHOD

Gout is a disease that arises from consuming

The type of research used is descriptive in
too much food that contains high purines
narrative form using a nursing process
such as nuts and decreased uric acid
approach and explaining the management of
excretion due to impaired kidney function.
nursing care
Apart from that, the cause of excessive uric
RESULTS
acid production in the body can occur due to

genetic (congenital) factors, dietary factors Application About Case Description

and disease factors.4 Application of Nursing Care for Elderly

Patients Mrs. 2023.

Gout or commonly known as gout arthritis is

a disease caused by the accumulation of The patient's name is Mrs. A, female, 63

monosodium urate crystals in a person's years old, Protestant Christian, elementary

body. 5 school education, occupation, housewife,

social address, entry date, July 1 2023 with

As per the data above, the author carried out
registration number 012521
the study for 3 days, namely July 1 2023 at

10:00 WIB at the Galela Community Health The main complaint was pain in the left

Center. During this study the author knee joint for about a year, dizziness and

provided nursing care for elderly clients heartburn for three days.

with gout. Through this study, students are

expected to be able to develop skills to

Physical examination, general condition is The patient appears to be walking slowly.

good, composmentis consciousness, Blood The patient's knees showed tremors after

pressure: 130/80 mmHg, Pulse: 70x/m, returning from walking around the

Body Temperature: 36.3oc, Respiration: orphanage. The third risk of falling was

20x/m, Body weight: 60 kilo grams, Height: proven by age ≥60 years. Subjective data:

157cm. The patient said that his children helped him

in his activities. Objective data: The patient's

Based on the results of the assessment, three
age is 63 years. The patient walks with the
diagnoses were obtained, namely first,
help of his child. The patient walks slowly
disturbance of comfort related to chronic
and is weak. The patient has more than one
pain, characterized by subjective data: the
secondary diagnosis, namely gout and
patient stated that he was unable to walk or
hypertension.
move because his left knee was painful. On

a scale of 7 (0-10), it came and went like Action plan for diagnosis Identify location,

being pricked. Objective data The patient characteristics, duration, frequency, quality,

appears to grimace when pain occurs Vital intensity of pain. Monitor uric acid levels.

signs BP: 130/80 mmHg N: 70x/m, Sb: Identify nonverbal pain responses. Teach

36.3oc Rr: 20x/m, Uric acid level 11g/dl, non-pharmacological techniques for deep

Redness and swelling around the left knee breathing relaxation, provide a comfortable

are visible . Second, physical mobility position, provide non-pharmacological

disorders related to pain are characterized by techniques of warm water compresses to

subjective data. The patient states that it is reduce pain. Collaborative administration of

difficult to move actively because the knee analgesics. For the second diagnosis

feels painful and swollen. Objective data: Monitor blood pressure before ambulation
begins, Identify physical tolerance for emerged, namely disturbance of comfort

ambulation, Help the patient to perform related to chronic pain which is

active range of motion and passive range of characterized by, subjective data: the patient

motion in the joints, Facilitate ambulation said he was unable to walk or move because

activities with a cane or crutches, Facilitate the knee was painful, provocative : pain due

physical mobility if necessary, Provide to gout, quality : stabbing, region: left knee,

motivation to improve again activity. Third scale : 7, timing: comes and goes. Objective

diagnosis: Identify risk factors for falling: Data: the patient appears to grimace when

for example balance disorders, vision pain occurs, there is visible redness around

problems, neuropathy. Identify behavior and the knee. Nursing diagnoses are established

factors that influence the risk of falling. based on the data that is studied, starting

Identify environmental factors that increase with determining the cause of the problem

risk factors for falling, for example slippery and supporting data for the nursing problems

floors, open stairs, use walking aids, for found, namely

example wheelchairs, walkers. , Monitor the

a. Disturbances in comfort are associated
ability to move from bed to chair and vice
with chronic pain
versa. Place patients at high risk of falling
b. Impaired physical mobility is associated
close to supervisors. Encourage the use of
with pain
non-slip footwear.

c. The risk of falls was demonstrated by age

Based on the data above, the author was able
≥60 years
to raise three diagnoses according to the

grouping of data from the patient The nursing care plan that is developed

assessment, the following nursing diagnosis according to theory includes observation of

independent actions, education and 2. Identify physical tolerance for

collaboration with the health team. ambulation.

