1. Celiac Disease: Celiac disease is an autoimmune disorder where the ingestion of gluten leads to damage in the small intestine. Common symptoms include diarrhea, bloating, gas, fatigue, and anemia, which can vary significantly among patients.
2. Fibromyalgia: Fibromyalgia is a condition characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues. Symptoms include chronic muscle pain, tenderness, fatigue, and disrupted sleep patterns.
3. Irritable Bowel Syndrome (IBS): IBS is a gastrointestinal disorder characterized by symptoms like abdominal pain, cramping, bloating, gas, and diarrhea or constipation, or both. It’s a chronic condition that needs long-term management.

Text B

Managing Autoimmune and Chronic Pain Conditions

While a diagnosis by a healthcare professional is critical, here’s an overview of initial management strategies for common autoimmune and chronic pain conditions:

General Measures:

Dietary Adjustments: For conditions like celiac disease, eliminating gluten from the diet is essential. For IBS, a low FODMAP diet may reduce symptoms.

Exercise: Regular, gentle exercise can help manage symptoms of fibromyalgia and IBS. Activities like walking, swimming, and yoga are beneficial.

Stress Management: Techniques like mindfulness, meditation, and cognitive-behavioral therapy (CBT) can help manage stress, which often exacerbates symptoms.

Sleep Hygiene: Maintaining good sleep habits is crucial, especially for conditions like fibromyalgia where sleep disturbances are common.

Seeking Medical Attention:

If symptoms worsen or do not improve with initial management strategies, consult a healthcare professional. They can provide a comprehensive treatment plan, including medication, therapy, and other interventions.

Additional Considerations:

Medication: Over-the-counter pain relievers and anti-inflammatory drugs can help manage pain and inflammation. Always consult a healthcare professional before taking any medication.

Therapies: Physical therapy, occupational therapy, and counseling can help manage chronic conditions and improve quality of life.

Text C

Drug Therapy Protocol:

Licensed Clinical Nurse Specialist (CNS) must consult with the Attending Physician or Nurse Practitioner (NP). Registered Nurse (RN) in specialized settings may proceed.

Drug	Form	Strength	Route of administration	Recommended dosage	Duration
Pain Relief A	Oral	10 mg	oral	10-20 mg every 4-6 hours as needed, not exceeding 120 mg/day	For elderly patients (≥65 years), start with the lowest effective dose and monitor closely for adverse effects.

Provide Patient Medication Guide: Caution against operating heavy machinery or driving while taking medication. Potential side effects include dizziness, drowsiness, and constipation.

In the event of respiratory depression, administer naloxone and notify prescriber immediately.

Text D

Technique for Applying Compression Stockings for Venous Insufficiency

Measure and Fit:

Measure the patient’s leg circumference at the ankle, calf, and thigh to ensure the correct stocking size.

Choose stockings that provide graduated compression, typically 20-30 mmHg for moderate venous insufficiency.

Patient Preparation:

Ensure the patient’s legs are clean and dry. Remove any jewelry from the legs.

Elevate the patient’s legs for a few minutes before applying the stockings to reduce swelling.

Application:

Roll the stocking inside out down to the heel.

Place the foot into the stocking and gradually unroll it up the leg, smoothing out any wrinkles.

Ensure the stocking fits snugly but not too tightly, avoiding constriction at the top.

Maintenance:

Instruct the patient on proper care and maintenance of the stockings. They should be washed regularly and replaced every 3-6 months.

Note: This is a general guideline. A medical professional should assess and recommend the appropriate treatment for venous insufficiency.

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