Fibromyalgia Flashcards
The nurse is completing a physical assessment on a client with possible fibromyalgia. To support the diagnosis of fibromyalgia, the nurse must assess and document pain upon palpation on how many standard tender points?
Eleven
Nine
Five
Seven
Eleven
To assist with the diagnosis of fibromyalgia, the client must have pain upon palpation at 11 or more of the 18 standard tender points, not nine, seven, or five of the standard tender points.
A student nurse is asking questions about fibromyalgia. The nurse educates the student that this disorder closely resembles what other disorder?
Osteoarthritis
Chronic fatigue syndrome
Muscular dystrophy
Sjögren syndrome
Chronic fatigue syndrome
Fibromyalgia closely resembles chronic fatigue syndrome, with the exception of the musculoskeletal pain typically associated with fibromyalgia. Fibromyalgia does not closely resemble Sjögren syndrome, muscular dystrophy, or osteoarthritis.
Which risk factor associated with fibromyalgia should the nurse inquire about while taking a client’s health history?
Age 60-75 years
History of osteoarthritis
Family history
Male gender
Family history
A family history of fibromyalgia is a risk factor for developing fibromyalgia. Female, not male, gender is a risk factor for developing fibromyalgia. Being diagnosed with another rheumatic disorder such as rheumatoid arthritis (not osteoarthritis) or systemic lupus erythematosus are risk factors associated with developing fibromyalgia. A risk factor for developing fibromyalgia is an age between 20 and 50 years old, not between 60 and 75 years old.
The nurse is caring for a client with suspected fibromyalgia. Which diagnostic tool does the nurse anticipate will be used to properly diagnose this client?
Blood tests for neurotransmitter levels
Abnormalities on a thyroid panel
Failure of a cardiac stress test
A widespread pain index
A widespread pain index
Fibromyalgia is a diagnosis of exclusion and based largely on client feedback, such as responding to questions on a screening tool like the widespread pain index. There is no laboratory or diagnostic study that establishes the diagnosis.
A healthcare provider prescribes duloxetine (Cymbalta) for a client diagnosed with fibromyalgia. The client asks the nurse why this medication is being prescribed. The nurse will base the response on which rationale?
To reduce neuropathic pain
To increase levels of dopamine and serotonin
To decrease joint pain and swelling
To relax the client and promote sleep
To increase levels of dopamine and serotonin.
Duloxetine (Cymbalta) is prescribed to a client with fibromyalgia to increase serotonin and norepinephrine levels. This medication is not prescribed to reduce neuropathic pain, decrease swelling to joints, or relax the client to promote sleep. Pregabalin (Lyrica) is prescribed to reduce neuropathic pain. Nonsteroidal anti-inflammatory drugs are prescribed to decrease swelling to joints. Fluoxetine (Prozac) and paroxetine (Paxil) are medications prescribed to promote sleep.
When planning care for a client affected by fibromyalgia, the nurse addresses the potential problem of activity intolerance. What will the nurse recommend to the client in order to most effectively address this problem?
Daily meditation and guided imagery
NSAID medications taken on a regular schedule
Referral to physical therapy for an assistive device
A program of regular, mild to moderate exercise
A program of regular, mild to moderate exercise.
Meditation and guided imagery can reduce anxiety. NSAIDs address the problem of pain. Assistive devices do not increase conditioning or activity tolerance in the absence of injury or neurologic deficits. Regular, mild to moderate exercise improves conditioning and activity tolerance.
In addition to genetic factors, what additional factor is likely to contribute to the development of fibromyalgia?
Excess physical exercise
Physical or emotional trauma
Nutritional deficiency
Previous injury to the bone
Physical or emotional trauma
Clients with fibromyalgia may recall the onset of pain after physical or emotional trauma. Excess exercise, previous injury to bones, and nutritional deficiencies may cause pain and discomfort, but none of these are associated with the development of fibromyalgia.
What occurrence usually precedes general symptom manifestations of fibromyalgia?
Septicemia with Group A Streptococcus infection
Bacterial infection of affected joint
Viral illness
Recent injury to joint or bone
Viral illness
The precise etiology and precipitating factors for fibromyalgia are not known, however there is no correlation between Strep A infection, mechanical injury to bones or local bacterial infections and the onset of symptoms. Affected individuals often report viral-like illness prior to onset of symptoms.
What is the purpose of pregabalin (Lyrica) in the treatment of fibromyalgia?
To reduce symptoms of fatigue
To treat neuropathic pain
To increase serotonin
To promote sleep
To treat neuropathic pain
Pregabalin was developed for the treatment of neuropathic pain. Serotonin reuptake inhibitors such as fluoxetine increase serotonin, promote improved sleep, and may reduce the symptoms of fibromyalgia.
