NUR210 Chapter 20: Coordinating Care for Connective Tissue Disorders PDF

1 Osteoarthritis (OA; degenerative joint disease) cartilage & bone ends slowly break down, joint space narrows, bone spurs develop, joint lining becomes inflamed Weight-bearing joints, hands, vertebral column most affected Risk factors: heredity, being overweight, mechan...

1 Osteoarthritis (OA; degenerative joint disease) cartilage & bone ends slowly break down, joint space narrows, bone spurs develop, joint lining becomes inflamed Weight-bearing joints, hands, vertebral column most affected Risk factors: heredity, being overweight, mechanical stress on synovial joints, trauma, sepsis, congenital anomalies, certain metabolic diseases, RA S/sx: pain, stiffness (improves w/ movement; worst in AM), joint swelling, Heberden and Bouchard nodes (Painful bony nodes on the finger joint; more common in women), radiating pain and muscle spasms of limbs if spinal column affected. Dx: XR, MRI, synovial fluid analysis Tx: o Exercise (early AM movement), joint splinting for severe inflammation; Yoga and tai chi help stretch/reduce stiffness, muscle strengthening exercise to prevent atrophy, provide joint stabilization. Avoid positioning that may lend itself to contractures (bent joints for extended periods of time). o Weight management to decrease stress on joints. o Meds: NSAIDs (monitor for complications), acetaminophen, corticosteroids, OTC topical creams. Synvisc-One (one injection) or SYNVISC (three injections) replace synovial fluid in knee joints o Heat & cold therapy o Acupressure, acupuncture, hydrotherapy, imagery, music therapy, massage o Total joint replacement Nursing care o Assessment: ▪ Unsteady gait ▪ Bony enlargement or swelling of affected joints ▪ Fatigue ▪ Painful range of motion of affected joints ▪ Elevated serum creatinine secondary to NSAID use ▪ Elevated liver enzymes related to multiple medication use ▪ Constipation secondary to decreased physical activity and/or use of narcotic analgesics ▪ VS (HTN caused by chronic NSAID use from renal failure) ▪ Skin integrity r/t decreased mobility o Nursing diagnoses ▪ Pain related to the disease process ▪ Ineffective sleep patterns related to pain  2 ▪ Self-care deficit related to decreased range of motion ▪ Impaired mobility o Interventions ▪ Administer analgesic and anti-inflammatory medications as ordered. ▪ Provide cold packs (reduce inflammation) ▪ Provide a heat pad (relaxes muscles) o Education ▪ Take medications only as prescribed ▪ Report chest pain, abdominal pain, abnormal bleeding, and blood in the stool or emesis if using NSAIDs ▪ Participate in regular physical activity ▪ Referals to PT/OT ▪ Refer to orthopedic surgery ▪ Referral for home healthcare o Goal of tx is to minimize pain, maximize movement, foster independence Rheumatoid arthritis (RA): chronic, progressive, systemic inflammatory disease; destroys synovial joints/connective tissues, including major organs Synovitis leads to thickening of synovium = fluid accumulation = joint swelling/pain. Joint cartilage & bone eventually destroyed, leading to joint deformity. Blood vessels, nerves, kidneys, pericardium, lungs, and subcutaneous tissue may be affected; organ failure/death can occur. Unpredictable remissions and exacerbations Cause: o family hx (2-3x more prevalent), oral pathogens (cause inflammation; RA may improve with ABX therapy), rheumatoid factor (antibody) joining with other antibodies to form antibody complexes that cause the destructive changes of RA S/sx: o B/L, symmetrical joint inflammation, usually starting in upper extremities; red, swollen, warm, stiff, painful joints; activity reduces pain typically. Low-grade fever, malaise, depression, lymphadenopathy, weakness, fatigue, anorexia, and weight loss. Joint deformities, Secondary osteoporosis & fx Dx: o increased WBC, platelets. Immunological testing (presence of rheumatoid factor, decreased RBC, decreased C4 compliment (protein complement system),  3 increased ESR, + antinuclear antibody test, + CRP). XR, MRI, bone or joint scan, arthrocentesis  4 Tx: o ABX, Disease-modifying antirheumatic drugs (DMARDs), NSAIDs, corticosteroids, capsaicin cream (analgesic), fish oil, antioxidants. Heat for stiffness, cold for acute inflammation. Total joint replacement Nursing care o Assessment: ▪ Unsteady gait ▪ Bony enlargement or swelling of affected joints ▪ Warmth and redness of joints ▪ Painful range of motion of affected joints ▪ Increased incidence of infection ▪ Elevated serum creatinine secondary to NSAID use ▪ Elevated liver enzymes secondary to methotrexate or leflunomide ▪ Constipation secondary to decreased physical activity and/or use of narcotic analgesics ▪ Nausea and oral ulcers related to methotrexate use ▪ Cough and/or shortness of breath due to interstitial lung disease, which can be caused by RA or by methotrexate therapy ▪ Assess for pleural effusion, pericarditis, pleuritic, scleritis, episcleritis, and osteopenia ▪ Self-care deficit ▪ Fatigue o Nursing diagnoses ▪ Pain related to disease process ▪ Ineffective sleep patterns related to pain ▪ Self-care deficit related to decreased range of motion ▪ Impaired joint mobility and function o Interventions ▪ Administer analgesics and anti-inflammatories as ordered ▪ Administer corticosteroids as ordered ▪ Administer DMARD therapy as ordered (slows disease progression by modulating the immune system and decreasing the inflammatory process. I.e. methotrexate) ▪ Administer biological therapies as ordered (slow or halt the progression of RA through inhibition of tumor necrosis factor (TNF) or interleukins (ILs). i.e., Humira, Remicade)  5 o Education ▪ Importance of adherence to treatment plan to control disease progression. ▪ Report signs and symptoms of infection Because of treatment with anti- inflammatories and immunosuppressive therapy ▪ Immunosuppressive therapy should be discontinued while patients have an active infection ▪ Assist with referral to an infectious disease specialist for patients with chronic or atypical infections ▪ Keep current with vaccinations (should not receive live vaccines if on immunosuppressive therapy) ▪ Refer to PT/OT o Evaluating outcomes ▪ Proper and consistent use of treatment plan ▪ will have very few or no tender or swollen joints with minimal morning stiffness while experiencing little or no adverse effects from pharmacological therapy. Scleroderma Scleroderma is an autoimmune disorder marked by chronic inflammation of the body’s connective tissue, resulting in damage and occlusion to the blood vessels (vasculitis). Scleroderma also causes overproduction of collagen, which causes tissues to become inflamed, fibrotic and sclerotic (hard). Approximately 20% of the patients who have scleroderma also have lupus. Unfortunately, patients can have more than one autoimmune disease, which is called polyautoimmunity. There are two main types of scleroderma — limited and diffuse. o Diffuse scleroderma - skin thickens over most of the body and some of the internal organs, like the heart, lungs and kidneys. o Limited scleroderma is when the skin thickening is mostly limited to the extremities, like finger, hands and toes. ▪ (CREST syndrome): Calcinosis (extra calcium deposits in your skin). Raynaud’s syndrome (color changes and numbness in your fingertips and toes). Esophageal dysfunction (difficulty swallowing and acid reflux).  6 Sclerodactyly (tight skin on your fingers). Telangiectasias (red or discolored spots on your skin). o Sine scleroderma, also known as limited cutaneous systemic sclerosis, is a variant of systemic sclerosis (scleroderma) characterized by the absence of skin thickening but the presence of other systemic symptoms Risk factors o Women are more likely than men to get scleroderma, and the age of onset is often between 30 and 50 years of age. Repeated exposure, such as at work, to certain harmful substances or chemicals also may increase the risk of scleroderma. S/sx o May be asymptomatic o Patches or streaks of thickened, waxy skin o Arthralgia (joint pain) o Numbness and swelling, especially in your hands and feet o If scleroderma reaches the esophagus, the patient may have reflux or dysphagia ▪ Digestive tract: bloating, constipation and diarrhea o If scleroderma reaches the heart the patient may develop arrhythmias, fluid buildup around your heart (pericardial effusion), and fibrosis (thickened heart muscle) o Scleroderma in the lungs and the resulting fibrosis of the lung tissue, causing coughing and dyspnea o Sclerosis of the kidneys can cause HTN and renal failure o Genitals: Erectile dysfunction (ED) and vaginal dryness Complications o Reynaud’s syndrome ▪ blood vessels in your digits suddenly contract, making the skin in your affected digits turn pale or lighter than your natural skin tone, or may look bluish ▪ Digital infarctions, Wound infections (and subsequent finger amputations) o Sjögren’s syndrome ▪ produce less moisture in certain glands (salivary glands, tear ducts) ▪ May experience muscle and joint pain o Some types of scleroderma can cause severe complications, including: ▪ Kidney failure. ▪ Pulmonary hypertension (high blood pressure in the arteries that carry blood from your heart to your lungs).  