Nursing 3Rd Semester: Exam 4: Autoimmune Diseases

Front 1

Rheumatoid Arthritis (RA) is an acute/chronic local/systemic, insidious disease that involves ______ of _____ tissue in diarthrodial (____) joints. It is accompanied by _____ manifestations. There is an autoimmune theory about RA's development- a normal/abnormal Ig_ leads to the presence of ___antibodies known as ____ ____. What type of hypersensitivity reaction is RA considered?

Back 1

Rheumatoid Arthritis (RA) is a chronic systemic disease that involves inflammation of connective tissue in diarthrodial (synovial) joints. It is accompanied by extraarticular manifestations. There is an autoimmune theory about RA's development- abnormal IgG leads to the presence of autoantibodies known as Rheumatoid Factor (RF). RA is a type 3 immune complex reaction- the complexes systemically damage tissues causing destruction.

Front 2

There may be a _____ component in adult RA. Extraarticular means that the disease does not just involve the joints (outside the joints). Is RA symmetrical or nonsymmetrical in its development? The exacerbations are very similar to ___ as far as how s/s occur.

Back 2

There may be a genetic component in adult RA. Extraarticular means that the disease does not just involve the joints (outside the joints). Is RA symmetrical in its development (not just one bad leg or hip etc. like in osteoarthritis.) The exacerbations are very similar to SLE as far as how s/s occur.

Front 3

Some of the areas outside the joints that are affected by RA include what 4?

Back 3

heart- pericarditis
lung- pleuritis
eyes
blood vessels

Front 4

What are the clinical manifestations of RA?

Back 4

Joints: SPAM WIFF
stiffness (esp. in morning or after periods of inactivity)
pain
anorexia
muscle atrophy (deformity)
Weight Loss
Inflammation (heat, swelling)
fever
fatigue (very debilitating)

Rheumatoid Nodules- firm, nontender granuloma type masses on surfaces of fingers and elbows (not usually removed because of high incidence of recurrence)
Sjögeren’s syndrome
Felty syndrome

Front 5

The presence of rheumatoid nodules usually indicates..

Back 5

The presence of rheumatoid nodules usually indicates active or more severe diseases, higher level of rheumatoid factors

Front 6

Sjögeren’s syndrome can occur as a disease by itself or in conjunction with RA and ____. Describe Sjögeren’s syndrome

Back 6

Sjögeren’s syndrome can occur as a disease by itself or in conjunction with RA and SLE. Sjögeren’s syndrome- ↓ ability to make tears, photosensitivity, dry, burning, itching eyes, ↓ salivation

Front 7

Felty's syndrome most commonly occurs in patients with severe, ___ forming RA. It is characterized by ...(5 things)

Back 7

Felty's Syndrome- occurs most commonly in patients with severe, nodule forming RA. It is characterized by inflammatory eye disorders, splenomegaly, lymphadenopathy, pulmonary disease, and blood dyscrasias (anemia, thrombocytopenia, granulocytopenia)

Front 8

Without treatment for RA, joint deformity can occur within a year. What are the complications of RA?

Back 8

joint destruction
flexion contractures & hand deformities- cause diminished grasp strength and affect patient's ability to perform ADLs
nodular myositis- infl. of muscle causing pain
rheumatoid nodules- can lead to pressure ulcers
cardiopulmonary effects- myocarditis, pericarditis

Front 9

What are some diagnostic studies involved with RA?

Back 9

Diagnostic studies
◦ Labs: positive RF, ANA titers
◦ ESR, C-reactive protein (CRP)
◦ Anti-cyclic citrulline peptide (anti-CCP) - confirms dx
◦ WBC count of synovial fluid elevated, fluid is cloudy
◦ X-rays

ESR and CRP are not diagnostic specifically for RA because they indicate nonspecific inflammation, it's a good lab to monitor effectiveness of drugs or tx.

