Connective Tissue Disorders: Fibromyalgia

A client is admitted to a clinic for possible fibromyalgia. The nurse understands that to confirm this​ diagnosis, a client must have pain upon palpation at standard tender points. When completing the physical​ assessment, where is the tender point in the lower extremities that the nurse should palpate to determine​ pain?

A B This is the correct answer. knee C D

The nurse is planning care for a client with fibromyalgia. Which potential problems are priority for the nurse to​ address?

Activity intolerance This is the correct answer. Decreased cardiac output Risk for injury Pain This is the correct answer. Fatigue correct Pain is a priority potential problem for the nurse to address because of the pain associated with fibromyalgia. Activity intolerance and fatigue are priority potential problems for the nurse to address because of the exacerbation of pain and fatigue associated with exercise or increased activity. Risk for injury and decreased cardiac output are not priority potential problems for a client with fibromyalgia.

Diagnosis and Treatment of Fibromyalgia: Complementary and Alternative Therapies

Complementary and alternative therapies used to treat fibromyalgia include: Therapy Indication Structured aerobic exercises Used for conditioning Stretching exercises Used for conditioning Heated pool treatments Used for pain relief Cognitive behavior therapy Used for pain relief Hypnotherapy Used for pain relief Biofeedback Used for pain relief Acupuncture Used for pain relief

Manifestations of Fibromyalgia: General

General manifestations of fibromyalgia begin after a viral illness. The client experiences: Chronic achy muscle pain Pain is localized or involves the entire body Neck, spine, shoulders, and hips often affected When palpating localized tender points, the client experiences pain. Local tightness and muscle spasms may also occur.

Because fatigue and activity intolerance are commonly manifested in​ fibromyalgia, which interventions would help to manage these health care​ needs?

Group most of the active tasks early in the morning. Discuss delegation of responsibilities with family members. This is the correct answer. Plan for rest period and naps throughout the day. Prioritize activities. This is the correct answer. engage in quiet activities to conserve energy. correct

A balance of which of the following interventions is helpful in symptom management for the client with​ fibromyalgia?

Limitation of daily caffeine intake Application of heat and cold applications Additional daily intake of calcium Structured aerobic and stretching exercises This is the correct answer. Stress management techniques correct

A student nurse is asking questions about fibromyalgia. The nurse educates the student that this disorder closely resembles what other​ disorder?

Muscular dystrophy Chronic fatigue syndrome This is the correct answer. Osteoarthritis Sjogren syndrome Fibromyalgia closely resembles chronic fatigue​ syndrome, with the exception of the musculoskeletal pain typically associated with fibromyalgia. Fibromyalgia closely resembles chronic fatigue​ syndrome, not​ Sjögren syndrome, muscular​ dystrophy, or osteoarthritis.

Which of the following are health needs of the client with​ fibromyalgia?

Provision of restful sleep This is the correct answer. Impaired oxygenation Management of fatigue This is the correct answer. Altered nutritional needs Pain management correct

Which of the following are risk factors for the development of​ fibromyalgia?

Recent injury to bone or joint Diagnosis of osteoarthritis Female gender This is the correct answer. Family history of fibromyalgia This is the correct answer. Older than 50 years of age

The nurse educates a new nurse that clients diagnosed with fibromyalgia have problems with sleep disruption because of what​ manifestation?

Shortness of breath Nausea and vomiting Restless leg syndrome This is the correct answer. Headache Shortness of breath Nausea and vomiting Restless leg syndrome This is the correct answer. Headache

Which of the following complementary treatments are used to relieve pain associated with​ fibromyalgia?

Stretching exercises Biofeedback This is the correct answer. Cognitive behavior therapy This is the correct answer. Heated water immersion This is the correct answer. Structured aerobic exercises

Manifestations of Fibromyalgia: Systemic

Systemic manifestations of fibromyalgia include: Fatigue Sleep disruptions Headaches Morning stiffness Painful menstrual periods Problems with thinking and memory, or "fibro fog" Pain and fatigue are aggravated by exertion.