7 ▪ Pulmonary fibrosis (scarring in your lung tissue). ▪ Cardiovascular disease (issues that affect your heart and blood vessels). ▪ Congestive heart failure. ▪ A weakened immune system (immunodeficiency). ▪ Gastrointestinal diseases (conditions that affect how your body processes food and absorbs nutrition). ▪ Cancer. Diagnosis o Blood tests to see how well the immune system is working o Pulmonary function tests to show if your lungs or respiratory system are affected o Biopsy to remove a sample of your affected skin or other tissue o Endoscopy o ECG, echo o CT, CXR Treatment o Skin treatments like topical glucocorticoids, topical lubricants o Immunosuppressants (i.e. methotrexate) o Medicines to manage specific symptoms ▪ Antihistamines ▪ low-dose aspirin ▪ Vasodilators ▪ Analgesics ▪ NSAIDs ▪ Low-dose corticosteroids ▪ Proton pump inhibitors o Physical therapy o Phototherapy o Stem cell transplant o Surgeries such as amputation and lung transplants Nursing care o Assessment: ▪ A thorough history should be taken including: Past and present health conditions Family health history Current symptomology Medication history Work history (determine exposure risk factors)  8 ▪ Head to toe assessment findings may include: Skin: o Thickening of skin o Pigment changes (hyper and hypopigmentation) o Telangiectasias of the face, hands, and chest o Tight and shiny skin o Decreased sweating o Lack of skin folds o Edema o Skin induration o Calcinosis o Hair loss Cardiac: o Arrhythmias o Cor pulmonale ENT: o Xerophthalmia o Tooth decay o Loose teeth o Xerostomia GI: o Esophagitis or candida esophagitis o Esophageal strictures o Gastroparesis Musculoskeletal: o Acroosteolysis o Contractures of flexion joints o Generalized arthralgias o Hand and joint decreased function o Myositis o Decreased range of motion Respiratory: o Dry rales o Pulmonic secondary heart sound (P2) or right ventricular heave ▪ The individual may complain of the following symptoms: Dry, itchy, and tight skin  9 Fatigue Weakness Dyspnea Palpitations Headache Dizziness Bloating Constipation Fecal incontinence Weight loss Poor appetite Hoarseness Cough Dry mouth Arthralgia Myalgia Morning stiffness Pain in the joints, chest, and/or face Vaginal dryness Menstrual irregularities Depression Anxiety o Nursing diagnoses ▪ Acute pain ▪ Anxiety ▪ Deficient knowledge of disease and disease processes ▪ Infection ▪ Impaired skin integrity ▪ Impaired tissue perfusion ▪ Fatigue ▪ Stroke ▪ Altered levels of consciousness ▪ Acute confusion ▪ Activity intolerance ▪ Imbalanced fluid volume ▪ Unstable blood pressure ▪ Imbalanced nutrition  10 ▪ Impaired gas exchange ▪ Ineffective beathing pattern ▪ Impaired swallowing ▪ Ineffective airway clearance ▪ Falls ▪ Body image disturbance ▪ Renal alteration ▪ Cardiovascular impairment ▪ Injury ▪ Depression ▪ Aspiration o Interventions ▪ Monitor: Vital signs Efficacy of treatment Intake and output Neurological status Cardiovascular status Respiratory status Pulse oximetry readings Arterial blood gas (ABG) ▪ Provide: Comfort measures Oral care Wound care Adequate skin moisturizers ▪ Encourage: Activities Ambulation Exercise o Education ▪ Disease process: Various topics needed for adequate management include: Avoid cold and/or wet environments Wear warm clothing Importance of sunscreen, oral care, and stress management ▪ Healthy diet options to aid in constipation relief and decrease heartburn  11 ▪Smoking cessation ▪Self-care: Adequate sleep and rest Staying active Deep breathing ▪ Medication compliance: Importance of taking medication as prescribed to manage symptoms and irreversible changes ▪ Awareness of medication adverse reactions/side effects and how to manage them and notify the provider ▪ Referrals for support groups o Evaluating outcomes ▪ Reduction of symptoms and/or little/no progression ▪ Vital signs within a normal clinical range ▪ Decrease in pain ▪ Compliance with medication regimen and ordered therapy services ▪ No report of falls and/or injuries