A 60 years old patient comes to the hospital in emergency with acute gouty arthritis. An immediate nursing intervention would be to:

Appeared in: NCL (MP) Nursing Officer - 2020

Explanation

Acute gouty arthritis is an intensely painful inflammatory condition caused by the deposition of monosodium urate crystals in a joint.
According to Maslow's hierarchy of needs and principles of emergency care, managing severe pain is a top priority after addressing life-threatening conditions.
The primary goal in the emergency setting is to alleviate the patient's suffering and reduce inflammation quickly to prevent joint damage and systemic stress.
Pharmacological interventions, such as NSAIDs, colchicine, or corticosteroids, are the mainstay of treatment for an acute attack.

Option B: During an acute attack, the affected joint needs rest and immobilization to reduce pain and inflammation. Encouraging movement with crutches would be counterproductive and painful.
Option C: Patient education is a vital part of long-term gout management but is not an immediate priority. A patient in severe pain is not in an optimal state to learn or retain information.
Option D: This intervention is contraindicated. Many diuretics, particularly thiazide and loop diuretics, decrease the renal excretion of uric acid, leading to hyperuricemia and potentially worsening the gout attack.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Priority nursing intervention for acute gouty arthritis in acute care settings.
A nurse's ability to rapidly assess and manage pain in acute gout is critical for patient comfort and satisfaction.
Recognizing contraindicated medications is a key patient safety role. Administering a diuretic could significantly harm a patient during an acute gout flare.
What if? If the 60-year-old patient also had chronic kidney disease (CKD), the choice of pain relief would change. NSAIDs would likely be contraindicated due to the risk of further kidney damage. The nurse would anticipate orders for lower-dose colchicine or the use of corticosteroids instead.

How to Approach the Question

First, identify the keywords in the question stem: 'acute gouty arthritis' and 'immediate nursing intervention'.
The word 'immediate' is a strong indicator that you need to prioritize actions. Think about what the patient needs right now in an emergency situation.
Analyze the core problem of acute gout: it is an extremely painful inflammatory condition.
Evaluate the options based on this priority. Does the option address the immediate problem of severe pain and inflammation?
Option A directly addresses pain. Options B and C are related to long-term management or recovery. Option D is a treatment that is actually harmful in this situation.
Therefore, relieving pain is the most appropriate and immediate action.

Concept Tested & Keywords

Concept Tested: Priority nursing intervention for acute gouty arthritis
Stem keywords: acute gouty arthritis, immediate nursing intervention, emergency
Lead-in keywords: immediate
Clinical cues: The phrase 'acute gouty arthritis' indicates a sudden, severe inflammatory process.
Clinical cues: The setting 'in emergency' highlights the need for urgent, priority-based care.

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E6 Medicine Harrison 22e Part 2 p. 863-865

E6 Pharmacology Nursing Lilley 11e Part 3 p. 67-69

Practise the full NCL (MP) Nursing Officer - 2020

Attempt every question from this paper in a timed mock, then review the full solution for each one.