Headache, Fever, And Musculoskeletal Injuries Flashcards
What are the 3 types of headaches?
Tension, sinus, migraine
Frequency: Tension Headache
Episodic or chronic
Frequency: Sinus Headache
Acute or chronic sinusitis
Frequency: Migraine
Patient specific triggers
Location: Tension Headache
Bilateral, over the top of the head, extending to the base of the skull
Location: Sinus Headache
Face, forehead, or periorbital area
Location: Migraine
Usually unilateral
Characteristics: Tension Headache
Diffuse aching, tight, pressing, constriction pain
Characteristics: Sinus Headache
Pressure behind the eyes or face, dull, bilateral pain, worse in the morning
Characteristics: Migraine
Throbbing, may be preceded by aura
Onset: Tension Headache
Gradual
Onset: Sinus Headache
Associated with sinus symptoms
Onset: Migraine
Sudden
Duration: Tension Headache
Minutes to days
Duration: Sinus Headache
Resolves with sinus symptoms
Duration: Migraine
Hours to 2 days
What other symptom(s) may someone experience with a tension headache?
Scalp tenderness
What other symptom(s) may someone experience with a sinus headache?
Nasal congestion
What other symptom(s) may someone experience with a migraine?
Photophobia, incapacity, nausea (PIN)
Risk factors: Tension Headache
Stress
Risk factors: Sinus Headache
Viral infection
Risk factors: Migraine
Tiggers, female gender, family history
What are possible migraine triggers?
Stress, fatigue, oversleeping, fasting/skipping meals, medications, caffeine, alcohol, changes in altitude/pressure, menstrual period
Describe: Cluster Headache
Relatively uncommon (effects primarily men), severe, unilateral, and pulsating, typically lasts 30-180 minutes, “attacks”= once’s every other day + 8x/day with headache free periods for days-months. Autonomic symptoms on the same side of headache
What medications can cause headache?
Overuse (more than 2/weekly for 3 months+) of acetaminophen, aspirin, caffeine, triptans, opioids, butalbital, ergotamine. Can occur within hours of stopping agents so they should be tapered and eliminated
What are the exclusions for self-care for headache?
-severe pain (pain score >6)
-persistent headache > 10 days
-last trimester of pregnancy
-<8 years old
-high fever or signs of serious infection
-history of liver disease or consumption >2 drinks per day
-secondary headache, due to underlying disease
-migraine, but no formal migraine diagnosis
What are the treatment goals for self-care of headache?
-alleviate acute pain
-restore normal functioning
-prevent relapse
-minimize side effects
-reduce frequency
Non-pharmacological treatment: Tension Headaches
relaxation exercise, physical therapy
Non-pharmacological treatment: Migraines
maintain regular sleep/eat schedule, practice methods for stress relief, dietary restrictions, cold packs, avoid light
MOA: Acetaminophen (APAP)
produces analgesia through a central inhibition of prostaglandin synthesis
Indication: Acetaminophen (APAP)
relief of mild-moderate pain and fever
Pharmacokinetics/pharmacodynamics: Acetaminophen
-rapidly absorbed from the GI tract
-extensively metabolized in the liver
-onset of analgesic activity in 30 minutes
-duration of action= 4 hours
Dosing: Acetaminophen
-adults=
-> reg 325-650 mg q8h or 1000mh 3-4x/day
->ext 1300 q8h
MAX= 4000 mg/day or 2000mg/day in pt with liver disease
-pediatrics (<12 yo)
-> 10-15 mg/kg/dose every 4-6h
-> MAX= 5 doses in 24 hours
Adverse Effects: Acetaminophen
-hepatoxicity
-nephropathy
-blood dyscrasias
-anemia
Drug Interactions: Acetaminophen
-alcohol
-warfarin
Patient Counseling Points: Acetaminophen
-avoid or limit alcohol use
-read package labeling
-know dosing limits
-avoid duplicating products that contain acetaminophen
MOA: NSAIDS
relieve pain through peripheral inhibition of prostaglandin synthesis (analgesic, antipyretic, anti-inflammatory)
Indications: NSAIDS
relief of minor pain associated with headache, common cold, toothache, muscle ache, backache, arthritis, menstrual cramps
Adverse Effects: NSAIDS
-dyspepsia
-heartburn
-nausea
-anorexia
-epigastric pain
-fluid retention/edema
Drug Interactions: NSAIDS
-aspirin
-ibuprofen
-digoxin
-anti-hypertensive agents
-anticoagulants
-alcohol
-methotrexate
Patient Counseling: NSAIDS
-take with food, milk, or antacids
-avoid in patients at high risk for GI or cardiovascular risk
-naproxen not recommended in children <12
MOA: Salicylates (aspirin)
inhibit prostaglandin synthesis from arachidonic acid by inhibiting both COX-1 and COX-2
Pharmacodynamics/pharmacokinetics: Salicylates
-absorbed by passive diffusion in stomach and small intestines
-eliminated through the kidneys
Indication: Salicylates
mild-moderate pain and fever
Dosing: Salicylates
650-100 mg every 4-6h, MAX= 4000mg/day, not recommended for children < 16 yo due to risk of Reye’s Syndrome
Define: Reye’s Syndrome
Adverse Effects: Salicylates
-upper GI symptoms (dyspepsia, epigastric discomfort, N/V)
-gastritis, GI bleed, ulceration
-serious ASA intolerance
Define: Salicylism
chronic toxic blood levels, multitude of symptoms, patients at high risk include: renal or hepatic impairment, metabolic disorders, unstable disease, status asthmaticus, multiple co-morbidities
Drug Interactions: Salicylates
-NSAIDS/COX inhibitors
-anticoagulants
-alcohol
-methotrexate
-sulfonylureas
Patient Factor Precautions: Salicylates
-hypoprothrombinemia
-vitamin K deficiency
-hemophilia
-H/O bleeding disorders
-H/O peptic ulcer disease
-H/O gout/hyperuricemia
-children/teenagers with viral illness
Define: Fever
core body temp >100F, regulated rise in body temp maintained by the hypothalamus in response to a pyrogen
Define: Hyperthermia
malfunctioning of the normal thermoregulatory process at the hypothalamic level
Define: Hyperpyrexia
body temp >106F that typically results in mental and physical consequences , resulting from hyperthermia or fever
Signs/Symptoms: Fever
-headache
-sweating
-malaise
-chills
-tachycardia
-arthralgia/myalgia
-irritability
-anorexia
Describe: Digital Thermometers
-quickest, most accurate reading
-regulated by the FDA
-easy-to-read
-can be used at any age depending on route
Describe: Electronic Ear Thermometers
-measures tympanic temp
-quick reading
-accurate when used correct
-not recommended <6 months
Describe: Forehead Thermometers
-measures temporal artery temp
-non-invasive
-prone to error
-not recommended to make clinical decisions
What complication can arise from having a fever?