Lupus a chronic autoimmune condition 2 kinds: o Systemic lupus erythematosus (SLE): affect multiple organs and systems in the patient’s body, including skin, joints, kidneys, heart, lungs, and the nervous system. The immune system mistakenly attacks healthy tissues, leading to widespread inflammation and tissue damage. o Discoid lupus erythematosus (DLE) is a type of cutaneous lupus erythematosus (CLE). People with discoid lupus get round sores, usually on their face or scalp. Key risk factors: o Sex (Female patients have a higher likelihood of developing lupus with a 9:1 female-to-male ratio.) o Age (most common between ages 15 and 45) o Ethnic background (higher prevalence in Black or African American, Hispanic/Latinx, Asian American, and Native American populations) o Family history of autoimmune diseases o Environmental triggers (UV light exposure, infections, medications like hydralazine or procainamide) Symptoms: o General: Fatigue, fever, weight loss  12 o Musculoskeletal: Joint pain (arthralgia), swelling, stiffness o Dermatological: Butterfly-shaped rash across the cheeks and nose (malar rash), photosensitivity, discoid rash o Renal: Proteinuria, hematuria (indicative of lupus nephritis) o Neurological: Headaches, seizures, cognitive dysfunction o Cardiopulmonary: Pleuritis, pericarditis, chest pain o Hematological: Anemia, thrombocytopenia, leukopenia Diagnosis: o Antinuclear antibody (ANA) test: This is the most sensitive screening test for lupus; a positive result is seen in nearly all patients with lupus. o Anti-dsDNA and anti-Smith antibodies: This is more specific testing for lupus, often associated with more severe disease and lupus nephritis. o Complete blood count (CBC): This may show anemia, thrombocytopenia, or leukopenia. o Urinalysis: This checks for proteinuria and hematuria, which may indicate kidney involvement. o Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP): Elevated levels suggest inflammation. o Kidney biopsy: This may be required to assess the severity of lupus nephritis. o Differential diagnoses include rheumatoid arthritis, Sjögren’s syndrome, scleroderma, and other autoimmune or inflammatory diseases. Treatment: o Lupus treatment options ▪ Medications Nonsteroidal anti-inflammatory drugs (NSAIDs): These help to manage pain and inflammation, particularly in joints and muscles. Antimalarial drugs: o Hydroxychloroquine (Plaquenil): A cornerstone of lupus treatment, it helps control skin and joint symptoms and may prevent flares. Corticosteroids: o Prednisone: This is used for managing moderate to severe flares. Long-term use is limited due to side effects, including osteoporosis, diabetes, and hypertension. Immunosuppressive agents:  13 o Azathioprine (Imuran), methotrexate, and mycophenolate mofetil (CellCept): These are used in more severe cases or when corticosteroids are not sufficient. Biologic therapies: o Belimumab (Benlysta): The first biologic approved for lupus, used to reduce disease activity by inhibiting a specific immune system protein (BLyS). o Rituximab: This is sometimes used in refractory cases. ▪ Surgery Kidney transplant Total joint arthroplasty ▪ Preventive measures Sun protection: Encourage patients to use sunscreen (SPF 50 or higher), wear protective clothing, and avoid direct sunlight, as UV exposure can trigger flares. Vaccinations: Immunizations are important for lupus patients, but live vaccines should be avoided in those on immunosuppressive therapy. Infection prevention: Due to immunosuppressive treatment, patients with lupus are at a higher risk for infections and should be monitored closely. Nursing care o Assessment ▪ Pain assessment: Monitor for joint pain, muscle pain, and headaches. Assess for changes in pain levels that may indicate disease flares. ▪ Skin assessment: Observe any rashes, photosensitivity, and other skin lesions. ▪ Renal function: Watch for signs of kidney involvement (e.g., proteinuria, hematuria, fluid retention, elevated blood pressure). ▪ Neurological status: Assess for any cognitive changes, headaches, or seizures. ▪ Emotional status: Evaluate for signs of depression or anxiety, as chronic disease can impact mental health. o Nursing diagnoses ▪ Chronic pain related to inflammation and joint involvement ▪ Fatigue related to chronic disease and inflammation ▪ Risk for compromised skin integrity related to photosensitivity and rashes  14 ▪ Risk