When taking a health history, which statement from the client would support a diagnosis of fibromyalgia?
”I have experienced persistent pain in my knees, ankles, and feet.”
”I have had generalized pain throughout my body for at least 3 to 4 months.”
”My joints are stiff when I get up in the mornings.”
”I have experienced heart palpitations and a fluttering sensation for the past few weeks.”
”I have had generalized pain throughout my body for at least 3 to 4 months.”
Heart palpitations are not associated with fibromyalgia. Difficulty sleeping, morning stiffness and knee pain may result from fibromyalgia but the duration of symptoms for greater than 3 months is a diagnostic criterion.
Which element is included in the focused physical examination portion of the nursing assessment of the client with fibromyalgia?
Pattern of fatigue
Symptom severity scale
Palpation of tenderness points
Duration of pain
Palpation of tenderness points
Palpation is an element of the physical examination portion of the nursing assessment. Duration of pain, fatigue pattern, and symptom severity scale are elements of the health history portion of the nursing assessment.
Which areas of counseling are appropriate for the client affected by fibromyalgia?
(Select all that apply.)
Examples of mild to moderate exercise
Nonpharmacologic methods of pain relief
The importance of adhering to an around-the-clock schedule of narcotic analgesics
Strategies for improving quality of sleep
Identifying resources and support systems
Examples of mild to moderate exercise
Nonpharmacologic methods of pain relief
Strategies for improving quality of sleep
Identifying resources and support systems
Narcotics are not the treatment of choice for fibromyalgia pain as their side effects may lead to tolerance and dependence and worsen other fibromyalgia symptoms such as fatigue and activity intolerance. Nonpharmacologic methods of pain control, support systems, exercise, and improved sleep patterns are effective at improving symptoms and quality of life.
Jennifer Carson is a 35-year-old woman who presents at the healthcare provider’s office. She states that she “has been more tired than usual” for the past few months and that she has “a general achiness, especially in my back and hips.” The healthcare provider is questioning a diagnosis of fibromyalgia and has ordered blood to be drawn for thyroid hormone levels. While preparing to perform the blood draw, Ms. Carson says, “If there are no tests to determine the diagnosis of fibromyalgia, why are they testing my thyroid”? What is your most informative response”
”Sometimes the symptoms of fibromyalgia present similar to the symptoms of hypothyroidism. Knowing how your thyroid is functioning will allow for an accurate diagnosis.”
”Thyroid problems may precede the onset of fibromyalgia. If your thyroid is not functioning properly, it will be important to treat both conditions.”
”Checking thyroid function is the first endocrine gland to assess because fibromyalgia often presents with endocrine imbalances.”
”If your thyroid is not functioning properly, correcting thyroid hormone levels may prevent fibromyalgia from developing.”
”Sometimes the symptoms of fibromyalgia present similar to the symptoms of hypothyroidism. Knowing how your thyroid is functioning will allow for an accurate diagnosis.”
Explaining the process of exclusion for other diagnoses is the most informative response. The development and course of fibromyalgia are not dependent on thyroid function
Karen O’Connell is a young woman who recently graduated from college and is working at her first position as an architect. Up to this time, she has been in very good health and has led an active lifestyle. She enjoys hiking, cycling, and jogging. During your assessment, Ms. O’Connell states that she is frequently tired and has achy pain in her neck, back, and hips. You suspect fibromyalgia. When questioned further, how would you expect Karen to describe her fatigue and pain?
”The tiredness and pain seem to be relieved after I do some light activity.”
”I am not able to determine a pattern with the pain and fatigue.”
”The pain and fatigue are greatest in the early evening.”
”The pain and tiredness are worse when I am very active.”
”The pain and tiredness are worse when I am very active.”
Fibromyalgia symptoms follow a specific pattern that includes morning stiffness and acute fatigue following increased activity. The other options do not adequately describe the pain associated with fibromyalgia.
Aisha Griffin is a 42-year-old mother of three who has returned to your practice for a follow-up visit regarding her fibromyalgia. You are interviewing her prior to her examination. Which statement from Mrs. Griffin would indicate the need for further teaching regarding self-care?
”I’ve been pretty good about walking outside for at least 30 minutes every day.”
”I tried some pain medicine my friend had and it worked even though it made me sleepy.”
”Sometimes I get really frustrated about being tired so much.”
”I’ve been trying to go to bed at the same time every day and make sure I don’t get on the computer for a couple of hours before bedtime.”
”I tried some pain medicine my friend had and it worked even though it made me sleepy.”
Mild to moderate exercise and consistent sleep habits have been proven effective at reducing the severity of fibromyalgia symptoms. Frustration is a normal, common response to symptoms. It is dangerous to take medicines prescribed to someone else and, based on the description of side effects, this medication may have been a narcotic, which can worsen activity intolerance.