Intervention 3. Help the patient to perform active range

of motion and passive range of motion in the

a) disturbance of comfort related to pain
joints.
1. Identify the location, characteristics,
4. Facilitate ambulance activities with a cane
duration, frequency, quality and intensity of
or crutches.
pain.

5. Facilitate physical mobility if necessary.

2. Monitor uric acid levels.

6. Provide motivation to increase activity

3. Identify nonverbal pain responses.
4. Teach non-pharmacological
breathing relaxation techniques.
5. Provide a comfortable position
again.
deep
c) Risk of falling is proven by age ≥ 60
years. Identify risk factors for falling: for
example balance disorders, vision problems,

6. Give non-pharmacological techniques of neuropathy. Identify behaviors and factors

warm water compresses to reduce pain. that influence the risk of falling.

7. Collaborative administration of analgesics 1. Identify environmental factors that

b) Impaired Physical Mobility Associated increase the risk of falling, for example

with Pain slippery floors, open stairs.

1. Monitor blood pressure before ambulation 2. Use walking aids, for example a

begins. wheelchair, walker.

3. Monitor the ability to move from bed, to 7. Ketorolac injection 3x30 mg (iv)

chair and vice versa.

b) Impaired Physical Mobility Associated

4. Place patients at high risk of falling close with Pain

to supervisory monitors.
1. Measuring blood pressure.

5. Recommend using non-slip footwear.

2. Ask the patient the level of mobilization.

The purpose of implementation is to help

3. Help the patient to perform active
patients achieve the goals that have been set
movements.
which include improving health, preventing
4. Encourage the patient to use a cane and
disease and restoring health. In its
walking aids.
implementation the author takes action.

5. Encourage patients to carry out activities

a) disturbance of comfort related to chronic
according to their abilities.
1. Ask about the pain the patient feels
6. Motivate the client to resume normal
including the location, characteristics,
activities, if the swelling and pain decrease.
duration, frequency and quality of the pain.

c) The risk of falling is proven by age ≥ 60

2. Check the uric acid level in the blood.
3. Look at nonverbal reactions to pain.
4. Teaching non-pharmacological
breathing relaxation techniques.
years
1. Look at the client's cognitive or physical
deep
deficits that may increase the potential for
falls in certain environments.

5. Provide padding under the patient's knees.

2. Look at behavior and factors that

6. Warm compress on the painful knee. influence the risk of falling.

3. Look at environmental characteristics that evaluation criteria that have been determined

can increase the potential for falls (for in the nursing plan.

example slippery floors and open stairs).

Conclusion

4. Give the patient a wheelchair.

After carrying out nursing care for the

5. See the ability to transfer from bed to elderly patient Mrs. For 3 Days to Patients.

chair and vice versa. Nursing actions can be carried out well with

the patient's condition being good. Nursing

6. Encourage patients to use safe footwear.
care will be carried out on 1-3 July 2023 for
Evaluation
gout with 3 diagnoses, namely

After providing nursing care for three days,

a. Chronic pain associated with chronic
the patient's needs can be met. The
conditions (gouth arthritis, risk of falls, N
evaluation carried out includes process
VIII balance disorders
evaluation and results evaluation. Process
b. Impaired Physical Mobility Is Associated
evaluation is carried out at the end of each
With Pain
patient's nursing action which focuses on

changes in the patient's behavior or health c. The risk of falling is proven by age ≥ 65

status. Meanwhile, evaluation of results is years

carried out continuously until the goal is

After implementing nursing for three days,
achieved. Evaluation is carried out by
all three problem diagnoses were resolved,
collecting data on the patient's progress or
the patient went home.
changes in the patient's condition and
Suggestion
comparing the situation before and after the

action has been taken using the achievement

By implementing nursing care for clients 6. For Writers

with gout that can be provided, namely:

The results of the research create a learning

1. For STIKMAH experience in increasing knowledge and

skills related to gout arthritis and increase

Maintaining the quality of guidance for
insight as a reference for future researchers
students in implementing nursing care.
in developing further research.
2. For the Soasio Community Health Center

Maintaining the quality of guidance for

students in carrying out nursing care.

