Fatigue Flashcards
What is a good approach to evaluating fagtigue
systems based approach
elicit what the patient actually means by fatigue
define fatigue
- perceived generalized weakness causing inability to initiate some activities
- increased fatiguability reducing the ability to maintain activity
- mental fatigue causing poor concentration, memory impairment and emotional instability
define somnolence
abnormal sleepiness
define muscle weakness
true muscular weakness, wherein the strength of muscles is less than expected
must differentiate this from perceived muscular weakness where the patient feels more effort is required than normal but muscle power itself is normal
cardiopulmonary causes of fatigue
*post MI
*OSA
CHF
COPD
angina
critical aortic stenosis
endocrine causes of fatigue
*DM
*hypothyroidism
addisons disease
GI causes of fatigue
malignancy
celiac disease
chronic liver disease
renal causes of fatigue
chronic kidney disease
hematologic causes of fatigue
*anemia
lymphoma
leukemia
autoimmune disease
infectious causes of fatigue
*viral illness HIV viral hepatitis subacute bacterial endocarditis TB EBV
MSK causes of fatigue
rheumatoid arthritis
neurological causes of fatigue
cerebrovascular disease MS ALS myasthenia gravis parkinsons disease
psychiatric causes of fatigue
*depression
*anxiety
*dementia
chronic fatigue syndrome
fibromyalgia
chronic pain syndrome
“other” causes of fatigue
*disordered sleep
*medication
malignancy
lupus
pregnancy
what are the COMMON causes of fatigue
post MI OSA DM hypothyroid anemia viral illness depression dementia anxiety disordered sleep medications
what are the LIFE THREATENING causes of fatigue
CHF COPD angina malignancy HIV
some things to ask specifically on HPI for fatigue
impact on daily life
constitutional symptoms –weight loss, fevers, night sweats
what meds are associated with fatigue
beta blockers
benzodiazepines
*also ask about OTC, herbals, CAM
what to ask on social history for fatigue
substances social stressors intimate partner violence, abuse recent travel or emigration sexual history (HIV, viral hep)
what to ask on ROS specifically for fatigue in the following system:
CV/RESP
chest pain SOB syncope daytime sleepiness snoring
what to ask on ROS specifically for fatigue in the following system:
ENDO
polyuria polydipsia dry skin goiter hyperpigmentation
what to ask on ROS specifically for fatigue in the following system:
GI
changes in bowel pattern
black or bloody stool
abdo pain
ascites
what to ask on ROS specifically for fatigue in the following system:
renal
edema nausea emesis anorexia pruritis
what to ask on ROS specifically for fatigue in the following system:
heme
SOBOE
petechial rash
LAD
what to ask on ROS specifically for fatigue in the following system:
infectious
constitutional
travel
social risk factors
what to ask on ROS specifically for fatigue in the following system:
MSK
joint pain
swelling
what to ask on ROS specifically for fatigue in the following system:
neuro
vision changes weakness paresthesias vertigo ptosis atrophy fasciculations
what to ask on ROS specifically for fatigue in the following system:
psych
SIGECAPS excessive worry panic anxiety memory changes SI/HI
what to ask on ROS specifically for fatigue in the following system:
other
CAGE
sleep habits
rash
menstrual history
in which patients should you order a colonoscopy
in iron deficiency anemia in women over 50 and in any man
how to manage fatigue if no underlying cause is found
BATHE approach to patient counselling
ensure frequent follow up i.e monthly to monitor symptoms–continue to screen for red flags
consider alternate diagnoses if its chronic and no other causes IDed ie fibromyalgia, CFS
lifestyle changes
pharmacologic options
referral
what is the BATHE approach to patient counselling
Background factors
how is this Affecting you
what is it about this that Troubles you most
how are you Handling this
Empathize and Empower –elicit patients resources and coping mechanisms
what are some lifestyle changes that can help with fatigue
- sleep hygiene–> ensure adequate sleep duration, consistent sleep/wake times, dark room, no TV/electronics in bedroom, no caffeine after noon, avoid food or exercise late in the day, avoid naps
- stress reduction–> mindfulness exercises, reduction of work hours, hobbies, counselling
- exercise–> regular, structured exercise i.e daily 30 min walk
- reduce or eliminate substances
what pharmacologic therapy may be offered for fatigue
a 6 week trial of SSRI may be offered if diagnosis of depression is being considered
short course of treatment with hypnotic like zopiclone may be appropriate for insomnia
