Gout

Republic of the Philippines
Nueva Ecija University of Science and Technology

College of Nursing
GOUT (CHRONIC PAIN)
_____________________________
A Research
Presented to the Faculty of the
College of Nursing
_____________________________
In Partial Fulfillment
of the Requirements for the Subject
INTENSIVE NURSING PRACTICUM
___________________________
Submitted By:
Francess Mharie Jhoyce P. Tolentino
BSN IV-A
Submitted to:
Archito Dela Cruz, RN
CHN Instructor
JANUARY 2017
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ACKNOWLEDGEMENT
Extending my sincerest gratitude to all the people who
contributed a significant role upon completing this research, I
would like to thank Honorable Mayor Ricardo I. Padilla of
Bongabon Nueva Ecija, for permitting us to accomplish this
coursework in their community, as well as to Hon. Joe Lagrimar
T. Ruz, the Barangay Captain of Barangay Sampalucan Bongabon,
Nueva Ecija for wilfully allowing us to conduct the study in his
area.
I also want to give my deepest thanks to the beloved Dean
of the NEUST College of Nursing, as well as the CHN and Research
and Extension Coordinator, Jean N. Guillasper, Ph. D., R.N, for
giving us the opportunity to be exposed in this said activity.
Also to Luzviminda D. Samin, Ph. D., R.N, the RLE Coordinator,
for her valuable support in the development of this research.
To Archito Dela Cruz, R.N., I would like to express my
appreciation and thankfulness for showing us the passion in this
field which played a great influence as encouragement, together
with Emily Flores, R.N, M.A.N., who had been very dedicated and
stayed with us all throughout the completion of this research.

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To my Head Nursing, Ms. Noemi Grace Florencondia, I am
indeed grateful for having you as my guide who payed a great
amount of meaningful and important suggestions to make this
research study quite possible. To Community People, for their
warm welcome and cooperation with regards to giving us their
honest health condition, I, as student nurse, give thanks and
gratefulness, and most importantly to my Client who had been
very honest and willing to participate in this research study.
To my supportive Parents who continuously bestow me with
the love, understanding, financial and material support.
And above all, to our Heavenly Father who touched the
hearts and minds of the people who cooperated to make this
accomplishment happen.
F.M.J.P.T.
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STUDENT PROFILE
I. PERSONAL BACKGROUND
Name : Frances Mharie Jhoyce P. Tolentino
Sex : Female
Age : 19 years old
Date of Birth : September 14, 1997
Address : Saint Joseph Street Kapitan Pepe Subd.,

Cabanatuan City, Nueva Ecija
Civil Status : Single
Citizenship : Filipino
Father : Joey L. Tolentino
Mother : Anna Marie P. Tolentino
II. EDUCATIONAL BACKGROUND
Level School Year

Attended
Elementary Cabanatuan Christian Learning 2008
Center
High Nueva Ecija High School 2012

School
Tertiary Nueva Ecija University 2012-
Of Science and Technology present
COURSE: Bachelor of Science in
Nursing
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TABLE OF CONTENTS
TITLE PAGE. . . . . . . . . . . . . . . . . . . . . . . i
DEDICATION . . . . . . . . . . . . . . . . . . . . . . . ii
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . iii
STUDENT PROFILE . . . . . . . . . . . . . . . . . . . . . v
TABLE OF CONTENTS . . . . . . . . . . . . . . . . . . . vi
LIST OF FIGURES . . . . . . . . . . . . . . . . . . . viii
CHAPTER I: THE PROBLEM AND ITS SETTING
Introduction ........................................... 1
General Objectives ..................................... 2
Specific Objectives .................................... 2
Client’s Profile ....................................... 4
Assessment ............................................. 5
Health Perception – Health Management................ 5
Nutrition and Metabolic Pattern...................... 6
Elimination Pattern.................................. 6
Activity and Exercise Pattern........................ 7
Sleep and Rest Pattern............................... 9
Cognitive and Perceptual Pattern.................... 10
Vital Signs ........................................... 11
Height and Weight ..................................... 11
Summary Presentation of Client’s Assessment ........... 12
CHAPTER II: CASE DISCUSSIONS AND PRESENTATION

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Chapter Overview ...................................... 15

Review of Anatomy and Physiology ...................... 15
Pathophysiology ....................................... 17
Signs and Symptoms .................................... 19
Risk Factors .......................................... 20
Diagnostic Tests and Procedures ....................... 21
Prevention ............................................ 22
Complications ......................................... 22
Nursing Management .................................... 23
Medical Management .................................... 23
Nursing Care Plan ..................................... 24
Review of Related Literature and Studies .............. 30
Local Literature.................................... 30
Foreign Literature.................................. 32
Local Studies....................................... 35
Foreign Studies..................................... 37
CHAPTER III: METHOD AND PROCEDURES FOR DATA GATHERING
Chapter Overview ...................................... 42

Data Gathering Technique .............................. 42
Administration of the Instrument ................................................................................................................................ 42
Locale of the Study ............................................................................................................................................................. 43
Location Map and History ............................................................................................................................................... 43
Sampling Design ................................................................................................................................................................. 44
Chapter IV: Findings, conclusions, and recommendations
Summary of Findings ........................................................................................................................................................ 46

Conclusions ........................................................................................................................................................................... 47
Recommendations .............................................................................................................................................................. 48
BIBLIOGRAPHY .................................................................................................................................................................. 49
APPENDIX ............................................................................................................................................................................. 51
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CHAPTER I
THE PROBLEM AND ITS SETTING
Gout is a term used for a group of at least nine metabolic
disorders characterized by an elevation in the serum uric acid
concentration (hyperuricemia). Gout may be primary or secondary.
Primary gout is the direct result of the body’s overproduction
of or decreased secretion of uric acid. Secondary gout occurs
when the overproduction or decreased secretion of uric acid is
secondary to another disease process or medication. The problem
develops when the crystals of monosodium urate monohydrate form
in the joints and surrounding tissues. These needlelike crystals
are responsible for the acute inflammatory reaction that
develops, resulting in the severe pain commonly associated with
an acute gouty attack. These crystal deposits can lead to
extensive joint and soft-tissue damage if left untreated.
(Anderson, Sylvia et.al (1992).pathophysiology clinical concepts
of disease processes 4th edition. Mosby-yearbook, Inc.11830
st.louis)
Gout is actually a group of diseases known as the gout
syndrome. It includes gouty arthritis with recurrent attacks of