BIBLIOGRAPHY
3. For the Community

There needs to be education about gouty

arthritis from related parties

1 Pribadi, Teguh, Ainur
4. For STIKMAH Students
Rahma, And Rika
To Stikmah Students to Improve and Yulendasari. "Pemberian
Sharpen Skills, Attitudes and Knowledge to Akupresur Untuk
Become Professional Nurses in Providing Menurunkan Nyeri Dan
Nursing Care with Optimal Nursing Kadar Asam Urat Pada
Processes. Klien Asam Urat Di

5. For Patients Poncowarno Kecamatan

Kalirejo Lampung
It is hoped that this can be used as a guide to
Tengah. Jurnal
find out more about the situation being
Kreativitas Pengabdian
experienced
 Kepada Masyarakat 5 Elvie Febriani Dungga,

(PKM). 2021; Volume. 4. Pola Makan Dan

Nomor. 3. Hubungan Terhadap

Kadar Asam Urat. Jurnal

2 Riskesdas . Laporan Jamburan Nurisng. 2022;

Hasil Riset Kesehatan Vol. 4. No. 1.

Halmahera Utara : 2022

6 Mapanawang. Riset Di

3 Puskesmas Galela. Buku Bidang Kesehatan.

Register : 2023 Tobelo: Medika Mandiri

Halmahera,2016

4 Jaliana, Suhadi La Ode

Muh, Sety, Faktor-Faktor 7 Muttaqin, Arif. Buku

Yang Berhubungan Ajar Asuhan

Dengan Kejadian Asam Keperawatan Dgn

Urat Pada Lansia 20-40 Gangguan Sistem

Tahun Di Rsud Persarafan. Penerbit

Behteramas Provinsi Salemba. 2020

Sulawesi Tenggara.

Jurnal Ilmia Mahasiswa 8 Sari, Mila Triana. Upaya

Kesehatan Masyarakat. Peningkatan Pengetahuan

2018; Vol. 3. No. 2. Tentang Asam Urat Pada

Lansia Di Posyandu
 Lansia Rt 12 Kelurahan Muskuloskeletal. Jakarta.

Rawasari. Jurnal Salemba Medika. 2018

Abdimas Kesehatan

Volume 1 Nomor 2 Juni 12 Wahyuni, Fatma Sri,

2019. Intan Nedia Putri, And

Dessy Arisanti. Uji

9 Harlina, Rokhimah P. Toksisitas Subkronis

Gambaran Kadar Asam Fraksi Etil Asetat Kulit

Urat Pada Lansia Studi Buah Asam Kandis

Di Puskesmas Maospati, (Garcinia Cowa Roxb.)

Kabupaten Magetan). Terhadap Fungsi Hati

Diss. Stikes Insan Dan Ginjal Mencit Putih

Cendekia Medika Betina. Jurnal Sains

Jombang. 2020. Farmasi & Klinis Volume

2 Nomor 3. 2017

10 Yatim, Faisal. Penyakit

Tulang Dan Persendian. 13 Saraswati, Sylvia. Diet

Jakarta. Pustaka Obor Sehat Untuk Penyakit

Populer. Ed 1 2019 : 32- Asam Urat, Diabetes,

51. Hipertensi, Dan

Stroke.Yogyakarta: A+

11 Helmi, Z. N. Buku Ajar Plus Books. 2020

Gangguan