Nursing Diagnosis for Gout

Gout is a form of arthritis that can attack any joint and cause pain, swelling and stiffness. The attacks may last several days or months and can recur often. After the attack, the skin around the affected area may begin to peel. There are several possible nursing diagnosis and interventions for patients with gout. Remember to prioritize by the most severe.

Pain

• A diagnosis for acute pain should be first on the list as this is the highest priority. An example is "pain, acute related to swelling of the joints as manifested by patient stating he has pain." The pain should be assessed on an ongoing basis using a scale of one to 10 to describe the severity. Respond to the patients complaints right away to create trust and alleviate anxiety. Use cognitive therapy such as creative visualization to distract the patient from his pain.

Activity Intolerance

• Pain can cause an intolerance to activity. This could be written as "activity intolerance related to pain as manifested by patient stating she cannot get out of bed." Assess the level of intolerance and assist the patient in activities she feels unable to perform. However, do not perform tasks she feels she is capable of doing herself because this can lead to a feeling of inadequacy. If the gout is attacking the leg joints to the point where she has difficulty making it to the bathroom, provide a bedside commode.

Skin Integrity

• If the patient is lying in bed most of the day, has tears from the swelling or is putting pressure on the same location for long periods of time, he is at risk for developing bed sores. As of 2008, Medicare will no longer cover treatment for facility-acquired bed sores, so this diagnosis should appear on your care plan if there is even a remote possibility the patient could develop one. A possible diagnosis may read "risk for impaired skin integrity related to decreased activity level." Interventions include repositioning the patient every two hours, checking the skin for breaks, keeping the affected area clean and moisturized and ensuring adequate hydration to help keep the skin supple.

Powerlessness

• Pain-causing diseases that can recur at any time may lead to a feeling of helplessness. Powerlessness can be written as "powerlessness related to recurring illness as manifested by patient stating she feels no control over when the pain will come back." Educating her about her illness and possible ways to prevent it, for example the gout diet, are good ways to give back her power. Giving her control over aspects of her care is also a good intervention. The more she feels power, the less helpless she may feel.

Considerations

• These are sample diagnoses and should be adapted to fit each patient, especially the "as manifested by" portion. If a patient isn't verbalizing pain, look for other cues such as grimacing or wincing when the affected area is bumped. Likewise, interventions should be patient specific.