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Oncology and Such Flashcards

1
Q

What is the pathogenesis of cancer?

A
  • uncontrolled growth and spread of abnormal cells
  • starts with some carcinogen, oncogene
  • changes in a single cell: altered cell DNA, normal controls on cell growth are ineffective resulting in rapid cellular proliferation
  • cells keep mutating-why we see in elderly
  • cancer-relevant genes discovered
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2
Q

What group are most cancers in?

A

70% are in 65 years old and up

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3
Q

What are oncology risk factors?

A
  • advancing age
  • exposure to viruses: HPV
  • lifestyle or personal behaviors
  • geographic location and environment
  • ethnicity, herditary
  • stress
  • precancerous lesions
  • exposure to hormones
  • socioeconomic status
  • occupation: fumes, etc
  • inflammatory bowel disease: increased risk of cancer
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4
Q

When do cancers usually develop symptoms?

A

when they metastasize?

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5
Q

What cancers have screening?

A

breast, tongue, mouth, colon, rectum, cervix, prostate, testis, skin

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6
Q

Tell me about tumors/neoplasms

A
  • benign or malignant
  • -better survival rate; metastases
  • carcinoma in situ: encapsulated, can be removed easily
  • primarily-cells that are local to the structure: determines the type of treatment
  • secondary-result of metastasized cancer cells from the primary site
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7
Q

Metastases

A

cells break away from the primary tumor and travel via the blood or lymphatic system where they infiltrate organ tissue and grow in a new tumor

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8
Q

dysplasia

A

disorganization of cells

-Pap smear

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9
Q

Hyperplasia

A

abnormal growth of abnormal cells-onset of tumor

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10
Q

differentiation

A

don’t look like original cells

-stage four, poor prognosis

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11
Q

Tumor types

A

benign

  • non-invasive
  • non-metastatic: invasive (basal cell-skin cancer), doesn’t metastasize to another organ

malignant

  • invasive
  • metastatic (carcinoma, sarcoma): malignant tumor made up of epithelial cells tending to infiltrate surrounding tissue and metastasize (85% of all cancers)
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12
Q

Classifications of Neoplasm

A
  • basis of cell type
  • tissue of origin
  • degree of differentiation: biopsy
  • anatomic site
  • benign vs. malignant
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13
Q

HEY

A

go look on your “stuff to know” doc for some beautiful notes and also charts about cancers

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14
Q

what is a sentinal node thing?

A

biopsy to determine if there’s metastasis

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15
Q

Who do sarcomas effect most often?

A

adolescents, young adults

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16
Q

What’s a big thing that happens a lot with sarcomas, and why are they underdiagnosed?

A
  • amputations

- usually starts with pain complaint brushed off as growing pains

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17
Q

How do they treat leukemias?

A

stem cell transplants

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18
Q

What are clinical symptoms of cancer?

A
  • early stages asymptomatic
  • nausea, vomiting and retching accompanied by anorexia with weight loss common with advanced cancer
  • muscular weakness due to fatigue and anemia; anemia and coagulation disorders occur in advanced stages
  • pain may or may not occur: early stages 50-70%, late stages 60-90%
  • fatigue, fever, decreased immunity with increased infections-get sick and never get better
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19
Q

Cancer signs and symptoms: breast cancer

A

abnormal mammogram; lump; skin irritation, dimpling, distortion; nipple pain or retraction

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20
Q

cancer signs and symptoms: prostate

A

no early symptoms; weak or interrupted urine flow; inability to urinate or difficulty stopping and starting flow; frequency, especially at night; continual pain in low back, ribs, pelvis, or thighs

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21
Q

cancer signs and symptoms: colon/rectal

A

rectal bleeding; abdominal pelvic, back or sacral pain; pain that radiates down LEs; blood in stool; change in bowel habits

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22
Q

cancer signs and symptoms: leukemia

A

fatigue, paleness; weight loss; repeated infeciton; bruising easily; nosebleeds or other hemorrhages

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23
Q

cancer signs and symptoms: lung

A

persistent cough; sputum with streaked blood; dyspnea; chest or upper back pain aggravated by inspiration; recurring pneumonia or bronchitis

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24
Q

cancer signs and symptoms: lymphoma

A

enlarged lymph nodes; itching; night sweats; unexplained weight loss; intermittent fevers

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25
Q

cancer signs and symptoms: pancreas

A

no early symptoms; jaundice; abdominal pain; glucose intolerance

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26
Q

Paraneoplastic syndromes

A

produce signs and symptoms that aren’t direct effects of the tumor or it’s metastases; 10-20% of patients

  • most common produces ACTH causing Cushings syndrome (moon phase)
  • cancer arthritis: typically in hands
  • symptoms: neurologic changes, anorexia, malaise, diarrhea, weight loss and fever
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27
Q

Signs and symptoms of integumentary mets

A
  • skin lesion
  • palpable nail bed changes
  • bleeding, discharge, tenderness
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28
Q

Signs and symptoms of musculoskeletal mets

A
  • idiopathic proximal muscle weakness
  • deep localized bone pain
  • decreased tolerance of WBing
  • soft tissue swelling
  • pathologic fracture
  • back or rib pain: does not respond to modalities
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29
Q

Osteoblastic tumors

A
  • common with prostate, 15-30% with uterine, lung, colon, stomach, kidney
  • skeletal related events sequelae: pain and pathologic fractures
  • increased bone density
  • making bone so fast that it’s not well made so you get weak bones
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30
Q

Osteolytic tumors

A
  • moth eaten
  • common with breast cancer and multiple myeloma
  • skeletal related events sequelae: severe pain, pathological fractures, life threatening hypercalcemia, SC compression (neuro exams!)
  • risk of kidney damage
  • hypercalcemia-joints kidneys (perfuse less)
  • increase edema (legs, chest)-SOB, WBing
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31
Q

What do you have to watch for with osteoblastic and osteolytic fractures?

A

most patients with bone mets have evidence of both abnormal bone resorption and formation
-both are at risk fracture

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32
Q

How do they diagnose osteolytic/blastic tumors and what do they do for it?