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severe articular and periarticular inflammation; tophi or the
accumulation of crystalline deposits in articular surfaces,
bones, soft tissues, and cartilages; gouty nephropathy or renal
impairement; and uric acid kidney stones. The term primary gout
is used to designate cases in which the cause of the disorder is
unknown or an inborn error in metabolism and is characterized
primarily by hyperuricemia and gout. Primary gout is
predominantly a disease of men, with a peak incidence in the
fourth to sixth decade. In secondary gout, the cause of the
hyperuricemia is known but the gout is not the main disorder.
Asymptomatic hyperuricemia is a laboratory finding and not a
disease. (Brunner and Suddhart’s textbook of Medical Surgical
Nursing 11th edition Lippincot Williams and Wilkins,
Philadelphia)
The researcher had chosen this case as the subject for her
research study primarily because of the lack of attention given
to this condition. She believes that the study of this disease
would allow for further understanding of the disease, as well as
enhancement of her knowledge and skills in handling patients,
gathering data, and providing appropriate nursing care in the
community setting.
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General Objectives
The General Objectives of this study is to instill
additional information for further understanding regarding the
disease process of gout and the nursing interventions,
management needed to treat the illness. This also aims to
promote wellness, prevent the occurrences of complication
disease.
Specific Objectives
At the fourteen (14) days of Intensive Nursing Practicum
the stubent nurse will be able to:
1. Obtain the client’s profile variable in terms of:
1.1 Name
1.2 Age
1.3 Sex
1.4 Civil Status
1.5 Family size
1.6 Family stage of development
1.7 Health perception and management
1.7.1 Family history of illness
1.7.2 Past history of illness

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1.7.3 Present history of illness
1.8 Nutrition and Metabolic pattern
1.9 Elimination Pattern
1.10 Act and Exercise
1.11 Cardiovascular
1.12 Respiratory Pattern
1.13 Sleep Pattern
1.14 Cognitive and perceptual Pattern
1.15 Physical assessment
2. Establish good student nurse-client working relationship.
3. To know the anatomy and physiology of gout.
4. To determine and minimize the signs and symptoms that
occurred to the client.
5. To provide the proper intervention that will prevent the
development of the disease and the appearance of new
complicated symptoms.
6. To identify the risk factors that may contribute to the
occurrence of the disease.
7. And to treat or lessen the symptoms and difficulties
experiencing by the client.

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Client’s Profile
Name : Mr. One Day
Birthday : July 30, 1955
Gender : Male
Address : Brgy. Sampalucan, Bongabon N.E.
Nationality : Filipino
Age : 61 years old
Religion : Roman Catholic
Educational Attainment : Elementary Graduate
Height : 5’3
Weight : 60 kg
Blood Type : “O” positive
Diagnosis : Gout (Chronic Pain)
Physician : Dr. Mejia
ASESSMENT
Health Perception - Health Management

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Family History of Illness
Mr. One Day has a family history of lung problem. His
father had emphysema which is the cause of his father’s death.
Past Medical History:
Mr. One Day stated that he does not have any other disease
or condition aside from gout, before he reached the age of 55,
when he was diagnosed to have the disease.
History of Present Illness:
According to the client, his condition started from
acute joint pain. It worsens because of his uncontrolled alcohol
consumption. Because of the pain he is experiencing, he can’t
even rest and sleep enough. After a few months, acute pain
developed and turned to chronic pain which precipitated to the
development of signs and symptoms such as severe and intense
pain, swelling, warmth, and redness of a joint. He was brought
to the district hospital, where he was diagnosed of having Gout
(Chronic Pain) which shown at his X-ray imaging. From that
incidence he started to take Allopurinol 300mg once a day.
Nutrition and Metabolic Pattern

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Usual Food Intake
The client usual food intake during breakfast was one and
half (1 ½) cup of rice and boiled eggs or three (3) piece of
small sized bread. During lunch, he usually ate rice and
vegetables and for dinner he ate the same foods as lunch.
Food Restrictions
The client was advised to eat a healthy diet and avoid
sardines and dried peas.
Food Allergies
The client has no known food or drug allergies.
Usual Fluid Intake
The client usual fluid intake was not less than 4,000 mL
per day, he avoids as much as possible fluids containing
caffeine such as coffee.
Problems with Ability to Eat
The client has no experiencing difficulty of eating and has
a good appetite.
Supplements and other Medications by the Patient

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The client was taking a drug maintenance which was
prescribed for his gout. This medication includes Allopurinol.
Elimination Pattern
Bladder Pattern
The client has no difficulty in urination during daytime
but there were times that he has frequency in urinating at
night.
Bowel Pattern
The client has normal bowel elimination, he defecate semi-
formed stool once a day every morning without experiencing
difficulty or straining during defecation.
Activity and Exercise Pattern
Self-Care Ability:
0=Independent
1=Assistive device
2=Assistance from others
3=Assistance from person and equipment
4=dependent/Unable
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0 1 2 3 4 REMARKS
Eating The client can eat

independently.
Bathing He is able to take
bath independently.
Dressing He can wear clothes
with assistance
from others.
Toileting He can do it all
alone.
Bed The client can do
it
Mobility
Transferrin The client can

transfer any
g object.
Ambulating The client can

stand and walk
independently.
Stairs The client can walk
on stairs with
assistance.
Shopping The client did not
shopping.
Cooking The client can cook
foods.
Home The client can do
it
Maintenance Independently.
Table 1 Self Care Ability
The client was independent in his activity such as eating,
bathing, toileting, bed mobility, transferring, ambulating,

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cooking and home maintenance except dressing, walk on stairs and
shopping.
Usual Daily Activity Exercise
The client was doing a household chores such as cleaning
the house and at times doing laundry as daily activity. These
serve as his daily exercise.
Any Limitations of Physical Activities
The patient was restricted to do strenuous activities as
advice by his doctor.
Cardiovascular
Upon assessing the client, his pulse was regular and strong,
his blood pressure was 150/90 mmHg in sitting position, and
extremities are cold.
Respiratory
The client’s chest was symmetrical; his respiration was
twenty (20) cycles per minute with diaphragmatic respiration.
Sleeping and Rest Pattern
Usual Sleep Pattern

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The client usually sleeps at eight pm and usually awakens
at four thirty am. His sleep is at least eight hours per day.
Cognitive and Perceptual pattern
The clients communicate calm and attentively. There was no
problem in memory functioning. The client can recall past as
well as recent events in his life. He was oriented to time,
place and person and to his condition. The client talks with
sense and explains things logically.
Roles and Relationship
The client lives with his wife, four children, two
grandchildren and his daughter-in-law. Although he was working
in a lottery, he wasn’t the only one to support the whole family
in terms of financial needs.
Sexuality and Reproductive
The client has no history of any reproductive problem.
Coping and Stress Tolerance