Front 10

The American Rheumatism Association Classification defines a RA by having at least ___ of the following 7 criteria:

Back 10

The American Rheumatism Association Classification defines a RA by having at least four of the following 7 criteria:
morning sitffness lasting ≥ 1 h*
swelling in 3+ joints*
swelling in hand joints*
symmetric joint swelling*
erosions or decalcification seen on hand x-rays
Rheumatoid nodules
presence of serum RF
*must be present for at least 6 weeks

Front 11

Review drug therapy p. 3 of rheumatoid powerpoint and table 65-3, 65-9

Back 11

..

Front 12

RA requires no specific ____, balanced nutrition is important, and ______ therapy is often very important for treatment.
Corticosteroid therapy are often used as intraarticular _____ or systemically. Corticosteroids can cause ___ ____ which are detrimental to joints.

Back 12

RA requires no specific diet, balanced nutrition is important, and occupational therapy is often very important for treatment.
Corticosteroid therapy are often used as intraarticular injections or systemically. Corticosteroids can cause weight gain (hunger) which are detrimental to joints.

Front 13

Nursing management for RA involves..
◦ Planning for Satisfactory __ relief
◦ Minimal loss of ___
◦ Participate in planning & carrying out therapeutic regimen
◦ Maintain a positive ___ image
◦ Perform self-care to best of ability
◦ Prevent exacerbations.

Back 13

Nursing management for RA
◦ Planning for Satisfactory pain relief
◦ Minimal loss of function
◦ Participate in planning & carrying out therapeutic regimen
◦ Maintain a positive self image
◦ Perform self-care to best of ability

Front 14

In treating RA, warmth/cold is good for stiff joints such as a ___ shower. Warmth/cold is good for inflammation. What is better sitting or standing? Sometimes ____ are good for joint protection, but still need regular ___ checks, active or passive ____ (usually just used for periods of inflammation if choosing to use them.) Keep joints in a ____ position. ____ needs to be alternated with activity and movement is important. Occupational therapy is good for daily chores and ADL's. Moist heat should be limited to ___ minutes.

Back 14

In treating RA, warmth is good for stiff joints such as a warm shower. Cold is good for inflammation. Sitting is better than standing. Sometimes splints are good for joint protection, but still need regular skin checks, active or passive ROM (usually splints just used for periods of inflammation if choosing to use them). Keep joints in a dependent position. Rest needs to be alternated with activity and movement is important. Occupational therapy is good for daily chores and ADL's. Moist heat should be limited to 20 minutes.

Front 15

Gout is caused by increased/decreased levels of ___ ___ , a product of ____ metabolism and cell breakdown. There are both primary and secondary forms of gout.

Back 15

Gout is caused by increased levels of uric acid, a product of protein metabolism and cell breakdown. There are both primary and secondary forms of gout.

Front 16

Gout can be caused by what 3 things? What is the difference between primary and secondary gout?

Back 16

↑ uric acid production
↓ excretion of uric acid by kidneys ↑ intake of food containing purines (Results in sodium urate crystals deposits)

Primary- hereditary overproduction or retention of uric acid

secondary- some other cause, anything that causes more cell breakdown (more common)

Front 17

What are some examples of factors that can cause more cell breakdown like in secondary gout?

Back 17

CHARD
chemo
hypertension
alcohol
renal disease
diabetes

Front 18

What is the classic sign of gout?

Back 18

Pain in big toe is classic also foot, ankle, hands
Excruciating pain, pressure- usually brings patients in and gets them diagnosed

Front 19

Acute gout usually affects 1- __ joints
Usually lasts __ to ___ days
There is NO joint _____.
Chronic gout involves multiple joints. There is presence of visible/hidden deposits of urate crystals (Tophi)
◦ Uric acid____ ____ →__________→ ____ disease

Back 19

Acute gout usually affects 1- 4 joints
Usually lasts 2-10 days
There is NO joint deformity.
Chronic gout involves multiple joints. There is presence of visible deposits of urate crystals (Tophi)
◦ Uric acid kidney stones → pyelonephritis→ kidney disease

Front 20

Diagnostic studies for gout include
serum ___ ___, a 24 hr urine uric acid, and aspiration of ____ fluid to look for uric acid.

