Headache, Fever, And Musculoskeletal Injuries Flashcards
(78 cards)
1
Q
What are the 3 types of headaches?
A
Tension, sinus, migraine
2
Q
Frequency: Tension Headache
A
Episodic or chronic
3
Q
Frequency: Sinus Headache
A
Acute or chronic sinusitis
4
Q
Frequency: Migraine
A
Patient specific triggers
5
Q
Location: Tension Headache
A
Bilateral, over the top of the head, extending to the base of the skull
6
Q
Location: Sinus Headache
A
Face, forehead, or periorbital area
7
Q
Location: Migraine
A
Usually unilateral
8
Q
Characteristics: Tension Headache
A
Diffuse aching, tight, pressing, constriction pain
9
Q
Characteristics: Sinus Headache
A
Pressure behind the eyes or face, dull, bilateral pain, worse in the morning
10
Q
Characteristics: Migraine
A
Throbbing, may be preceded by aura
11
Q
Onset: Tension Headache
A
Gradual
12
Q
Onset: Sinus Headache
A
Associated with sinus symptoms
13
Q
Onset: Migraine
A
Sudden
14
Q
Duration: Tension Headache
A
Minutes to days
15
Q
Duration: Sinus Headache
A
Resolves with sinus symptoms
16
Q
Duration: Migraine
A
Hours to 2 days
17
Q
What other symptom(s) may someone experience with a tension headache?
A
Scalp tenderness
18
Q
What other symptom(s) may someone experience with a sinus headache?
A
Nasal congestion
19
Q
What other symptom(s) may someone experience with a migraine?
A
Photophobia, incapacity, nausea (PIN)
20
Q
Risk factors: Tension Headache
A
Stress
21
Q
Risk factors: Sinus Headache
A
Viral infection
22
Q
Risk factors: Migraine
A
Tiggers, female gender, family history
23
Q
What are possible migraine triggers?
A
Stress, fatigue, oversleeping, fasting/skipping meals, medications, caffeine, alcohol, changes in altitude/pressure, menstrual period
24
Q
Describe: Cluster Headache
A
Relatively uncommon (effects primarily men), severe, unilateral, and pulsating, typically lasts 30-180 minutes, “attacks”= once’s every other day + 8x/day with headache free periods for days-months. Autonomic symptoms on the same side of headache
25
What medications can cause headache?
Overuse (more than 2/weekly for 3 months+) of acetaminophen, aspirin, caffeine, triptans, opioids, butalbital, ergotamine. Can occur within hours of stopping agents so they should be tapered and eliminated
26
What are the exclusions for self-care for headache?
-severe pain (pain score >6)
-persistent headache > 10 days
-last trimester of pregnancy
-<8 years old
-high fever or signs of serious infection
-history of liver disease or consumption >2 drinks per day
-secondary headache, due to underlying disease
-migraine, but no formal migraine diagnosis
27
What are the treatment goals for self-care of headache?
-alleviate acute pain
-restore normal functioning
-prevent relapse
-minimize side effects
-reduce frequency
28
Non-pharmacological treatment: Tension Headaches
relaxation exercise, physical therapy
29
Non-pharmacological treatment: Migraines
maintain regular sleep/eat schedule, practice methods for stress relief, dietary restrictions, cold packs, avoid light
30
MOA: Acetaminophen (APAP)
produces analgesia through a central inhibition of prostaglandin synthesis
31
Indication: Acetaminophen (APAP)
relief of mild-moderate pain and fever
32
Pharmacokinetics/pharmacodynamics: Acetaminophen
-rapidly absorbed from the GI tract
-extensively metabolized in the liver
-onset of analgesic activity in 30 minutes
-duration of action= 4 hours
33
Dosing: Acetaminophen
-adults=
-> reg 325-650 mg q8h or 1000mh 3-4x/day
->ext 1300 q8h
MAX= 4000 mg/day or 2000mg/day in pt with liver disease
-pediatrics (<12 yo)
-> 10-15 mg/kg/dose every 4-6h
-> MAX= 5 doses in 24 hours
34
Adverse Effects: Acetaminophen
-hepatoxicity
-nephropathy
-blood dyscrasias
-anemia
35
Drug Interactions: Acetaminophen
-alcohol
-warfarin
36
Patient Counseling Points: Acetaminophen
-avoid or limit alcohol use
-read package labeling
-know dosing limits
-avoid duplicating products that contain acetaminophen
37
MOA: NSAIDS
relieve pain through peripheral inhibition of prostaglandin synthesis (analgesic, antipyretic, anti-inflammatory)
38
Indications: NSAIDS
relief of minor pain associated with headache, common cold, toothache, muscle ache, backache, arthritis, menstrual cramps
39
Adverse Effects: NSAIDS
-dyspepsia
-heartburn
-nausea
-anorexia
-epigastric pain
-fluid retention/edema
40
Drug Interactions: NSAIDS
-aspirin
-ibuprofen
-digoxin
-anti-hypertensive agents
-anticoagulants
-alcohol
-methotrexate
41
Patient Counseling: NSAIDS
-take with food, milk, or antacids
-avoid in patients at high risk for GI or cardiovascular risk
-naproxen not recommended in children <12
42
MOA: Salicylates (aspirin)
inhibit prostaglandin synthesis from arachidonic acid by inhibiting both COX-1 and COX-2
43
Pharmacodynamics/pharmacokinetics: Salicylates
-absorbed by passive diffusion in stomach and small intestines
-eliminated through the kidneys
44
Indication: Salicylates
mild-moderate pain and fever
45
Dosing: Salicylates
650-100 mg every 4-6h, MAX= 4000mg/day, not recommended for children < 16 yo due to risk of Reye's Syndrome
46
Define: Reye's Syndrome
47
Adverse Effects: Salicylates
-upper GI symptoms (dyspepsia, epigastric discomfort, N/V)
-gastritis, GI bleed, ulceration
-serious ASA intolerance
48
Define: Salicylism
chronic toxic blood levels, multitude of symptoms, patients at high risk include: renal or hepatic impairment, metabolic disorders, unstable disease, status asthmaticus, multiple co-morbidities