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The client viewed his problem as a challenge that made him to
be more knowledgeable in resolving circumstances in life, and he
believes that God never give him a life without a purpose.
Vital Signs
The Table below shows the vital signs of the client during
the home visits
Date Blood Temperature Pulse Respiration
Pressure Rate Rate
Jan. 5, 150/90 mmHg 36.4ᵒ 82 bpm 20 cpm
2017 Celsius
Jan. 6, 140/90 mmHg 36.2ᵒ 85 bpm 19 cpm
2017 Celsius
Height and Weight
The client weighs 60 kilograms and her height is five (5)
feet and (3) three inches.
Body Mass Index
BMI= Weight (kg)

Height (m²)
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BMI= 60 kg
1.6m
BMI= 37.5
Basis of Interpretation
BMI of less than 18.5 classified as underweight.
BMI of 18.5 to 24.9 is classified as normal.
BMI of 25 to 29.9 is classified as overweight.
BMI of 30 to 39 is classified as obesity.
Interpretation
The final height and weight based on the computation of the
client’s body mass index is 37.5 which is classified as obesity
referred to the body mass index chart of Brunner and Suddarth’s
Medical Surgical Nursing 10Th edition, (2010).
Summary presentation of Client’s Assessment
The table below shows the normal and abnormal findings of
physical assessment or also called as Cephaulo Caudal Assessment
of the client.
Body Parts Normal findings Actual Findings

Skull Generally round with Normal, No
in the prominence in tenderness noted
the frontal and upon palpation
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occipital.
Scalp Lights in color than Normal, no scars
the complexion. noted, no lesions or
masses, free from
dandruff
Hair Can be black, brown, Abnormal. Black hair
evenly distributed, but not distributed
covers the whole evenly covering the
scalp, no evidenced whole scalp.
of alopecia
Face Shape may be oval or Normal, Face is
round, Face is symmetrical, no
symmetrical. involuntary muscle
movement
Eyes Normal white Normal, Conjunctivae
conjunctivae are pink and sclera moist,
and clear, pupils are pupils are equal,
normal in size. round react to light
and accommodation,
no decrease in
visual acuity
Ears The earlobes are Normal, The earlobes
bean, shaped, are bean-shaped,
parallel and parallel and
symmetrical. symmetrical, no
discharge and
lesions
Nose and paranasal Lymph nodes may not Normal, Negative
sinuses be palpable, non- unusual discharge
tender if palpable and lesions
firm and smooth,
slightly movable.
Neck and throat No mass or lumps Normal, No visible
mass or lumps
Chest Normal breath sounds, Normal, Chest is
Normal respiration is symmetrical, no
12-20B/M. distress noted
Skin Well hydrated, not Abnormal, dry skin
dry
Abdomen Skin color is uniform Normal, No
,no lesion, no venous tenderness noted, no
engorgement muscle guarding
Genitalia Yellowish color. Abnormal. Has
difficulty in
urinating at night.
Anus and rectum Semi formed stool, Normal, No straining
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brownish color during defecation

Upper and Lower Both extremities are Abnormal. Lower
Extremities equal in size, have extremities have
the same contour with edema.
prominences on
joints, No
involuntary movement,
No edema
Table 2 Head to Toe Assessment
Table 2 presents the head to toe assessment. All findings
are normal except from the client’s hair, skin, genitalia and
lower extremities.
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CHAPTER 2
CASE DISCUSSION AND PRESENTATION
This chapter presents the case discussion/ presentation
and the view of related literature and studies on the subject
made by the researcher during the exploration stage of the case
finding.
Anatomy and Physiology:
Figure 1 Anatomy of the Musculoskeletal System
(www.slideshare.net)
Bone, or osseous tissue, is a hard, dense connective tissue
that forms most of the adult skeleton, the support structure of

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the body. In the areas of the skeleton where bones move (for
example, the ribcage and joints), cartilage, a semi-rigid form
of connective tissue, provides flexibility and smooth surfaces
for movement. The skeletal system is the body system composed of
bones and cartilage and performs the following critical
functions for the human body:
• supports the body
• facilitates movement
• protects internal organs
• produces blood cells
• stores and releases minerals and fat
Support, Movement, and Protection
The most apparent functions of the skeletal system are the
gross functions—those visible by observation. Simply by looking
at a person, you can see how the bones support, facilitate
movement, and protect the human body.
Just as the steel beams of a building provide a scaffold to
support its weight, the bones and cartilage of your skeletal
system compose the scaffold that supports the rest of your body.
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Without the skeletal system, you would be a limp mass of organs,
muscle, and skin.
Bones also facilitate movement by serving as points of
attachment for your muscles. While some bones only serve as a
support for the muscles, others also transmit the forces
produced when your muscles contract. From a mechanical point of
view, bones act as levers and joints serve as fulcrums. Unless a
muscle spans a joint and contracts, a bone is not going to move.
For information on the interaction of the skeletal and muscular
systems, that is, the musculoskeletal system, seek additional
content.
Bones Support Movement
Bones act as levers when muscles span a joint and contract;
Bones also protect internal organs from injury by covering or
surrounding them.
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Bones Protect Brain
The cranium completely surrounds and protects the brain
from non-traumatic injury.
Mineral Storage, Energy Storage, and Hematopoiesis
On a metabolic level, bone tissue performs several critical
functions. For one, the bone matrix acts as a reservoir for a
number of minerals important to the functioning of the body,
especially calcium, and phosphorus. These minerals, incorporated
into bone tissue, can be released back into the bloodstream to
maintain levels needed to support physiological processes.
Calcium ions, for example, are essential for muscle contractions
and controlling the flow of other ions involved in the
transmission of nerve impulses.

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Bone also serves as a site for fat storage and blood cell
production. The softer connective tissue that fills the interior
of most bone is referred to as bone marrow. There are two types
of bone marrow: yellow marrow and red marrow. Yellow marrow
contains adipose tissue; the triglycerides stored in the
adipocytes of the tissue can serve as a source of energy. Red
marrow is where hematopoiesis—the production of blood cells—
takes place. Red blood cells, white blood cells, and platelets
are all produced in the red marrow.
Head of Femur Showing Red and Yellow Marrow
The head of the femur contains both yellow and red marrow.
Yellow marrow stores fat. Red marrow is responsible for
hematopoiesis.
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Physiology of Gout (Book Based)
Renal
Dietary purine
secretion
load
Urate Level
Endogenous
Gout
purine
synthesis
Urate supersaturation and

crystallization
Gout
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Pathophysiology of Gout (Client-Based)
Sedentary Lifestyle
Poor Circulation & Accumulation

of Uric Acid in the body
Deposited in the joint
Change in appearance of Pain

structure
Swelling within joints &

Impaired functioning
blood vessels
Gout
This diagram shows the client based pathophysiology. It
explains briefly what the process of how Mr. One Day developed
gout.
Definition
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Gout is a form of inflammatory arthritis that develops
in some people who have high levels of uric acid in the blood.
The acid can form needle-like crystals in a joint and cause
sudden, severe episodes of pain, tenderness, redness, warmth and
swelling.
Stages of gout:
 Asymptomatic hyperuricemia is the period prior to the first
gout attack. There are no symptoms, but blood uric acid
levels are high and crystals are forming in the joint.
 Acute gout, or a gout attack, happens when something (such
as a night of drinking) causes uric acid levels to spike or
jostles the crystals that have formed in a joint,
triggering the attack. The resulting inflammation and pain
usually strike at night and intensify over the next eight
to 12 hours. The symptoms ease after a few days and likely
go away in a week to 10 days. Some people never experience
a second attack, but an estimated 60% of people who have a
gout attack will have a second one within a year. Overall,
84% may have another attack within three years.

