Complex 1c Pt2
Nonpharmacological Interventions
Nurses become highly experienced with medications but must not overlook nonpharmacological interventions.
Nonpharmacological interventions can be more important or enhance medication effectiveness.
They may allow patients to reduce medication dosages, which is generally desirable.
The goal is to use the smallest amount of medication necessary to help patients achieve their goals, maintain their level of functioning, perform activities of daily living (ADLs), ensure mobility, and provide general comfort.
General Comfort Measures
Address basic needs:
Is the room temperature appropriate?
Is the patient clean and dry?
Is their skin moisturized?
Are they repositioned frequently?
Are they getting enough quality sleep?
Activity
Activity, including exercise, stretching, and yoga, can help with chronic pain management.
It can be challenging to convince patients to increase activity when they are in pain.
Finding the right balance of exercise and movement is crucial to avoid worsening pain. Massage can be helpful. It may be beneficial to start with massage and stretching before progressing to more intense activities like yoga.
Consistency is key; even small, regular activities can add up to significant benefits.
Aromatherapy and Acupuncture
Aromatherapy and acupuncture are scientifically proven to help with pain.
Distraction Techniques
Distraction techniques such as watching TV, movies, looking at stars, or meditating can be helpful.
Meditation can be a beneficial addition to medication regimens.
Psychotherapy and Support Groups
Psychotherapy, particularly cognitive behavioral therapy (CBT), and support groups are incredibly helpful.
Some patients may be hesitant to participate in therapy if they perceive it as implying their pain is due to mental weakness or illness.
Example: A person with fibromyalgia has a comprehensive treatment plan that includes:
A thousand-dollar-per-month app featuring meditation, distraction, and daily self-assessment tools.
Immediate access to a therapist during crises.
Support groups with other young adults who have fibromyalgia.
This helps address developmental stage challenges and fears.
Preventing Isolation and Seeking Support
Preventing isolating behaviors and seeking support from loved ones is crucial.
Friends and family may struggle to understand or know how to help, but compassion and flexibility are essential.
Support can take many forms:
Listening and talking.
Engaging in activities together.
Providing practical assistance like driving to appointments or picking up medications.
Any amount of support improves psychological well-being and aids pain management.
Self-isolation can be emotionally dangerous and may lead to a mental health crisis.
Physical and Occupational Therapy
Physical therapy and occupational therapy can be very helpful.
Transcutaneous electrical nerve stimulation (TENS) units and dry needling can be effective for some individuals.
Advanced tools and techniques in physical and occupational therapy can also aid in pain management.
Dietary Approaches
Dietary approaches, including supplements and low-inflammatory diets, can help manage inflammation and promote healing.
Supplements like ginger, turmeric, and probiotics may be beneficial.
Low-inflammatory diets, such as gluten-free or casein-free diets, may reduce inflammation in some individuals.
Gluten, found in bread, and casein, found in dairy, can be pro-inflammatory for some people.
High-sugar diets can also cause inflammation.
It requires effort to identify foods that trigger or alleviate symptoms.
Example: A person with fibromyalgia found that eliminating gluten significantly increased their daily step count and improved their overall well-being.
Fibromyalgia
Fibromyalgia is a complex condition with many unknowns.
Symptoms include chronic fatigue, generalized muscle aching and stiffness, sleep disturbances, and functional impairment.
Patients may experience daily symptoms with occasional flare-ups.
Pain often starts in the head, neck, and shoulder area.
A key characteristic is disproportionate pain from light touch.
Pressure points (tender points) were previously used for diagnosis but are no longer required, although they can indicate fibromyalgia.
Pathology and Risk Factors
The pathology of fibromyalgia is not completely understood.
Risk factors include trauma, high stress, and being assigned female at birth.
Fibromyalgia involves an amplification of pain pathways.
The location of the pain can vary throughout the body.
The cause is idiopathic or unknown.
People assigned female at birth are twice as likely to experience fibromyalgia.
Comorbidities such as depression, anxiety disorders, and irritable bowel syndrome increase the likelihood of developing fibromyalgia.
Practitioners should avoid dismissing a patient's pain as solely due to anxiety or depression.
The highest-risk group is women around 40 with other chronic conditions.
Stressful triggers, such as car accidents, can contribute to the onset of fibromyalgia.
Repeated infections or invasive procedures can cause an abnormal immune response.
Other health conditions, like osteoarthritis, are also associated with fibromyalgia.
