Conditions › Bones, joints & skin
Gout Nursing Care Plan and Interventions
A gout flare is treated with NSAIDs, colchicine or steroids, plus rest and ice for the joint. Long-term, allopurinol lowers uric acid to a target, and teaching covers fluids, alcohol and purine-rich foods.
Gout nursing care plan
| Nursing problem | Goal | Key interventions |
|---|---|---|
| Acute pain | Joint pain and swelling ease. | |
| Risk for recurrent flares | Uric acid at target on long-term therapy. | |
| Health maintenance: needs teaching | Knows trigger foods and drinks enough fluid. |
Problem wording is plain-language nursing diagnosis style. Your program may require NANDA-I labels and your own assessment data.
What it is
Gout: what it is
Uric acid builds up and forms needle-shaped urate crystals in a joint. The body attacks the crystals, causing sudden, intense inflammation. 1,2
Most clients make normal amounts but excrete too little uric acid through the kidneys.
Gout triggers
Alcohol (especially beer), purine-rich foods, sugary drinks, thiazide or loop diuretics, kidney disease, surgery, illness or injury. 2,3
New gout after starting hydrochlorothiazide? Report it; the provider may switch the BP drug.
Assessment: what you will see
Gout flare cues
Sudden severe pain, often at night, usually in one joint, most often the big toe. The joint is red, hot, swollen and exquisitely tender. 2
It can look like infection. A hot joint with fever needs joint fluid testing to rule out a septic joint.
Confirming gout
Joint fluid shows needle-shaped urate crystals. Serum uric acid can be normal during a flare, so a normal level does not rule gout out. 2
Recheck uric acid between flares to get a true baseline.
Priority: what the nurse does first
Allopurinol safety
Stop it and call at the first sign of a rash: severe, even fatal, skin reactions occur. Drink enough to pass at least 2 L of urine a day. 4
Take it after meals to ease stomach upset. Report any rash, even one that looks mild.
Nursing interventions and treatment
Treating a gout flare
Start early with one first-line drug: an NSAID, colchicine or a corticosteroid. Rest the joint and apply ice. 3
NSAIDs: watch for GI bleeding, fluid retention and kidney injury. Ask about ulcers and kidney disease.
Colchicine for a flare
Low dose: 1.2 mg at the first sign of a flare, then 0.6 mg one hour later. Works best when started within 12 to 24 hours. 4,2
Report diarrhea, muscle weakness or numb toes. No grapefruit; it raises colchicine levels.
Evaluation: is care working?
Treat to target
Long-term urate-lowering therapy keeps uric acid under 6 mg/dL, so flares fade and tophi shrink. Allopurinol is the usual first choice. 3
Flares can increase early on, so colchicine or an NSAID is given with it for 3 to 6 months.
Client teaching
Gout diet
Limit alcohol (beer most of all), organ meats, red meat, shellfish and high-fructose corn syrup drinks. Low-fat dairy is encouraged. 3,2
Diet helps but rarely controls gout alone; the medicine does most of the work. Weight loss helps too.
Fluids in gout
Drink plenty of water, about 3 L a day unless fluid-restricted. It helps the kidneys flush uric acid and prevents uric acid stones. 2,5
Clients with heart failure or kidney failure follow their own fluid limit instead.
NCLEX traps
Allopurinol during a flare
Allopurinol lowers uric acid over months; it does not relieve a flare. Already taking it? Keep the same dose through the flare. 2,3
Starting it mid-flare is the provider's call; ACR guidance allows it if flare treatment is also given.
Keep studying gout in NurseLingo Pro
Everything for gout in one place. A free account gets 5 free opens of any condition; Pro opens all 277.
Test yourself: free med-surg practice questions with answers and rationales.
Frequently asked questions
What are the priority nursing diagnoses for gout?
Common nursing problems for gout include acute pain; risk for recurrent flares; health maintenance: needs teaching. Choose the ones your assessment supports and rank airway, breathing and circulation problems first.
What does the nurse do first for gout?
Stop it and call at the first sign of a rash: severe, even fatal, skin reactions occur. Drink enough to pass at least 2 L of urine a day.
Which intervention will the nurse include in the plan of care for a patient with gout?
Rest the painful joint, apply ice and give the ordered flare medication (an NSAID, colchicine or a steroid). Encourage fluids. Long term, teach about allopurinol to lower uric acid and limiting alcohol and purine-rich foods such as organ meats and some seafood.
More bones, joints & skin
Sources
- OpenStax Clinical Nursing Skills, 25.3
- merckmanuals.com
- pmc.ncbi.nlm.nih.gov
- dailymed.nlm.nih.gov
- OpenStax Pharmacology for Nurses, 6.4
For study only, not medical advice. Follow your program, your facility's policies and the provider's orders.