discussion response

Peer Response

Instructions:

Review the plans posted by your peers from your advanced practice nursing role perspective (educator, leader or nurse practitioner).  From this mindset, reflect upon a discussion you would like to have with your colleagues about their plan.

· For example - if you are a nurse educator (clinical or academic) what are your thoughts about the patient education provided in the plan, or do you want to comment on or add to the education provided?  

· If you a nurse leader what are your thoughts about the risk profile or cost effectiveness of the plan.?

· If you are a nurse practitioner did your peer develop a plan that aligns with evidence-based practice and current clinical guidelines? Etc.

Please be sure to validate your opinions and ideas with citations and references in APA format. 

Kristin Feltz

Assessment/Diagnosis: Patient is presenting with Acute Gout. “Gout is an inflammatory condition that results from monosodium urate crystals precipitating in the synovial fluid between joints due to hyperuricemia.” (Arcangelo et al., 2021) Patient symptoms of redness, warmth, swelling, pain in first metatarsal joint. “Diagnosis of gout usually occurs clinically when a patient is experiencing rapid monoarticular arthritis, typically in the first metatarsophalangeal joint. This arthritis is accompanied by swelling and redness of the joint.” (Arcangelo et al., 2021) This patient also has risk factors (male, advanced age, drugs, and HTN) contributing to his incidence of gout.

Management and Rationale: First line treatment include “for patients with mild to moderate pain in small joints or one to two large joints, initial therapy includes NSAIDs, systemic corticosteroids, or colchicine. If the pain started more than 36 hours prior, then colchicine is no longer a preferred agent.” (Arcangelo et al., 2021) Given that the patient has no contraindications to NSAIDs (e.g., no renal impairment, peptic ulcer disease, or history of gastrointestinal bleeding), an NSAID would be appropriate for this case. The patient is out of the time frame for Colchicine (symptoms started 48 hours ago).

Medication: Naproxen 750 mg initially followed by 250 mg q8h until attack subsides (Arcangelo et al., 2021)

Patients may need to consider long term treatment of Chronic gout if symptoms continue.

Patient Education:

Diet/Lifestyle Modification: “Making dietary modifications and discontinuing the usage of medications that can induce gout attacks and weight loss and controlling other diseases states will help decrease the frequency of attacks, but they will occur in gout patients”

“Reduce or even eliminate your intake of meat and shellfish, both of which can raise uric acid levels.

Cut back on alcohol and foods or drinks made with high-fructose corn syrup, like soft drinks.

Drink plenty of water every day. Dehydration increases uric acid levels.

Manage your weight, as gout is linked with excess weight and obesity.” (Restivo, 2023)

Alternatives/Tips: Patient should also Rest, Ice and elevate to help reduce inflammation and ease pain.

Patient should also be advised to take NSAIDS with food to avoid GI upset.

Follow-Up:

Patient should be scheduled within 2 weeks for follow-up to reevaluate symptoms and treatment. Patient should also at this time, if symptoms have resolved be scheduled for labs (serum uric acid, renal function). Referral to Rheumatologist. Consider change in Hydrochlorothiazide. “For patients with gout, losartan and calcium channel blockers are the preferred antihypertensive medications with diuretic properties, as they do not increase uric acid levels and can help prevent gout flares. Traditional diuretics like hydrochlorothiazide, chlorthalidone, and furosemide should be avoided when possible as they can increase uric acid levels and trigger gout flares.” ( What Diuretics Are Suitable for Patients with Gout?, 2025)

 

References:

Arcangelo, Crnp, V. P. a. P., Pharmd, A. M. P., PhD, Wilbur, V., & Reinhold, J. A. (2021).  Pharmacotherapeutic Advanced Pract 5. LWW. 

Restivo, J. (2023, May 31).  5 Medically-Approved Gout Treatments | Treatment for Gout. Harvard Health.  https://www.health.harvard.edu/diseases-and-conditions/treatments-for-goutLinks to an external site.

What diuretics are suitable for patients with gout? (2025, April 16). Droracle.ai.  https://www.droracle.ai/articles/76897/what-diuretics-to-use-in-goutLinks to an external site.

Daniel Munoz

Unit 5: Management of the Patient with Gout

Diagnosis

Based on the patient's clinical presentation, the sudden onset of severe pain, erythema, warmth, and swelling on the first metatarsophalangeal joint, also known as the big toe, it is most likely Acute Gout. These classic symptoms of Acute Gout, result from the deposition of monosodium urate crystals in the joints and lead to intense inflammation and pain in the metatarsophalangeal joint (Arcangelo & Peterson, 2021).

Treatment Plan and Rationale

Managing Acute Gout involves controlling pain and inflammation as quickly as possible. Nonsteroidal anti-inflammatory drugs are first line agents. Given the patient's history of hypertension, colchicine may be preferred over NSAIDs due to the potential impact of NSAIDs on blood pressure (Arcangelo & Peterson, 2021).

Prescription

Colchicine 1.2 mg orally at the first sign of flare, followed by 0.6 mg one hour later.

May continue with 0.6 mg once or twice daily until the attack resolves, for up to 10 days total.

Patient Education

Educate the patient on the importance of medication adherence and early administration at the onset of symptoms. Discuss dietary changes such as reducing purine rich foods like red meats, alcohol, and seafood, staying hydrated, and maintaining a healthy weight. Also, it is important to explain to the patient that untreated gout flares may become more frequent and lead to joint damage (Herdiana et al., 2025).

Follow Up

A follow up visit should be scheduled within 2 to 4 weeks to evaluate symptom resolution and determine whether urate lowering therapy is appropriate. If the patient has frequent flare ups or chronic gout symptoms, referral to a rheumatologist may be needed (Chan et al., 2025).

References

Arcangelo, V. P., & Peterson, A. M. (2021). Pharmacotherapeutics for advanced practice: A practical approach (5th ed.). Wolters Kluwer. Chan, K., Chiang, L., Ho, K. K., Li, Y., Ko, S. H., & Chen, C. X. (2025). Management of gout in primary care of Hong Kong in accordance with international guidelines: any gaps to bridge?  BMC Primary Care, 26, 1-8.  https://doi.org/10.1186/s12875-024-02664-2Links to an external site.

Herdiana, Y., Wardhana, Y. W., Insan, S. K., Gozali, D., Wathoni, N., & Ferry, F. S. (2025). Current Status of Gout Arthritis: Current Approaches to Gout Arthritis Treatment: Nanoparticles Delivery Systems Approach.  Pharmaceutics, 17(1), 102.  https://doi.org/10.3390/pharmaceutics17010102