for ineffective coping related to chronic illness and unpredictable disease flares o Interventions ▪ Provide pain management. Administer NSAIDs or other prescribed medications. Encourage non-pharmacological methods like heat therapy or physical therapy. ▪ Education on skin protection. Educate on sun safety and the use of sunscreens and protective clothing to prevent photosensitivity-related flares. ▪ Monitor for signs of lupus nephritis. Regularly assess for changes in urine output, blood pressure, and signs of fluid overload. ▪ Support emotional health. Provide emotional support and refer to mental health professionals if needed. Support groups and counseling may help patients cope with the emotional aspects of lupus. o Education ▪ Education helps patients with lupus manage their disease, prevent flares, and recognize early signs of complications. Consider the following when providing patient education: Medication adherence: Educate patients on the importance of taking medications as prescribed, even during remission, to prevent flares. Sun protection: Teach the importance of avoiding UV exposure and using broad-spectrum sunscreen and protective clothing. Recognizing symptoms: Instruct patients to monitor for symptoms of a lupus flare, such as increased fatigue, joint pain, or rashes, and to seek medical care if symptoms worsen. Healthy lifestyle: Encourage a balanced diet, exercise, and stress management techniques to improve overall health and prevent flares. o Evaluating outcomes ▪ The patient will experience reduced pain and improved mobility with appropriate treatment. ▪ The patient will maintain skin integrity and avoid photosensitivity-related flares by following sun protection measures. ▪ The patient will demonstrate improved coping strategies to manage the psychological impact of living with lupus.  15 ▪ The patient will report an understanding of the disease, medications, and the importance of follow-up care. Gout an acute, inflammatory arthritis caused by poor metabolism of purines in the blood. The poorly metabolized purines result in the formation of urate crystals in and around joints Risk factors/causes: o Genetic defect in purine metabolism (hyperuricemia) o Poor renal excretion of uric acid o Over secretion of uric acid o Hereditary factors o Gout associated with medications (e.g., hydrochlorothiazide or pyrazinamide) o Radical dieting, starvation, or overeating o Diabetes mellitus o Hypertension o Leukemia o Myeloma o Obesity o Polycythemia o Renal disease o Sickle cell anemia o Lead poisoning o Chemotherapeutic drugs Symptoms o Tophi - large bumps that form where uric acid gout crystals have accumulated and settled in the joint o Gout is characterized by acute, recurrent attacks of pain and swelling. Diagnosis o physical examination: ▪ Inflammation at the joint (usually the first metatarsal) ▪ Pain ▪ Erythema ▪ Heat ▪ Swelling ▪ Difficulty moving the affected joint  16 o A definitive diagnosis is made by performing an arthrocentesis or withdrawal of synovial fluid from the affected joint. The synovial fluid findings will indicate urate monohydrate crystals in the joint fluid Treatment o can spontaneously resolve within 1 to 2 weeks o Medications: ▪ long-term urate-lowering therapy: Allopurinol (Zyloprim®) Febuxostat (Uloric®) Probenecid (Col-Benemid®) Colchicine (Colcrys®) (for anti-inflammatory prophylaxis) ▪ NSAIDs ▪ Corticosteroids ▪ interleukin-1 blockers (acute attacks with severe pain, especially if multiple joints are involved) o Non-pharmacological: ▪ Resting ▪ Applying cold packs ▪ Elevating affected joint(s) ▪ Following a diet low in purines ▪ Maintaining good hydration status Nursing care: o Assessment ▪ Assess for signs and symptoms of gout, such as: Inflammation of a joint or joints Pain at the site Erythema at the site Joint is warm to touch Affected joint is swollen Difficulty moving the affected joint o Nursing diagnoses ▪ Pain, related to joint inflammation ▪ Activity intolerance, related to pain and swelling of weight-bearing joints ▪ Deficient knowledge, related to lack of information about disease management o Interventions  17 ▪ Determine the level of knowledge regarding disease process, low purine diets, and preventative medication regimen. ▪ Provide education for areas where there is a lack of knowledge, such as avoiding foods with high purines, controlling weight, following preventative medication