We rarely see chronic uric acid crystal increases, treatment is avail. chronic gout is what causes ____ of ____.

Back 20

Diagnostic studies for gout include
serum uric acid, a 24 hr urine uric acid, and aspiration of synovial fluid to look for uic acid.(if urine uric acid levels are too low then that means that kidneys aren't getting uric acid out and it ,may be depositing in joints)

We rarely see chronic uric acid crystal increases, treatment is avail. chronic gout is what causes deformity of cartilage.

Front 21

Look at drug therapy for Gout

Back 21

p. 11 of powerpoint

Front 22

True or False: Elevation is helpful for people with gout.

Back 22

False. Elevation doesn't help swelling.

Front 23

Patients with gout should be encouraged to use foot ____s, (also used for people with pressure ulcers)
_____ may be indicated for short time

Patients with gout should avoid ____, avoid ____, and some _____ are contraindicated.

Back 23

Patients with gout should be encouraged to use foot cradles, (also used for people with pressure ulcers)
Bedrest may be indicated for short time
Patients with gout should avoid niacin, avoid aspirin, some diuretics are contraindicated

Front 24

What are 4 precipitating events for attacks of gout?

Back 24

Food and alcohol intake (purine)
Fasting (causes protein metabolism, more uric acid)
Drug use
Medical events (trauma, surgery, systemic infections

Front 25

Onset of gout symptoms usually occurs when? There is sudden swelling and excruciating pain that peaks within several hours. They are often accompanied by what?

Back 25

Onset of gout symptoms usually occurs at night. There is sudden swelling and excruciating pain that peaks within several hours. They are often accompanied by low-grade fever.

Front 26

if a colchicine relieves the symptoms, you have ___. An improvement should be seen in ___ to ___ h. This medication can cause ___ symptoms so advise patients to... Does this med help with inflammation, pain, or both?

Back 26

if a colchicine relieves the symptoms, you have gout. An improvement should be seen in 24 to 48 h. This medication can cause GI symptoms so advise patients to take medication with food. This med helps with inflammation, not pain-- so an NSAID should be taken with it.

Front 27

Allopurinol (Zyloprim) is often used for CHF and long term diabetes. How does it work in the treatment of gout? It is especially used for which patients?

Back 27

Allopurinol is often used for CHF and long term diabetes. It blocks the production of uric acid. It is especially used for patients with renal impairment.

Front 28

probenecid (Benemid) is a medication used to treat gout. How does it work? What are some important nursing implications?

Back 28

probenecid (Benemid) is a medication used to treat gout. It enhances excretion of uric acid by kidneys. So, it requires adequate kidney function. Patients need adequate fluid intake to flush the kidneys of the uric acid
Not used much for patients >60 because kidneys start to lose function at this time
Don't give with aspirin because it inactivates probenecid, use tylenol instead.

Front 29

Uloric is a medication used for the long/short term management of chronic gout. It is more expensive than some other medications.

Back 29

long term

Front 30

Acute management of gout includes what 3 drugs?

Back 30

colchicine, NSAIDS, corticosteroids

Front 31

allopurinol (Zyloprim) and probenecid (Benemid) are used to ....

Back 31

prevent gout

Front 32

pegloticase (Krystexxa) is given to which patients? It is given in what route?

Back 32

given to those who don't respond to other mentioned gout meds, given IV

Front 33

Losartan (Cozaar) is a drug in which class? It is used to treat...

Back 33

Losartan (Cozaar) is a ARB It is used to treat gout and HTN in the elderly

Front 34

See ch 46 table 46-13 foods
high in purine such as
shellfish, sardines, mussles, liver,
goose, salami, chicken, etc

Back 34

..

