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NSG 430 - Critical Care > T7: SLE and Myofascial Pain Syndrome and Fibromyalgia > Flashcards

T7: SLE and Myofascial Pain Syndrome and Fibromyalgia Flashcards

1
Q

Systemic Lupus Erythematosus

A

chronic autoimmune inflammatory disease of collagen in skin, joints, and internal organs

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2
Q

SLE affects

A

skin, joints, serous membranes (pleura, pericardium), renal system, hematologic system, neurologic system

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3
Q

SLE clinical manifestations: dermatologic

A

-Vascular skin lesions (Most commonly in sun-exposed areas)
-Butterfly rash
-Discoid lesions (round-coin shaped lesions)
-Subacute cutaneous lupus
-Oral/nasopharyngeal ulcers
-Alopecia

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4
Q

SLE clinical manifestations: musculoskeletal

A

-Polyarthralgia with morning stiffness
-Arthritis
-Swan neck fingers
-Ulnar deviation
-Subluxation with hyperlaxity of joints
-Increased risk of bone loss and fracture

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5
Q

SLE clinical manifestations: cardiopulmonary

A

-Tachypnea
-Cough
-Pleurisy
-Dysrhythmias (Fibrosis of SA and AV nodes)
-Pericarditis
-Antiphospholipid syndrome-hypercoaguability (MI, stroke, gangrenous lesions due to emboli)

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6
Q

SLE clinical manifestations: renal

A

-Mild proteinuria to rapidly progressive glomerulonephritis
-Scarring, permanent damage can lead to end-stage renal disease-leading cause of death

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7
Q

treatments for SLE

A

-Corticosteroids-prednisone, methylprednisolone
-cytotoxic agents-Cytoxan
-immunosuppressive agents-Imuran, cyclosporine, CellCept

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8
Q

immunosuppressive drug fro SLE

A

methotrexate

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9
Q

SLE clinical manifestations: nervous system

A

-Generalized/focal seizures
-Peripheral neuropathy
-Cognitive dysfunction (Disordered thinking, Disorientation, Memory deficits)

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10
Q

SLE clinical manifestations: hematomogic

A

-Formation of antibodies against blood cells
-Anemia
-Leukopenia
-Thrombocytopenia
-Coagulation disorder

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11
Q

SLE clinical manifestations: infection

A

-Increased susceptibility to infections
-Defects in ability to phagocytize invading bacteria
-Deficiency production of antibodies
-Immunosuppressive effect of many antiinflammatory drugs
-Infection is a major cause of death

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12
Q

diagnostics for SLE

A

really hard to diagnose
-Anti-nucleic antibody (ANA)
-ANA is present in 97% of persons with the disease
-Anti-DNA 50%
-Anti-Sm(Smith) 30-40%
-ESR, CRP (only used for monitoring not diagnosis)

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13
Q

care for SLE

A

*managing the disease while preventing complications of treatments.

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14
Q

drug therapy for SLE

A

-NSAIDs (Mild arthralgia or arthritis)
-Antimalarial drugs
-Steroid-sparing drugs
-Corticosteroids (Severe cutaneous SLE)
-Immunosuppressive drugs (Methotrexate, azathioprine, cyclophosphamide)

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15
Q

in SLE observe for

A

-Fever pattern
-Joint inflammation
-Limitation of motion
-Location and degree of discomfort
-Fatigue

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16
Q

SLE Psychosocial Issues

A

-Supportive therapies to help patient cope with the disease
-Inform patient and caregiver that SLE has good prognosis for most people
-Stress importance of planning recreational and occupational activities
-Assist patient in developing goals

17
Q

Lupus and pregnancy

A

-Infertility can result (Renal involvement, High-dose corticosteroids, Immunosuppressive drugs)
-Women with serious SLE should be counseled AGAINST pregnancy

18
Q

health promotion of SLE

A

-Prevention of SLE is not currently possible
-Education of health professionals and the community to create a clear understanding of the disease and need for early diagnosis and treatment

19
Q

ambulatory care of SLE

A

-Emphasize importance of patient involvement for successful home management
-Help patient understand that strong adherence to treatment is no guarantee against flares
-Reduce exposure to precipitating factors

20
Q

precipitating factors that decrease activity in SLE

A

*fatigue, sun exposure, emotional stress, infection, drugs, and surgery.

21
Q

Myofascial pain syndrome

A

*chronic form of muscle pain marked by musculoskeletal pain and tenderness, typically in the chest, neck, shoulders, hips, and lower back.
-can cause referred pain , HA, TMJ

22
Q

trigger or tender points in myofascial pain syndrome are activated by

A

-Activated by pressure
-Worsens with activity or stress

23
Q

patients with myofascial pain syndrome complain of

A

Deep, aching pain accompanied by burning, stinging, stiffness

24
Q

treatment for myofascial pain syndrome

A

-Physical therapy
-“Spray and stretch” method
-Painful area is iced or sprayed with a coolant and then stretched
-Topical patches
-Trigger point injections
-Massage, acupuncture, biofeedback, ultrasound

25
Q

Fibromyalgia

A

*chronic central pain syndrome marked by widespread, nonarticular musculoskeletal pain and fatigue with multiple tender points.

26
Q

People with fibromyalgia may also experience

A

-Nonrestorative sleep
-Morning stiffness
-Irritable bowel syndrome
-Anxiety

27
Q

Fibromyalgia is a disorder involving…

A

abnormal central processing of nociceptive pain input.

28
Q

clinical manifestations of fibromyalgia

A

-Widespread burning pain
-Worsens and improves throughout day
-Trouble determining if pain is in muscles, joints, or soft tissues
-Head or facial pain
-Can accompany TMJ dysfunction
-Difficulty concentrating/memory lapses
-Migraine headaches

29
Q

Tender Points in Fibromyalgia

A

*Physical examination typically reveals point tenderness at 11 or more of 18 identified sites.

30
Q

allodynia

A

Pain due to a stimulus that does not normally provoke pain

31
Q

complications of fibromyalgia

A

-Depression and anxiety
-Stiffness
-Nonrefreshing sleep
-Fatigue
-Paresthesia
-Restless legs syndrome
-Irritable bowel syndrome
-Difficulty swallowing
-↑ Frequency of urination and urinary urgency
-For women, difficult menstruation

32
Q

diagnostic studies of fibromyalgia

A

-Low ANA titer, but not diagnostic

33
Q

Fibromyalgia if two criteria are met:

A

-Pain is experienced in 11 of 18 tender points on palpation
-History of widespread pain is noted for at least 3 months

34
Q

drug therapy for fibromyalgia (for chronic wide spread pain)

A

-Pregabalin (Lyrica) gabapentin (Neurontin)
-Duloxetine (Cymbalta)
-Milnacipin (Savella)

35
Q

other medications for fibromyalgia

A

-Low-dose tricyclic antidepressants (TCAs), SSRIs, or benzodiazepines
-Muscle relaxants
-Nonopioid analgesics
-Zolpidem (Ambien)

36
Q

interprofessional care for fibromyalgia

A

-Symptomatic treatment
-Requires high level of patient motivation
-Patient teaching to be an active part in therapeutic regimen
-Rest

37
Q

nursing management of fibromyalgia

A

-Supportive care
-Massage combined with ultrasound
-Application of alternating heat and cold packs
-PT (gentle stretching)
-Yoga/Tai Chi
-Low impact aerobic exercise
-Limit intake of sugar, caffeine, alcohol (May be muscle irritants)
-Vitamin and mineral supplements
-Biofeedback, imagery, meditation, cognitive behavioral therapy

NSG 430 - Critical Care (42 decks)

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