A
  • biochemical markers for bone degradation; imaging-bone scan and PET, CT, MRI, radiographs (50% of bone involved before it shows up on xray)
  • restricted WBing, surgery
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33
Q

Neurologic mets: signs and symptoms

A
  • headaches with nausea and vomiting
  • irritability
  • confusion
  • seizure
  • changes in bowel and bladder
  • change in DTR, clonus, Babinski
  • vision changes
  • change in mental status
  • balance/coordination problems
  • numbness and tingling
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34
Q

Pulmonary mets: signs and symptoms

A
  • pleural pain
  • dyspnea
  • new onset of weakness
  • productive cough
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35
Q

Hepatic mets: signs and symptoms

A
  • abdominal pain and tenderness
  • jaundice
  • ascites
  • peripheral edema
  • right shoulder pain
  • general malaise
  • bilateral CTS
  • 50% of people get liver damage,
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36
Q

Staging vs grading

A
  • staging describes the extent of the disease at the time of diagnosis based on primary tumor, regional lymph nodes, metastasis
  • staging is more predictive than grading
  • systems specific for each kind of cancer
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37
Q

BRAIN BREAK

A

go read the staging and grading slides on page 9&10 of the oncology handout; diagnostic imaging slide (10), lab slide (10)

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38
Q

metaplasia

A

change in cells

ex-Berret’s esophagus

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39
Q

anaplastic

A

very poorly differentiated, no longer look like primary tumor

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40
Q

What are the kinds of endoscopy?

A
  • colonscopy
  • ERCP: endoscopic retrograde cholangiopancreatography
  • EGD/upper GI: esophagogastroduodenoscopy
  • sigmoidscopy
  • cystoscopy/cystourethroscopy
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41
Q

What are you going to see with an endoscopy?

A
  • what the name says

- colon, esophageal, head/neck cancers, stomach cancers

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42
Q

What kind of imaging is used to see cancers?

A
  • endoscopy
  • Xrays
  • CT scans
  • bone scans
  • lymphangiogram
  • mammogram
  • US (breast cancer-determines if follow up is needed)
  • MRI (determines extensiveness of tumors/mets, surgical candidates, non-weight bearing status)
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43
Q

combined modality therapy

A
  • more than one therapy in treating a pt
  • ex radiation and chemo
  • better survival rates with CMT
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44
Q

adjuvant

A

treatment given after primary cancer tx is completed to improve chance of a cure

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45
Q

neoadjuvant

A

given before the primary therapy to kill any cancer cells and contribute to the effectiveness of the primary therapy

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46
Q

what are 4 treatment options for cancer?

A

Surgical, Radiation, Chemotherapy, Biotherapy

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47
Q

The good thing about combined therapy is that there’s a better survival rate? What’s a bad thing?

A

long term implications of multiple treatments

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48
Q

What is targeted biologic therapy?

A

an adjuvant therapy for people with genetic markers for a certain cancer (ex-breast, lung)

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49
Q

breast cancer treatments

A

surgery, chemo, radiation, hormone, targeted biologic therapy

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50
Q

prostate cancer treatments

A

surgery, chemo, radiation, hormone

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51
Q

colon/rectal

A

surgery, chemo, radiation

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52
Q

leukemia

A

chemo, blood transfusion, bone marrow, stem cell transplant

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53
Q

lung

A

surgery, chemo, radiation, targeted biologic therapy

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54
Q

lymphoma

A

Hodgkin: chemo, radiation

Non-hodgkin: chemo, radiation, stem cell transplant

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55
Q

pancreas

A

surgery, chemo, radiation

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56
Q

liver

A

surgery, chemo, ablation, liver transplant

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57
Q

Does surgery help with cancer?

A

surgical resection alone fails to cure 70% of cancers due to regional and distal mets; not used as a single modality

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58
Q

what part of surgery correlates with overall survival

A

lymph node status

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59
Q

What are the types of surgery for cancer?

A
  • curative
  • palliative
  • preventative/prophylactic
  • diagnostic
  • staging
  • debulking
  • restorative
  • cryosurgery
  • laser surgery (brain cancers-less destructive of tissue)
  • electrosurgery
  • microscopically controlled surgery (reduce risk of infection, smaller incision)
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60
Q

what are the curative surgeries?

A
  • local excision: excise tumor and tissue around it
  • -lumpectomy
  • -followed by other treatment option
  • block dissection: take full section because cancer is in advanced stage
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61
Q

What are the two types of surgical margins?

A
  • negative clear: edges of the surgical biopsy are clear of cancer cells
  • positive: edges of the surgical biopsy have cancer cells
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62
Q

What are advantages of surgical intervention?

A
  • no biological resistance
  • no carcinogenic effects
  • cure large portion of undisseminated cancer
  • assists in quantifying extent/histology of tumor
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63
Q

What are complications of surgery?

A
  • non-healing wounds
  • lymphedema
  • DVTs and emboli
  • loss of tissue/disfigurement
  • infection
  • nerve interruption
  • pain
  • fatigue
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64
Q

What are indications for radiation?

A
  • cure: depends on how radiosensitive the tumor is
  • control: shrink tumor before surgery to minimize spreading
  • palliative: decrease s/s, shrink tumor to alleviate; poor prognosis, increase quality of life
  • prophylactic: done in area where they believe all cancer is gone but want to make sure none is left
  • more useful in more localized lesions
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65
Q

What’s a problem with radiation?

A

it causes a lot of scar tissue

ex-breast cancer-decreased ROM in shoulder

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66
Q

What are the two ways to deliver radiation?

A

internal and external beam

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67
Q

Describe internal radiation

A
  • very intense, but less damage to healthy cells
  • hospitalized
  • isolated from others (psychologic implications)
  • indicated for breast, prostate, thyroid, head and neck cancers
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68
Q

describe external beam radiation

A
  • tomotherapy
  • minimal dose-fractionated
  • outpatient
  • delivered in the form of electromagnetic waves
  • proton therapy, laser beam
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69
Q

bracytherapy

A
  • often used for prostate cancer; can be used for thyroid and breast cancer
  • seeds that release radiation over a period of time; can control the amount
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70
Q

what are advantages of bracytherapy?

A
  • OP, minimal hospitalization
  • individualized placement of seeds
  • few long-term side effects
  • return to normal activity
  • tolerated by pts in poor medical condition
  • good long-term clinical outcomes
  • cost effective
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71
Q

what are disadvantages of bracytherapy?

A
  • pts experience transient urinary irritative symptoms
  • close contact with small children and pregant women avoided in first 2 months after treatment
  • hip soreness, knee soreness-in that position for 45 mins to an hour
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72
Q

What are side effects of radiation?

A
  • skin erythema or irritation (observe skin reactions while exercising***)
  • watch wound healing
  • muscle weakness
  • fatigue
  • CT fibrosis***: hip, abdominal region
  • effects on bone: osteoporosis, fractures (osteolytic, osteoblastic)
  • lymphedema (radiation fields get lymph nodes)
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73
Q

What is the acute tissue reaction to radiation?

A

(while undergoing treatment) erythema

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74
Q

What is the intermediate reaction to radiation?

A

(up to 6 months) fibrotic tissue changes-ROM

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75
Q

What is the chronic tissue reaction to radiation?

