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Gout Nursing Guide

Content Revised by Kathleen Koopmann, RN, BSN, PCCN

Gout Overview

This content is intended as a Quick Reference for gout and will cover an overview as well as nursing considerations utilizing the nursing process.


Gout Etiology and Epidemiology

Gout is a metabolic disease that results from an accumulation of uric acid in the blood and is also referred to as gouty arthritis. It is an acute, inflammatory arthritis caused by poor metabolism of purines in the blood. The poorly metabolized purines result in the formation of urate crystals in and around joints (Golenbiewski & Keenan, 2019). Gout is characterized by acute, recurrent attacks of pain and swelling.

Gout is more prevalent in men than in women and can lead to an impaired quality of life for the individual. Approximately 9.2 million people living in the U.S. are affected by gout (DynaMed, 2018). Incidences increase with age and plateaus around age 70. The condition is more prevalent in people living in North America and Europe and certain ethnic groups such as Taiwanese, Pacific Islanders, and the Maori of New Zealand.

Frequent causes of gout include:

  • Genetic defect in purine metabolism (hyperuricemia)
  • Poor renal excretion of uric acid
  • Over secretion of uric acid
  • Hereditary factors
  • Gout associated with medications (e.g., hydrochlorothiazide or pyrazinamide)
  • Radical dieting, starvation, or overeating

Secondary gout can be associated with the following (DynaMed, 2018):

Complications of gout can be:

  • Recurrent flare-ups
  • Advanced gout
  • Renal calculi
  • Risk of morbidity from a decrease in mobility due to pain
  • Joint infections

Gout is common in individuals with chronic kidney disease (CKD) (DynaMed, 2018). Hyperuricemia resulting from CKD leads to excess urate crystals depositing in the joints. CKD also affects the treatment of gout because the urate lowing medications need to be carefully monitored depending on the level of kidney function.

Gout Diagnosis

Gout generally affects the foot, great toe, ankle, and midfoot but can also affect other joints.

Findings in the physical examination of the joint include:

  • Inflammation at the joint (usually the first metatarsal)
  • Pain
  • Erythema
  • Heat
  • Swelling
  • Difficulty moving the affected joint

A definitive diagnosis is made by performing an arthrocentesis or withdrawal of synovial fluid from the affected joint. The synovial fluid findings will indicate urate monohydrate crystals in the joint fluid (DynaMed, 2018).


Acute gout attacks can spontaneously resolve within 1 to 2 weeks, but early initiation of treatment will hasten the resolution of symptoms.

For individuals with mild to moderate pain, use of monotherapy from one of the following is effective (DynaMed, 2018) :

  • Colchicine (Colcrys®)
  • Non-steroidal anti-inflammatory drugs (NSAID) such as naproxen (Aleve®) or indomethacin (Tivorbex®)
  • Corticosteroids such as prednisone (Deltasone®)

For acute attacks with severe pain, especially if multiple joints are involved, combination therapy should be considered with the above medications and the use of interleukin-1 blockers such as:

  • Canakinumab (ILaris®)
  • Anakinra (Kineret®)

Non-pharmacological treatments include:

  • Resting
  • Applying cold packs
  • Elevating affected joint(s)
  • Following a diet low in purines
  • Maintaining good hydration status

Because the goal of therapy for gout is to dissolve the uric acid deposits, a long-term urate-lowering therapy might be recommended to prevent flare-ups. Urate-lowering therapies include drugs such as:

  • Allopurinol (Zyloprim®)
  • Febuxostat (Uloric®)
  • Probenecid (Col-Benemid®)
  • Colchicine (Colcrys®) (for anti-inflammatory prophylaxis)

Individuals with gout should be monitored for:

  • Gout flare-ups 24 to 96 hours postoperatively
  • Routine monitoring of serum uric acid levels
  • Proper hydration

Goat Nursing Care Plan 

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for gout are listed below.


Assess for signs and symptoms of gout, such as:

  • Inflammation of a joint or joints
  • Pain at the site
  • Erythema at the site
  • Joint is warm to touch
  • Affected joint is swollen
  • Difficulty moving the affected joint

Gout Nursing Diagnosis/Risk For

  • Pain, related to joint inflammation as evidenced by:
    • Verbalization
    • Limited movement
    • Redness, swelling, and warmth at affected joints
  • Activity intolerance, related to pain and swelling of weight-bearing joints, as evidenced by:
    • Pain with ambulation
    • Immobility
    • Expressing difficulty with movement or ambulation related to pain
  • Deficient knowledge, related to lack of information about disease management, as evidenced by:
    • Recurrent disease flare-ups
    • Excessive intake of foods high in purines
    • Non-compliance with preventative medication regimen


  • Determine the level of knowledge regarding disease process, low purine diets, and preventative medication regimen.
  • Provide education for areas where there is a lack of knowledge, such as avoiding foods with high purines, controlling weight, following preventative medication regimens, and recognizing acute flare-ups.
  • Elevate affected extremities.
  • Promote bedrest and immobilization of the affected joint.
  • Administer pain medication and NSAIDs as ordered.
  • Promote a non-sedentary lifestyle between acute attacks.
  • Review high purine food diet (such as limiting amounts of red or processed meat, shellfish, alcohol, food, and drinks containing sugar and refined grains) (Golenbiewski & Keenan, 2019).
  • Encourage weight-lowering diets such as the Mediterranean diet that effectively lowers purines in the diet (Stamostergiou et al., 2018).
  • Apply intermittent cold packs to affected joints.
  • Allow adequate time for activities of daily living.

Expected Outcomes

  • Verbalizes or demonstrates a decrease in pain.
  • Verbalizes understanding of preventative diet therapy and medication regimen.
  • Demonstrates ability to mobilize affected joint and to ambulate without difficulty.
  • Verbalizes knowledge of detecting and immediately reporting acute flare-ups such as sudden acute pain in joint

Patient/Caregiver Education

  • Review risk factors for gout to include:
    • Obesity
    • Hypertension
    • Excessive alcohol consumption
    • Diet high in purines
  • Review factors that increase risk of disease flare-ups:
    • Fasting
    • Recent surgery
    • Overeating
    • Dehydration
  • Review signs of gout flare-up such as:
    • Sudden pain in a joint or joints
    • Swelling of joints
    • Fever
    • Redness or heat at joints
  • Review treatment to prevent gout flare-ups such as:
    • Weight loss and a diet low in purines
    • Strict preventative medication regimen
    • When and how to report problems to the healthcare provider

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Content Contributor

The content for this was revised by Kathleen Koopmann, RN, BSN, PCCN. Kathleen earned her Associate Degree in nursing in 1987 at Mid-Michigan Community College and her Bachelor of Science in nursing in 2018 from Western Governor’s University. She has training from the North Carolina Statewide Program for Infection Control and Epidemiology through NCDHHS and the University of North Carolina. Kathleen has worked in long-term care, outpatient care, acute care, and nursing education. She has hospital experience in Med-Surg, OR/PACU, Critical Care, Telemetry, and outpatient experience in Occupational Health. Kathleen has experience as a clinical instructor for the LPN program at Susquehanna County Career and Technical Center in Pennsylvania. Most recently, she worked in long-term care as a Staff Development Coordinator and Infection Control Practitioner.



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