regimens, and recognizing acute flare-ups. ▪ Elevate affected extremities. ▪ Promote bedrest and immobilization of the affected joint. ▪ Administer pain medication and NSAIDs as ordered. ▪ Promote a non-sedentary lifestyle between acute attacks. ▪ Review high purine food diet (such as limiting amounts of red or processed meat, shellfish, alcohol, food, and drinks containing sugar and refined grains) ▪ Encourage weight-lowering diets such as the Mediterranean diet that effectively lowers purines in the diet ▪ Apply intermittent cold packs to affected joints. ▪ Allow adequate time for activities of daily living. o Education ▪ Review risk factors for gout to include: Obesity Hypertension Excessive alcohol consumption Diet high in purines Review factors that increase risk of disease flare-ups: Fasting Recent surgery Overeating Dehydration ▪ Review signs of gout flare-up such as: Sudden pain in a joint or joints Swelling of joints Fever Redness or heat at joints ▪ Review treatment to prevent gout flare-ups such as: Weight loss and a diet low in purines Strict preventative medication regimen When and how to report problems to the healthcare provider  18 o Evaluating outcomes ▪ Verbalizes or demonstrates a decrease in pain. ▪ Verbalizes understanding of preventative diet therapy and medication regimen. ▪ Demonstrates ability to mobilize affected joint and to ambulate without difficulty. ▪ Verbalizes knowledge of detecting and immediately reporting acute flare- ups such as sudden acute pain in joint Fibromyalgia Fibromyalgia is a chronic pain disorder of soft connective tissues that is characterized by widespread pain and other symptoms such as insomnia, fatigue, stiffness, and cognitive dysfunction The mechanism involved appears to relate to an abnormality in pain processing in the central nervous system. This results in maladaptive pain responses and the brain receiving an overload in pain stimuli; in turn, this results in central sensitization and the body becoming hypersensitive to pain from sensory stimuli including heat, touch and auditory tones. However, a definitive etiology is unknown. Risk factors o Neuroendocrine changes o Genetic predisposition o Anxiety o Depression o Viral infections o Exposure to emotional and/or physical trauma o May be no identifiable trigger Symptoms o Physical symptoms ▪ Widespread chronic pain lasting >3 months ▪ Gastrointestinal disorders ▪ Alterations in sleep ▪ Headaches ▪ Muscle stiffness ▪ Fatigue ▪ Swelling ▪ Paresthesia o Psychological symptoms  19 ▪ Anxiety ▪ Low mood ▪ Low self-esteem ▪ Panic attacks o Cognitive symptoms ▪ Word mix-ups ▪ Poor concentration ▪ Cognitive dysfunction (‘brain fog’) o Has a considerable effect on quality of life and affects patients’ social roles, with many finding it difficult to continue working. Additionally, the constant nature of symptoms means that patients have a high demand for healthcare services. Diagnosis o exclude other causes of musculoskeletal pain: o Full blood count o Serum inflammatory marker test, including for C-reactive protein o Creatinine kinase test o Vitamin D test o Blood glucose test o Thyroid function test o Autoantibody screen Common triggers o Emotional stress caused by a job, financial situation or social life. o Changes in daily routine. o Changes in diet or not getting enough nutrition. o Hormone changes. o Not getting enough sleep or changing when you sleep. o Weather or temperature changes. o Getting sick. o Starting new medication or treatments or changing usual fibromyalgia treatment routine. Treatment o Physical exercise - both aerobic and resistant activities for muscle stretching and strengthening o Cognitive behavioural therapy o improve their sleep pattern (sleep hygiene) ▪ Develop a sleep routine that involves settling and getting up at a regular time; ▪ Reduce intake of stimulants, such as caffeine and alcohol;  20 ▪ Exercise regularly; ▪ Ensure the bedroom is well ventilated; ▪ Avoid distractions in the bedroom, such as watching television o Mindfulness-based techniques o Breaking down daily activities into small, realistic goals to maintain function o Duloxetine, pregabalin or tramadol for severe pain o Amitriptyline or pregabalin for sleep disturbance o Analgesics for pain Nursing care o Assessment ▪ Pain Assessment: Evaluate the location, intensity, and characteristics of the pain. ▪ Sleep Quality Assessment: Assess patterns