Case Study Chapter 46 Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty: Care of a Patient with Gout Mr. Busch, a 68-year-old man, comes to the ED with severe pain of his left great toe. The toe and surrounding area is red, hot and tender to touch, and edematous. Mr. Busch is unable to wear a shoe or sock; he states "It hurts too much to put something on my foot!" He rates his pain as an 9 on a scale of 0 to 10, and states that he is unable to perform his daily routines because of the pain. Question 1 What laboratory value results should the nurse expect for Mr. Busch? Question 2 Mr. Busch's lab results have returned with slight elevations in the ESR and uric acid levels. The provider wants to be sure of the diagnosis before prescribing treatment. What procedure may the patient require to confirm a diagnosis of gout? Question 3 Mr. Busch asks the nurse, "My doctor said I have gout and it is something I need to control with diet or my kidneys could go bad. What do I need to know about my diet?" How should the nurse respond to Mr. Busch's question? Question 4 Mr. Busch tells the nurse that he wants to watch his diet, but he has trouble cooking for himself since his wife of 40 years recently passed away. With whom on the interprofessional health care team should the nurse collaborate to help Mr. Busch meet his dietary needs?
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Answer 1

Question 1. What laboratory value results should the nurse expect for Mr. Busch?The nurse should expect uric acid levels to be higher than 6.8 mg/dL which will confirm the presence of gout in Mr. Busch. High uric acid levels lead to gout and Mr. Busch already has classic symptoms of gout (hot, swollen, and painful great toe).Question 2. What procedure may the patient require to confirm a diagnosis of gout?The patient may require the synovial fluid aspiration procedure to confirm a diagnosis of gout. The synovial fluid aspiration procedure is the most definitive test for gout. The procedure entails aspirating synovial fluid from the affected joint to determine whether there are urate crystals in the fluid.Question 3. How should the nurse respond to Mr. Busch's question?"You will need to avoid foods that are high in purine to help control gout. High purine foods such as organ meats, shellfish, and gravies should be avoided. Alcohol should be limited or avoided completely because it increases uric acid levels in the body," should be the nurse's response.Question 4. With whom on the interprofessional health care team should the nurse collaborate to help Mr. Busch meet his dietary needs?To help Mr. Busch meet his dietary needs, the nurse should collaborate with the dietitian or nutritionist on the interprofessional healthcare team. They can help by designing a meal plan for Mr. Busch that is low in purine and can also provide education on healthy eating habits.

Answer 2

1: The nurse should expect elevated uric acid levels and an elevated erythrocyte sedimentation rate (ESR) in Mr. Busch's laboratory results, indicating gout and inflammation.

2: To confirm a diagnosis of gout, Mr. Busch may require a procedure called joint aspiration or arthrocentesis to examine the joint fluid for urate crystals.

3: The nurse should respond to Mr. Busch by explaining that he needs to follow a low-purine diet to control his gout and preserve kidney function.

4: The nurse should collaborate with a social worker or community support services to help Mr. Busch meet his dietary needs and address his difficulty in cooking after his wife's passing.

1: Gout is characterized by elevated uric acid levels in the blood, which can lead to the formation of urate crystals in the joints. This causes inflammation and the characteristic symptoms experienced by Mr. Busch. The ESR, a marker of inflammation, is also typically elevated in gout due to the inflammatory response triggered by the urate crystals.

2: Joint aspiration involves inserting a needle into the affected joint and aspirating a sample of the synovial fluid. The fluid is then analyzed under a microscope to identify the presence of urate crystals. The presence of these crystals confirms the diagnosis of gout, as they are characteristic of the condition.

3: Gout is associated with high levels of uric acid in the blood, and a low-purine diet helps reduce the production of uric acid. The nurse should advise Mr. Busch to avoid or limit purine-rich foods such as organ meats, seafood, red meat, and alcohol. Additionally, emphasizing the importance of adequate hydration and consuming plenty of fluids, particularly water, can help prevent uric acid buildup and promote its excretion through the kidneys.

4: Dealing with the loss of a spouse and the challenges of cooking for oneself can significantly impact an individual's ability to adhere to a specific diet. Collaborating with a social worker or community support services can provide Mr. Busch with assistance in meal planning, accessing community resources such as meal delivery services or support groups, and addressing any emotional or practical concerns related to his recent loss. By working together, the nurse and social worker can provide comprehensive support to help Mr. Busch meet his dietary needs and manage his gout effectively.

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