A

(6 months-2 years)

  • vascular damage: avascular necrosis-BVs thrombosed, vessels destroyed; lack vascularization in joint, usually hip->necrosis of the joint; surgically treated
  • fibrotic changes continue resulting in ROM limitations or chest expansion (irreversible)
  • effect on pigment producing cells: vitiligo
  • tensile strength compromised
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76
Q

When would you use chemotherapy?

A
  • widespread metastatic disease (leukemia, lymphoma)
  • adjuvant chemo after surgery or radiation to kill remaining tumor cells
  • neoadjuvant to shrink tumor before surgery
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77
Q

What does chemotherapy do?

A

-apoptosis by interfering with DNA, RNA, and protein synthesis and cell function

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78
Q

How is chemotherapy given?

A
  • central line
  • PICC
  • ports (infection, thrombosis, extravasation)
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79
Q

What’s a major downside of chemotherapy?

A

immunocompromised

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80
Q

What are side effects of radiation?

A
  • weight loss
  • infection
  • sterility
  • pulmonary
  • cardiac: pericarditis; long-term implications: hypertrophic myopathy (scar tissue heart), increase in HR, dyspnea with activity
  • CNS effects: memory loss, difficulties with emotions, depression,
  • late carcinogenic effects
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81
Q

What cells take the longest to go through the cycle?

A

blood cells

-leukemia: on chemo for 2-3 years

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82
Q

How do they use the cell cycle for chemo?

A

-treatment is 2-3 different drugs that have different effects at different parts of the cell cycle

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83
Q

How long does chemo usually last?

A

3-4 month treatment course

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84
Q

How does chemo effect the blood?

A

decreases RBCs, WBCs, and platelet count

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85
Q

What are the classes of chemo agents?

A
  • alkylating agents (platinum compounds)
  • antitumor antibiotics
  • antimetabolites
  • taxanes
  • plant alkaloids
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86
Q

BRAIN BREAK

A

read the slides on pages 18-19

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87
Q

What is a side effect of antitumor antibiotics?

A

cardiotoxicity

  • can be up to 20 years later
  • -pay attention to vitals
  • -SVT, dyspnea with exercise, fatigue
  • -interval training
  • -you’ll see poor exercise response, so you see it first
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88
Q

What are taxanes?

A

-paclitaxel, docetaxel, abraxane

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89
Q

What are plant alkaloids?

A

-vincirstine, etoposide, vinlastine

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90
Q

What is a major concern with chemo, especially taxanes and plant alkaloids?

A
  • CIPN
  • -can contribute to dizziness, weakness, visual problems
  • -chemo drugs wrap around nerves
  • -vestibular problems, balance issues, increase in visualization problems
  • -resolves after chemo for some, some resolves later, some doesn’t resolve
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91
Q

What are side effects of doxorubicin?

A

(antitumor antibiotic)

  • decrease in blood cell counts
  • heart damage
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92
Q

What are the side effects of cyclophosphamide?

A

(alkylating agent)

  • decrease in blood cell counts
  • lung or heart damage
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93
Q

What are the side effects of taxol?

A

(plant alkaloid)

  • arthalgias and myalgias
  • peripheral neuropathy
  • hypersensitivity reaction
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94
Q

What is a side effect of Docetaxel?

A

(antimetabolite)

-numbness and tingling in hands and feet (CIPN)

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95
Q

What is biotherapy?

A

stimulates or restores the ability of the immune system to fight cancer, infection, and other diseases

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96
Q

What are side effects of biotherapy?

A
  • CV changes-take vitals!
  • flu-like symptoms: low grade fever, nausea, frequent diarrhea
  • loss of appetite
  • GI symptoms
  • rash with dry itchy skin
  • fluid retention (edema, can effect gait, decreased proprioception)
  • CNS effects
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97
Q

What are biological response modifiers?

A
  • enhance immune system, enhances other treatments like chemo
  • -interferons: direct antitumor effect
  • -interleukin-2: trigger immune response
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98
Q

Bone Marrow or stem cell transplant

A
  • preventing bone marrow destruction
  • allows high doses of chemo and radiation
  • used for leukemia, lymphomas, solid tuomrs, neuroblastoma, multiple myeloma, severe aplastic aneumia
  • can be autologous or allogenic
  • can do through IV-not as invasive
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99
Q

What are side effects of bone marrow transplant?

A
  • infection
  • fatigue
  • malaise
  • CNS symptoms
  • graft versus host disease: native cells reject donor cells
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100
Q

What’s the best thing to do for someone after a bone marrow transplant?

A

mobilize!!

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101
Q

Graft versus host disease complications

A
  • loss of end ROM in multiple joints, esp. hip, knee, DFers
  • develop bronchiolitis obliterans: chronic cough, dyspnea, and expiratory wheezes; chronic pleural effusions
  • significant weight loss
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102
Q

What can PTs do for GVHD?

A
  • mobilization and manual soft tissue work to maintain joint motion-chest wall
  • comprehensive exercise program
  • breathing exercises, bed mobility, theraband in bed
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103
Q

What are colony-stimulating factors?

A
  • supports person with low blood counts due to chemo
  • acts as a hematopoietic growth factor-erythropoietin, thrmobopoietin
  • helps bone marrow recover quicker
  • many pts are anemia this increases oxygenation, enhances RBCs
104
Q

What are monoclonal antibodies?

A
  • lab engineered copies of proteins that stimulate the immune system (WBCs)
  • used in combo with chemo for colorectal cancers, T cell lymphomas, neuroblastoma, melanomas
  • give by IV over 4-6 hours
105
Q

What are side effects of monoclonal antibodies?

A
  • allergic reaction (common-pts take antihistamine->get sleepy)
  • wheezing
  • fever, chills
  • rash
  • headache
  • nausea, vomiting
  • tachycardia
106
Q

What is hormonal therapy?

A
  • used for cancer affected by specific hormones (breast prostate, cervical, uterine)
  • blocks or prevents cancer cells from being exposed to hormones that cause them to grow
  • ex: Tamoxifen
107
Q

What are side effects of hormonal therapy?

A
  • nausea and vomiting
  • hot flashes, sweating
  • impotence, decreased libido
  • weight gain
  • myopathy (proximal muscle weakness)
  • hypertension (may need to be on meds)
  • altered mental status: cloudy thought, decreased executive function; repeat education
108
Q

What is a specific hormone therapy?

A

aromatase inhibitors

109
Q

What do aromatase inhibitors do?

A
  • stop estrogen production in postmenopausal women

- less estrogen available to stimulate growth of hormone-receptor-positive breast cancer cells

110
Q

What’s a big problem with aromatase inhibitors?

A
  • aromatase inhibitor associated musculoskeletal syndrome
  • -wrist and hand pain in 75%
  • -carrying 10lbs is a problem
111
Q

What are 10 types of oncologic emergency?