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 Interval gout is the time between attacks. Although there’s
no pain, the gout isn’t gone. Low-level inflammation may be
damaging joints. This is the time to begin managing gout –
via lifestyle changes and medication – to prevent future
attacks or chronic gout.
 Chronic gout develops in people with gout whose uric acid
levels remain high over a number of years. Attacks become
more frequent and the pain may not go away as it used to.
Joint damage may occur, which can lead to a loss of
mobility. With proper management and treatment, this stage
is preventable.
Signs and symptoms
Book based Client’s based

Excruciating pain and The client experiences pain
swelling (from the big toe, and swelling in lower
foot, ankle/knee, wrist and extremities
fingers)
Trauma (Illness/Injury)
Tophi
Tenderness around joint
Skin that is red, shiny and
painful to touch
Decreased kidney function and
kidney stones
Hyperuricemic
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Symptoms vary widely in people with gout. Gout usually
affects one joint at a time, but if left untreated it can affect
many joints. Joint pain that used to resolve in a week to 10
days could become a milder, but constant pain. Eventually,
untreated gout can cause other problems. Tophi – painless but
disfiguring lumps of crystals formed from uric acid may develop
under the skin around joints. The crystals can also form kidney
stones.
Gout is associated with other serious health risks such as

high blood pressure, diabetes, chronic kidney disease and
cardiovascular disease.
Risk Factors
The people risk in having gout is Genetics; Have other
health conditions such as high cholesterol, high blood pressure,
diabetes and heart disease; Diuretic medications or “water
pills” taken for high blood pressure that can raise uric acid
levels; Gender and age commonly in men than women until around
age 60; Diet; Alcohol; Sodas; Obesity; Those who have undergone
gastric bypass surgery.

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Frequently, the cause for gout is identified. This is
a condition called hyperuricemia, the result of excess uric acid
in the body.
Diagnostic Test
To diagnose gout, the doctor will take a patient's medical
history, examine the affected joint and do a blood test. He or
she will also ask about:
 Other symptoms
 What medications the patient is taking
 The patient's diet
 How quickly and intensely the gout attack came on
Details of the attack the doctor is looking for: severity of
pain, length of attack and joints affected.
The doctor will need to rule out other potential causes of
joint pain and inflammation such as infection, injury or another
type of arthritis. He or she will take a blood test to measure
the level of uric acid in your blood. A high level of uric acid
in your blood doesn’t necessarily mean you have gout, just as a
normal level doesn’t mean you don’t have it. Your doctor may
take an X-ray, ultrasound, CT or MRI to examine soft tissue and

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bone. The doctor might also remove fluid from the affected joint
and examine it under a microscope for uric acid crystals.
Finding uric acid crystals in the joint fluid is the surest way
to make a gout diagnosis.
Prevention
This gout can be prevented by regular exercise and by
making a few dietary and lifestyle modification.
A well-balanced diet can boost your immune system and also
prevent joint ailments. It is best to avoid fatty foods
altogether or keep them to a minimum. Fat increases your
cholesterol levels and makes you vulnerable to joint disorders.
Smoking and alcohol intake puts unnecessary stress
specifically with the disease. Avoidance of nicotine and alcohol
can be highly beneficial for them.
Complication
Lifestyle disruption such as Sleep and Disability: Gout
attacks most often come on at night and may wake you from your
sleep. Continued pain can also keep you from falling back to
sleep. A lack of sleep can lead to a variety of issues including
fatigue, increased stress, and mood swings: The pain of a gout

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attack can interfere with walking, household chores, and other
everyday activities. In addition, the joint damage caused by
repeated gout attacks can cause permanent disability.
Tophi are deposits of urate crystals that form under the
skin in cases of chronic gout, or tophaceous gout. These occur
most often in the hands, feet, wrists, ankles, and ears. Tophi
feel like hard bumps under the skin and are usually not painful,
except during gout attacks when they become inflamed and
swollen.
Joint deformity. If the cause of gout is not treated, acute
attacks happen more and more often. The inflammation caused by
these attacks, as well as the growth of tophi, causes damage to
joint tissues. Joints can eventually come out of alignment and
become immobile.
Kidney stones. The same urate crystals that cause the
painful symptoms of gout can also form in the kidneys. These can
create painful kidney stones. High concentrations of urate
kidney stones can interfere with kidney function.
Kidney disease. According to the National Kidney
Foundation, many people with gout also have kidney disease. This
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sometimes ends in kidney failure. However, there are conflicting
opinions as to whether or not the pre-existing kidney disease
creates the high uric acid levels that cause gout symptoms.
Heart disease. Gout is common among people with high blood
pressure, coronary artery disease, and heart failure.
Nursing Management/Intervention
Give pain medication as needed especially during acute
attacks, apply cold packs to inflamed joints to ease discomfort
and reduce swelling, encourage bed rest.
Encourage the patient to perform techniques that promote
rest and relaxation. Provide nutritious diet. Avoid purine rich
foods. Urge the patient to perform as much self-care as his
immobility and pain. Urge the patient to drink plenty of fluids
to prevent renal calculi. Discuss the principles of gradual
weight reduction with an obese patient.
Urge the patient to control hypertension, especially if he
has renal deposits. Provide emotional support.
Medical Management
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Drugs used to treat acute attacks and prevent future
attacks include:
• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs
include over-the-counter options such as ibuprofen (Advil,
Motrin IB, others) and naproxen sodium (Aleve, others), as well
as more-powerful prescription NSAIDs such as indomethacin
(Indocin) or celecoxib (Celebrex).
Your doctor may prescribe a higher dose to stop an acute
attack, followed by a lower daily dose to prevent future
attacks.
NSAIDs carry risks of stomach pain, bleeding and ulcers.
• Colchicine. Your doctor may recommend colchicine
(Colcrys, Mitigare), a type of pain reliever that effectively
reduces gout pain. The drug's effectiveness is offset in most
cases, however, by intolerable side effects, such as nausea,
vomiting and diarrhea.
After an acute gout attack resolves, your doctor may
prescribe a low daily dose of colchicine to prevent future
attacks.
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• Corticosteroids. Corticosteroid medications, such as
the drug prednisone, may control gout inflammation and pain.
Corticosteroids may be administered in pill form, or they can be
injected into your joint.
Corticosteroids are generally reserved for people who can't
take either NSAIDs or colchicine. Side effects of
corticosteroids may include mood changes, increased blood sugar
levels and elevated blood pressure.
Medications to prevent gout complications
If you experience several gout attacks each year or if your
gout attacks are less frequent but particularly painful, your
doctor may recommend medication to reduce your risk of gout-
related complications.
Options include:
• Medications that block uric acid production. Drugs
called xanthine oxidase inhibitors, including allopurinol
(Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric), limit the
amount of uric acid your body makes. This may lower your blood's
uric acid level and reduce your risk of gout.

