What is Fibromyalgia

  • fibromyalgia Is a syndrome characterized by fatigue, diffuse muscle pain and stiffness, sleep disturbance, and the presence of tender points on physical examination.
  • There is no unknown etiology, but theories have suggested a variety of possible pathophysiologic mechanisms, such as neural-hormonal disturbance, antecedent physical trauma, viral infection, immune dysregulation, psychiatric disturbances, and heightened sensitivity to pain.
  • Complications include disability and inability to maintain functional roles.

Assessment

  1. Fatigue, poor or nonrestorative sleep.
  2. Generalized muscle aches and stiffness
  3. Irritable bowel syndrome
  4. Tension headaches
  5. Paresthesias, sensation of swollen hands
  6. Presence of pain in 11 of 18 defined tender point sites
    • Anterior: low cervical, second rib, lateral epicondyle, knee.
    • Posterior: occiput, trapezius, supraspinatus, gluteal, greater trochanter.
  7. Complete history and physical examination to rule out other disorders.

Diagnostic Evaluation

  1. Complete blood count, blood chemistries, erythrocyte sedimentation rate, thyroid-stimulating hormone, and arthritis panel rule out other disorders.
  2. X-rays and imaging studies are all normal.

Therapeutic Interventions

  1. Cardiovascular fitness training
  2. Electromyogram biofeedback
  3. Cognitive behavioral therapy
  4. Hypnotherapy
  5. Electrical stimulation or acupuncture.

Pharmacologic Interventions

  1. Nonsteroidal anti-inflammatory drugs, acetaminophen or tramadol to relieve pain.
  2. Antidepressants to help control chronic pain and depression.
  3. Muscle relaxants, such as cyclobenzaprine, to relieve muscle tension and spasm.
  4. Sleep agents and antianxiety agents may be considered.

Nursing Interventions

  1. Monitor pain level and effectiveness of treatment plan.
  2. Assess functional ability.
  3. Encourage regular use of analgesics and antidepressants as directed.
  4. Encourage regular exercise routine, including stretching, aerobic activity, and muscle-strengthening exercises.
  5. Suggest referrals to physical therapist or pain specialists for additional pain control modalities as needed.
  6. Suggest regular night time ritual to promote sleep.
  7. Discourage staying up late and erratic sleep habits.
  8. Encourage relaxation periods or short nap during day as needed for fatigue.
  9. Advise limiting caffeine intake during day and especially after 4 p.m.
  10. Encourage patient to look at fibromyalgia as a chronic condition that can be controlled.
  11. Help patient plan schedule and pace activities to accomplish routine activities.

 

Nursing Care Plan – Fibromyalgia

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