Manifestations of Fibromyalgia: Pain, Sleep, and Fatigue

The client with fibromyalgia experiences manifestations related to pain, sleep, and fatigue, specifically:1 Problem Manifestations Pain Widespread pain lasting 3 months or longer Pain at 11 of 18 standard tender points upon palpation Sleep disruption Insomnia Restless leg syndrome Fatigue Chronic fatigue Acute fatigue exacerbations associated with exercise or increased activity

Pathophysiology of Fibromyalgia: Risk Factors

The risk factors for fibromyalgia are as follows: Female gender Between the ages of 20 and 50 years Family history of fibromyalgia Diagnosed with another rheumatic disorder such as RA or systemic lupus erythematosus

The nurse is providing education about ongoing care for a client with fibromyalgia. Which information should the nurse​ include?

Using cold therapy to reduce pain to joints Taking medications as prescribed This is the correct answer. Support organizations This is the correct answer. Reducing stress to manage symptoms This is the correct answer. Importance of keeping​ follow-up appointments correct The nurse should educate the client about available support organizations such as the Fibromyalgia Network and the American College of Rheumatology. The nurse should educate the client about reducing stress to assist in managing symptoms of fibromyalgia. The nurse should educate the client about the importance of keeping​ follow-up appointments with health care providers. The nurse should educate the client about taking medications as prescribed. The client should use heat​ therapy, not cold​ therapy, in managing symptoms of fibromyalgia.

Nursing Care of Fibromyalgia: Assessment

Your assessment of the client with fibromyalgia is based on the health history and physical examination, specifically: Assessment Criteria Health history Presence of pain for at least 3 months History of fatigue, sleep disruptions, headaches, morning stiffness Physical examination Presence of pain at 11 of the 18 standard tender points on palpation

Karen​ O'Connell is a young woman who has recently graduated from college and has been working at her first position as an architect. Up to this​ time, she has been in very good health and has led an active lifestyle. She enjoys​ hiking, cycling, and jogging. During your​ assessment, Ms.​ O'Connell states that she is frequently tired and has achy pain in her​ neck, back, and hips. You suspect fibromyalgia. When questioned​ further, how would you expect Karen to describe her fatigue and​ pain?

"The tiredness and pain seem to be relieved after I do some light​ activity." ​"I am not able to determine a pattern with the pain and​ fatigue." ​"The pain and tiredness are worse when I am very​ active." This is the correct answer. ​ "The pain and fatigue are greatest in the early​ evening." The fatigue and pain of fibromyalgia are aggravated by exertion. The client is generally able to determine a pattern of exacerbation of pain and fatigue with increased activity. The early evening is not a period of greatest symptom manifestation with fibromyalgia.​ Activity, even light​ activity, does not relieve the pain of fibromyalgia.

The nurse when assessing a patient suspected of having fibromyalgia should complete which priority assessment during the physical​ assessment?

Assessing for crepitation in joints Auscultation of lung sounds Percussion of the abdomen Palpation of standard tender points correct The priority assessment when completing a physical examination on a client with possible fibromyalgia is the palpation of standard tender points. The presence of pain upon palpation at 11 of the 18 standard tender points will assist with diagnosis this disorder. Auscultation of lung​ sounds, assessing for crepitation in​ joints, and percussion of the abdomen are not priority assessments when completing the physical examination on a client suspected of having fibromyalgia.

When planning care for a client with fibromyalgia the nurse recommends which activity to assist the patient with the potential problem of​ fatigue?

Bike riding Listening to music This is the correct answer. Swimming Playing table tennis The nurse should encourage quiet activities such as listening to music to assist in addressing the potential problem of fatigue.​ Swimming, playing table​ tennis, and bike riding will not assist in addressing the potential problem of fatigue.

A nurse is providing education about fibromyalgia to a group of new nurses. When discussing the pathophysiology of this​ disorder, the nurse needs to address which systems of the body that are involved with​ fibromyalgia?

Cardiac system Endocrine system This is the correct answer. Renal system Autonomic nervous system This is the correct answer. Somatic peripheral nervous system correct The pathophysiology of fibromyalgia involves the autonomic nervous​ system, somatic peripheral nervous​ system, and endocrine system. The pathophysiology of fibromyalgia does not involve the renal or cardiac systems.

