Med-Surg: Chapter 20: Fibromyalgia

Question 1

Fibromyalgia

Answer 1

chronic pain disorder of soft connective tissue that is characterized by widespread pain and other symptoms such as insomnia, fatigue, stiffness, and cognitive dysfunction (e.g. inability to focus on or concentrate on tasks)

Question 2

Pathophysiology

Answer 2

• unclear
• theories include the abnormal processing of stimuli by the CNS, causing normal pain signals to be amplified
• the amplification of stimuli caused fibromyalgia patients to feel pain
• may be triggered by an infection or physical or emotional trauma

Question 3

Triggers

Answer 3

• infection
• physical or emotional trauma
• menstrual cycle can affect sensitivity to pain
• normal daily stress combined with common fibromyalgia symptoms can create a cycle that builds on one another

Question 4

Clinical Manifestations

Answer 4

• widespread pain
• insomnia
• fatigue
• stiffness
• cognitive dysfunction (inability to focus on or concentrate on tasks)
• often report hurting all over or feeling as if they have the flu
• other complaints: fatigue, headaches, cognitive impairments, and abdominal pain

Question 5

Diagnosis

Answer 5

• history and physical assessment
• patients often report hurting all over or feeling as if they have the flu
• other complaints: fatigue, headaches, cognitive impairments, and abdominal pain
• physical exam usually normal, with no evidence of joint or muscle inflammation

Question 6

Criteria of Diagnosis

Answer 6

experience pain at 11 or more of 18 specified locations (tender points) and have widespread pain

• assessment of tender points is done by applying 4 kg of pressure (comparable to the pressure it would take to blanch your nail bed) to specific points on the patient’s body
• widespread pain involves pain on both sides of the body and above and below the waist

Question 7

Non Pharmacological Treatment

Answer 7

• physical therapy (maintains strength and function)
• strength training
• aerobic exercise
• cognitive behavioral therapy (used to help understand the illness and change patients behavioral response to pain)
• education
• self-management (relaxation techniques to minimize stress, establishing regular sleep patterns, and exercise regularly)

Question 8

Pharmacological Treatment

Answer 8

• medications that alter chemicals in the brain (serotonin and norepinephrine), or block overactivity of nerve cells
• medications that improve sleep and treat pain
• opioid analgesics not recommended b/c habit forming and ineffective

Question 9

Nursing Assessment and Analysis

Answer 9

clinical manifestations due to enhanced pain perception and stress r/t that enhanced pain

• fatigue
• arthralgia and myalgia
• headache
• abdominal pain
• decreased desire to participate in activity
• nonrestorative sleep
• anxiety

Question 10

Nursing Interventions: Assessents

Answer 10

> Vital Signs
-pain may alter vital signs (increased HR and BP)

> Affect
-depression may be an associated symptoms b/c of chronic pain

> Pain

• fibromyalgia causes chronic pain
• increased levels indicated ineffective treatment strategies

Question 11

Nursing Actions

Answer 11

> Administer medications as ordered: NSAIDs, Antidepressants, and Antiseizure medications

• Pain management is an integral part of managing fibromyalgia
• NSAIDs manage inflammation
• Antidepressants manage depression, promote sleep, and help control pain through inhibition of the reuptake of neurotransmitters, which inhibit pain transmission in the brain
• Antiseizure medications work for unknown reasons but may modify the release of neurotransmitters through action on calcium channels

> Provide heating pad for painful muscles and cold packs for painful joints

• heat is used to relax muscles, increasing blood flow to the area
• cold packs may soothe aching joints

Question 12

Teaching

Answer 12

> Take medications only as prescribed

> participate in regular physical activity
-maintain or improve strength and function

> teach effective coping skills
-to maintain a positive attitude and improve self-concept

> assist with referring the patient for a sleep study
-ineffective sleep may increase pain and fatigue

> assist with referring to mental health facility if necessary
-to help deal with depression r/t chronic pain

> assist with referral to OT and PT
-to formulate exercise plan

Question 13

Antidepressants

Answer 13

to help with pain and promote sleep
-inhibits norepinephrine and serotonin reuptake

> Duloxetine (Cymbalta)
-side effects: nausea, dry mouth, constipation somnolence

> Milnacipran (Savella)
-side effects: nausea, vomiting, constipation, insomnia

> Amitriptyline (Elavil)
-side effects: drowsiness, dry mouth, dizziness, constipation

> Fluoxetine (Prozac)
side effects: nausea, headache, insomnia, nervousness

Question 14

Antiseizure Medications

Answer 14

to reduce pain
>Pregabalin (Lyrica)
-side effects: dizziness, weight gain

Question 15

Evaluating Care Outcomes

Answer 15

compliance with a healthy diet and exercise regimen and getting adequate rest

• taking medications as prescribed helps control the enhanced sensation of pain and the depression associated with the disease process
• well-managed patient has decreased pain and fatigue, healthy sleep patterns, and maintenance or improvement of strength and function