- Acute pain related to inflammatory process as evidenced by Reddened, swollen joints and reports pain characteristics and intensity
- Deficient Knowledge related to misinformation and inadequate participation in care planning as evidenced by inaccurate follow-through of instructions and nonadherence to the treatment plan
- Impaired Physical Mobility related to pain and limited range of motion as evidenced by altered gait and decreased range of motion
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective Data: -Expressions of pain, such as crying -Unpleasant feeling (such as a prick, burn, or ache) Objective Data: -Significant changes in vital signs -Changes in appetite or eating patterns -Changes in sleep patterns | Acute pain related to inflammatory process as evidenced by Reddened, swollen joints and reports pain characteristics and intensity | The patient will verbalize pain relief and perform activities of daily living without discomfort The patient will display an absence of redness, swelling, and warmth to the affected joints | 1. Administer pain medications as indicated. NSAIDs are usually prescribed to help relieve pain and reduce joint inflammation in patients with gout. Steroids can also help reduce damage to the joints. 2. Elevate the limb. Elevating the affected joint can help reduce inflammation. 3. Apply cool compresses. Nonpharmacologic interventions such as the application of cool compresses and ice can reduce inflammation and soothe burning sensations. 4. Adjust lifestyle behaviors. Gout attacks can be minimized by reducing risk factors such as the intake of alcoholic beverages, sugary drinks, and high-purine foods such as red meats and some seafood. | Patient reported relief of pain. Patient will rate the pain scale lower than the initial rate at a level that is acceptable to them or 0/10. Patient manifested vital signs within normal limits. Patient verbalized regaining appetite and sleep. |
| Subjective Data: Verbalizes poor understanding Seeks additional information Objective Data: -Inaccurate demonstration or teach-back of instruction -Exhibiting aggression or irritability regarding teaching follow-up -Poor adherence to recommended treatment or worsening medical condition | Deficient Knowledge related to misinformation and inadequate participation in care planning as evidenced by inaccurate follow-through of instructions and nonadherence to the treatment plan | The patient will be able to explain the disease process and the importance of compliance with the treatment regimen The patient will specify two diet recommendations to prevent gout The patient will verbalize their medication regimen to treat gout | 1. Educate the patient about the importance of proper nutrition. Since gout can be aggravated by food choices, provide the patient with verbal and written foods that should be avoided (red meat, bacon, organ meats, sardines) and foods that should be increased (water, vegetables, whole grains). 2. Refer to a rheumatologist. Gout is a form of arthritis that is often managed by a rheumatologist. If a patient is struggling with controlling their gout, they may need the expertise of a specialist. 3. Explain the importance of pharmacologic treatment for gout. Colchicine is a common medication for gout pain. Medications such as allopurinol block uric acid production. Educate the patient on how to safely administer OTC medications for pain. 4. Educate on chronic conditions. Patients may not realize risk factors such as diabetes, heart disease, and renal disease contribute to the build-up of uric acid and gout. Discuss how controlling these conditions will reduce the incidence of gout attacks. | Patient identified risk factors of their disease process and how to prevent worsening of symptoms. Patient participated in the learning process. Patient demonstrated the proper execution self-care skills such as wound care/insulin administration/blood pressure monitoring/etc. Patient identified barriers to their learning and recognize potential solutions to these barriers where possible. |
| Subjective Data: Expression of pain and discomfort with movement Refusal to move Objective Data: -Limited range of motion -Uncoordinated movements -Poor balance -Inability to turn in bed, transfer, or ambulate -Postural instability -Gait disturbances -Reliance on assistive devices -Contractures -Decreased muscle strength -Inability to follow or complete instructions | Impaired Physical Mobility related to pain and limited range of motion as evidenced by altered gait and decreased range of motion | The patient will be able to ambulate with minimal discomfort The patient will participate in activities to improve their range of motion | 1. Encourage the patient to do as much as they can. Once the nurse has assessed the degree of immobility, they should encourage independence aligned with the patient’s capabilities. This decreases dependence on others and increases the patient’s self-esteem. 2. Medicate for pain. If pain and discomfort are a barrier, the nurse can provide analgesics prior to performing exercises or planned ADLs. Even simple interventions such as a heating pad or ice packs may alleviate muscle and joint pain and increase movement. 3. Schedule activities around rest periods. Allow the patient to determine the best times for exercise or movement related to their energy levels. Do not overwhelm or exhaust and allow periods of rest between activities. 4. Provide adaptive equipment. Provide equipment that allows for maximum movement related to the patient’s capabilities. For example, if bed-bound but able to use upper extremities, a trapeze bar can help the patient pull themselves up. 5. Provide passive ROM. If the patient is unable to perform exercises independently, the nurse should provide passive range of motion (ROM) several times per day to prevent contractures and muscle weakness. 6. Promote proper nutrition and hydration. Malnourishment prevents recovery and contributes to a higher risk of functional disability. Adequate caloric intake is required for energy with high-protein foods supporting muscle mass and strength. Hydration will prevent dehydration, promote circulation, and keep skin, tissues, and muscles hydrated. 7. Incorporate family and caregivers. Patients who feel supported by their families and spouses will feel committed to increasing their mobility. 8. Consult with the multidisciplinary team. Impaired mobility may require the support of a physiotherapist or occupational therapist to instruct on exercises and perform activities that stimulate muscle control and fine motor movement. 9. Coordinate ongoing support at discharge. Patients may require ongoing support either at home through home health services or at a rehab center. 10. Set goals. Patients may feel overwhelmed or hopeless if their barriers seem impossible. Helping them choose small goals, such as brushing their hair or sitting up in bed, gives them the motivation to keep going. 11. Provide positive reinforcement. A patient who is making an effort, no matter how small, will be more inclined to continue when their accomplishments are noticed and praised. | Patient participated in their activities of daily life (ADLs) and prescribed therapies. Patient displayed improvement in physical mobility by transferring from bed to wheelchair independently (if this is a realistic goal). Patient remained free of contractures and decubitus ulcers from impaired mobility. Patient demonstrated exercises to improve physical mobility. |