A client recently diagnosed with fibromyalgia is receiving education from the nurse. What reason should the nurse give the client about perceiving pain at a lower level of stimulation with this​ disorder?

Decreased neurotransmitter levels Fat and connective tissue replace muscle fibers Autoantibodies attack host tissues Abnormal hypothalamic response correct A client with fibromyalgia perceives pain at a lower level of stimulation because of increased neurotransmitter levels and an abnormal hypothalamic response. A client with fibromyalgia perceives pain at a lower level of stimulation because of​ increased, not​ decreased, neurotransmitter levels. A client with fibromyalgia perceives pain at a lower level of stimulation because of increased neurotransmitter levels and an abnormal hypothalamic​ response, not because of fat and connective tissue replacing muscle fibers or because of antibodies becoming autoantibodies and attacking host tissues.

In addition to genetic​ factors, what additional factor is likely to contribute to the development of​ fibromyalgia?

Excess physical exercise Physical or emotional trauma This is the correct answer. Nutritional deficiency Previous injury to the bone Fibromyalgia is associated with genetic and environmental​ factors, such as physical or emotional trauma. Too much physical exercise does not contribute to the onset of fibromyalgia. Nutritional deficiencies and previous bone injuries are not contributing factors. Connective tissue disorders such as rheumatoid arthritis may predispose a client to the development of fibromyalgia.

Based on the involved pathophysiology of​ fibromyalgia, how do clients with the disease experience​ pain?

Experience pain at areas of the body distal from the sensory stimulation Perceive pain as unusual tactile sensations Experience pain as anxious energy Perceive pain at lower levels of stimulation correct Because of increased levels of neurotransmitters and an abnormal hypothalamic​ response, clients with fibromyalgia experience pain at lower levels of stimulation. The pain may be achy muscle pain that is either localized or involves the entire body. Pain is not experienced as unusual tactile​ sensations, as anxious​ energy, or at points of the body that are not at the point of sensory stimulation.

Pathophysiology of Fibromyalgia: Introduction

Fibromyalgia is a common connective tissue disorder characterized by chronic widespread musculoskeletal pain, stiffness, and tenderness. Although fibromyalgia can develop at any age, it is most prevalent in older women. A combination of genetic and environmental factors is believed to contribute to fibromyalgia even though the exact cause is unknown. Clients diagnosed with this disorder recall the onset of pain with physical or emotional trauma. Fibromyalgia closely resembles chronic fatigue syndrome except that musculoskeletal pain is predominant in fibromyalgia. It can be a complication of rheumatoid arthritis (RA) or another connective tissue disorder.

Complementary and alternative therapies are used to treat fibromyalgia. Which therapies should the nurse encourage a client with fibromyalgia to try to assist with pain​ relief?

Hypnotherapy This is the correct answer. Acupuncture This is the correct answer. Ice therapy Biofeedback This is the correct answer. Structured aerobic exercises The nurse should encourage the client to try​ biofeedback, acupuncture, and hypnotherapy because these therapies will assist in pain relief. The nurse should encourage the client to try structured aerobic​ exercises, but it will assist with​ conditioning, not pain relief. Ice therapy should not be used with a client diagnosed with fibromyalgia.

A health care provider prescribes duloxetine​ (Cymbalta) for a client diagnosed with fibromyalgia. The nurse anticipates that this medication is being prescribed for what​ reason?

Increases serotonin and norepinephrine levels This is the correct answer. Reduces neuropathic pain Relaxes client and promotes sleep Decreases swelling to joints Duloxetine​ (Cymbalta) is prescribed to a client with fibromyalgia to increase serotonin and norepinephrine levels. This medication is not prescribed to reduce neuropathic​ pain, decrease swelling to​ joints, or relax the client to promote sleep. Pregabalin​ (Lyrica) is prescribed to reduce neuropathic pain. Nonsteroidal​ anti-inflammatory drugs are prescribed to decrease swelling to joints. Fluoxetine​ (Prozac) and paroxetine​ (Paxil) are medications prescribed to promote sleep.