Front 35

Treatment for gout also involves increasing ____, limit ____ and foods ↑ purine. Weight reduction is also recommended if indicated.

Back 35

Treatment for gout also involves increasing fluid, limit alcohol and foods ↑ purine. Weight reduction is also recommended if indicated.

Front 36

Systemic Lupus Erythematosus (SLE) is an acute/ chronic multi____ inflammatory disease associated with abnormalities of ____ system, It mostly effects men/women of what age?
Etiology is unknown – most probable causes include genetic, hormones, environmental factors, certain medications.

Back 36

Systemic Lupus Erythematosus (SLE) is a chronic multisystem inflammatory disease associated with abnormalities of immune system, It mostly effects women of childbearing age.
Etiology is unknown – most probable causes include genetic, hormones, environmental factors, certain medications.

Front 37

True or False: SLE ranges from a relatively mild disorder to rapidly progressing. There are alternating periods of exacerbations & remissions

Back 37

true

Front 38

SLE is a what type of hypersensitivity reaction? Antibody-antigen complexes get into tissues, capillaries, cause damage. Is there reversal after damage occurs?

Back 38

SLE is a type 3 hypersensitivity antibody-antigen complexes get into tissues, capillaries, cause damage. Is there reversal after damage occurs? NO

Front 39

There is a strong association between SLE and exposure to _____.

Back 39

estrogen
Hormones increase and worsen symptoms during postpartum, OC's worsen symptoms, onset of menarche. If a woman with SLE is pregnant and gets an abortion the symptoms don't improve.

Front 40

What are the s/s of SLE?

Back 40

Fever, wt. loss, arthralgia, fatigue may precede an exacerbation (sometimes in mild cases fatigue is only symptom)

Skin:
Cutaneous vascular lesions Oral/nasopharyngeal ulcers alopecia
butterfly rash (classic)

Musculoskeletal:
Polyarthralgia morning stiffness
Arthritis (extremely common)

Front 41

True or False: Release of complement causes damage to tissues such as skin & muscles, inflammation is caused by the autoantibodies

Back 41

False
Autoantibodies cause damage to tissues and release of complement causes inflammation

Front 42

What are some cardiopulmonary complications of SLE?

Back 42

CD- PATH
↑ Cholesterol
Dysrhythmias (AV & SA node become fibrotic)
Pericarditis,Pleurisy
2ndary antiphospholipid syndrome (APS)
Tachypnea
HTN

Front 43

What are the 6 body systems that are most commonly effected by SLE?

Back 43

integumentary
renal
cardiovascular
cns
immune
musculoskeletal (joints)
(pretty much everything)

Front 44

The major renal complication of SLE is called ____ _____.

What labs would you look at for someone with SLE in regard to kidney function or onset of kidney problems?

Back 44

lupus nephritis

Renal probelms are huge with SLE. Immune complexes --> glomerulis, may have ↓ urine output, CBC and urinalysis
might tell you there's protein in urine
RBCs in urine- may be kidney damage
Of course look at creatinine, BUN, GFR

Front 45

What are some CNS complications of SLE (3)?

Back 45

CNS:
Cognitive dysfunction
Neuropathy (peripheral)
Seizures (Generalized/focal)

Front 46

Some hematologic problems seen with SLE include what 4?

A major cause of death in SLE is what?

Back 46

anemia
thrombocytopenia
leukopenia
coagulation problems

Infection is a major cause of death.

Front 47

Diagnostic studies for SLE include:
◦ CBC
◦ ANA
◦ anti-DNA antibody
◦ anti-Smith (Sm)
◦ LE cell prep (also may be positive in other rheumatic diseases)
◦ CRP, ESR (to monitor tx)
◦ CXR, ECG- gives a baseline for cardiac and pulmonary d/o's
(lots of other anti- labs)
Is there a specific test that is diagnostic for SLE? It is characterized by the presence of ___ and it's identification establishes the presence of an autoimmune disease. High levels of ____ and ____ are rarely seen with other diseases or conditions other than SLE.