A
  • SC compression
  • pathologic fracture
  • superior vena cava syndrome
  • increased ICP (brain tumor, inflammatory response to exercise)
  • pericardial effusion/cardiac tamponade
  • pleural effusion
  • tumor lysis syndrome
  • uretal/intestinal obstruction
  • hemarhtrosis
  • hypercalcemia
112
Q

What are signs of superior vena cava syndrome?

A
  • life threatening!
  • facial/arm edema-immediate
  • headaches
  • vein distension
  • tachypnea
  • dyspnea
113
Q

What do they do for superior vena cava syndrome?

A

radiation immediately

114
Q

What are signs of increased ICP?

A
  • headaches
  • nausea and vomiting
  • decreased cognition
  • change in mental status with a chronic headache
115
Q

What is pericardial effusion/cardiac tamponade? What are signs of it?

A
  • tumor growing, lymphoid tissue accumulates in chest, pushes on heart, lungs, etc
  • life threatening, needs to be treated immediately
  • dyspnea, cough, chest pain; tachycardia; anxiety; hypotension; peripheral edema
116
Q

What are signs of pleural effusion?

A

dyspnea, cough, dull chest pain, tachypnea, anxiety, labored breathing

117
Q

What is tumor lysis syndrome?

A

Pt has rapid response to chemo, dead cells accumulate in pts body (usually they pee them out); kidneys don’t function correctly; watch for change from yesterday to today

118
Q

What are signs of tumor lysis syndrome?

A
  • proximal muscle weakness
  • twitching tetany
  • seizures
  • paresthesia
  • bradycardia
  • nausea and vomiting
  • lethargy
119
Q

What do they do for tumor lysis syndrome?

A

short-term dialysis (makes pt more weak!)

120
Q

What are signs of hemarthrosis?

A
  • increased swelling
  • bruising
  • petichia
  • decreased ROM
121
Q

What are signs of hypercalcemia?

A
  • muscle wasting and fatigue (mets, osteolytic lesions)
  • confusion
  • apathy
  • N&V
  • renal failure-dialysis
122
Q

What can you do for hypercalcemia?

A
  • weight bearing activities!

- educate family on fall risk

123
Q

BRAIN BREAK!

A

Read the 2nd slide on pg 26!

124
Q

What can exercise do for cancer?

A
  • predx: reduce risk
  • pretreatment: enhance treatment tolerance
  • treatment: maintain function, strength, QOL
  • survivorship: improve general health, strength, endurance
  • end of life: pt control and assist family (educate family on body mechanics, etc when helping pt)
125
Q

CAUTIONS

A
  • screening OPs for cancer
  • Changes in bowel/bladder
  • A sore that doesn’t heal
  • Unusual bleeding or discharge
  • Thickening or lump
  • Indigestion/difficulty swallowing
  • Obvious change in wart or mole
  • Nagging cough, hoarseness
  • Supplemental signs/symptoms (weight loss, confusion, N&V, anxiety
126
Q

How long does it take for things to appear after chemo/bone marrow transplant?

A
  • effects usually occur 7-10 days after chemo
  • bone marrow starts to return to normal 15-21 days after treatment
  • so don’t discharge them before that!
127
Q

What are precautions for oncology pts?

A
  • resting HR>100-110
  • vital signs that decrease with activity
  • develop an arrhythmia or change an arrhythmia during activity-tell your nurse!
  • blood counts should be read prior to each treatment
  • myelosuppression is suppression of bone marrow which produces RBC, WBC, and platelets
128
Q

What is thrombocytosis?

A
  • over 1 million cells

- caused by iron deficiency, neoplasm, infection, inflammation

129
Q

What is thrombocytopenia?

A
  • less than 150,000 cells
  • heavy bleeds-GI, CNS
  • coagulation factor deficiency
  • no aggressive ROM
  • black, tarry school
  • hypotensive response
130
Q

What are peds signs for thrombocytopenia?

A
  • nose bleeds
  • bruising
  • fatigued
  • pale
  • diaphoretic
131
Q

What are communication problems chemo pts may experience? What can you do for them?

A
  • LDs, mental depression, decreased libido, sterility, impotence, altered mental status, hot flashes/hormonal symptoms, alopecia, pain, weight gain
  • last a long time from chemo, hormone therapy
  • write down education, repeat education, make them say it back
132
Q

What are CPGs for psychosocial health care?

A
  • effective communication between pts, fam, HCPs
  • systematically monitoring, evaluating and reevaluating, and adjusting plans
  • identifying psychosocial needs
  • link to psychosocial services
  • establish comprehensive pt education programs
133
Q

What are integumentary complications?

A
  • non-healing wounds
  • lymphedema
  • loss of tissue/disfigurement
  • fibrosis of CT
  • decreased rate of wound healing
  • skin is atrophic
  • skin is easily damaged (diarrhea, incontinence)
  • infection
  • mucositis
134
Q

What are limb volume outcome measures?

A
  • bioelectric impedence-can predict lymphedema
  • perometry: fluid; not FDA approved; reliable and valid
  • water displacement
  • circumferential measurements
135
Q

Can you exercise if the pt has radiation erythema?

A
  • yes, if only erythema
  • no exercise if there is blistering of the skin until skin is healed
  • exercise can aggravate erythema
136
Q

What are musculoskeletal impairments?

A
  • movement disorder
  • generalized weakness
  • myopathy
  • effects of bone
  • fibrosis
  • axillary web syndrome
137
Q

Musculoskeletal Outcome Measures for oncology

A
  • Pain VAS
  • goniometry
  • sit and reach/flexibility
  • grip strength
  • MMT
  • DASH: disabilities of arm, shoulder, hand test; lymphedema (entire arm)
  • PENN shoulder score
138
Q

What is the best predictor of total body strength and survival?

A

grip strength

139
Q

What interventions should you do for someone with multiple myeloma or bone mets?

A

non-WBing- risk for fracture or severe deconditioning (cycling, rowing, swimming)

140
Q

What interventions should you do for someone if they have a risk for osteoporosis?

A

weight bearing

141
Q

What kind of weight training should you do for a more conditioned patient? For an elderly patient?

A
  • high rep, low weight circuit program

- low intensity, low reps

142
Q

What is axillary web syndrome?

A

threadlike tissue bands in axilla and medial UE

143
Q

When do people usually get axillary web syndrome?

A
  • 20% with sentinel node biopsy, 72% with axillary clearance (lymph nodes)
  • 25-40% of patients
  • shows up 2-8 weeks after surgery, but can show up years later
144
Q

What is axillary web syndrome associated with?

A
  • risk of lymphedema

- most times with breast cancer

145
Q

How do you treat axillary web syndrome?