College of Nursing
Side effects of allopurinol include a rash and low blood
counts. Febuxostat side effects include rash, nausea and reduced
liver function.
• Medication that improves uric acid removal. Probenecid
(Probalan) improves your kidneys' ability to remove uric acid
from your body. This may lower your uric acid levels and reduce
your risk of gout, but the level of uric acid in your urine is
increased. Side effects include a rash, stomach pain and kidney
stones. (mayoclinic.com, 2011).

College of Nursing
Assessment Nursin Planning Interventio Rationale Evaluati

g n on
Diagno
sis
Subjective: Impair General  Evalua  Level The
“Paminsan ed Objective te or of patient
minsan physic : After 3 contin activ was able
sumasakit al days of uously ity to
yung binti mobili nursing monito or maintain
ko, hindi ty intervent r exerc or
ko relate ions, the degree ise increase
maigalaw” d to patient of depen strength
as pain. will joint ds on and
verbalized maintain inflam progr function
by the or mation essio of
client. increase of n and affected
strength pain. resol or
Objective: and ution compensa
 Pain function of tory
scale of infla body
of 5 compensat mmato part.
out of ory body ry
10. part. proce Goal was
 Reluct  Mainta ss. met
ance Specific in bed  Syste
to Objective rest mic
attemp : or rest
t After 2 chair durin
moveme hours of rest g
nt nursing when acute
intervent
 Limite indica attac
ions the ted. ks
d
client’s Schedu and
range
pain will le impor
of
subside activi tant
motion
 Vital ties throu
Signs provid ghout
Temp- ing all
36.4ᵒC freque phase
PR-82 nt s of
bpm rest disea
RR-20 period se to
cpm s and reduc
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BP uninte e
-150/90 rrupte fatig
mmHg d ue
night and
time impro
sleep. ve
 Encour stren
age gth.
adequa  To
te assis
fluid t
intake with
. excre
tion
of
uric
acid
and
 Assist decre
with ase
active likel
or ihood
passiv of
e stone
range forma
of tion.
motion  Maint
. ain
or
impro
ves
joint
funct
 Review ion,
foods muscl
that e
are stren
rich gth,
in and
purine gener
s like al
sardin stami
College of Nursing
es, na.
shellf  To
ish avoid
and foods
organ that
meats. preci
pitat
e
acute
attac
ks
College of Nursing
Assessme Nursin Planning Interventi Rationale Evaluation

nt g on
Diagno
sis
Subjecti Dizzin After 1-2 Independen After 1-2
ve: ess hours of t: * * To hours of
“Nahihil relate nursing Elevated promote non nursing
o ako” d to interventi the head pharmacolog interventi
as increa on, the of the ical pain on, the
verbaliz sed client bed. management. client
ed by blood will * To verbalized
the pressu verbalize prevent absence of
patient re absence of * Provided fatigue. dizziness
dizziness. comfort and felt
Objectiv measures rested.
e: like
reposition * To assist Goal was
Vital ing or in muscle met
Signs touch. and
Temp- * generalized
36.4ᵒC Encouraged relaxation
PR-82 adequate *To
bpm rest maintain
RR-20 periods. “acceptable
cpm ” level of
BP pain.
-150/90 * To
mmHg decrease
* Assisted blood
client to pressure.
learn deep
breathing
techniques
.
College of Nursing
Assessme Nursing Planning Intervent Rationale Evaluatio

nt Diagnosis ion n
Subjecti Risk for After 1-2 Independe After 1-2
ve: ineffecti hours of nt: hours of
“Hindi ve nursing * Identify nursing
ko alam therapeut intervent * Assess specific intervent
kung ic ion, the the level clients ion, the
bakit regimen client of need and client
ito ang related will understan develop verbalize
gamot to verbalize ding of individual d
ko” as Insuffici understan the ized understan
verbaliz ent ding client. teaching ding
ed by knowledge regarding plan. regarding
the to the * Explain the
client. therapeut complianc the * The complianc
ic e of the Actions, informatio e of the
regimen. drug Side n provides drug
maintenan effects additional maintenan
ce. and the knowledge ce.
purpose from which
of the the client Goal was
medicatio will trust met
ns. and
continue
* the
Discussed Medication
the .
importanc
e of
taking
the
medicatio
n in a
regular
basis.
College of Nursing
Drug Actio Classifi Indicati Contraind Adverse Nursing

Name n cation on ication Effect Consider
ation
Generi Actio Hyperuri Primary, Hypersens GI  Ass
c n: cemia uncompli itivity, disturban ess
Name: Treat and Gout cated children, ces, skin if
Allopu ment preparat hyperuri pregnancy rash the
rinol of ions cemia; , (disconti cli
prima mild lactation nue) ent
Brand ry or gout; , rarely is
Name: secon uric idiopathi toxic all
Llanol dary acid c epidermal erg
gout nephropa hemochrom necrolysi ic
thy atosis, s, to
Dosag asymptoma Stevens all
e: tic Johnson opu
300 hyperuric syndrome, rin
mg emia thrombocy ol,
topenia, blo
Frequ allopurin od
ency: ol dys
Once hypersens cra
a day itivity sia
syndrome s,
Route liv
: er
Oral dis
eas
e,
ren
al
fai
lur
e,
lac
tat
ion
.
Enc
our
age
pat
ien
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t
to
dri
nk
2.5
to
3
L/d
ay
to
dec
rea
se
the
ris
k
of
ren
al
sto
ne
dev
elo
pme
nt.
 Che
ck
uri
ne
alk
ali
nit
y
ura
tes
cry
sta
lli
ze
in
aci
d
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uri
ne;
sod
ium
bic
arb
ona
te
or
pot
ass
ium
cit
rat
e
may
be
ord
ere
d
to
alk
ali
ze
uri
ne.
College of Nursing
CHAPTER III
METHOD AND PROCEDURES FOR DATA GATHERING
Chapter Overview
In this chapter, the method of research and procedure
utilized in the study as well as the instrument used to gather
data was presented.
Data Gathering Technique
The descriptive method of research was applied in this
study. A descriptive method examines phenomena, group of people,
idea or theory with a particular focus on facts and conditions
of the subject. The goal is to collect factual evidence and
information that can provide a comprehensive perception of the
subject.
Descriptive research seeks to depict what already exists in
group or population. Descriptive studies do not seek to measure
the effect of a variable; they seek only to describe (Cherry,
2014).
Administration of the Instrument