Back 47

There is not a specific test that is diagnostic for SLE. It is characterized by the presence of ANA and it's identification establishes the presence of an autoimmune disease. High levels of anti-DNA are rarely seen with other diseases or conditions other than SLE. Anti-Smith seems to be found almost exclusively in SLE.

Front 48

Look at Nursing assessment (Table 65-16), CARE PLANS
and page 13 of powerpoint at mediations....


oh and there's more... some table .
Pat1668 teaching
page 65-17

Back 48

what fun! ... : /

Front 49

Some Nursing Dx r/t SLE:
◦ Fatigue
◦ Acute pain
◦ Impaired skin integrity
◦ Deficient knowledge
Planning involves...
◦ Satisfactory relief of ___
◦ Adhere with therapeutic regimen
◦ Demonstrate awareness and avoid activities that cause disease _______
◦ Maintain optimal role function and positive self-image

Back 49

Planning for SLE involves...
◦ Satisfactory relief of pain
◦ Adhere with therapeutic regimen
◦ Demonstrate awareness and avoid activities that cause disease exacerbation
◦ Maintain optimal role function and positive self-image

The key is decreasing amt of exacerbations, decreases inflammation, which decreases damage to organs and tissues

Front 50

For the tx of SLE,
Record severity of Sx and response to Tx
Observe for: ___ pattern, joint _____, limitation of ____, location & degree of discomfort, fatigue
Monitor weight, I&O
Collect 24 hr, urine sample Assess neurological status Explain nature of disease
Provide support
Counsel pt. & family that SLE has good/poor prognosis.
Physical aspects could lead to isolation, self-esteem, and body image disturbances
Counsel women with SLE about...

Back 50

For the tx of SLE,
Record severity of Sx and response to Tx
Observe for: fever pattern, joint inflammation, limitation of movement, location & degree of discomfort, fatigue
Monitor weight, I&O
Collect 24 hr, urine sample Assess neurological status Explain nature of disease
Provide support
Counsel pt. & family that SLE has good prognosis.
Physical aspects could lead to isolation, self-esteem, and body image disturbances
Counsel women with SLE about avoidance of pregnancy.

Front 51

Systemic sclerosis is a disorder of _____ tissue characterized by ____, _____ changes.
There can be _____ cutaneous systemic sclerosis or ____ cutaneous systemic sclerosis (SSc)

The cause of SS remains unknown. Immunologic dysfunction and vascular abnormalities are thought to play a role. What are some risk factors for its development?
It involves the protein that gives normal skin its strength and elasticity, ____, is over/under produced.

Back 51

Systemic sclerosis is a disorder of connective tissue characterized by fibrotic, degenerative changes
There can be limited cutaneous systemic sclerosis or diffuse cutaneous systemic sclerosis (SSc)

Risk factors: environmental exposure to coal, plastics, and silica dust.

It involves the protein that gives normal skin its strength and elasticity, collagen, is overproduced.

Front 52

The limited systemic sclerosis primarily manifests just in the ___, organ fibrosis is usually limited, and progression is slower/faster than the diffuse type.
The diffuse kind involves skin and organs, has a higher/lower mortality rate, and progresses faster/slower. The main organs effected include what 3?

Back 52

The limited systemic sclerosis primarily manifests just in the skin, organ fibrosis is usually limited, and progression is slower than the diffuse type.
The diffuse kind involves skin and organs, has a higher mortality rate, and progresses faster. The main organs effected include the heart, lungs, and kidneys most affected due to fibrosis of these organs

Front 53

Sudden puffy fingers is an early sign of...

Back 53

systemic sclerosis

Front 54

The manifestations of Systemic Sclerosis include what 5?

