# A nurse is caring for a client with acute gout. Which nursing intervention should be the priority?

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> subject: Adult Health

## 문제

A nurse is caring for a client with acute gout. Which nursing intervention should be the priority?

A 55-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 rates his pain as 9/10 and states he cannot bear weight on his foot. His serum uric acid level is elevated at 9.2 mg/dL (normal: 3.5-7.2 mg/dL). The physician diagnoses acute gout and orders colchicine and allopurinol.

## 보기

1. Elevate the affected extremity **✔ 정답**
2. Encourage active range of motion exercises
3. Apply warm compresses to the affected joint
4. Massage the affected area to improve circulation

**정답: 1**

## 해설

Elevating the extremity reduces swelling and pain by promoting venous return. Ice application limits inflammation. Other options (active ROM, warm compresses, massage) can worsen acute gout inflammation.

## 심화 해설

Understanding Acute Gout Pathophysiology

In acute gout, monosodium urate crystals precipitate within the joint space, triggering an intense inflammatory cascade. The body's immune system recognizes these crystals as foreign, leading to the release of cytokines such as interleukin-1-beta, which causes vasodilation, increased vascular permeability, and the recruitment of neutrophils. This process manifests clinically as the classic signs of inflammation: erythema, warmth, swelling, and severe pain . The goal of immediate nursing care is to reduce this inflammatory process and minimize joint movement to prevent further crystal-induced mechanical irritation.

Prioritizing Rest and Elevation

The priority intervention is to elevate the affected extremity. Non-pharmacologic management is a cornerstone of acute flare care, and rest of the involved joint is explicitly recommended in clinical practice guidelines [1]. Elevation promotes venous return, which helps reduce the dependent edema and swelling that contribute to tissue distension and pain. By mechanically reducing swelling, pressure on pain-sensitive nerve endings is decreased. This intervention directly addresses the client's immediate comfort and works in synergy with pharmacologic therapy like colchicine, which inhibits microtubule polymerization to block neutrophil migration and activity . Active range of motion, warm applications, and massage are contraindicated during an acute attack as they can exacerbate inflammation and pain by increasing metabolic activity and blood flow to an already engorged joint.

Analyzing the Incorrect Options

Encouraging active range of motion exercises is inappropriate; movement of the inflamed joint will aggravate the crystal-induced mechanical irritation and synovial inflammation, leading to a significant increase in pain. Applying warm compresses is also contraindicated because heat causes vasodilation, which would worsen the existing edema and inflammatory response. Cold therapy is sometimes used for its analgesic and vasoconstrictive effects, but the primary non-pharmacologic recommendation remains joint immobilization and elevation. Massaging the affected area would apply direct mechanical pressure to the intensely inflamed and hyperalgesic tissues, causing extreme pain and potentially dislodging more urate crystals into the joint space, thereby amplifying the inflammatory reaction. The serum uric acid level of 9.2 mg/dL confirms hyperuricemia, but the immediate nursing priority is symptom management through rest and elevation while awaiting the therapeutic effects of the prescribed medications [1,3].References (research sources)

- [1]2012 American College of Rheumatology guidelines for management of gout. Part 2: Therapy and antiinflammatory prophylaxis of acute gouty arthritisGuidelineDinesh Khanna, Puja Khanna, John FitzGerald, Manjit Singh, Sangmee Bae, Tuhina Neogi (2012) · DOI: 10.1002/acr.21773

## 임상 시나리오

Acute Gout Flare: Immediate Nursing CarePrioritizing Non-pharmacologic Pain Relief
The priority intervention is to elevate the affected extremity. This uses gravity to promote venous return, which effectively reduces dependent edema and swelling, thereby decreasing pressure on pain-sensitive nerve endings.

Complete rest of the joint is essential. Any movement can mechanically irritate the monosodium urate crystals within the joint space, exacerbating the inflammatory cascade and intensifying pain.

CautionAvoid warm compresses and massage during an acute attack. Cold applications are preferred for their vasoconstrictive effect. Do not initiate active range of motion exercises until the flare has completely subsided.

## 핵심 개념

- **Colchicine** — A medication that inhibits microtubule polymerization, blocking neutrophil migration and activity to reduce inflammation in acute gout.
- **Allopurinol** — A xanthine oxidase inhibitor used for long-term urate-lowering therapy, typically not initiated during an acute flare to avoid prolonging the attack.
- **Monosodium Urate Crystals** — Needle-shaped crystals that precipitate in joints and trigger an intense inflammatory response, causing the signs and symptoms of gout.
- **Hyperuricemia** — An elevated serum uric acid level (above 7.2 mg/dL), which is a major risk factor for the development of gout.

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