# A nurse is caring for a client with acute gout. Which nursing intervention should be the priority? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541085 > language: ko > subject: Adult Health ## 문제 A nurse is caring for a client with acute gout. Which nursing intervention should be the priority? A 45-year-old male client presents to the emergency department with severe pain in his right great toe. The toe appears red, swollen, and warm to touch. The client reports that the pain started suddenly during the night and rates it as 9/10. He has a history of hypertension and admits to drinking alcohol regularly. Laboratory results show elevated serum uric acid levels at 9.2 mg/dL (normal: 3.4-7.0 mg/dL). The physician diagnoses acute gouty arthritis. ## 보기 1. Administer prescribed anti-inflammatory medication immediately **✔ 정답** 2. Apply heat therapy to the affected joint for pain relief 3. Encourage active range of motion exercises to the joint 4. Restrict all fluid intake to reduce joint swelling now **정답: 1** ## 해설 During an acute gout attack, the priority is immediate pain management with anti-inflammatory medications to reduce inflammation and provide relief. Other options are contraindicated or less urgent. ## 심화 해설 Understanding Acute Gout and the Clinical Scenario The client is presenting with classic signs of acute gouty arthritis: sudden onset of severe pain (9/10), erythema, warmth, and swelling in the first metatarsophalangeal joint (podagra). The laboratory finding of hyperuricemia (9.2 mg/dL) supports the diagnosis, though it is the inflammatory response to monosodium urate crystals in the joint, not the uric acid level itself, that directly causes the symptoms. The priority during an acute flare is to rapidly and safely terminate the inflammatory process to relieve pain and prevent further joint damage. Analysis of the Correct Answer: Immediate Anti-inflammatory Administration The correct priority intervention is to administer prescribed anti-inflammatory medication immediately. The cornerstone of acute gout management, as outlined in major rheumatology guidelines, is the prompt initiation of pharmacotherapy to control inflammation. The British Society for Rheumatology guideline for the management of gout emphasizes that first-line options for an acute attack include non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids, with the choice depending on the patient's comorbidities and risk factors [1]. The goal is to reduce the intense inflammatory cascade triggered by urate crystal phagocytosis by synovial cells, which releases mediators like prostaglandins and interleukins, causing vasodilation, increased vascular permeability, and the sensation of pain. Delaying this intervention prolongs the patient's severe pain and can lead to a longer, more damaging inflammatory episode. For this client, with a history of hypertension, the nurse must be aware that NSAIDs can increase blood pressure and should be used with caution, but administering the prescribed medication remains the immediate priority to address the acute pain and inflammation. Analysis of Incorrect Options Applying heat therapy is contraindicated during an acute gout flare. The inflammatory process has already caused significant local vasodilation, which contributes to the redness and warmth. Applying heat would further increase blood flow to the area, potentially worsening the edema and the influx of inflammatory cells, thereby intensifying the pain. The appropriate non-pharmacologic comfort measure is rest and the application of cold or ice packs to the affected joint to promote vasoconstriction and reduce swelling. Encouraging active range of motion (ROM) exercises is also incorrect. During an acute attack, the inflamed synovium and periarticular tissues are exquisitely sensitive. Movement of the joint exacerbates the pain and can perpetuate the inflammatory response. The standard of care is to immobilize and rest the joint in a position of comfort until the acute inflammation begins to subside with medication. Restricting all fluid intake is a harmful and incorrect intervention. Adequate hydration is a key supportive measure for a client with gout. Maintaining a high fluid intake (unless contraindicated by another condition like heart failure) helps to dilute the urine and promote the renal excretion of uric acid, which can help lower serum urate levels over time. Restricting fluids would concentrate the urine, potentially impairing uric acid clearance and increasing the risk of urolithiasis. While the 2018 ESC/ESH guidelines for hypertension management do not directly address gout, they underscore the importance of assessing overall cardiovascular and renal risk, which includes managing fluid balance appropriately . Dehydration is a known trigger for acute gout attacks, making fluid restriction counterproductive [1].References (research sources) - [1]The British Society for Rheumatology Guideline for the Management of GoutGuidelineMichelle Hui, Alison Carr, Stewart Cameron, Graham Davenport, Michael Doherty, Harry Forrester (2017) · DOI: 10.1093/rheumatology/kex156 ## 임상 시나리오 Acute Gout Flare: Priority Nursing InterventionRapid Inflammation Control is Key The immediate priority during an acute gout attack is to administer prescribed anti-inflammatory medication. First-line options include NSAIDs, colchicine, or corticosteroids, chosen based on the patient's renal function and comorbidities. The goal is to suppress the inflammatory response to monosodium urate crystals within 24 hours of symptom onset for best results. Non-pharmacological comfort measures include bed rest and joint immobilization in a position of comfort. Apply cold or ice packs to the affected joint to promote vasoconstriction and reduce swelling. Avoid any form of heat application or active exercise during the acute phase. CautionNever initiate long-term urate-lowering therapy (e.g., allopurinol) during an acute flare without concurrent anti-inflammatory cover, as rapid shifts in serum uric acid levels can worsen or prolong the attack. Encourage hydration (2-3 L/day) unless contraindicated, but avoid alcohol and sugary drinks. ## 핵심 개념 - **Podagra** — Acute gouty arthritis affecting the first metatarsophalangeal joint (big toe), the most common site for an initial gout attack. - **Hyperuricemia** — An abnormally high level of uric acid in the blood (typically >7.0 mg/dL in men), which is a prerequisite for but not diagnostic of an acute gout flare. - **Monosodium Urate Crystals** — Needle-shaped crystals that deposit in joints and soft tissues, triggering an intense inflammatory cascade when phagocytosed by synovial cells. - **First-line Pharmacotherapy** — Standard initial treatments for acute gout including NSAIDs, colchicine, or corticosteroids, selected based on patient comorbidities to quickly suppress inflammation. ## 같은 주제 문제 - [A nurse is assessing a 55-year-old male client who presents to the emergency department wi…](https://mymerci.kr/pages/nclex_q.php?qn_id=541083) - [A 40-year-old male client presents to the emergency department with severe pain in his rig…](https://mymerci.kr/pages/nclex_q.php?qn_id=541084) - [A nurse is caring for a client with acute gout. 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