A
  • stretching and scar release

- non-aggressive because aggressive can make inflammatory response worse

146
Q

What does axillary web syndrome cause?

A

pain and limitation of flexion, abduction

147
Q

What are cardiopulmonary complications?

A
  • DVTs/emboli
  • cardiac toxicity
  • pulmonary toxicity
  • pericarditis
  • later carcinogenic effects
  • cancer related fatigue**
148
Q

What cardiopulmonary outcome measures should you use?

A
  • HR, BP, RR, O2 sat, dyspnea, pulmonary function tests
  • graded exercise test
  • 6MWT or 2MWT
  • Borg scale
  • SPADI (shoulder)
  • EORTC QLQ C30 (quality of life, validated)
  • SF-12 (pt interpretation of health and QOL)
149
Q

What is the most common unmanaged symptom of cancer treatment?

A

Cancer Related Fatigue

150
Q

What factors related to cancer contribute to fatigue?

A
  • anemia
  • cachexia/nutrition
  • infection
  • paraneoplastic syndrome (especially with small cell carcinoma lung cancer)
  • metabolic disorders (DM)
  • pain
  • emotional distress, stress, depression, sleep disturbances
151
Q

What is the FACIT-F?

A

a fatigue questionnaire; asks about ADLs, QOL

152
Q

What intervention has the strongest evidence of therapeutic effect?

A

aerobic exercise

153
Q

Why should you be careful to have a good warm-up and cool down for oncology patients?

A
  • risk for cardiotoxicity

- on beta blockers

154
Q

When should you start exercise programs?

A

begin with cancer treatments and continue on

155
Q

General standards for:

  • exercise level
  • HR
  • METS
  • Borg
A
  • low levels, progress to moderate levels
  • 50-70% max HR
  • 3-5 METS
  • 9-11, progress to 11-13
156
Q

What causes CIPN? Is it sensory or motor?

A
  • things bind around nerve and interfere with axonal transport
  • -can effect ganglion or nerve
  • primarily sensory (stocking glove)
157
Q

What are good outcome measures for CIPN?

A
  • TUG
  • timed sit to stand
  • Berg and Tinetti Scales
  • Purdue pegboard scale
  • pain quality assessment scale
  • QOL: fact-g, modified total neuropathy scale, ped-mTNS, CIPN-20, brief fatigue inventory
158
Q

How do you treat CIPN with meds?

A
  • use lower does of their chemo, or a different kind of chemo
  • protective agent
  • vitamin E
  • glutamin (nerve growth factor)
  • NSAIDs
  • antidepressants
159
Q

What should you educate your patients with CIPN on?

A
  • cold allodynia (can’t tolerate cold)
  • mechanical allodynia (can’t tolerate blanket on legs)
  • AD if lack of sensation effects gait
  • check feet, wear shoes, check water temp
  • fall prevention, balance training (progressive static and dynamic, 45-60 mins, 2x/week for 4 weeks; HEP 2x/day)
  • TENS for pain
  • MIRE (not reimbursed)
160
Q

What are the top four kinds of cancer?

A
  • breast
  • lung
  • large bowel
  • prostate
161
Q

What are types of breast cancer?

A
  • 80% infiltrating ductal adenocarcinomas (unilateral)
  • 10% lobular (small cell carcinoma)-diffuse, often bilateral
  • -usually requires full masectomy
  • 10% medullary, squamous cell (need radical masectomy)
  • ductal carcinoma in situ
  • inflammatory breast cancer (dimpling, read streaks, see hair follicles, skin around breast changes, discharge)
  • -infiltrates lymphatic system quickly, under diagnosed
162
Q

What are risk factors for breast cancer?

A
  • age, long menstrual history
  • obesity after menopause
  • genetics, family history
  • lack of exercise=more estrogen in body
  • previous chest wall radiation (past risk of lymphedema)
163
Q

What is a sentinnel node biopsy?

A

take 1 or 2 lymph vessels (increased lymphedema risk)

164
Q

What’s a MS effect of a modified radical mastectomy?

A

involves muscles, can involve nerves

disfigurement

165
Q

What are breast reconstruction impairments?

A
  • exercise delayed (don’t see for 2-3 weeks)
  • pectoralis on tension
  • postural adaptations
  • pain
  • decreased shoulder ROM
166
Q

What muscles can they use for breast reconstruction?

A
  • abdominal: long-term complications; start with small pelvic tilts, body mechanics; 2 weeks after-have to stay in flexed position
  • latissimus: need special operation table; decreased shoulder ROM, lose sensation; back, arm, shoulder weakness; no pushing or pulling (in and out of bed, hair), no repetitive motions until drains come out
167
Q

What are complications of breast reconstruction?

A
  • neuropathies
  • mastodynia pain syndrome
  • fatigue
  • weight gain
  • lymphedema
  • decreased strength and ROM in abduction and flexion, and lateral rotation
  • menopause symptoms
168
Q

BRAIN BREAK

A

page 43, slide 1, 2

169
Q

What is a risk reduction program for breast reconstruction?

A
  • reduce post op swelling
  • glenohumeral/scapula complex ROM
  • reduce scar tissue formation: scar massage
  • restore neuro muscular control and strength of the glenoumeral scapular musculature (rhomboids, midtrap)-abductors, scapular stabilizers
  • lymph drainage (if radiation therapy)
  • minimize risk of infection (hand and arm care)
  • -they are immunocompromised
  • education of early signs and symptoms
170
Q

BRAIN BREAK

A

page 44 levels of evidence slides

page 45 slides 1 and 2

171
Q

What nerve palsies might you see with breast reconstruction?

A
  • long thoracic (serratus anterior)

- thoracodosal nerve (strengthen rhomboids)

172
Q

How do you assess for lymphedema?

A
  • c/o heaviness, tightness, swelling

- >2cm at any of the 4 measurement points

173
Q

How do they diagnose prostate cancer?

A
  • digital exam

- PSA

174
Q

What are late symptoms of prostate cancer? Does it grow fast or slow?

A
  • urinary retention, urethral obstruction

- slow growing

175
Q

How do you treat prostate cancer?

A
  • surgery
  • Rad rx hormones
  • androgen deprivation therapy: deprive tumor of testosterone, increased risk of stroke diabetes and CV disease, cognitive decline in pts with PD or Alzheimer’s
176
Q

What do you do in rehab for prostate cancer?

A
  • spinal mets
  • LE lymphedema
  • incontinence
  • cancer related fatigue
  • resistance exercise
  • progressive aerobic exercise
177
Q

Colorectal cancer: ranking, dx, growth, treatment, rehab

A
  • 3rd leading cause
  • colonoscopy
  • slow growing
  • sx, rad rx, chemotherapy
  • wellness, deep breathing, function, ostomy precautions
  • -exercise, healthy eating
178
Q

BRAIN BREAK wow so many

A

page 46 slide 2, 3

179
Q

How do they treat lung cancer?