Back 54

◦ Calcinosis
◦ Raynaud’s phenomenon
◦ Esophageal dysfunction
◦ Sclerodactyly
◦ Telangiectasia

(especially presents with raynauds, these are the 5 warning signs)

Front 55

describe sclerodactyly

Back 55

fatty fingers, hard to move, stiffening CT is
hardening

Front 56

Describe Calcinosis

Back 56

painful deposits of calcium in the skin

Front 57

Describe Telangiectasia

Back 57

red spots on the hands, forearms, palms, face, and lips

Front 58

Esophageal symptoms include...

Speaking may be impaired due to...

Back 58

difficulty swallowing, GERD (fibrotic
esophogus- internal scarring)
also difficulty speaking due to collagen becoming non functioning in face etc.

Front 59

True or False: If a patient complains of more than one of the 5 "CREST" signs of systemic sclerosis then there's a high likelihood they have it.

Back 59

true

Front 60

Incidence of systemic sclerosis is highest in what race?

True or False: there's a familial tendency to getting systemic sclerosis

Back 60

African American

true

Front 61

Early recognition of ___ involvement and initiation of therapy is critical in the management of systemic sclerosis.

Back 61

renal

Front 62

Patients with systemic sclerosis may develop secondary Sjorgen's syndrome, a syndrome associated with dry eyes and dry mouth. What are some problems this can cause?

Back 62

dysphagia
gum disease
cavities

Front 63

If GERD is a problem for people with esophageal fibrosis due to SS, what patient may end up increasing/decreasing their food intake and losing/gaining weight. Reduced ____ joint function may occur as an early symptom of poly____.

Back 63

If GERD is a problem for people with esophageal fibrosis due to SS, what patient may end up decreasing their food intake and losing weight.

Reduced peripheral joint function may occur as an early symptom of polyarthritis.

Front 64

Patients with SS may develop pleurlal thickening, pulmonary fibrosis, and pulmonary function abnormalities. They may experience symptoms like ____ and ___. Pulmonary artery _____ is common. Primary heart disease consists of pericarditis, pericardial effusion, and cardiac dysrhythmias. Myocardial ____ resulting in heart failure most frequently occurs in patients with diffuse SS.

Back 64

Patients with SS may develop pleurlal thickening, pulmonary fibrosis, and pulmonary function abnormalities. They may experience symptoms like cough and dyspnea. Pulmonary artery HTN is common. Primary heart disease consists of pericarditis, pericardial effusion, and cardiac dysrhythmias. Myocardial fibrosis resulting in heart failure most frequently occurs in patients with diffuse SS.

Front 65

Diagnostic studies for SS include:
scleroderma antibody SCL-70,
___ factor, anitcentormere antibody, u____
◦ X-rays, _____ motility studies, ____ function tests

Back 65

Diagnostic studies for SS include:
scleroderma antibody SCL-70,
RF factor, anitcentormere antibody, urinalysis
◦ X-rays, esophageal motility studies, pulmonary function tests

(lookin for complications too)

Front 66

Some meds used in treatment of SS include...
Calcium channel blockers
ACE inhibitors
reserpine (Serpasil)
tracleer (Bosentan)
epoprostenol (Flolan)
CCBs
also Immunosuppressive drugs
Capsaicin cream- vasodilates and helps with pain
Drugs to treat GERD, pain and other symptoms may be prescribed too.
Why are we using all these heart type meds?

Back 66

vasodilate to improve blood flow (i.e. Raynauds)
may assist in preventing and treating digital ulcers
improve exercise capacity
control/prevent heart & lung problems.

