A nurse is teaching a client who has a new prescription for colchicine to treat gout. Which of the following instructions should the nurse include?

Choice A rationale:
While taking colchicine with food can help minimize gastrointestinal side effects like nausea, it's not the most crucial instruction for this medication. The primary concern with colchicine is its potential for muscle toxicity.

Choice B rationale:
Colchicine can cause muscle pain, tenderness, or weakness, which can be a sign of a serious condition called rhabdomyolysis. Rhabdomyolysis involves the breakdown of muscle tissue, potentially leading to kidney damage and other complications.
It's crucial for patients to monitor for muscle pain and report it to their healthcare provider promptly if it occurs. Early detection and intervention can help prevent serious complications.

Choice C rationale:
Increased bruising is not a common side effect of colchicine. It's more frequently associated with medications that affect blood clotting, such as warfarin or aspirin.

Choice D rationale:
Grapefruit juice can interact with many medications, including colchicine. It can increase the concentration of colchicine in the bloodstream, potentially leading to toxicity.
It's crucial for patients taking colchicine to avoid grapefruit juice and other grapefruit products.

Choice A:
Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties. Activity intolerance is a common symptom, resulting in patients experiencing increased fatigue, pain, and decreased function with exertion.
A program of regular mild to moderate exercise is considered the cornerstone of management for fibromyalgia. Exercise improves physical fitness, reduces pain intensity, and enhances sleep quality. It also decreases fatigue and depression, and improves overall well-being and quality of life. The key is to start with low-impact activities, gradually increase intensity and duration over time, and listen to the body's signals to avoid overexertion.
Here's how exercise benefits patients with fibromyalgia:
Pain reduction: Exercise releases endorphins, natural pain-relieving chemicals in the brain. It also strengthens muscles and improves joint flexibility, leading to decreased pain intensity and frequency.
Improved physical fitness: Regular exercise increases cardiovascular health, muscle strength, and endurance, allowing patients to tolerate activity better and perform daily tasks with less fatigue.
Enhanced sleep quality: Exercise can regulate sleep patterns, promoting deeper sleep and reducing nighttime pain, leading to improved energy levels and mood throughout the day.
Reduced fatigue and depression: Exercise triggers the release of mood-boosting neurotransmitters, like serotonin and dopamine, which can help alleviate symptoms of depression and fatigue commonly associated with fibromyalgia.
Improved overall well-being: Regular physical activity enhances self-efficacy, reduces stress, and promotes social interaction, contributing to a better quality of life for patients with fibromyalgia.
Therefore, a program of regular mild to moderate exercise is the most effective recommendation for patients with fibromyalgia to address activity intolerance and improve their overall well-being.
Rationale for other choices:

Choice B: While daily meditation and guided imagery can be helpful for managing stress and improving sleep in fibromyalgia, they are not as effective as exercise in directly addressing activity intolerance and improving physical fitness and function.

Choice C: Referral to physical therapy for an assistive device may be necessary in some cases with severe limitations, but it is not the first-line intervention for addressing activity intolerance in most patients with fibromyalgia. Exercise should be the initial focus, with assistive devices considered later if needed.

Choice D: NSAID medications can offer temporary pain relief, but they do not address the underlying cause of activity intolerance in fibromyalgia and can have side effects like gastritis and kidney problems. NSAIDs should be used cautiously and only as a complementary therapy alongside exercise in managing fibromyalgia symptoms.
Remember, a tailored exercise program, starting with low-impact activities and gradually increasing intensity, is the key to managing activity intolerance and improving function in patients with fibromyalgia.