A client who has a history of gout is also diagnosed with urolithiasis. The stones are of uric acid type. A nurse gives the client instruction to limit intake of which foods?

1. A

   Liver

2. B

   Apples

3. C

   Carrots

4. D

   Milk

Appeared in: AIIMS Bhatinda NO - 2019

Explanation

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• Gout and uric acid stones are both caused by hyperuricemia, which is an excess of uric acid in the blood.
• Uric acid is the final metabolic product of purines, which are found in high concentrations in certain foods.
• Liver is an organ meat and is one of the foods with the highest purine content.
• Consuming liver directly leads to a significant increase in uric acid production, exacerbating both gout and the risk of uric acid stone formation.
• Therefore, limiting liver intake is a primary dietary recommendation for these patients.

Why Other Options Were Wrong

• Option B: Apples are fruits that are low in purines. They do not contribute to high uric acid levels and are considered a healthy part of a diet for someone with gout.
• Option C: Carrots, like most vegetables, are low in purines. They are safe to consume for patients with gout and uric acid stones.
• Option D: Milk and other low-fat dairy products are low in purines. Some studies suggest that dairy consumption may even help the body excrete uric acid, potentially lowering the risk of gout attacks.

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Clinical Relevance

• Nursing practice connection: Use the key finding related to Dietary management for gout and uric acid urolithiasis to guide bedside assessment, documentation, and the next nursing action.
• Patient education on diet is a cornerstone of nursing care for managing chronic conditions like gout and preventing complications like kidney stones.
• Nurses must be able to provide clear, practical advice that patients can follow to improve their health outcomes and reduce painful flare-ups.
• What if the client's stones were calcium oxalate instead of uric acid? The dietary advice would be different. The nurse would instruct the client to limit high-oxalate foods (like spinach, rhubarb, nuts, and beets) and ensure adequate calcium intake, rather than focusing on purines.

How to Approach the Question

• First, identify the key conditions in the question: 'gout' and 'urolithiasis' of the 'uric acid type'.
• Recall the common pathophysiology: both conditions are linked to high levels of uric acid in the body.
• Connect the pathophysiology to diet: High uric acid results from the breakdown of purines found in food.
• The question asks which food to 'limit', so the task is to identify the food with the highest purine content among the options.
• Evaluate each option based on its purine content: Liver (organ meat, very high), Apples (fruit, low), Carrots (vegetable, low), Milk (dairy, low).
• Conclude that liver is the food that must be limited to manage the client's condition.

Concept Tested & Keywords

• Concept Tested: Dietary management for gout and uric acid urolithiasis.
• Stem keywords: gout, urolithiasis, uric acid type, limit intake
• Lead-in keywords: limit intake
• Clinical cues: The combination of gout and uric acid stones strongly points to an underlying issue with purine metabolism.

Question ID

QNWCOD1HBFcb1MYPwm4Y-u

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Reference Book

E6 Nutrition Monika Sharma 3e p. 247-249

E6 Medicine Harrison 22e Part 2 pp. 357-359, 353-355