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Upon approval of Hon. Mayor Ricardo I. Padilla, the
researcher then sought permission and assistance from Hon. Joe
Lagrimar T. Ruz, Barangay Captain of Brgy. Sampalucan. The
researcher together with the group personally visited the
designated area of their selected target participants and
gathered data through questionnaire and interview.
Locale of the Study
This research was conducted during the Intensive Nursing
Practicum exposure in January 2017. The selected respondent is a
resident of Brgy. Sampalucan Bongabon, Nueva Ecija.
Location Map
Figure 7: Location Map of Brgy. Sampalucan, Bongabon
History of Barangay Sampalucan Bongabon NE

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Figure 3.2: Map of Bongabon
History of Bongabon
The Augustinian missionaries who preached Catholicism in
Pampanga extended their outposts into what is now the province
of Nueva Ecija by following the Rio Grande dela Pampanga. Thus,
Santol (present day Barangay Santor) was part of Pantabangan and

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established in 1659. In 1760, Bongabon was named as a town and
parish under the patronage of St. Francis of Assisi.
Bongabon was the first capital of Nueva Ecija. Philippine
Revolution under the Spanish Colonial Period When the Philippine
Revolution began on 1896 to 1898 against Spain. The Philippine
Revolutionary and Republican troops with the aid of Katipunero
rebels invaded the municipal town of Bongabon and fought the
Spanish Colonial forces and started the Siege of Bongabon. The
Filipino revolutionary troops and Katipunero rebel fighters
captured the municipal town after the siege forcing the Spanish
troops to retreat.
Philippine-American War and the American Colonial Period
With the outbreak of the Philippine–American War on 1899 to
1902, the town saw the arrival of American troops which fought
the Filipino revolutionary troops and Katipuneros in the Battle
of Bongabon on 1899. In the ensuing battle, the town was
captured by the American troops.
World War II under the Japanese Occupation. The outbreak
was start the Second World War, Japanese planes was crushed to
invaded the town municipality in Bongabon on December 1941 under

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the Japanese Invasion and through the occupied by the Imperial
Japanese forces was entering the town on 1942 and begins the
Japanese Occupation. The active of the general headquarters and
garrison bases of the Imperial Japanese Armed Forces was
established on 1942 through the combined Allied United States
and the Philippine Commonwealth military and recognized
guerrilla raid and captured on 1945 and they stationed in the
municipality of Bongabon during the Japanese Occupation.
Started the conflicts and insurgencies during the Japanese
Occupation on 1942 to 1944. Many several various guerrilla
fighter groups and the Hukbalahap Communist resistance at the
municipal town in Bongabon was side by side and fought attack to
attack from the local military and guerrilla conflicts and
arrival and helping aided of all stronghold Filipino soldiers
and officers of the ongoing Philippine Commonwealth Army and
incoming Philippine Constabulary 2nd Infantry Regiment units and
against by the Imperial Japanese troops and Makapili militia
groups. After the insurgencies on 1944, many guerrilla fighters
and Hukbalahap resistance was they retreated by the Japanese
soldiers and air raid planes was recaptured the municipality in
Bongabon. Before the combined force of the Filipino troops of

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the Philippine Army and Constabulary units and the American
troops of the U.S. Armed Forces units with aiding guerrilla
groups and Hukbalahap fighters was beginning the liberation on
1945 since the Battle of Bongabon.
Some of all outgoing guerrillas and non-combanant civilians
are found arrested, tortured, marches and killed by the Imperial
Japanese troops. When the all local outgoing guerrillas and
civilians was torturing and killed by the Japanese hands at the
Imperial Japanese military general headquarters, garrisons and
concentration camps in Bongabon.
Since the liberation and the Battle of Bongabon on 1944 to
1945 between the fought of the combined Filipino and American
troops and the recognized guerrillas with the Japanese troops.
When the combined military force of the Filipino troops and
officers of the 2nd, 22nd and 26th Infantry Division of the
Philippine Commonwealth Army and 2nd Infantry Regiment of the
Philippine Constabulary and the American troops and officers of
the U.S. Armed Forces units was found liberated and invaded the
town municipality of Bongabon and aiding various guerrilla
groups and Hukbalahap communist fighters and defeats Imperial
Japanese troops and Makapili militia groups and ending aftermath

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of World War II. The casualties at the fall of main battle of
Bongabon was over 14,200 Filipino troops and guerrillas killed
and wounded in action, 6,000 American troops killed and wounded
in action, 68,000 Japanese troops and Makapili militias killed,
wounded and captured in action and over 28,000 outgoing
guerrillas and civilians killed by the Japanese.
Sampling Procedure
The student nurse utilized purposive sampling where a group
of people believed to be typical or average or a group of people
specially picked for some unique purpose the researcher never
knows if the sample is representative of the population, and
this method is largely limited to exploratory research (Trochin,
2006).
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Chapter 4
Findings, Conclusion and Recommendation
This chapter presents the conclusions and recommendations
offered based on the result of the study.
Summary of Findings
The following are the summary of the study based on the
general survey and assessment of the client:
1. The client’s personal data was kept in secrecy due to right
of privacy.
2. They lived in Brgy. Sampalucan for 27 years, which
classified the client as permanently living in the area.
3. The client family structure was nuclear and extended. Due
to they are living with his wife and children together with
his daughter-in-law and grandchildren. The stage family
development is launching family and Early Childhood.
4. The family’s source of income came from him as employer of
a lottery; from his son as call center agent; and from his
daughter as domestic helper.
5. The client was diagnosed with Gout (Chronic Pain).

