M8: 2 Flashcards
Deciding if fatigue is cancer related:
Things to consider
- look at reference ranges for RBC and HgB (watch O2 stats if low)
- are they having SOB or palpitations?
- Platelet values: low or have they got significant bleeding that may play a role?
- How long since last chemo? Consider nadir
- Any s/s of systemic infection?
- Any dull or sharp bone pain?
- Rule all other causes out
What is the most appropriate response to a pt with cancer ℅ new onset bone pain?
- treat them as having metastasis to the bone until proven otherwise
- confirm with radiograph, bone scan, MRI, or CT
What should lead a PT to suspect bony metastasis?
First sign: bone pain that is aching or sharp in nature
What should be done if a bone met is confirmed?
Caution should be used to avoid pathologic fx
What is the most common problem affecting cancer survivors?
Cancer related fatigue
What does FEWS stand for?
Function
Education
Wellness
Safety
Explain the FEWS framework
Assures interventions are comprehensive and can be applied to pts with all types of impairments
FEWS
F
Function
Optimize pt’s functional status
FEWS
E
Education
Educate pt/caregiver
FEWS
W
Wellness
Promote wellness to prevent disease progression and/or development of comorbidities
FEWS
S
Safety
Stress safety within the pt’s typical environments
When should exercise programs begin for a cancer pt? How long should they continue?
- should begin when pt begins cancer tx
- should continue throughout active tx
What type of program should a cancer pt have?
- warm-up/cool-down for each session
- flexibility
- strength
- aerobic exercise (emphasize this)
- low/mod intensity
- progress based on cardio conditioning
- exercise log
- SAFETY AT ALL COSTS
From where should you progress a cancer patient (duration/frequency/intensity)?
From
15-30 mins
3-5 days/wk
Low-mod intensity » higher (intensity should NOT provoke sx)
What is meant by low-mod intensity?
50-70% MHR
RPE 11-13 on Borg scale
Avoid exhaustion
Surgery basics of breast cancer: overall types
- Breast conservation
- Mastectomy
- Node dissection
Breast conservation
- removal of tumor
- preservation of majority of normal breast tissue
Mastectomy
Removal of entire breast
Node dissection
- lymph nodes assessed during surgery for invasive CA
- can be removed if necessary
PT implications for BC
- lymphedema
- reduced ROM
- adhesions, fibrosis, soft tissue contracture
- shoulder mm weakness
- decreased trunk strength
Types of radiation for BC
Internal
External
What is the most common type of radiation for BC?
External beam - radiation delivered to specific breast tissue
PT implications for radiation tx (BC)
- fatigue
- impaired mobility
- adhesions
Systemic therapy types for BC
- chemo
- hormonal
- biologic
Systemic therapy for BC: PT implications
Peripheral neuropathy
What are the types of breast reconstructions?
- TRAM
- DIEP
- lat dorsi flap
TRAM =
Transverse abdominal myocutaneous flap
What happens with TRAM?
- large elliptical transabdominal incision made
- skin, RA, and underlying fat removed and transferred to chest
PT implications for TRAM procedure
- trunk weakness
- abdominal wall laxity
- hernia
DIEP =
Deep inferior epigastric artery perforator
What is DIEP?
- spares the RA
- transplants skin, fat, and perforating branches of deep inferior epigastric artery
What is the lat dorsi flap procedure?
skin, subcutaneous fat, and ipsilateral lat is transplanted
Lat dorsi flap procedure
PT implications
decreased strength/mobility of shoulder due to adhesions of scar tissue to underlying tissue
Which reconstruction procedures keep their original blood supplies?
- lat flap
- TRAM
Which reconstruction has the least of the implications for PT and why?
- DIEP
- doesn’t cut through any muscles
- Plus, you get rid of the pooch!
