ADULT HEALTH

NURSING
PAGET’S DISEASE &
GOUT
Soha Ramzan Masih
Generic BSN Year II, Semester IV
Faculty: Miss Mitchelle Inayat
 Paget’s Disease
• Paget’s disease of the bone is a skeletal disorder resulting from excessive
osteoclastic activity.

AFFECTED ORGANS
Long Lumbar
bones
Pelvis vertebrae Skull
 SIGNS AND
SYMPTOMS
●
can lead to OA, joint
destruction, spinal
●

●
as a result of skull
enlargement.
Tinnitus or vertigo may also
RISK FACTORS
deformity.
• Age
occur.

Pagetic lesions Hearing loss

• Sex
Rarely, heart failure, hypertension,

• Family history
●

atherosclerosis, and aortic valve

calcification occur.

• National Origin
Heart disorders

●
Malignant
bone tumor.
Tumor
 CAUSES DIAGNOSTIC
EVALUATION
• The cause is unknown, although
there is evidence of familial
tendency (25% to 40% have at
least one affected relative).
• More common in men than
women.
• Rare before age 40 and increases
as age does__ 12% after age 80.
• May be caused by infection from
blood-borne viruses. After acute Elevated Serum calcium,
serum phosphorus, and
viremia, osteoclasts become alkaline albumin levels
chronically infected, stimulating phosphate usually normal.
osteoclastic proliferation.
MEDICAL MANAGEMENT
• Pain management- NSAIDs, aspirin.
• Medication- Calcitonin
• Bisphosphonates etidronate disodium(Didronel),
alendronate(Fosamax), pamidronate (Aridia),
risedronate (Acetonel); an antineoplastic agent,
plicamycin (Mithramycin).

SURGICAL INTERVENTIONS
Tibial osteotomy done to realign knees and relieve pain.
 NURSING
ASSESSMENT
Assess pain and functional
ability.
Observe for bowing (legs) or
complaint that hats feel tight.
Assess for cardiovascular
complications.
Assess for auditory symptoms-
tinnitus, vertigo, and hearing
loss.

NURSING
DIAGNOSIS
Chronic pain related to
pathophysiologic process.
Risk for Injury related to falls
 NURSING
INTERVENTIONS
• Administer and teach self-
administration of analgesics.
• Establish exercise protocols through a
PT consult to maintain physical
abilities and prevent falls.
• Provide function and mobility aids
such as heel lifts, walking aids as
needed, through an OT consult.
• Encourage follow-up for periodic
hearing tests and blood work.
• Make sure that patient knows how to
use mobility aids.
GOUT
Gout is a common and complex form of arthritis that can affect anyone.
It's characterized by sudden, severe attacks of pain, swelling, redness
and tenderness in the joints, often the joint at the base of the big toe.
 SIGNS AND
CAUSES
SYMPTOMS
  Urate crystals
accumulate in your
joint, causing the
inflammation and
intense pain of a gout
attack. Urate crystals
can form when you
have high levels of
uric acid in your
blood.
RISK FACTORS
Diet COMPLICATIONS
Obesity Recurrent Gout
Medical Conditions Advanced Gout
Certain Medications Kidney Stones
Age and Sex
Family history of gout
Recent surgery or
trauma
DIAGNOSTIC EVALUATION
Joint fluid test

Blood test
Dual Energy
CT Scan

X-Ray imaging Ultrasound

MEDICAL MANAGEMENT
• NSAIDs-ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), as well
as more-powerful prescription NSAIDs such as indomethacin (Indocin) or
celecoxib (Celebrex).
• Colchicine.
• Corticosteroids.
• Medications that block uric acid production. Drugs called xanthine oxidase
inhibitors (XOIs), including allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat
(Uloric), limit the amount of uric acid your body makes.
• Medication that improves uric acid removal. These drugs, called uricosurics,
include probenecid (Probalan) and lesinurad (Zurampic).
NURSING ASSESSMENT
●
Stiffness in joint
●
Tenderness of the joint
●
Limited range of motion
●
Joint Inflammation
●
Sudden pain in joint
●
Itching
●
Joint edema

Joints

●
Renal Calculi
 NURSING INTERVENTIONS
• Administer medications, Apply cool cloths as tolerable, Assist with positioning to
avoid pressure on the affected joint.
• Assist with mobility
• Assist with mobility
• Monitor signs of joint inflammation
• Promote hydration and increase fluid intake
• Assist with AROM or PROM
• Patients should avoid foods high in purines as these will cause a buildup of uric acid
within the body.
REFERENCES
• Lippincott Manual of Nursing Practice 8th edition
• Mayo clinic
• NRSG.com
THANKYOU