Case Study Two days before April Daves
Case Study Two days before April Daves is scheduled to return to her orthopedic physician, she is awakened by severe pain. Because she is unable to get out of bed, Ms. Daves calls 911. She is transferred to the hospital by ambulance. As her emergency department (ED) nurse, you assess Ms.Daves. Her only complaint is pain, which she rates at a 9 on a scale of 0 to 10. Ms. Daves reports she has been taking NSAIDS as prescribed. Her heart rate, respiratory rate, and blood pressure are all slightly elevated. Ms. Daves further reports that the pain has prevented her from sleeping more than 3-4 hours each night. Aside from motor vehicle crush, Ms.Daves has no history of illness or trauma. You report your findings to the ED physician. After reviewing Ms. Dave’s medical history and performing a physical assessment, the physician orders a complete blood count (CBC) and a urinalysis, the result of which are normal. He also obtains the results of Ms. Daves’s CT scans, which are normal. The ED physician suspects that Ms. Daves may have fibromyalgia. Using the 2010 fibromyalgia criteria, the ED physician determines that Ms. Dave’s widespread pain index is 8 and her symptom severity scale score is 9. The physician diagnoses Ms.Daves with fibromyalgia and prescribes milnacipran (Savella). He instructs her to visit her primary care physician for follow up as soon as possible. What causes fibromyalgia? For the client with fibromyalgia, what findings would you expect to be revealed by the CBC and urinalysis? With reference to her diagnosis and based on your knowledge of Ms. Dave’s clinical signs and symptoms, what somatic symptom is likely to be experiencing? What is the primary symptom of fibromyalgia? Why did the ED physician order diagnostic tests? During a home visit to Ms.Daves, she is concerned about being constantly tired. Which response should the nurse make to Ms.Daves?
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