-parental anxiety
-acute= seizures, dehydration, change in mental status
-febrile seizures
-fever management more difficult in patients with comorbid condition
Non-pharmacological recommendations: Fever
-adequate fluid intake
-wear light clothing
-remove blankets
-maintain room temp at 68F
Exclusions for Self-Care: Fever (children and adolescents)
infants <3 months= >100.4F and children >104F or temp of 100.4F with any of the following symptoms: inability to swallow, drooling excessively, difficulty breathing, refusing oral fluids, drowsy (difficult to wake), delirious, glassy-eyed, extremely cranky or irritable, vomiting/diarrhea
Exclusions for self-care of fever at any age
-unexplained spots or rashes
-loss of appetite, low energy, or noticeably pale or flushed
-environmental exposure to high temperatures
-history of seizures or febrile seizures
-stiff neck, severe headache, severe ear pain, or sore throat
-taking steroids or immunocompromised
Define: Myofascial Pain
pain originating in the fascia (connective tissue)
Define: Musculoskeletal Pain
pain originating from muscle, ligaments, tendons, and/or bone
Define: Myalgia
generalized muscle pain
Define: Fibromyalgia
chronic pain syndrome characterized by diffuse muscle and joint pain, joint stiffness, fatigue, and sleep disturbances
Define: Tendonitis
inflammation of a tendon resulting from acute injury or chronic overuse of body part
Define: Bursitis
common cause of localized pain, tenderness, and swelling which is worsened by any movement of the structure to the bursa
Define: Sprain
injury to a ligament caused by joint overextension
Define: Strain
injury to muscle or tendon caused by overexertion
Define: Muscle Spasm
involuntary contraction of muscle
Define: Muscle Cramp
prolonged muscle spasm that produces painful sensation
Exclusions for self-care of muscular skeletal injuries
-moderate to severe pain (pain score >6)
-pain lasting >10 days after oral analgesics
-pain lasting >7 days after topical analgesics
-increased intensity or character of the pain
-pelvic or abdominal pain
-nausea, vomiting, fever, and/or other signs of systemic infection/disorder
-visual deformity of a joint, abnormal movement, weakness in a limb, or suspected fracture
-third trimester of pregnancy
Complications: Muscular Skeletal Injuries
-further tissue damage or bone/cartilage remodeling
-disability
-loss of function
-reduction in ADLs, loss of work time
-physical impairment
Describe: RICE Therapy
nonpharmacological treatment option for muscular skeletal injuries to promote healing and help reduce swelling and inflammation
-R= REST the injured area using slings or splints if necessary
-I= ICE the area as soon as possible in 10-15 minute increments 3-4 times per day (do NOT apply ice directly to skin)
-C= COMPRESS the injured area with an elasticized bandage (not too tight)
-E= ELEVATE at or above heart level for 2-3 hours per day to decrease swelling and pain
OTC Pharmacological options for muscular skeletal injuries
systemic analgesics are the go to such as acetaminophen, NSAIDS, salicylates (limited to 10 days)
topical analgesics: counterirritants/topical salicylates, capsaicin, lidocaine, topical NSAIDS
Describe: Counterirritants
-indication: treatment of minor aches and pains of muscles/joints
-MOA: nerve stimulation vs depression, paradoxical pain relief by causing less severe pain to counter more severe pain
-adjunct therapy
-dosing: apply no more than 3-4 times a day for 7 days
-products: methyl salicylate, camphor, menthol
Describe: Capsaicin
-indication: relieves pain(not inflammation) of rheumatoid arthritis and osteoarthritis and diabetic neuropathy
-MOA: thought to deplete substance P from sensory neurons, elicits a transient feeling of warmth
-takes 14 days to exert full clinical action, could take 4-6 weeks
Describe: Lidocaine Patch
-ideal for localized peripheral neuropathic pain
-patch or spray
