| Nursing Interventions | Medication | Pain | ADPIE | Mixology |
|---|---|---|---|---|
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C. Avoid interrupting clients sleep
Rationale: Patients with fibromyalgia are typically in chronic pain making it even more difficult to sleep at night. Allowing these patients to sleep when tired allows them to be less fatigued
Which of the following nursing interventions would benefit a client w/ FMS the most?
a. Advise the client to limit the time spent in direct sunlight. b. Stress the importance of having routine eye exam c. Avoid interrupting clients sleep |
Answer B: improve the quality of sleep
Rationale: Elavil is ordered to improve sleep, to decrease stress and fatigue, and as an adjuvant medication for pain control. It would not be ordered to prevent depression, although it can be used
Pt w/ FMS says, "Why am I taking Elavil? I don't feel depressed, just tired and achy." The nurse would inform the pt that:
a. it prevent depression b. improve the quality of sleep c. gives you more energy throughout the day d. that means your depressed |
Answer B: headache
Rationale:Fibromyalgia is a chronic syndrome of musculoskeletal tissues characterized by chronic widespread pain. Assessment: painful muscles, fatigue, sleep disturbances, headache, restlessness leg syndrome, depression.
The client is diagnosed to have fibromyalgia. Which of the following signs and symptoms is commonly experienced by the client?
a. irritability b. headache c. fever d. lethargy |
Answer A: Sleep disturbance patterns
Rationale: Patients with fibromyaglia have difficulty getting a good nights rest d/t their pain leaving them chronically fatigue the next day
The nurse is developing a plan of care for a client diagnosed with fibromyalgia. Which nursing diagnosis should the nurse include?
a. sleep pattern disturbance b. Risk for infection c. fluid volume deficit d. urge urinary incontinence |
Answer: B: Rheumatologists
Rationale: Rheumatologists diagnose (detect), treat and medically manage patients with arthritis and other rheumatic diseases. These health problems affect the joints, muscles, bones
Which of these medical specialists may be the most knowledgeable in recognizing and diagnosing fibromyalgia?
A. Osteopaths B. Rheumatologists C. Endocrinologist D. Immunologist |
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Answer D: Stress
Rationale: Stress can exacerbate fatigue and cause greater pain; therefore decreasing the amount of stress encountered can lessen the chance of an exacerbation
It is important to teach a patient with fibromyalgia to decrease which of the following?
a. Sleep b. Exercise c. Alcohol d. Stress |
Answer B: A client with progressive pancreatic cancer
Rationale: Cancer pain generally worsens with disease progression and the use of opioids is more generous. fibromyalgia is more likely to be treated with non-opiod and adjuvant medications
Bonus: Which client is most likely to receive opioids for extended periods of time?
a. A client with fibromyalgia b. A client with progressive pancreatic cancer c. A client with rheumatoid arthritis d. A client with ALS |
Answer B: 2 tabs
Rationale: Desired amount DIVIDED by whats on hand 200/100= 2 tabs
Pt has Lyrica 200 mg scheduled for q 8hrs. On hand you have Lyrica 100 mg tabs. Pt is not to exceed more than 600 mg in 24 hrs. How many tabs will this pt receive in 1 dose?
a. 1 b. 2 c. 3 4. 1 1/2 |
Answer B: fatigue, unrelieved by sleep
Rationale: Fatigue that is unrelieved by sleep or rest is the most commonly presented problem of fibromyalgia. Fatigue is often caused by depression and is the result of a lack of stage 4 sleep.
What is the most common clinical manifestation for FMS?
a. deformities of the fingers and toes. b. fatigue, unrelieved by sleep. c. migratory areas of numbness. d. erythema of the skin |
Answer D: Pain in Temporomandibular Joint (TMJ)
Rationale: About 4% of the population has fibromyalgia, and about 20% of TMD patients have it. Fibromyalgia will exacerbate an existing TMD condition, not cause it. Pts will exhibit pain during max opening.