A
  • sx for localized cancer
  • radiation/chemo-higher stages
  • -higher doses=high risk for CIPN
180
Q

What are rehab issues with lung cancer?

A
  • decrease chest expansion, trunk mobility, ambulation tolerance
  • monitor vitals
  • -SpO2
  • paraneoplastic syndromes: peripheral neuropathy, proximal myopathy, tibia tenderness, hypercalcemia (bone mets)
181
Q

What are interventions for lung cancer pts?

A
  • breathing techniques, pulmonary hygeine
  • chest expansion
  • diaphragmatic breathing
  • strengthening
  • aerobic exercises
  • physcial modalities for pain
  • interval training-don’t tolerate continuous training
  • fall prevention
182
Q

Head and neck cancers: risks, common signs, when, men/women, psych issues, rehab

A
  • smoking and alcohol
  • dysphagia, hoarseness, lump in throat, difficulty swallowing, trouble eating
  • 5th and 6th decades
  • men
  • isolated, withdrawn due to aesthetic problems
  • secondary to surgery, limited ROM
183
Q

What impaired sensation might you have with head and neck cancers?

A

-lose spinal accessory nerve for a short period of time

184
Q

Where the hell would you get edema with head and neck cancer?

A

cheek and tongue-trouble eating

185
Q

What are barriers to participation for head and neck cancer patients?

A
  • dry mouth or throat
  • fatigue
  • drainage in mouth or throat
  • difficulty eating
  • SOB
  • muscle weakness
186
Q

BRAIN BREAK

A

read page 49, page 50 slide 3

187
Q

What is PRET?

A

-progressive resistance exercise training

188
Q

What is the goal of PRET?

A

enhance scapular stability and strength of upper extremity

189
Q

What do you do with PRET?

A
  • progressive strengthening of rhomboids, levator scap, biceps, triceps, infraspinatus, subscapularis, post delt, middle delt, supraspinatus
  • proper posture, may need taping at first
  • -facilitates neuromuscular feedback
190
Q

How is trismus related to cancer?

A
  • limited ROM in 50% of head and neck cancer pts
  • can occur years later
  • pts with head and neck cancer difficult to treat w/ exercise therapy
  • TheraBite increased mouth opening more than exercise
  • -exercise alone not effective
  • -decreased compliance
191
Q

Should you use modalities with radiated skin?

192
Q

brain tumors: who, peak incidence, adults vs kids

A
  • 2nd most common cancer in children
  • peaks during infancy and childhood and again in 5-8th decades
  • adults: mostly cerebral hemispheres, children: cerebellum and brainstem
193
Q

What are rehab implications for brain tumors?

A
  • ICP concerns (headaches, slurring words, behavioral changes)
  • early mobility-start in ICU
  • avoid valsalva/resistive exercise
  • identifyfunctional impairments
  • identify functional limitations
  • monitor vitals
  • monitor neurologic changes
  • meds to reduce N&V
  • increased DVTs, PE
  • cognitive impairments
  • fall prevention
  • seizure precautions
194
Q

leukemia

A
  • malignant tumor of the blood forming cells that replaces normal bone marrow with a malignant clone of lymphocytic or myelogenous cells
  • inhibits normal cell production
195
Q

BRAIN BREAK

A

classifications on page 52 slide 2

196
Q

acute vs chronic leukemia

A
  • acute: accumulation of immature lymphoid or myeloid cells in the bone marrow and peripheral blood
  • accumulation of mature lymphoid or meyloid cells
197
Q

What are the 3 main leukemia symptoms?

A
  • anemia
  • infection
  • bleeding tendencies-thrombocytopenia
198
Q

AML: who, tx, survival

A
  • acute myelogenous
  • most common in adults; difficult to treat in children
  • initial therapy aimed at eradicating the leukemic clone, bone marrow transplant
  • long term survival 60%, 75% with complete remission will relapse in 2 years
199
Q

CML: what, signs, tx, outcomes

A
  • chronic myelogenous
  • philadelphia chromosome
  • fatigue, fever, night sweats, splenomegaly
  • treatment is palliative to control WBC and platelets
  • poor outcome
200
Q

ALL: who, tx, outcome, risks, problems

A

-acute lymphoblastic
-children
-prolonged chemo, CNS prophylaxis
-good outcome, high treatment success rate
-high risk for CIPN
ADD, LDs following chemo; deficits in motor performance, balance

201
Q

Chronic lymphocytic leukemia

A
  • palliative chemo tx
  • incurable
  • 1-10 year survival
202
Q

Hodgkin’s lymphoma

A
  • lymphocyte-predominant; lymph nodes enlarged (neck-hoarseness, chest-difficulty breathing)
  • hella curable
  • chemo and radiation
  • -PET scans for tx effect
  • does not respond: autologous stem cell, peripheral blood stem cell transplant, last ditch effort
  • monoclonal antibody-based therapies
  • due to treatments, high risk for fatal MI, development of solid tumor
  • -radiation trauma-close to heart
203
Q

Non-Hodgkin’s lymphoma

A
  • lymphadenopathy
  • -large lymph nodes in chest
  • superior vena cava syndrome: dyspnea; rescue care needed-emergency radiation
  • slow growing tumors-palliative
  • aggressive treatment for fast tumors: stage 1 or 2 radiation, widespread chemo or radiation; immune modulators, BMT
  • -fibrosis everywhere-get up and moving ASAP
  • -chemo before BMT
204
Q

BRAIN BREAK

A

page 54 slide 3, page 55, slide 1,2

205
Q

Multiple Myeloma: what, presentation, treatment

A
  • overproduction of IgG, IgA antibodies
  • presents as back (bone) pain, anemia-check vitals
  • chemo, surgery, spinal decompression and fusion
206
Q

Rehab issues for multiple myeloma

A
  • WBing activity valuable to minimize further calcium loss
  • avoid torsion
  • safe mobility education: OP precautions
  • -pain with WBing-get the Dr (osteopathic fractures)
  • splinting/bracing
  • TENS/palliative pain measures
  • if positive for bone mets, dr has to clear them for exercise
  • sub max pressure for MMT, just make sure they can move against gravity
207
Q

Multiple myeloma: exercise program

A
  • aerobic exercise: 4-5x/week, 15-30 mins, moderate intensity (55-70% HR max, 11-16 RPE)
  • resistance exercise: 5-8 reps, 3 days/week for 20 mins with theraband
  • -chair stands, knee flexion/extension, bicep/tricep curls, upright rows, leg curls
  • flexibility exercise: 3 days/week, slow static prolonged stretch for 10-30 sec hold
208
Q

