Fatigue Flashcards
Define fatigue
A subjective lack of physical and/or mental energy that is perceived by the individual or caregiver to interfere with usual and desired activities.
Fatigue Scope of Concept
The scope of fatigue is presented on a continuum of having vitality and energy with no fatigue at one end to a feeling of exhaustion at the other end .
When is fatigue normal?
Fatigue can be considered an expected symptom experienced by healthy individuals, but it is not considered a normal or expected finding when fatigue is persistent or severe. In healthy individuals, fatigue is relieved by physical and/or cognitive rest.
Fatigue Categories
- Temporary
vs. - Chronic: lasting longer than 6 months
Leading theories of fatigue
- Waste product accumulation
- Insufficient supply of substances
- An inflammatory process
Consequences of Fatigue
- Significant changes in a person’s life that result in the loss of a job, loss of relationships, and inability to care for oneself.
- Significant psychological consequences, particularly depression.
- Mortality from suicide was higher in patients than the generalpopulation.
- Poor prognosis for complete long-term resolution of symptoms.
Assessment for Fatigue
History:
Subjective
Personal description of the fatigue
Onset and course
Duration and daily pattern
Factors that alleviate or exacerbate
Impact on daily life
Physical Examination:
Objective
Inspection: general appearance, gait, skin
Palpation: lymphadenopathy, thyroid nodules, and goiter
Auscultation: heart and lungs underlying conditions
Diagnostic Tests for Fatigue
There are no specific diagnostic markers for fatigue. Diagnostic testing is primarily completed to rule out underlying diseases. Measurement of motor or cognitive function does not show significant correlations with perceived fatigue.
Primary prevention for fatigue
- Good nutrition
- Exercise
- Getting adequate sleep
- Managing stress
- Vitamin supplements
Secondary prevention (screening) for fatigue
- No population-wide screening efforts with respect to fatigue.
- High-risk patients for fatigue should be asked additional questions or use a fatigue screening tool.
Nursing Interventions for Fatigue
Collaborative interventions include:
- Manage physiological fatigue by managing poor lifestyle choices and disease.
- Manage secondary fatigue to treat underlying condition and reduce fatigue
- Exercise/ rest therapy
- Sleep hygiene
- Nutrition teaching
- Stress management
- Pharmacological treatment
- Psychological care
Define Chronic Fatigue Syndrome
- Chronic fatigue syndrome (CFS), also called chronic fatigue and immune dysfunction syndrome or myalgic encephalomyelitis, is a disorder characterized by debilitating fatigue and a variety of associated complaints.
- CFS is a poorly understood condition that can have a devastating impact on the lives of patients and their families.
- An estimated 1 million people in the United States have CFS, but less than 20% of them have been diagnosed.
- Women are affected more often than men.
- CFS occurs in all ethnic and socioeconomic groups.
- The prevalence of CFS is difficult to establish because of the lack of validated diagnostic tests.
- Precise mechanisms remain unknown
- Many theories about cause:
- Neuroendocrine abnormalities have been implicated involving a hypofunction of the HPA axis and the hypothalamic-pituitary-gonadal (HPG) axis, which together regulate the stress response and reproductive hormone levels.
- Several microorganisms have been investigated as etiologic agents, including herpesviruses (e.g., Epstein-Barr virus [EBV], cytomegalovirus [CMV]), retroviruses, enteroviruses, Candida albicans, and mycoplasma.
- Because cognitive deficits (e.g., decreased memory attention, concentration) occur in many of these patients, it has also been proposed that CFS is due to changes in the CNS.
Manifestations of Chronic Fatigue Syndrome
- Difficult to distinguish between CFS and fibromyalgia
- Onset insidious, intermittent –> chronic, or sudden
- In other situations, CFS arises suddenly in a previously active, healthy individual. An unremarkable flu-like illness or other acute stress is often identified as a triggering event.
- Incapacitating fatigue is the most common symptom of CFS and is the problem that causes the patient to seek health care.
Associated symptoms may fluctuate in intensity over time:
- Impaired memory or concentration
- Frequent or recurring sore throat
- Tender cervical or axillary lymph nodes
- Muscle pain
- Multijoint pain without joint swelling or redness
- Headaches of a new type, pattern, or severity
- Unrefreshing sleep
- Postexertional malaise
- The patient may become angry and frustrated with the inability of health care providers to diagnose a problem.
- The disorder may have a major impact on work and family responsibilities. Some individuals may even need help with activities of daily living.
Diagnostics for Chronic Fatigue Syndrome
- Physical examination and diagnostic studies rule out other possibilities
- In general, a diagnosis of exclusion
CDC algorithm:
- Major criterion + four or more of minor criteria for 6 months or more
- Major criterion = fatigue
- Minor criteria = specific associated symptoms
For a diagnosis to be made, the patient must demonstrate the major criterion, plus four or more of the minor criteria for 6 months or more.
Major Criterion:
* Unexplained, persistent, or relapsing chronic fatigue of new and definite onset (not lifelong). Not due to ongoing exertion. Not substantially alleviated by rest. Results in substantial reduction in occupational, educational, social, or personal activities.
Minor Criteria:
* Impaired memory or concentration
* Frequent or recurring sore throat
* Tender cervical or axillary lymph nodes
* Muscle pain
* Multijoint pain without joint swelling or redness
* Headaches of a new type, pattern, or severity
* Unrefreshing sleep
* Postexertional malaise
Nursing Interventions for Chronic Fatigue Syndrome
- Supportive care
- Patient teaching: Tell the patient about what is known about the disease. All complaints should be taken seriously.
- Drug therapy:
NSAIDs: can be used to treat headaches, muscle and joint aches, and fever.
Antihistamines/decongestants: Because many patients with CFS also have allergies and sinusitis, antihistamines and decongestants can be used to treat allergic symptoms.
Tricyclic antidepressants: (e.g., doxepin [Sinequan], amitriptyline [Elavil]) and SSRIs (e.g., fluoxetine [Prozac], paroxetine [Paxil]) can improve mood and sleep problems.
Clonazepam (Klonopin): can also be used to treat sleep disturbances and panic disorders.
Low-dose hydrocortisone: is being studied to decrease fatigue and disability. - Activity: Total rest is not advised because it can potentiate the self-image of being an invalid, while strenuous exertion can exacerbate the exhaustion. Therefore, it is important to plan a carefully graduated exercise program.
- Well-balanced diet: including fiber and fresh dark-colored fruits and vegetables for antioxidant action is essential in treatment.
- Behavioral therapy: may be used to promote a positive outlook, as well as improve overall disability, fatigue, and other symptoms.
- Financial instability/disability: Major problem facing CFS patients, Cannot work or decreased time working
- Occupational/psychosocial needs: Patients with CFS may experience substantial occupational and psychosocial impairments and loss, including the social pressure and isolation from being characterized as lazy or “crazy.”
- Prognosis variable
- Financial instability: When the illness strikes, they cannot work or must decrease the amount of time working. Loss of a job often leads to loss of medical insurance. Obtaining disability benefits can be frustrating because of the difficulty of establishing a definitive diagnosis of CFS.
- CFS does not progress: most patients recover or at least gradually improve over time, some do not show substantial improvement. Recovery is more common in individuals with a sudden onset of CFS.
