A nurse is caring for a client with a gout flare-up. Which of the following indicate appropriate care? 


• Acute gout (or a gout flare) is an intensely painful and disabling inflammatory arthritis, usually involving a single joint but occasionally involving two or more joints. The goal of therapy in an acute gout attack is prompt and safe termination of pain and disability.

• When uric acid levels reach a certain level, they crystallize, and the crystals called tophi are deposited in the connective tissue which can lead to arthritis. Application of ice over the inflamed joints may relieve pain associated with arthritis.

• Gradual weight loss is encouraged after the initial gout attack. Weight loss alone may reduce the incidence of attacks and uric acid levels; however a sudden loss of weight may precipitate an attack because of the destruction of cells, which release uric acid.

• Alcohol and red meats are known aggravators of gout. Alcohol intake increases serum urate levels by inhibiting renal excretion as a result of lactic acidosis. Alcohol ingestion increases urate production by stimulating purine breakdown. Excessive alcohol in any form should be avoided.

• Reducing fluid intake is inappropriate. Ample amount of fluid intake is encouraged daily with the amount of 2000 to 3000 ml/day to promote excretion of uric acid

• Aspirin should be avoided because of the paradoxical effects of salicylates on serum urate. NSAIDs such as naproxen or indomethacin are the first choice of treatment to reduce pain and inflammation during an acute gout attack. 

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