What risk factors associated with fibromyalgia should the nurse be aware of when taking a​ client's health​ history?

Male gender Age between 60 and 75 Family history This is the correct answer. History of osteoarthritis A family history of fibromyalgia is a risk factor for developing fibromyalgia. ​Female, not​ male, gender is a risk factor for developing fibromyalgia. Being diagnosed with another rheumatic disorder such as rheumatoid arthritis​ (not osteoarthritis) or systemic lupus erythematosus are risk factors associated with developing fibromyalgia. A risk factor for developing fibromyalgia is an age between 20 and 50 years​ old, not between 60 and 75 years old

Diagnosis and Treatment of Fibromyalgia: Medication Treatment

Medications used to treat fibromyalgia include the following:2 Medication Indications Duloxetine (Cymbalta) Milnacipran (Savella) Mixed with reuptake inhibitors to increase serotonin and norepinephrine levels Pregabalin (Lyrica) Developed to treat neuropathic pain May reduce the pain associated with fibromyalgia Fluoxetine (Prozac) Paroxetine (Paxil) Promote better sleep Relieve the manifestations of fibromyalgia Tramadol (Ultram) NSAIDs Used for pain relief

Which of the following systemic manifestations may a client who is diagnosed with fibromyalgia​ experience?

Memory impairment This is the correct answer. Hypersomnia Headaches This is the correct answer. Hypertension Unsteady gait

The nurse is educating a​ 26-year-old client recently diagnosed with fibromyalgia about systemic manifestations. Which manifestations should the nurse include when educating this​ client?

Memory problems This is the correct answer. Painful menstrual periods This is the correct answer. Headaches This is the correct answer. Sleep disturbances This is the correct answer. Nausea and vomiting The nurse should include memory problems because they are systemic manifestations of fibromyalgia. Problems with thinking and memory are also referred to as​ "fibro fog." The nurse should also include sleep disturbances or​ disruptions, painful menstrual​ periods, and headaches because these are also systemic manifestations of fibromyalgia. Nausea and vomiting are not systemic manifestations of​ fibromyalgia, so they should not be included in client education about fibromyalgia.

The nurse is educating a client newly diagnosed with fibromyalgia about home medications. What medication will assist in treating neuropathic pain and may reduce pain associated with​ fibromyalgia?

Milnacipran​ (Savella) Fluoxetine​ (Prozac) Pregabalin​ (Lyrica) This is the correct answer. Tramadol​ (Ultram) Pregabalin​ (Lyrica) is prescribed to a client with fibromyalgia to assist in treating neuropathic pain and to help in reducing pain associated with fibromyalgia. Tramadol​ (Ultram) is prescribed to a client with fibromyalgia to assist with pain​ relief, but it does not assist in treating neuropathic pain. Fluoxetine​ (Prozac) is prescribed to a client with​ fibromyalgia, but it does not assist in treating neuropathic pain or reduce pain associated with fibromyalgia. This medication promotes better sleep and helps in relieving other manifestations of fibromyalgia. Milnacipran​ (Savella) is prescribed to a client with​ fibromyalgia, but it does not assist in treating neuropathic pain or reduce pain associated with fibromyalgia. This medication mixes with reuptake inhibitors to increase serotonin and norepinephrine levels.

The nurse needs to emphasize to a client with fibromyalgia that​ ____________ is aggravated by​ exertion?

Morning stiffness Fatigue This is the correct answer. Joint swelling Weakness The nurse needs to emphasize that fatigue is the manifestation of fibromyalgia aggravated by exercise or increased activity. Pain is also aggravated by exertion. Morning​ stiffness, joint​ swelling, and weakness are not manifestations of fibromyalgia aggravated by exertion.

The nurse is completing a physical assessment on a client with possible fibromyalgia. To assist with​ diagnosis, a client must have pain upon palpation at how many standard tender​ points?

Nine Five Seven Eleven correct To assist with the diagnosis of​ fibromyalgia, the client must have pain upon palpation at 11 or more of the 18 standard tender​ points, not​ nine, seven, or five of the standard tender points.

