Fatigue HYHO Flashcards
Fatigue
Sensation of exhaustion after usual activities OR insufficient energy to begin usual activities
–pt can describe as tired, lack of energy, excessive sleepiness, weakness
Broad differential for fatigue
DEAD TIRED Depression Environment/lifestyle Anxiety, Anemia Diabetes/endocrine
Thyroid, tumors Infection Rheumatologic Endocarditis/cardiovascular Drugs (medication or substance abuse)
Recent stressor identified?
Provide support, discuss sleep hygiene, re-eval in 1 month
New med or substance abuse?
Adjust or remove substance, re-eval in 1 month
Sign or symptom of bleeding?
Obtain CBC
If no stressor, no new meds, no substance abuse or bleeding?
- ask about anxiety & depression
- Obtain a sleep history
- Perform complete ROS & PE
- obtain CBC, TSH, CMP, UA and other tests depending on risk factors
Qs for sleep history
what time do they go to bed?
How long does it take to fall asleep?
how often do they wake in the night?
Do they nap? (napping can disrupt sleep cycle)
Do they drink alcohol in the evening? (results in poor sleep quality)
Do they feel rested when they wake in the morning?
Do they exercise & what time of day (exercise in the evening can delay sleep onset)
When is Hep C screening recommended?
Men who have sex with men, anyone with history of injection drug use or persons born between 1945-1965
Endocrine PE findings
VS- tachy or bradycardia, weight change from previous visits Gen- temporal or muscular wasting Neck: palpate thyroid Skin: assess turgor, dryness Hair: tug test, alopecia Nails for brittleness/dryness Neuro: DTR & muscle strength
Anemia PE findings
VS- tachycardia, hypotension or orthostatic hypotension
gen: general pallor
HEENT: glossitis, angular chelitis
CV: potentially new murmurs
nails: cyanosis, check cap refill
abd: assess for masses, changes in organ size
rectal: fecal occult blood test
Acute insomnia
often stress related, consider new meds and/or medication side effects
Chronic insomnia
at least 3 nights/week for 3 months, irregular sleep cycle (shift workers, travel, etc)
Sleep hygiene
- Establish a sleep pattern–go to bed and rise at same time everyday
- Avoid lying in bed sleepless–after 30 min get out of bed & engage in mundane activities
- use the bedroom only for sleep & sex
- avoid naps >30 min long
- avoid eating 3 hours before lying down
- avoid drinking 1 hour before lying down
Primary prevention of sleep disorder
healthy lifestyle that includes exercise, stress reduction, and proper sleep habits
Seconday tx: pharm
titrate lowest effective dose, limit use to 2-4 times/wk
Benzodiazepine, benzodiazepine receptor agonists, tricyclic antidepressants
Obstructive sleep apnea (OSA)
temporarily stop or decrease breathing during sleep for at least 10 sec. >15 events per hour is diagnostic
Increases with age, obesity, M>w
Gold standard for diagnosis of OSA
polysomnography: combined eval of sleep, breathing, & movement
Treatment for OSA
weight loss, smoking cessation, avoiding alcohol
CPAP
Periodic Limb movement disorder
Urge to move legs, accompanied by uncomfortable or unpleasant sensation of “crawling” on legs
legs twitch or move every 20-24 sec during non rem sleep
diagnosed with polysomnography
Management of fatigue: what diagnoses you shouldn’t miss
MUST NOT MISS: anemia, hypothyroid, diabetes, depression/anxiety, OSA
Biomechanical model hypothyroid
thoracic somatic, OA, and rib dysfunctions related to somatovisceral reflexes
resp-circ model for hypothyroid
lymphatic restrictions mesenteric lift (constipation)
Neuro model hypothyroid
sym innervation for head & neck: T1-4
sym innervation for distal transverse colon to rectum: T12-L2
parasym innervation either vagus or S2-4 (distal transverse colon to rectum)
chapmans
Metabolic model hypothyroid
- hormone treatment*
- -rule out related autoimmune disorders
- -consider iodine intake if needed
behavioral modeal hypothyroid
exercise
proper nutrition
therapy/psychiatric eval (depression)
Ant chapman’s thyroid
b/l second intercostal space
visceral somatics thyroid
sym: T1-4
parasym: vagus