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6. Mr. One Day is taking a prescribed medication for his Gout.
This medication includes Allopurinol.
Conclusions
The student nurse, therefore conclude the following:
1. The client shows an increase of energy and performs activity
of daily living effectively.
2. The client verbalizes understanding the different
interventions in preventing the occurrence of his joint
pain.
3. The client shown understanding as advised him to eat a
healthy diet and avoid fatty and salty foods.
4. The client verbalized understanding about his condition.
5. The client is taking his medication in regular bases which
help to control his gout.
Recommendations
The following are hereby recommended:
1. Emphasize to the client the importance of having a
periodical checkup.
College of Nursing
2. Encourage adapting a healthy lifestyle (eating healthy
diet).
3. Keep in mind the information and importance of his
medication to increase compliance.
4. Motivate to verbalize concerns about his health to provide
a necessary approach.
5. Educate the client for further understanding how to manage
stress and cope with it.
6. Family and relative of the client should support him
physically, morally, spiritually, and socially.
7. This research study will serve as references for the
nursing student to be guided and to have an idea on how
provide a proper nursing care management for the client
having this kind of disease.
8. For the community health office, they should do monthly
monitoring of the clients and they should also give
additional information on how to prevent it.

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Bibliography
Brunner and Suddhart’s textbook of Medical Surgical Nursing
11th edition Lippincot Williams and Wilkins, Philadelphia
Anderson, Sylvia et.al (1992).pathophysiology clinical
concepts of disease processes 4th edition. Mosby-yearbook,
Inc.11830 st.louis
Brunner and Suddarth’s Medical Surgical Nursing 10Th
edition, (2010).
http://philschatz.com/anatomy-book/contents/m46341.html#
http://www.slideshare.net/iqbal1313/the-skeletal-system
25998218
http://www.arthritis.org/about-arthritis/types/gout/what-
is-gout.php
http://www.pchrd.dost.gov.ph/index.php/news/library-health-
news/4307-number-of-filipinos-suffering-from-gout-hits-1-6-
https://www.scribd.com/document/60169517/Gout#
http://www.healthline.com/health/gout-
complications#Lifestyle2
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http://www.mayoclinic.org/diseases-
conditions/gout/basics/treatment/con-20019400
Appendix A
(Sample Questionnaire)

General Tinio St., Cabanatuan City
College of Nursing
Community Health Nursing
INTENSIVE NURSING PRACTICUM ASSESSMENT FORM
Date:
I. GENERAL INFORMATION
A. FAMILY DATA
Family Name:____________________
Barangay House No._______
Length of residency:______( )Permanent()Transient
Family size:( )1-3 Small( )4-6 Medium( )7or more
Large
Family Members’ Chart
Famil Birthd Ag Se Civil Religio Relationsh Education Occupa
y ay e x Statu n ip al tion
Membe s To the attainmen
r Family t
Head
1.
2.
3.
4.
5.
6.
7.
8.
B. Family Characteristics
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Type of family Structure

Tradional: Extended________ Nuclear______
Non-Traditional : Single Parenthood___ Other,specify___=
Stages of Family Development
___Beginning Family ___with Teenagers
___Early Childhood ___Launching Family
___With Pre-schooler ___Middle Aged Family
___With Schooler ___Aging Family
II. ASSESSMENT
A. HEALTH PERCEPTION-HEALTH MANAGEMENT
Past Medical History:
Illnasses:________________________________________
Surgery:__________________________________________
History of Chronic Disease ______________________
Immunization History:__Tetanus__Pneumonia__Influenza__MMr
__Polio__Hepatits B
Smoking: __None __Quit(date)_______________Pks/yr history
Alcohol: Amount/type _______________Frequency of use
Family History of
Illness:________________________________________________________
________________________________________________________________
________________________________________________________________
History of present illness:
________________________________________________________________
________________________________________________________________
Other drugs: Amount/Type :___________ Freq. of use:____________
Medication(prescription/ Dose Frequeny Last Dose
Nonprescription)Name
VITAL SIGNS:
Do you have any allergies? No__Yes__ What?! _______
(Check reactions to medication, foods, cosmetics, insect
bites,etc) Review admission CBC, Urinalyses and chest x-ray.
Note any abnormalities here:
DATE Temperature Pulse Respiratory Blood Weight Height
Rate Rate pressure
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B.NUTRITION AND METABOLIC PATTERN

Weight fluctuations last 6 months__________________________
Usual Food intake
MEALS AMOUNT FOODS/DRINKS
Breakfast
Lunch
Snacks
Dinner
Food restriction:_______________________
Food allergies:_________________________
Usual fluid intake:____________________
Problems with ability to eat/Food intolerance:__________________
Feeding__self___Assist
Condition of mouth: __pink___inflammed___moist___dry
___lesion/ulcerations describe______teeth/gum
___dentures
Skin Condition:
_____color:pallor,ashen,pink,jaundice,cyanotic,ruddy
_____Temperature: warm, cool, hot
_____dry,moist,clammy,diaphoretic
_____edema: pitting/non-pitting
_____turgor: good, poor
_____pruritis
_____intact
_____bruises/lesions describe: (size,location)______________
Body temperature:_________
Supplements and other medicine:______________________________
B. ELIMINATION PATTERN
Bowel Habits Describe:_____________________________________
(consistency,color,amount)
____#BM’s/day ____Date of last BM
_____Constipation_____diarrhea____Incontinence
Bladder Habits Describe:_____________ color,clarity,amount)
___Frequency____Dysuria____Nocturia____Urgeny____Hematoria
___Retention____Burning____Hesitancy___Pressure
Incontinency:____No____Yes___Daytime___nightime____occasion
al___difficulty delaying voiding
Inspect abdomen:___symmetry___flat___rounded___obese
College of Nursing
Auscultate Abdomen:___normal bowel sounds

___hypoactive___hyperactive
Palpate abdomen:____soft___firm___tender;describe__________
_____distention:describe___________________________________
C. Activity and Exercise Pattern

A. Musculoskeletal:____tremors____atrophy____swelling
Self Care Ability:
0=Independent
1=Assistive device
2=Assistance from others
3=Assistance from person and equipment
4=dependent/Unable
0 1 2 3 4 REMARKS
Eating
Bathing
Dressing
Toileting
Bed Mobility
Transferring
Ambulating
Stairs
Shopping
Cooking
Home
Maintenance
Assistive Devices:___none___crutches ___ Bedside

commode___Walker____cane___splint/brace___wheelchair__other
Gait:___normal___abnormal____________________________(describe)
Range of motion:____normal___limited________________(describe)
Posture:____normal___kyphosis___Lordosis
Deformities:____no____yes__________________________(describe)
Amputation______________________Prosthesis___________________
Physical Development Assessment:_______normal__________abnormal
Describe;____________________________________________________
E.Cardiovascular
Hair distribution:____normal____abnormal________(describe)
Pulses : ______Femoral___Popliteal___Post-tibial___Dorsalis
______Palpable____Doppled
F.Respiratory
College of Nursing
____not Assessed
Inspect chest:____symmetrical___________asymmetrical
Respiration:__rate___depth(shallow,deep,abdominal,diaphragmatic)
__regular___irregular________periods of apnea
Dyspnea at rest___orthopnea___dyspnea on exertion
______Cough:dry/productive describe_____________
______Sputum describe:
Auscultate chest:___crackles___rhonchi___friction rub___wheezing
Describe:_________________________________________________
G.SLEEP AND PATTERN