Diagnosis and Treatment of Fibromyalgia: Diagnosis

No specific tests are used to diagnose fibromyalgia, although the American College of Rheumatology criteria are used to aid in the diagnosis. A client is diagnosed with the disorder if the following criteria are present: History of widespread pain that has been present for at least 3 months Pain at 11 or more of the 18 standard tender points on palpation Because this disorder may mimic chronic fatigue syndrome or hypothyroidism, diagnostic tests may be prescribed to rule out these other health problems.

Which of the following diagnostic criteria must be present for a diagnosis of fibromyalgia to be​ given?

Pain at least at 11 of the 18 standard tender points upon palpation This is the correct answer. Periods of sleepiness through the day Excessive energy and movement of the lower​ extremities, especially when resting Widespread pain for at least 3 months This is the correct answer. Frequent episodes of feeling cold

Pathophysiology of Fibromyalgia: Pathophysiology

The pathophysiology of fibromyalgia involves the autonomic and somatic peripheral nervous systems and the endocrine system. In fibromyalgia, there is a disorder in the brain's processing of pain, with abnormal levels of neurotransmitters present, specifically, substance P, serotonin, and norepinephrine (NE). There is also an abnormal hypothalamic-pituitary-adrenal axis response. Because of the increased neurotransmitter levels and abnormal hypothalamic response, clients with fibromyalgia perceive pain at a lower level of stimulation.

What is the purpose of pregabalin​ (Lyrica) in the treatment of​ fibromyalgia?

To increase serotonin To promote sleep To reduce symptoms of fatigue To treat neuropathic pain correct In the treatment of​ fibromyalgia, pregabalin​ (Lyrica) is used to treat the associated neuropathic pain. Fluoxetine​ (Prozac) and paroxetine​ (Paxil) promote restful sleep and may also relieve symptoms. Duloxetine​ (Cymbalta) and milnacipran​ (Savella) increase serotonin and norepinephrine levels.

What occurrence usually precedes general symptom manifestations of​ fibromyalgia?

Viral illness This is the correct answer. Recent injury to joint or bone Septicemia caused by group A​ beta-hemolytic streptococcus Bacterial infection of affected joint or muscles General manifestations of fibromyalgia usually follow a viral illness. Bacterial​ infections, recent injuries to joint or​ bone, or blood infection caused by group A​ beta-hemolytic strep do not predispose the development of fibromyalgia.

Nursing Care of Fibromyalgia: Ongoing Care

When providing ongoing caring for your client with fibromyalgia, you will teach the client about: The symptoms of the disorder Ways to manage the symptoms The use of heat, exercise, and stress reduction techniques to manage the symptoms The importance of taking medications as prescribed Support organizations such as the Fibromyalgia Network and the American College of Rheumatology Keeping scheduled follow-up appointments with the health care provider

Nursing Care of Fibromyalgia: Activity and Fatigue

Your client with fibromyalgia will have problems with activity intolerance and fatigue. Your care for these problems will include the following: Problem Interventions Activity intolerance Assess current activity level. Assess tolerance of activities. Assess vital signs. Teach to establish priorities for activities. Instruct to take frequent rest periods or naps when scheduling daily activities. Suggest delegation of responsibilities to other family members to conserve energy and encourage family support. Fatigue Assess level of malaise and fatigue. Discuss the impact of the disease process on lifestyle. Encourage quiet activities, such as reading or listening to music, to reduce feelings of fatigue and conserve energy.

Which of the following statements by a client support the diagnosis of​ fibromyalgia?

​"I have had difficulty falling asleep and staying asleep for many​ nights." This is the correct answer. ​"I have experienced heart palpitations and a fluttering sensation for the past few​ weeks." ​"I have had generalized pain throughout my body for at least 3 to 4​ months." This is the correct answer. ​"My joints are stiff when I get up in the​ mornings." This is the correct answer. ​"I have experienced persistent pain in my​ knees, ankles, and​ feet."

