SCIENCE PHOTO LIBRARY
CPD reflective account terminating episodes of the condition where one or two joints are affected. Non-pharmacological measures should be used to improve patient comfort, such as rest and elevation of the affected limb, using a bed cradle to keep bedding clear of the affected area and use of covered ice packs for 20 minutes at a time to keep the joint cool. Assistance should be provided where mobility is compromised.
Preventing recurrence
Gout A CPD article enhanced Patricia Briggs’s knowledge of gout and confidence in providing advice to patients Gout predominantly affects people aged between 40 and 60 years and frequently occurs alongside diabetes, cardiovascular disease, hypertension and reduced renal function. I was interested to read this article because of my work caring for older people. Hyperuricaemia is the most important risk factor in developing gout. The build-up of uric acid in the blood encourages the formation of monosodium urate crystals, which collect around the joints. This may occur over many years until an inflammatory response is triggered, causing swelling, heat, erythema and pain – an attack of gout. The first episode of gout presents rapidly, with extreme pain, typically at night and affecting the first metatarsophalangeal joint. The violent nature of the pain is distressing for patients. They may not be able to tolerate anything touching the area, including bedding and their mobility may be affected. Left untreated, subsequent episodes of gout may become
more frequent, prolonged and generalised. Gout progresses through four distinct stages unless treated, eventually causing deformity and irreversible damage. Accumulation of urate crystals around joints leads to the formation of tophi, which results in bone erosion and painful, stiff joints. Appropriate management of acute episodes may help prevent recurrence. Treatment consists of the lowest effective dose of a non-steroidal anti-inflammatory drug, alongside a proton pump inhibitor to reduce the risk of gastrointestinal bleeding. Corticosteroids are effective for
This reflective account is based on NS760 Burbage G (2014) Gout: clinical presentation and management. Nursing Standard 29, 2, 50-56.
Lifelong treatment to prevent recurrence of gout should be considered if there have been two or more exacerbations in one year. Allopurinol is the drug treatment of choice, but should only be commenced when an acute attack has subsided. The article states that allopurinol should be introduced at a low dose, 100mg daily, and increased gradually until uric acid levels are below 300mcmol/L. Changes in lifestyle and diet can help reduce uric acid levels and the incidence of gout episodes. Eating less meat and fish and drinking less beer and spirits will reduce purine intake. Low impact exercise may be beneficial in weight reduction, since being overweight may lead to raised uric acid levels. After reading this article, I am more knowledgeable about gout and more confident in my ability to recognise its signs and symptoms. I also appreciate the importance of patient education in avoiding recurrence of gout NS Patricia Briggs is a staff nurse at Lourdes Community Nursing Home, Westgate on Sea
Write your own reflective account You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a reflective account. Turn to page 49 for this week’s article and on page 62 you can find out how to present and submit your reflective account.
Visit the RCN Learning Zone The RCN Learning Zone is a FREE online service to help RCN members with their continuing professional development and professional portfolio management. The RCN Learning Zone can be found at www.rcn.org.uk/members/learningzone.php
NURSING march 25 other :: vol uses 29 no 30 :: permission. 2015 61 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 24, 2015. For personal use only. No without Copyright © 2015 RCNi Ltd. All rights reserved.
CPD reflective account terminating episodes of the condition where one or two joints are affected. Non-pharmacological measures should be used to improve patient comfort, such as rest and elevation of the affected limb, using a bed cradle to keep bedding clear of the affected area and use of covered ice packs for 20 minutes at a time to keep the joint cool. Assistance should be provided where mobility is compromised.
Preventing recurrence
Gout A CPD article enhanced Patricia Briggs’s knowledge of gout and confidence in providing advice to patients Gout predominantly affects people aged between 40 and 60 years and frequently occurs alongside diabetes, cardiovascular disease, hypertension and reduced renal function. I was interested to read this article because of my work caring for older people. Hyperuricaemia is the most important risk factor in developing gout. The build-up of uric acid in the blood encourages the formation of monosodium urate crystals, which collect around the joints. This may occur over many years until an inflammatory response is triggered, causing swelling, heat, erythema and pain – an attack of gout. The first episode of gout presents rapidly, with extreme pain, typically at night and affecting the first metatarsophalangeal joint. The violent nature of the pain is distressing for patients. They may not be able to tolerate anything touching the area, including bedding and their mobility may be affected. Left untreated, subsequent episodes of gout may become
more frequent, prolonged and generalised. Gout progresses through four distinct stages unless treated, eventually causing deformity and irreversible damage. Accumulation of urate crystals around joints leads to the formation of tophi, which results in bone erosion and painful, stiff joints. Appropriate management of acute episodes may help prevent recurrence. Treatment consists of the lowest effective dose of a non-steroidal anti-inflammatory drug, alongside a proton pump inhibitor to reduce the risk of gastrointestinal bleeding. Corticosteroids are effective for
This reflective account is based on NS760 Burbage G (2014) Gout: clinical presentation and management. Nursing Standard 29, 2, 50-56.
Lifelong treatment to prevent recurrence of gout should be considered if there have been two or more exacerbations in one year. Allopurinol is the drug treatment of choice, but should only be commenced when an acute attack has subsided. The article states that allopurinol should be introduced at a low dose, 100mg daily, and increased gradually until uric acid levels are below 300mcmol/L. Changes in lifestyle and diet can help reduce uric acid levels and the incidence of gout episodes. Eating less meat and fish and drinking less beer and spirits will reduce purine intake. Low impact exercise may be beneficial in weight reduction, since being overweight may lead to raised uric acid levels. After reading this article, I am more knowledgeable about gout and more confident in my ability to recognise its signs and symptoms. I also appreciate the importance of patient education in avoiding recurrence of gout NS Patricia Briggs is a staff nurse at Lourdes Community Nursing Home, Westgate on Sea
Write your own reflective account You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a reflective account. Turn to page 49 for this week’s article and on page 62 you can find out how to present and submit your reflective account.
Visit the RCN Learning Zone The RCN Learning Zone is a FREE online service to help RCN members with their continuing professional development and professional portfolio management. The RCN Learning Zone can be found at www.rcn.org.uk/members/learningzone.php
NURSING march 25 other :: vol uses 29 no 30 :: permission. 2015 61 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 24, 2015. For personal use only. No without Copyright © 2015 RCNi Ltd. All rights reserved.
