03.08 Fibromyalgia

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Overview

  1. Fibromyalgia
    1. Widepread pain
    2. Exact cause unknown

Nursing Points

General

  1. Stressors
    1. Trauma (physical or emotional)
    2. Autoimmune disorders
      1. Lupus
      2. Rheumatoid arthritis
  2. Affects autonomic nervous system
    1. Veins decreased ability to constrict -> low blood pressure and heart rate more common
  3. Affects neuroendocrine system
    1. Unable to suppress cortisol
    2. Nerve stimulation increased
    3. Brain pain receptors sensitive ->overreact to pain signals
  4. No test to confirm
  5. Genetic influences
  6. Mostly in women

Assessment

  1. Presentation (at least three months)
    1. Widespread pain
      1. Above and below waist
      2. Muscles
      3. Tendons
      4. Joints
    2. Restless sleep ->fatigue
    3. Memory issues
    4. Low blood pressure
    5. Low heart rate
    6. Depression and anxiety

Therapeutic Management

  1. Calm environment
  2. Therapeutic listening
  3.  Medication
    1. Pregabalin
      1. Long term
      2. Calm overactive nerves
    2. Pain relievers (short term)
    3. Antidepressents
    4. Anti-anxiety
    5. Sleep medications

Nursing Concepts

  1. Comfort
    1. Widespread pain
  2. Coping
    1. Widespread pain and fatigue cause psychological stress
  3. Functional Ability
    1. Pain, depression, anxiety affect ADLs

Patient Education

  1. Manage Stress
  2. See psychological therapist
  3. Prioritize sleep
  4. Excercise

Reference Links

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Video Transcript

Hey guys! Welcome to the lesson on fibromyalgia. 

So fibromyalgia causes widespread pain in the patient. The exact cause of fibromyalgia is unknown, but it is thought to start from a stressor like physical or psychological  trauma, or autoimmune disorders like lupus or rheumatoid arthritis. Let’s explore how fibromyalgia affects the body. 

So fibromyalgia affects the body in a few different ways. The autonomic nervous system is affected making it more difficult for veins to constrict causing  low blood pressure and low heart rates in these patients. The neuroendocrine system is affected making it more difficult for the body to suppress cortisol. Think of cortisol as a stress hormone that is released during stressful situations making the body overly sensitive. Nerve stimulation is increased and brain pain receptors are overly sensitive causing the body to overreact to pain signals. 

Fibromyalgia affects mostly women for unknown reasons. There is no test to confirm this disease, so instead it is a matter of ruling out other disease processes. There is thought to be genetic influences on people that get fibromyalgia. Let’s move on the the patient presentation.

So people with fibromyalgia have widespread pain in the locations of these red dots in this picture in the muscles, tendons and joints. These patients have a difficult time sleeping because of the constant pain, causing them to be tired. The lack of sleep, constant pain, and neurological effects cause memory issues. The lack of vasoconstriction cause low blood pressure and low heart rate. Guys, having this pain all the time and the lack of sleep is really emotionally exhausting for these patients, so they often have depression and anxiety. I have noticed that these patients are so much more sensitive to painful stimuli, like putting in an IV is a lot more painful for them. It is helpful to acknowledge that they have pain, let them know you understand and are here for them. Now let’s talk about how to help them manage this disease. 

Guys, these patients have overstimulated nerves, so it’s helpful to provide a calm relaxed environment for them to decrease the anxiety and stress. Just be there for them and listen to their concerns, validate the way they feel as it is a disease that they don’t have much control over. The doctor may order medications such as pain relievers, antidepressants, anti-anxiety, or sleep medications. You will often see pregabalin ordered long term for these patients as it helps to calm the overactive nerves. Let’s move on to patient education. 

We should discuss stress management with this patient to help the explore ways to decrease stress in their life that may worsen the fibromyalgia symptoms. Psychological therapists may help with the depression and anxiety that these patients experience. Let these patients know how important it is to prioritize sleep and take the time to exercise to help manage the psychological distress from the overactive nerves. 

Our priority nursing concepts for the patient with fibromyalgia are comfort, coping, and functional ability. 

Alright guys, let’s go over the key points. So the patient with fibromyalgia has widespread pain, and it is unknown what the exact cause is. There aren’t any tests to confirm this disease, but it is often related to autoimmune diseases like lupus and rheumatoid arthritis. Fibromyalgia affects the autonomic nervous system causing impaired vasoconstriction, and the neuroendocrine system causing increased cortisol in the body increasing pain. The patient will present with widespread pain throughout the body. They might have low blood pressure and heart rate from the decreased vasoconstriction. Depression and anxiety are common in these patients along with fatigue and memory loss. We should help these patients manage the disease by reducing stressors, and administering medications ordered by the doctor. Pregabalin is prescribed long term to help decrease nerve stimulation. Other pain meds may be provided short term. Depression and anxiety medications may be needed along with sleep aids. Educate your patient on the importance of managing their stress,  keeping up with exercise, and prioritizing sleep to manage the depression and anxiety that go along with the widespread pain. They may need encouragement to follow up with a psychological therapist as well.  

Well, I hope you have a good understanding on fibromyalgia! Now go out and be your best self today, and as always, happy nursing!

 

Read more

  • Question 1 of 6

A nurse is assessing a client with fibromyalgia and knows that which of the following is unlikely to be associated with the client’s history of fibromyalgia?

  • Question 2 of 6

The nurse is caring for a client with fibromyalgia and knows that which of the following can help manage this condition?

  • Question 3 of 6

The nurse is caring for a client with fibromyalgia and cellulitis. Which of the following can the nurse delegate to the nursing assistant?

  • Question 4 of 6

A client with fibromyalgia wants to incorporate massage into her weekly routine to better manage her condition. Which of the following is true of massage as a form of complementary therapy? Select all that apply.

  • Question 5 of 6

The nurse is caring for a client that has a history of fibromyalgia and lupus. The client complains of pain. The nurse knows that which of the following would be an inappropriate question to assess the client’s pain?

  • Question 6 of 6

A nurse is caring for a client with fibromyalgia and knows to encourage which of the following to help manage the fibromyalgia?