of sleep and any disturbances. ▪ Mental Health Assessment: Screen for signs of depression, anxiety, trauma, or other mental health issues. ▪ Functional Ability Assessment: Determine the impact of symptoms on the patient’s daily life and activities. ▪ Subjective Data for Fibromyalgia Reports of widespread pain, often described as a constant dull ache. Fatigue and tiredness despite adequate sleep. Non-restorative sleep. Cognitive difficulties, often referred to as “fibro fog,” affecting concentration and memory. Emotional distress, including anxiety and depression. ▪ Objective Data for Fibromyalgia Presence of “tender points” during physical examination. Observations of sleep disturbances Documentation of coexisting conditions, such as irritable bowel syndrome (IBS), migraine, and interstitial cystitis. o Nursing diagnoses ▪ Chronic Pain related to fibromyalgia syndrome. ▪ Disturbed Sleep Pattern related to pain and physical discomfort.  21 ▪ Impaired Memory related to cognitive disturbances associated with fibromyalgia (fibro fog). ▪ Risk for Ineffective Coping related to chronic pain and fatigue. o Interventions ▪ Pain Management Intervention: Regularly assess the patient’s pain level and provide guidance on both medication and non-medication pain relief methods, like heat therapy or gentle exercise. Rationale: Because fibromyalgia causes chronic pain, it’s important to keep track of how much pain the patient is feeling and help them manage it. Different methods, like medicine or heat packs, can help reduce this pain. ▪ Promoting Good Sleep Intervention: Help the patient develop good sleep habits by creating a restful environment and suggesting routines like avoiding caffeine before bed. Rationale: People with fibromyalgia often have trouble sleeping, which can make their pain and tiredness worse. Helping them sleep better can improve their overall well-being. ▪ Encouraging Physical Activity Intervention: Encourage light physical activities like walking or swimming, based on the patient’s ability and comfort. Rationale: Regular, gentle exercise can help reduce pain and fatigue. It’s important to find activities that are doable and don’t make the patient’s symptoms worse. ▪ Nutritional Guidance Intervention: Provide advice on a healthy diet, possibly including consultation with a nutritionist. Rationale: Eating a balanced diet can help manage symptoms and improve energy levels. ▪ Emotional and Psychological Support Intervention: Offer emotional support and consider recommending counseling or support groups as needed. Rationale: Living with chronic pain can be challenging. Emotional support, counseling, or talking with others who have fibromyalgia can provide comfort and coping strategies. ▪ Cognitive Behavioral Therapy (CBT)  22 Intervention: Suggest cognitive behavioral therapy to help the patient cope with the pain and changes in lifestyle. Rationale: CBT can help change the way patients think about their pain and teach them coping skills, which can improve their ability to handle the condition. ▪ Regular Follow-Ups Intervention: Ensure regular follow-up appointments to monitor the patient’s condition and adjust the care plan as needed. Rationale: Fibromyalgia symptoms can change over time. Regular check-ups help in keeping track of the patient’s condition and modifying their treatment plan to suit their current needs. o Education ▪ Educate the patient about fibromyalgia and encourage self-care practices like stress management techniques. Understanding their condition can help patients manage their symptoms better. Techniques to reduce stress can also help control pain and improve quality of life. ▪ Educate about importance of adequate sleep, including methods to improve sleep hygiene. ▪ Educate about the importance of psychological care in the presence of emotional distress, trauma, or menta health conditions, as it may decrease pain and cognitive alterations long-term o Outcome evaluation ▪ Pain Level Monitoring: Regular assessment of pain severity and effectiveness of pain management strategies. ▪ Sleep Quality Assessment: Monitor improvements in sleep patterns and patient-reported sleep quality. ▪ Cognitive Function Evaluation: Assess any changes or improvements in memory and cognitive abilities. ▪ Lifestyle Modification Adherence: Evaluate the patient’s adherence to recommended lifestyle changes and their impact on symptom management.