Diagnosis and Comorbidities
There is no specific diagnostic test for fibromyalgia.
Diagnosis usually occurs after ruling out other conditions.
Patients may remain undiagnosed for many years.
Common comorbidities include other autoimmune diseases (rheumatoid arthritis, lupus, ankylosing spondylitis), anxiety, depression, and sleep problems.
Treatments
Treatments include nonsteroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants, SNRIs, SSRIs, and muscle relaxers.
Anticonvulsants can help with adjunctive pain control by slowing down neuron firing.
Finding the right dose is crucial to balance pain relief with manageable side effects such as drowsiness, weight gain, and constipation.
Cognitive behavioral therapy, daily exercise, yoga, and acupuncture are helpful.
Emotional support is essential due to the invisible nature of the pain.
Activity and Balance
Balancing rest and exercise is a challenge.
Start with gentle activities, such as a three-minute walk, and gradually increase the duration.
Balance therapy, support groups, yoga, acupuncture, and exercise to potentially reduce the need for pharmacologic therapy.
Chronic Fatigue Syndrome (Myalgic Encephalomyelitis)
Chronic fatigue syndrome is the generic term; the actual term is myalgic encephalomyelitis.
There is no known cause or cure.
Myalgic encephalomyelitis is far more debilitating than typical fatigue.
Patients may have difficulty getting out of bed or lifting their head.
It can occur after infections like mononucleosis.
It can be completely debilitating, sometimes requiring patients to drop out of school or work.
Skin
Skin is the largest organ in the body.
It often shows the first signs of internal issues.
It aids in temperature management and prevents infection.
Skin pH
Skin has an acidic pH, ideally around 4.5.
Skin prefers acid and does not like base.
Facial products often contain alpha hydroxy acids.
Water and non-acidic soaps can be harmful to the skin.
Base can cause more skin damage than acid.
Lotions and emollients protect and heal the skin by:
Acting as a barrier against water.
Retaining moisture.
Subcutaneous tissue contributes to skin firmness, which decreases with age.
Corticosteroids have protective and healing properties but have side effects with long-term use.
Eczema
Often presents in infancy and children, and coincides with allergies and asthma.
Appears as dry, itchy, plaques and swollen skin. Bleeding may occur when picked.
An allergic/autoimmune response.
Treatment:
Steroid creams/ointments.
Hydrocortisone.
Calamine lotion for itchiness.
Moisturizers (Eucerin, Aquaphor, Vaseline) to add moisture and protect from water exposure.
Avoid bathing children with severe eczema every day.
Identify and remove irritants:
Detergents.
Soaps (use dye-free and scent-free varieties).
Extreme cases may need DMARCs (methotrexate) or biologics.
Eczema is usually itchier than psoriasis and is poorly demarcated.
Unlike cellulitis, eczema lacks the significant edema and swelling indicative of infection.
Deep Tissue Injury
Causes the same causes as any other pressure injury:
Shearing.
Immobility.
Decreased sensation.
Poor nutrition.
Risk factors:
Surgery (due to changes in blood pressure).
Anticoagulant use.
Identification:
Bruise-like with purple center and red ring.
Treatment:
*Turning every two hours.
*Applying no additional pressure to site.
*Foam dressing to reduce chances of friction.Natural progressions of Deep Tissue Injury:
Starts as a bruise but may turn into a blood blister.
Protect from moisture and protect from new friction/shear injury, and protect it from new pressure while it is blistered.
Avoid opening it up; a prime risk to infection.
Late stage Deep Tissue Injury:
Eschar development: necrotic/dead, black, leathery tissue.
Stable eschar should be kept dry.
Do NOT add moisture such as a hydrocolloid dressing.
Use betadine to keep dry and prevent spread.
Psoriasis
Raised, red plaques with very well demarcated silver scales.
Characterized:
Red
Raised
Flat
Demarcated well
Silverlike Scale
Causes: Autoimmune disease, cytokine production, overproduction of keratin.
Triggers: Stress, Genetics, Season, Hormones, Medication, Skin trauma.
Can cause psoriatic arthritis.
Located: Hairline, Ears, Eyes
Treatments:
Topical/systemic steroids.
Ultraviolet light / Phototherapy - decreases inflammation and slows cell growth of that area.
Chemotherapy (DMARC).
Immune system.
Coal tar ointment - Cooling effect and decreases the itching/inflammation.