Bonus: Why might an undiagnosed Fibromyalgia patient seek a dentist?
a. Pain in lower teeth b. Bad breath c. Gum Disease d. Pain in Temporomandibular Joint (TMJ) |
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Answer A: Yoga and meditation
Rationale: Yoga and mediation allows one to relax there mind and body. It also helps decrease stress which can exacerbate symptoms of Fibromyalgia
A patient newly diagnosed with Fibromyalgia complains to the nurse that she is frustrated with having constant pain. What would be an appropriate activity to suggest?
a. Yoga and meditation b. ZUMBA c. Karate d. Long range shooting |
Answer C: Pregabalin
Rationale: decreases pain and helps with sleep
While analgesics such as Tylenol, Advil and Tramdol are used to treat the pain associated with fibromyalgia, physicians will usually also prescribe which of the following?
a. Lorazepam b. Ceftriaxone c. Pregabalin d. Hydralazine |
Answer B: use of heat and cold applications
Rationale: Use of heat and cold applications is a standard therapy with guidelines for safe use and predictable outcomes, and an LPN will be implementing this therapy, under the supervision of a RN
In educating clients with Fibromyalgia about non-pharmaceutical alternatives, which topic could you delegate to an experienced LPN:
a. Therapeutic touch b. Use of heat and cold application c. Yoga d. TENS |
Answer: A: arrange for the patient to attend a meeting of the local fibromyalgia support group.
Rationale: support groups helps patients with similar problems voice there concerns and help each other cope with the disease process
A FMS pt cries of feeling overwhelmed and says she can no longer be the person she used to be. As a pt advocate, a nurse should:
a. arrange for the pt to attend a local FMS support group. b. tell her she is right c. put on suicide precautions |
Answer D: Eating chocolate before bed
Rationale: chocolate has caffeine and should be avoided prior to bedtime
All of the strategies below can help Ms. Carroll improve sleep quality EXCEPT:
a. A quiet sleep environment b. Relaxation exercises before bedtime c. Going to bed and waking up at about the same time every day d. Eating chocolate before bed |
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Answer C: Patient complaining of pain lasting longer than 3 months
Rationale: There is no definite test to diagnosis Fibromyalgia. Diagnosis is made primarily through symptoms of pain lasting greater than 3 months
Which of the following is used to diagnose fibromyalgia?
a. Complete Blood Count b. Thyroid Function Test c. Patient complaint of pain lasting longer than 3 months d. Positive Stress Test |
Answer: A: "it is ok to have wine as long as I don't drive"
Rationale: Lyrica causes drowsiness and drinking alcohol while taking Lyrica will add a synergistic effect
A pt w/ FMS is to be d/c home with a new prescription for Lyrica. The nurse should correct the pt if they say:
a. "its ok to have wine as long as I don't drive" b. I will take this medication as directed c. I will not operate heavy machinery |
Answer D: Around- the- clock
Rationale: If the pain is constant, the best schedule is around-the-clock, to provide steady analgesia and pain control. The other options may actually require higher doses to achieve control
What is the best way to schedule medication for a client with fibromyalgia who complains of constant pain?
a. PRN at the client’s request b. Prior to painful procedures c. IV bolus after pain assessment d. Around-the-clock |
Answer B: patient will verbalize a decrease in pain by end of shift
Rationale: pain is a common problem for clients who have fibromyalgia
When completing a care plan for a patient diagnosis with FMS a short-term goal for this patient would be:
a. pt will eat 50% of her lunch b. pt will verbalize a decrease in pain by end of shift c. pt will void in 1 hr d. pt will be free of infection |
Answer C: Believe client's pain perception.
Rationale: The client must be believed and his or her experience of pain must be acknowledged as valid. The data gathered via client reports can then be applied to other options.
In applying the principles of pain treatment to a FMS pt, what is the first consideration?
a. Tx is based on client goals. b. A multidisciplinary approach is needed. c. Believe the client's pain perception. d. Drug side effects must be managed |
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