Front 67

Nursing management for treating SS includes...
Physical & Occupational Therapy
Assessment for specific Sx and Tx accordingly
Encourage mouth _____s, keep fingers m___ing, heat- helps vasodilate, avoid ___.
Don't do finger____
Avoid smoking because it v_____
Skin care- lotions need to be rubbed in a lot for _____
nutrition- difficulty swallowing, lots of ___foods small freq. meals
HOB up/down to help with GERD
Prevent skin _____ & promote vascularization
Skin care
Nutrition
Role function
pt may experience social isolation due to....
Sexual dysfunctions could include vaginal ____ and e___ d____
Psychological support

Back 67

Nursing management for treating SS includes...
Physical & Occupational Therapy
Assessment for specific Sx and Tx accordingly
Encourage mouth exercises, keep fingers moving, heat- helps vasodilate, avoid cold.
Don't do fingersticks.
Avoid smoking because it vasoconstricts.
Skin care- lotions need to be rubbed in a lot for absorption.
Nutrition- difficulty swallowing, lots of soft foods small freq. meals
HOB up to help with GERD
Prevent skin retraction & promote vascularization

Role function
pt may experience social isolation due to difficulties with speech and facial expression.
Sexual dysfunctions could include vaginal dryness and erectile dysfunction.
Psychological support

Front 68

Myofascial Pain Syndrome is a chronic/acute form of ____ pain. Is it regional or generalized? It typically involves pain and tenderness in the chest, neck, shoulders, hips, and lower back. It is characterized by deep aching accompanied by sensation of burning, stinging, stiffness. The pain has been shown to originate in anterior and posterior ____ points resulting from muscle trauma or chronically strained muscles such as during desk or computer work. When activated by ____, trigger points are thought to activate a characteristic pattern of pain that can be made worse with ____ or stress. Diagnosis is made by palpating trigger points, which reveals induration and frequently a muscle ___ in the area of trigger point, and the patient feels local pain that may also be ____. Is it curative? What is the treatment?
What are some teaching points?

Back 68

Myofascial Pain Syndrome is a chronic form of muscle pain. It is regional. It typically involves pain and tenderness in the chest, neck, shoulders, hips, and lower back. It is characterized by deep aching accompanied by sensation of burning, stinging, stiffness. The pain has been shown to originate in anterior and posterior trigger points resulting from muscle trauma or chronically strained muscles such as during desk or computer work. When activated by pressure, trigger points are thought to activate a characteristic pattern of pain that can be made worse with activity or stress. Diagnosis is made by palpating trigger points, which reveals induration and frequently a muscle twitch in the area of trigger point, and the patient feels local pain that may also be referred. It is curative. Treatment involves
physical therapy
“spray & stretch” (painful area iced or sprayed with a coolant such as ethyl chloride and then stretched)
Injections of lidocaine or other local anesthetic
topical patches
Massage
Acupuncture
Biofeedback
Teaching: prevent muscle tension in work and leisure activities. Review good posture and resting/sleeping positions. Most patients can lead a normal and active lifestyle.
ultrasound

Front 69

Fibromyalgia (FMS) is a chronic disorder characterized by widespread/local, articular/nonarticular musculoskeletal ____ and ___ with multiple tender ___. The patient may experience non____ sleep which leads to fatigue, morning _____, irritable ___ syndrome, and anxiety. Pain worsens and improves throughout the day. Does the patient report the pain as muscular, joints, or soft tissues? Head or facial pain often result from stiff or painful shoulder muscles and may be accompanied by ___. Physical exam characteristically reveals point tenderness at __ or more of 18 identified sites and diagnosis is made if this accompanies a history of widespread pain noted for at least _ months. Cognitive effects can include difficulty concentrating, memory lapses, and feeling overwhelmed with multiple tasks. Many have migraine headaches. Depression and anxiety often occur. ____ or numbness and tingling of hands or feet often accompanies FMS. Patient may experience dys___ or difficulty swallowing, IBS, and ____ of urination & urinary urgency. Treatment includes rest, medications, massage, heat & cold applications, stretching, psychological counseling, Low impact exercise, dietary changes with a limitation placed on intake of sugar, caffeine, and alcohol because they have been shown as ___ ____. Is the response to local therapy curative or non sustained?

