Question

Case Study, Chapter 39, Assessment and Management of Patients With Rheumatic Disorders 1. Ellie Long, a 55-year-old patient, presents to the pain clinic with the diagnosis of fibromyalgia syndrome. The nurse at the clinic obtains a history and physical assessment of the patient. (Learning Objective 2) On what areas should the nurse concentrate when interviewing the patient during the history process? a. b. On what areas should the nurse concentrate when assessing the patient? c. What diagnostic tests are used with fibromyalgia syndrome? 2. Julie Walker, a 22-year-old patient, is newly diagnosed with systemic lupus erythematosus (SLE). She presented with extreme fatigue; muscle and joint aching and swelling; a butterfly-shaped, flat, red rash across the bridge of the nose; patchy alopecia; a low-grade fever; and loss of appetite. Further workup revealed a positive antinuclear antibodies (ANA) titer, anemia, leucopenia, and mild thrombocytopenia. She has an abnormal lipid profile, proteinuria, and hypertension. The liver and renal profiles are within normal range. The physician ordered over-the-counter ibuprofen as needed for joint discomfort, but not to exceed 1,200 mg/day; hydroxychloroquine sulfate (Plaquenil) before meals at the same time each day; and prednisone in tapering doses over the next month. The physician also started the patient on lisinopril, an ACE inhibitor for the hypertension and a statin for the elevated lipids. The clinic nurse is asked by the physician to provide patient and family education. (Learning Objective 5) a. What teaching-plan topics should the nurse provide for the patient?

Answer 1

1. a) Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. The nurse should concentrate on the following while taking an assessment. They are a) gender ( usually females are more commonly affected by this diseases) b) any other painful diseases like arthritis or an infection c) mood disorder like anxiety or depression d) Any occurrence of Posttraumatic stress disorder (PTSD) e) lack of exercises and f) family history of the same.

b) The nurse should concentrate on the symptoms because it is very similar to osteoarthritis, brusitis and tendinitis. The common symptoms are a) muscle pain, burning, twitching or tightness b) low pain threshold or tender pains c) drainage fatigue d) fibro fog ( trouble in concentrating and remembering) d) insomnia and e) nervousness, worried or depressed. Secondly, the nurse should concentrate on what leads to this disease in Ellie Long. Apart from these, the nurse should assess the pain score of the patient.The location of pain should also be assessed by the nurse to diagnose the disease.

c) There is no diagnostic plan for this disease. As it is so similar to other conditions like underactive thyroid, different types of arthritis and lupus, more commonly blood tests are done to check the hormone levels. X-rays are also taken in view to signs of inflammation. The ACR 1990 ( American College of Rheumatology) define fibromyalgia according to the presence of the following criteria. They are a) A history of widespread pain lasting more than 3 months, affecting all 4 quadrants of the body ( both sides, and above and below the waist) b) Tender points pains on the body. Based on these conclusions, appropriate treatment given to the patient.

2. Systemic lupus erythematosus is a chronic autoimmune disorder that affects every system in the body. The teaching plan is to be able to monitor the affected client in order to arrest or treat an exacerbation prior to complications developing that may cause morbidity. a) Educate the family members on how to assess the client's psychological status on a daily basis in the home b) Diet plan should be strictly followed as per the dietician advice because of the chances of might experiencing coronary artery diseases. Such findings should be reported. The client is also instructed to notify early signs of endocarditis by inspecting palms and soles of her hands and feets c) As corticosteroids are used fro treatments, the client should be aware of potential complications like infection and diabetes. d) urinalysis should be asked to perform regularly in view to reduce the risk of renal diseases. As it is the most common cause of death in SLE patients. e) Self-awareness should be maintained to avoid neuropsychiatric symptoms. The nurse should ask the client to monitor and record the mood changes in view to observe changes in the behavior f) Advice the client to have positive attitude through the course of this illness and encourage to exercise regualrly to reduce the symptoms. f) The client should instruct to wear sunscreen and to cover herself with a hat when out in the sun. Also instructed to take supplemental vitamin D due to lack of sun exposure.