Childhood cancer survivors: brain function

A
  • increased risk with brain tumors or ALL
  • brain cells in the early years grow very quickly, making them very sensitive to radiation
  • cognitive impairments: lower IQ, problems with memory and attention, poor hand-eye coordination, slower development over time,behavioral problems; non-verbal skills like math more likely to be affected
  • seizures & headaches
  • effects on pituitary gland: poor appetite, fatigue, listlessness, cold inolerance
209
Q

Childhood cancer survivors:vision

A
  • most common in retinoblastomas
  • radiation can cause cataracts, slow bone growth causing changes in eye shape as child grows
  • chemotoxic to eye and may lead to blurred vision, double vision, glaucoma
  • children with stem cell transplants may be at higher risk for eye problems if they develop chronic graft-versus-host disease
  • other late effects: dry eye, watery eye, discolored sclera, poor vision, light sensitivity, poor night vision, tumors on the eyelid, drooping eyelid
210
Q

Childhood cancer survivors: hearing

A
  • chemo, radiation, and antibiotics may cause hearing loss (especially high-pitched sounds, higher risk in children who are young at the time of treatment)
  • other late effects: ringing in the ears, trouble hearing with high background noise levels, dizziness, hard, crusty ear wax
  • trouble with background noise
211
Q

Childhood cancer survivors: growth

A
  • delayed growth
  • radiation: head and neck can affect overall growth and development by damaging the pituitary
  • may affect bones, height, full maturity
  • very young children most likely to be effective
  • growth hormone may reverse some effects when pituitary gland is damaged
212
Q

Childhood cancer survivors: thyroid

A
  • affected by radiation or surgery to the head and neck or some stem cell transplants
  • affect growht, development, metabolism
  • most often hypothyroidism-extreme fatigue, dry skin, unexplained weight gain, constipation, slowed bone growth, thinning hair
  • hyperthyroidism less likely but possible
  • greater risk for thyroid nodules
213
Q

Childhood cancer survivors: muscle and bone

A
  • bone, soft tissue, muscle and blood vessels sensitive to radiation during times of rapid growth (young children and growing children at greatest risk)
  • late effects: unequal growth, bone pain, joint stiffness, changes in gait, increase susceptibility to fractures, decreased calcium
  • high doses of chemo or corticosteroids to treat leukemia or lymphoma can cause osteonecrosis
  • gait changes, proximal muscle weakness
214
Q

Childhood cancer survivors: sexual development- males

A
  • radiation and chemo can reduce sperm production
  • treatments that alter testosterone can lead to failure to complete puberty, delayed or accelerated puberty, decreased sexual desire or impotence
215
Q

Childhood cancer survivors: sexual development- females

A
  • high doses of chemo can damage ovaries causing changes in menstrual cycle-more at risk after puberty
  • at risk for early menopause and reduced fertility-early menopause increases risk for OP and coronary heart disease
  • increased risk for miscarriage, low birght weight, premature birth
216
Q

Childhood cancer survivors: heart and lungs

A
  • increased cardiac mortality in adult survivors
  • chemo: damage to heart muscle, dysrhythmias, decreased left ventricular function associated with reduced contractility and excessive afterload; fibrosis and pneumonitis
  • radiation: CHF, dysrhythmias, heard valve abnormalities, and damage to coronary arteries; decrease lung volume, SOB, constant cough, pulmonary fibrosis, pneumonitis, increased risk of infections, increased risk for lung cancer, decreased chest wall growth
  • heart transplants
  • increased SOB, increased arhythmias-red flags
  • watch activity levels and changes in CV response
  • more likely to have a heart attack
217
Q

Childhood cancer survivors: teeth

A
  • mostly effects from chemo or radiation in children who were treated before the age of 5
  • include small teeth, missing teeth or delayed development, abnormal tooth enamel, increased risk of cavities, sensitivity to hot or cold, gum disease, short roots
  • salivary glands affected: decreased saliva and dry mouth
  • malnourished
  • dry mouth: increased risk of fungal infections in mouth->sores
  • -stay hydrated
218
Q

Childhood cancer survivors: obesity

A
  • ALL and brain tumors at greatest risk due to chronic steroid therapy and cranial radiation
  • more likely to have diabetes type 2
  • development of metabolic syndrome: obesity, HTN, dyslipidemia or impaired glucose tolerance
  • -increased cholesterol
219
Q

Childhood cancer survivors: second cancers

A
  • increased risk associated with: younger age, female, family hx of cancer, and primary diagnosis
  • chemo therapies associated with secondary incidence of AML and myelodysplastic syndrome (also known as preleukemia)
  • most common: breast, thyroid, bone cancer
  • -higher risk areas treated
  • -Hodgkin’s lymphoma survivors at highest risk of secondary cancers
220
Q

Risk factors for HIV/AIDS

A
  • unprotected sex
  • more than 6 partners
  • poverty
  • illegal drug use
  • poor access to health care
  • communities with high prevalence
221
Q

Does everyone exposed to HIV get it? Do they all get AIDs?

222
Q

Pathogenesis of HIV

A
  • progressive destruction of Tcell (cell mediated immunity)
  • destroys and inactivates T4 lymphocytes (CD4 cells); macrophages and B cells also affected
  • -every system relies on CD4 cells
  • migrates from serum into tissue to blood destroying lymphocytes
  • cell containing CD4 antigen serve as a receptor during DNA replication
  • HIV contains reverse transcriptase
  • -HIV viruses take over CD4; dropping CD4 determines tx, when they get symptoms
  • high mutation rate
223
Q

What is the first sign of HIV/AIDS usually?

A
  • worst flu they’ve ever had, reoccuring flus or pneumonias
  • infection they can’t get rid of
  • fluctuations in CD4/T cell counts
224
Q

What are symptoms in the early stages? Middle? Late?

A
  • skin infections, fatigue, night sweats, weight loss
  • mild symptoms increase
  • pneumocystis pneumonia, CMV, neurologic (coma), cancer
225
Q

What are five symptoms of aids?

A
  • fatigue, depression
  • frequent recurrent infections (enlarged lymph glands, joint pain)
  • diarrhea (malnutrition, weight loss)
  • Kaposi’s sarcoma (w/ it and under 60-get tested)
  • altered neurologic function
226
Q

What do infections look like for HIV patients?

A

1 or 3 forms

  • immunodeficiency with unusual malignancies and opportunistic infections (25-40% have Hep C)
  • autoimmunity such as RA, pneumonitis and production of autoimmune antibodies
  • neurologic dysfunction, AIDs, dementia, HIV encephalopathy and peripheral neuropathies
227
Q

What is the difference between acute infection and clinical latency and AIDS?