Back 69

Fibromyalgia is a chronic disorder characterized by widespread, nonarticular musculoskeletal pain and fatigue with multiple tender joints. The patient may experience nonrestorative sleep which leads to fatigue, morning stiffness, and irritable bowel syndrome. Pain worsens and improves throughout the day. The patient has difficulty discriminating the pain as originating from muscular, joint, or soft tissues. Head or facial pain often result from stiff or painful shoulder muscles and may be accompanied by TMJ, Physical exam characteristically reveals point tenderness at 11 or more of 18 identified sites and diagnosis is made if this accompanies a history of widespread pain noted for at least 3 months. Cognitive effects can include difficulty concentrating, memory lapses, and feeling overwhelmed with multiple tasks. Many have migraine headaches. Depression and anxiety often occur. Paresthesias or numbness and tingling of hands or feet often accompanies FMS. Patient may experience dysphagia or difficulty swallowing and frequency of urination & urinary urgency. Treatment includes rest, medications, massage, heat & cold applications, stretching, psychological counseling, Low impact exercise, dietary changes with a limitation placed on intake of sugar, caffeine, and alcohol because they have been shown as muscle irritants.

Front 70

Chronic Fatigue Syndrome is characterized by debilitating fatigue and a variety of associated complaints
mmune abnormalities may play a role in its development.
CFS and FMS share common features. CFS develops insidiously in approximately ½ the cases or patients may have intermittent. ____ criteria for CFS involves unexplained persistent or relapsing chronic fatigue or new and definite onset (not lifelong) not due to ongoing exertion, not substantially alleviated by rest, results in substantial reduction in quality of life and function. ___ criteria includes impaired memory or concentration, frequent or recurring sore throat, tender lymph nodes, muscle pain, multijoint pain without joint swelling or redness, headaches of new type, pattern, or severity, nonrestorative sleep, postexertional malaise.
episodes that gradually become chronic. It is diagnosed by _____. Management involves medications for associated conditions.
___ rest not recommended because it can potentiate the self-image of being an invalid, while strenuous exertion can make things worse. A well balanced diet is recommended with lots of fiber a dark-colored fruits and vegetables for their antioxidant properties. Behavioral therapy involves promoting a positive outlook, improving overall disability, faitgue, and other symptoms. Financial issues is major. Is CSF progressive? Recovery is more likely when?

Back 70

Chronic Fatigue Syndrome is characterized by debilitating fatigue and a variety of associated complaints
Immune abnormalities may play a role in its development.
CFS and FMS share common features. CFS develops insidiously in approximately ½ the cases or patients may have intermittent. Major criteria for CFS involves unexplained persistent or relapsing chronic fatigue or new and definite onset (not lifelong) not due to ongoing exertion, not substantially alleviated by rest, results in substantial reduction in quality of life and function. Minor criteria includes impaired memory or concentration, frequent or recurring sore throat, tender lymph nodes, muscle pain, multijoint pain without joint swelling or redness, headaches of new type, pattern, or severity, nonrestorative sleep, postexertional malaise.
episodes that gradually become chronic. It is diagnosed by exclusion. Management involves medications for associated conditions.
Total rest not recommended because it can potentiate the self-image of being an invalid, while strenuous exertion can make things worse. A well balanced diet is recommended with lots of fiber a dark-colored fruits and vegetables for their antioxidant properties. Behavioral therapy involves promoting a positive outlook, improving overall disability, fatigue, and other symptoms. Financial issues is major. CSF does not appear to be progressive. Some patients show gradual improvement, some don't show significant improvement. Recovery is more likely in individuals with a sudden onset of CFS. Patients with CFS may experience substantial occupational or psychosocial impairments and loss, including social pressure and isolation from being characterized as lazy or "crazy."