____Not assessed
Usual Sleep Habits:____hours per night____consecutive hours
slept per night
____a.m nap_____p.m nap
Feel rested after sleep:___yes___no
Awakening during night___yes___no insomnia ___yes___no
Methods used to promote sleep:___Medication________________
_____warm fluids___rituals:(bathing, reading, tv,music)
H.COGNITIVE AND PERCEPTUAL PATTERN

____not Assessed
Level of
consciousness:_alert_lethargic_drowsy_stuporous_comatose
Mood(subjective):_pleaseant_irritable_calm_happy_euphoric
_anxious_fearful_other:____________________
Affect(objective):_surprise_anger_sadness_joy_disgust_fear_flat_
blunted_full
Orientation level:_person_place_time_significant other
Memory: recent_yes_no remote:_yes_no
Pupils: _____size___reaction(brisk/sluggish)
Reflexes: ______normal_____absent
Grasps: _____Right:strong/weak______Left:strong/weak
Push/Pulls: ____Right:strong/weak____left:strong/weak
Other: _____numbness____tingling
Pain:____Denies
_____Location: describe_______________________
_____Radiation:describe______________________
Intensity(0-10 scale)
Senses:Visual Acuity:___Within limit____glasses____contacts
___blind(R/L)
Prothesis:(artificial eye)R/L
Hearing: __Within normal limit__impaired(R/L)__hearing aid
College of Nursing
__tinnitus__drainage from ears

Touch: __within normal limit__abnormal:describe__tingling
__numbness
Smell: _____normal_____abnormal
Ability to communicate: language spoken__read__clear
__articulate
I.SELF-PERCEPTION AND SELF-CONCEPT
____not assessed
Apperance:___calm__anxious__irritable__withdrawn___restless
___appropriate dress___hygiene
Level of anxiety:(subjective) Rate on 0-10 scale___________
(objective)face reddened:___no___yes
Muscle tenseness: relaxed fists/teeth clenched
Body language describe_____________________________________
J. ROLE AND RELATIONSHIP

____not assessed
Does patient live alone:___yes___no:with whom______________
Support System:__spouse__neighbors/friends_________ none
__family in the same residence-family in separate residence
Social Activities: ___active___limited____none
K.SEXUALITY AND REPRODUCTIVE

___not assessed
Female:__date of LMP__Para__Gravida__Pregnant
__Menopause___no___yes____year
Contrception_____no____yes_________type
Hx. Of vaginal bleeding____no___yes(describe)______________
Last Pap smear_______________
History of sexual transmitted disease______no_____yes
Male: History of prostate problems____yes____no
History of penile discharge,bleeding,lesions;____no___yes
Describe:_______________________________________________________
______________________________________________________
Last prostate exam:____________________________
History of sexually transmitted disease________no______yes
Both: Problems with sexual functioning?____________________
Sexual concerns at this time?______________________________
L. COPING AND STRESS TOLERANCE

_____not assessed
Overt signs of stress(crying,wringing of hands, clenched fists)
describe:__________________________________________
College of Nursing
Question patient regarding

Primary way you deal with stress?__________________________
Concerns regarding illness: (financial, self-care)_________
Major loss within last year______yes______no
Describe:_________________________________________________
Name of Student:______________________________________
Clinical Instructor:_________________________________
College of Nursing
Documentation
During Interview with the client
Blood typing at Brgy Sampalucan Bongabon, NE.

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Republic of the Philippines

Nueva Ecija University of Science and Technology

GOUT (CHRONIC PAIN)

Presented to the Faculty of the

of the Requirements for the Subject

INTENSIVE NURSING PRACTICUM

Francess Mharie Jhoyce P. Tolentino

Archito Dela Cruz, RN

Extending my sincerest gratitude to all the people who

contributed a significant role upon completing this research, I

would like to thank Honorable Mayor Ricardo I. Padilla of

Bongabon Nueva Ecija, for permitting us to accomplish this

coursework in their community, as well as to Hon. Joe Lagrimar

T. Ruz, the Barangay Captain of Barangay Sampalucan Bongabon,

Nueva Ecija for wilfully allowing us to conduct the study in his

I also want to give my deepest thanks to the beloved Dean

of the NEUST College of Nursing, as well as the CHN and Research

and Extension Coordinator, Jean N. Guillasper, Ph. D., R.N, for

giving us the opportunity to be exposed in this said activity.

Also to Luzviminda D. Samin, Ph. D., R.N, the RLE Coordinator,

for her valuable support in the development of this research.

To Archito Dela Cruz, R.N., I would like to express my

appreciation and thankfulness for showing us the passion in this

field which played a great influence as encouragement, together

stayed with us all throughout the completion of this research.

To my Head Nursing, Ms. Noemi Grace Florencondia, I am

indeed grateful for having you as my guide who payed a great

amount of meaningful and important suggestions to make this

research study quite possible. To Community People, for their

warm welcome and cooperation with regards to giving us their

honest health condition, I, as student nurse, give thanks and

gratefulness, and most importantly to my Client who had been

very honest and willing to participate in this research study.

To my supportive Parents who continuously bestow me with

the love, understanding, financial and material support.

And above all, to our Heavenly Father who touched the

hearts and minds of the people who cooperated to make this

Name : Frances Mharie Jhoyce P. Tolentino

Age : 19 years old

Date of Birth : September 14, 1997

Address : Saint Joseph Street Kapitan Pepe Subd.,

Civil Status : Single

Father : Joey L. Tolentino

Mother : Anna Marie P. Tolentino

II. EDUCATIONAL BACKGROUND

Level School Year

High Nueva Ecija High School 2012

LIST OF FIGURES . . . . . . . . . . . . . . . . . . . viii

CHAPTER I: THE PROBLEM AND ITS SETTING

CHAPTER II: CASE DISCUSSIONS AND PRESENTATION

Chapter Overview ...................................... 15

CHAPTER III: METHOD AND PROCEDURES FOR DATA GATHERING

Chapter Overview ...................................... 42

Chapter IV: Findings, conclusions, and recommendations

Summary of Findings ........................................................................................................................................................ 46

THE PROBLEM AND ITS SETTING

Gout is a term used for a group of at least nine metabolic

disorders characterized by an elevation in the serum uric acid

concentration (hyperuricemia). Gout may be primary or secondary.

Primary gout is the direct result of the body’s overproduction

of or decreased secretion of uric acid. Secondary gout occurs

when the overproduction or decreased secretion of uric acid is

secondary to another disease process or medication. The problem