49
Drug Interactions: Salicylates
-NSAIDS/COX inhibitors
-anticoagulants
-alcohol
-methotrexate
-sulfonylureas
50
Patient Factor Precautions: Salicylates
-hypoprothrombinemia
-vitamin K deficiency
-hemophilia
-H/O bleeding disorders
-H/O peptic ulcer disease
-H/O gout/hyperuricemia
-children/teenagers with viral illness
51
Define: Fever
core body temp >100F, regulated rise in body temp maintained by the hypothalamus in response to a pyrogen
52
Define: Hyperthermia
malfunctioning of the normal thermoregulatory process at the hypothalamic level
53
Define: Hyperpyrexia
body temp >106F that typically results in mental and physical consequences , resulting from hyperthermia or fever
54
Signs/Symptoms: Fever
-headache
-sweating
-malaise
-chills
-tachycardia
-arthralgia/myalgia
-irritability
-anorexia
55
Describe: Digital Thermometers
-quickest, most accurate reading
-regulated by the FDA
-easy-to-read
-can be used at any age depending on route
56
Describe: Electronic Ear Thermometers
-measures tympanic temp
-quick reading
-accurate when used correct
-not recommended <6 months
57
Describe: Forehead Thermometers
-measures temporal artery temp
-non-invasive
-prone to error
-not recommended to make clinical decisions
58
What complication can arise from having a fever?
-parental anxiety
-acute= seizures, dehydration, change in mental status
-febrile seizures
-fever management more difficult in patients with comorbid condition
59
Non-pharmacological recommendations: Fever
-adequate fluid intake
-wear light clothing
-remove blankets
-maintain room temp at 68F
60
Exclusions for Self-Care: Fever (children and adolescents)
infants <3 months= >100.4F and children >104F or temp of 100.4F with any of the following symptoms: inability to swallow, drooling excessively, difficulty breathing, refusing oral fluids, drowsy (difficult to wake), delirious, glassy-eyed, extremely cranky or irritable, vomiting/diarrhea
61
Exclusions for self-care of fever at any age
-unexplained spots or rashes
-loss of appetite, low energy, or noticeably pale or flushed
-environmental exposure to high temperatures
-history of seizures or febrile seizures
-stiff neck, severe headache, severe ear pain, or sore throat
-taking steroids or immunocompromised
62
Define: Myofascial Pain
pain originating in the fascia (connective tissue)
63
Define: Musculoskeletal Pain
pain originating from muscle, ligaments, tendons, and/or bone
64
Define: Myalgia
generalized muscle pain
65
Define: Fibromyalgia
chronic pain syndrome characterized by diffuse muscle and joint pain, joint stiffness, fatigue, and sleep disturbances
66
Define: Tendonitis
inflammation of a tendon resulting from acute injury or chronic overuse of body part
67
Define: Bursitis
common cause of localized pain, tenderness, and swelling which is worsened by any movement of the structure to the bursa
68
Define: Sprain
injury to a ligament caused by joint overextension
69
Define: Strain
injury to muscle or tendon caused by overexertion
70
Define: Muscle Spasm
involuntary contraction of muscle
71
Define: Muscle Cramp
prolonged muscle spasm that produces painful sensation
72
Exclusions for self-care of muscular skeletal injuries
-moderate to severe pain (pain score >6)
-pain lasting >10 days after oral analgesics
-pain lasting >7 days after topical analgesics
-increased intensity or character of the pain
-pelvic or abdominal pain
-nausea, vomiting, fever, and/or other signs of systemic infection/disorder
-visual deformity of a joint, abnormal movement, weakness in a limb, or suspected fracture
-third trimester of pregnancy
73
Complications: Muscular Skeletal Injuries
-further tissue damage or bone/cartilage remodeling
-disability
-loss of function
-reduction in ADLs, loss of work time
-physical impairment
74
Describe: RICE Therapy
nonpharmacological treatment option for muscular skeletal injuries to promote healing and help reduce swelling and inflammation
-R= REST the injured area using slings or splints if necessary
-I= ICE the area as soon as possible in 10-15 minute increments 3-4 times per day (do NOT apply ice directly to skin)
-C= COMPRESS the injured area with an elasticized bandage (not too tight)
-E= ELEVATE at or above heart level for 2-3 hours per day to decrease swelling and pain
75
OTC Pharmacological options for muscular skeletal injuries
*systemic analgesics are the go to such as acetaminophen, NSAIDS, salicylates (limited to 10 days)*
topical analgesics: counterirritants/topical salicylates, capsaicin, lidocaine, topical NSAIDS
76
Describe: Counterirritants
-indication: treatment of minor aches and pains of muscles/joints
-MOA: nerve stimulation vs depression, paradoxical pain relief by causing less severe pain to counter more severe pain
-adjunct therapy
-dosing: apply no more than 3-4 times a day for 7 days
-products: methyl salicylate, camphor, menthol
77
Describe: Capsaicin
-indication: relieves pain(not inflammation) of rheumatoid arthritis and osteoarthritis and diabetic neuropathy
-MOA: thought to deplete substance P from sensory neurons, elicits a transient feeling of warmth
-takes 14 days to exert full clinical action, could take 4-6 weeks
78
Describe: Lidocaine Patch
-ideal for localized peripheral neuropathic pain
-patch or spray