A
  • acute: CD4>500
  • latency: CD4=200-500
  • AIDS: CD4=<200
228
Q

BRAIN BREAK

A

read page 5, slide 2, because i’m not sure what you’re supposed to get out of that. Good luck!

229
Q

Clinical Manifestations of AIDS

A
  • persistent generalized adenopathy
  • weight loss, fatigue, night sweats, fevers, weakness
  • opportunistic infections (examples on page 6 if you care)
  • Nervous system: peripheral neuropathies, foot drop, balance issues; pain-burning, tingling, hypersensitivity and proprioceptive losses; severe dementia; incontinence (neurogenic->lose sensation to bladder); paraplegia, dizziness
  • more restricted exercise
  • osteomyelitis, bacterial myositis, non-Hodgkin’s
  • sternocleidomastoid infection if drug user
  • chronic diarrhea, fever, malnutirion
  • pelvic inflammatory disease in women (back pain)
  • polymyositis
230
Q

What is polymyositis?

A
  • autoimmune disorder-inflammation of proximal muscles bilaterally; can occur in face and neck
  • improves with plasmapheresis, corticosteroids
  • exercises to maintain and improve strength and flexibility and advise an appropriate level of activity
231
Q

What is plasmapheresis?

A
  • large catheter in vein in neck or upper leg
  • blood taken out plasma filtered, add donor plasma, return blood cells
  • done daily until platelets return to normal levels
  • can be done OP
232
Q

How do you treat HIV/AIDS?

A
  • no cure
  • prevention
  • HAART meds: goal- control growth of virus, improve overall immune system function, suppress symptoms, produce as few side effects as possible
233
Q

What is HAART?

A
  • highly active antiretroviral therapy
  • for when CD4 is <350
  • classes (use at least 2)
  • -reverse transcriptase inhibitors (nucleoside or non-nucleoside)
  • -protease inhibitors
  • -entry inhibitors
  • -integrase inhibitors
234
Q

What do nucleoside reverse transcriptase inhibitors do?

A

Stall reproduction of HIV by forcing the virus to use faulty version of building blocks
-Combivir, emtriva, retrovir, trizir, epivir, videx, vreaed

235
Q

What do nonnucleoside reverse transcriptase inhibitors do?

A

Interrupts early stage of the virus making copies of itself

-Rescriptor, viramune, sustiva, intelence, rilpivirine

236
Q

FUN FACT

A
  • the FDA has approved 2 one pill OD products which serve as a combo of different RT inhibitors
  • -Complera
  • -Aripla
237
Q

RT inhibitors: side effects

A
  • decrease in RBCs or WBCs
  • inflammation of pancreas
  • painful nerve damage
  • avascular necrosis of femoral head
  • AZT myopathy (proximal muscle wasting)
  • metabolic disorders: lipodystrophy, dyslipidemia (early atheroscloerosis and insulin resistance)
238
Q

Avascular necrosis of femoral head

A
  • lack blood flow-pain with weight bearing, tell Dr

- have to have joint replacement

239
Q

Lipodystrophy

A
  • arm, leg, face weakened, fat taken to abdomen
  • high levels of fat accumulation
  • insulin resistance, elevated blood sugars
  • Buffalo hump, lipomas (fatty tissue build up)
240
Q

Protease inhibitors: what they do, side effects

A
  • interfere with enzyme that HIV uses to create infectious viral particles; nucleoside reverse transcriptase
  • nausea, diarrhea, GI symptoms
  • -any fast growing or quickly cycling cells will be effected
  • Norvir, Invirase, Viracept
241
Q

Integrase inhibitors: what do they do?

A
  • block insertion of viral DNA into the host cell DNA
  • -stop virus from spreading it’s unhealthy DNA
  • isentress
242
Q

Entry inhibitors: what they do, side effects

A
  • help block HIV’s enry into healthy cells
  • dyspnea, chills, fever, skin rash, blood in urine, vomiting, low BP, fatigue, malaise
  • -apoptysis of cells: immune response
  • -fells like they have the flu for 40 years
  • Seizentry
243
Q

What is the leading cause of death for HIV/AIDS?

A

kidney or liver failure

244
Q

opportunistic infections

A

-CMV, pneumonia, pneumocystic pneumonia

245
Q

Candidiasis/thrush

A

fungal infection in mouth
extremely painful
lack nutiriton

246
Q

What do therapeutic interventions do for HIV/AIDs patients?

A
  • normalize insulin resistance caused by lipodystrophy
  • improves QoL
  • provides pain relief
  • improves appetite
  • enhances immune function
  • improves pulmonary function and prevents pneumonia
247
Q

Stage 1 therapeutic intervention

A
  • no limitation to exercise
  • competition acceptable but overtraining not advised
  • -worsens immune system-cortisol
  • –tired, malaise, fatigue-they have a hard time relowering
248
Q

Stage 2&3 therapeutic intervention

A
  • functional capacity reduced, can’t do some ADLs
  • require individualized program and lower intensity
  • competition not advised
  • energy conservations
249
Q

BRAIN BREAK

A

page 13, slide 1

250
Q

What are screening tools for neuropathy?

A

Total Neuropathy Score (good reliability), Subjective Peripheral Neuropathy Screen, Brief Peripheral Neuropathy Screen, Neuropathy Severity Score, Single Quest Neuropathy Screen

251
Q

Aerobic exercise parameters

A
  • graded exercise test for Stage 2 or 3
  • 60-80% max HR with RPE 14
  • 20 minutes (constant or interval)
  • -interval for later stages, someone having ADL trouble
  • *if you’re teaching energy conversation you should be teaching interval training
  • 3x/week
252
Q

What are safe CD4 levels for exercise?

A

100-1000 cells/mm3

253
Q

Progressive resistive exercise parameters

A
  • weights, resistive machines, theraband of large muscle groups
  • goal: minimize or reverse muscle wasting, weight gain
  • -big concern: lipodystrophy-enchance muscle function and bulk
  • 3x/wk
  • 20-25 mins
  • 50-90% 1 rep max
  • 1-5 sets of 4-18 reps
254
Q

But with exercise you should…

A

couple aerobic and resistive!!

255
Q

What does the evidence say about exercise and HIV/AIDs?

A

go read page 14. slides 2-3 and page 15, slide 1 to find out!

256
Q

What are 4 complimentary therapies for HIV/AIDs?

A
  • nutritional counseling
  • acupuncture: increased energy, decreased side effects of meds, pain control
  • homeopathy, herbs: increased energy, stimulate immune system, decreased side effects of meds; not regulated
  • -can counteract HAART meds
  • Meditation, Yoga, Tai Chi: decreased stress
257
Q

Read those cases bro

A

congrats you’re done after that!

MultiSystem Management (6 decks)

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