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Fibromyalgia - ANS- chronic condition with widespread aching and pain in the muscles and fibrous soft tissue; pain to normally not painful stimulus Fibromyalgia cause - ANS- unknown; affects 10 million Americans; Children and adolescents have juvenile primary fibromyalgia syndrome Fibro Risk Factors - ANS- family history; Psychiatric disorder (ADHD / depression); Medical disorder (IBS, RA), Genetics, Infections, trauma, vaccinations, chemical substances Fibro Criteria for diagnosis - ANS- Widespread pain - above & below waist, On both sides of body, 11 out of 18 trigger points; deep/gnawing/stabbing/burning, not the result of inflammation or trauma, chronic for 3 months or more Fibro Priority Nursing - ANS- Behavioral, cognitive affects, pain, fatigue, enhanced sensitivity to heat/cold, mood disorders Fibro Priority Diagnostics - ANS- CBC, ANA, Muscle biopsy Fibro common meds - ANS- NSAIDS, GABA analog (pregabalin); Duloxetine (mood), Zolpidem (sleep), Tricyclic antidepressants Fibro interventions - ANS- stay active/exercise; hydration; nutrition; sleep hygiene; pain management; melatonin, essential oils (Lavender), Acupuncture, Balance issues, strength training, yoga Diabetic meds and fibro - ANS- some will increase fluid retention Multiple Sclerosis (MS) - ANS- an immune-mediated disorder of the CNS in which immune cells attack the myelin sheath around nerve cells, causing decreased transmission of nervous signals; axon damage is NOT reversible MS Patho - ANS- demyelination resulting from autoimmune activation of T lymphocytes & macrophages crossing blood-brain barrier and destroying myelin sheath, axons, and oligodendrocytes in an immunologic cascade through release lymphokines and cytokines; repeated attacks cause scar tissue, plaque, causing permanent damage; brain, spinal cord, optic nerve MS Life/Cultural Consideration - ANS- Primarily norther European ancestry/Northern climates; women of childbearing age; 2-5% experience symptoms before 18 (seizures, mental status change, progresses slowly); thought to have a link to Low Vit D; Mono seems to trigger MS classifications - ANS- relapsing remitting (episode followed by recovery); primary progressive (deterioration from beginning); secondary progressive (combo of above 2); progressive relapsing (constant moving forward s/ periods of exacerbation); fatigue effects all clients MS symptoms - ANS- visual disturbances, weakness, loss of muscular control, speech disturbances, incontinence MS concepts - ANS- Sensory, comfort, stress/coping, elimination MS Diagnostics - ANS- MRI (see plaque); Lumbar puncture (CSF may have high WBC or protein); Evoked potentials ( by stimuli, EEG), Blood tests (r/o other conditions) MS common medications - ANS- Dexamethasone Methylprednisolone, Antidepressants, DMARDS Betaferon (decrease progression), Baclofen/Muscle relaxant (help w/muscle spasticity); Immunosuppressant/ Monoclonal antibody/Natalizaumab ( decrease nerve damage MS associated symptoms meds for - ANS- acute exacerbations of; fatigue; spasticity; constipation; pain; ED; depression; urinary stasis; bladder dysfunction; tremors; walking/mobility MS diet - ANS- Well balanced, Mediterranean, Omega 3 and antioxidants, Vit. D; avoid refined carbs/fatty foods; Maybe encourage Gluten Free (grain effects some people) MS priority interventions - ANS- mobility/balance; encourage activity, but avoid over exertion; avoid heat/hot baths; avoid spicy foods; stabilize emotions; reduce stress MS common complications - ANS- UTI, constipation, pneumonia MS collaborative care - ANS- Dietician; PT, OT, Speech, respiratory MS Nursing - ANS- S&Sx of infection; medications; pregnancy precautions (can be but is high risk); keep diary of symptoms; safety, self catherization Rheumatoid arthritis (RA) - ANS- chronic systemic autoimmune disorder causing inflammation of connective tissue primarily in the joints RA Patho - ANS- body develops immunoglobin M against its own IgG (rheumatoid factor). RF generates inflammation, tissue damage, and an autoimmune response; less blood goes to joints RA overview - ANS- imflammation results in synovial & connective tissue w/cartilage damage (primarily in joints, variable); has exacerbations and remissions RA etiology - ANS- combination of genetic, environmental, hormonal, reproductive factors, infectious agents; women 3x more than men; onset childbearing years; remission most likely first year of disease (if they will have one)
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