Helena Ratcliff is a​ middle-aged woman who has experienced fibromyalgia for several years. She is attending a group meeting of women who were recently diagnosed or are living with fibromyalgia. When you ask Ms. Ratcliff for a recommendation about how she manages her fatigue on a daily​ basis, which of the following statements would best respond to your​ request?

​"I relax and enjoy life more than I used to before I developed the​ disease." ​"I have added nutritional supplements to my daily intake for additional​ energy." ​"I do most of my activities in the morning when I am​ rested." ​"I have learned to knit and read more throughout the​ day." correct Managing fatigue and conserving energy can be accomplished by performing quiet​ activities, such as knitting and reading. Relaxing and enjoying life is an intended​ outcome, but the statement lacks specifics for the group to implement. Activities need to be balanced with periods of rest. Performing all activities in the morning hours does not allow for rest and relaxation. Nutritional supplements are not a component of treatment for fibromyalgia.

Tiffany Anderson is a​ 35-year-old recently widowed woman and mother of two young children. Her husband was a Marine who died in Afghanistan 6 months ago. You are performing an​ assessment, and she tells you about how she is coping with life today. Although she states that some days are really​ difficult, she believes that she is managing as well as can be expected. She focuses much of her energy on her children. She is at the health care​ provider's office today to discuss the possibility of​ fibromyalgia; her symptoms began about 16 weeks ago. She says to​ you, "I thought that there was no real known cause of fibromyalgia. What would have brought on the symptoms now when I really need to have energy and be pain​ free?" What would be your most accurate​ response?

​"Sometimes the pain is noted when experiencing physical or emotional​ trauma." Your answer is correct. ​"There can be so many factors that precede the onset of​ fibromyalgia, so we may never have an answer about why it occurred at this​ time." ​"Without your husband at​ home, you may have been doing extra work that resulted in additional stress and​ strain." ​"Perhaps your body is experiencing physical symptoms of grief reaction. Have you spoken with anyone about the possibility of​ depression?" There is a correlation between physical or emotional trauma and the onset of the pain of fibromyalgia. This information may help the client place at least a loose​ cause-and-effect connection for why the symptoms started at this time. If her husband was stationed in​ Afghanistan, she probably was already doing extra work. Although deployment of a spouse to a war zone is​ traumatic, it is not as severe as the death of a spouse. Grief reactions can present somatically.​ However, raising this possibility and its association with​ depression, especially at this time of confirmed clinical​ manifestations, is outside the role of the professional nurse. The client is looking for a reason for the onset of the condition. Addressing her concern vaguely does not help to establish a therapeutic relationship. Next Question

Jennifer Carson is a​ 35-year-old woman who presents at the health care​ provider's office. She states that she​ "has been more tired than​ usual" for the past few months and that she has​ "a general​ achiness, especially in my back and​ hips." The health care provider is questioning a diagnosis of fibromyalgia and has ordered blood to be drawn for thyroid hormone levels. While preparing to perform the blood​ draw, Ms. Carson​ says, "If there are no tests to determine the diagnosis of​ fibromyalgia, why are they testing my​ thyroid?" What is your most informative​ response?

​"Thyroid problems may precede the onset of fibromyalgia. If your thyroid is not functioning​ properly, it will be important to treat both​ conditions." ​"Sometimes the symptoms of fibromyalgia present similar to the symptoms of hypothyroidism. Knowing how your thyroid is functioning will allow for an accurate​ diagnosis." This is the correct answer. ​"If your thyroid is not functioning​ properly, correcting thyroid hormone levels may prevent fibromyalgia from​ developing." ​"Checking thyroid function is the first endocrine gland to assess because fibromyalgia often presents with endocrine​ imbalances." Some of the symptoms of​ fibromyalgia, such as fatigue and mental​ "fogginess," mimic hypothyroidism. Thyroid diseases require treatment for the body to function holistically. Knowledge of thyroid function is essential for an accurate diagnosis. Although thyroid disorders may mimic symptoms of​ fibromyalgia, thyroid disorders do not precede or increase the risk of fibromyalgia. Endocrine disorders are not associated with the presence of fibromyalgia.