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Med Conditions > Special Conditions > Flashcards

Special Conditions Flashcards

1
Q

Definition pf Cancer related Fatigue

A

Distressing persistent subjective sense of emotional, cognitive exhaustion

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2
Q

Does CRF improve with rest?

A

NO, Does not improve with rest
MULTIDIMENTIONAL : multifactorial, bio-behavioral phenomenon that impacts ADLs, well being, social, behavioral, occupation

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3
Q

Screening tools for CRF

A

-One item fatigue scale , fatigue thermometer, visual analogue scale
-FACIT Fatigue Scale
-Brief Fatigue inventory
**Eastern cooperative Oncology group performance scale (ECOG)
**Karnofsky performance status scale

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4
Q

CRF PT intervention largest treatment effect

A

combination to aerobic and resistance training provide the largest treatment effect

start low and progress slow but progress

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5
Q

Caution when performing exercise with any of the following

A

Bone metastases (cancer spread to bone)
Thrombocytopenia (low platelets)
Anemia(low RBC)
Neutropenia (low WBS)
(avoid env. where risk of exposure to infectious disease)

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6
Q

Characteristics of cancer pain

A

1.Directly related to cancer
2. Related to cancer therapy
3.Related to effects of cancer
4. Age related comorbidities

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7
Q

Breakthrough pain

A

An acute exacerbation of pain where it was previously stable

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8
Q

Two types of bone lesions

A
  1. Osteolytic - breakdown /destroy bone
  2. Osteoblastic - build up /overproduction
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9
Q

What is Mirels Scoring system

A

Used for pathologic fracture risk and determines decision
rated by: size, pain, lesion type, size

<7 radiation therapy and observation
8 use clinical judgment
>8 prophylactic surgical fixation

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10
Q

Pain characteristics impending fracture

A

Pain with weight bearing * Pain in the groin * Pain with hip scour * Pain with hip external rotation
and abductionPain with deep inspiration * Pain in a band around the chestwall * Increased pain with supine * Increased pain with valsalva

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11
Q

Spinal cord compression

A

primary or secondary disease spreads to the vertebra and impinges on spinal column

motor> sensory changes
DTR change /bowel bladder

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12
Q

Post Prostectomy Incontinence

A

Immediately after catheter removal: 90 %
after 1 year: 5% to 40%

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13
Q

Plasma (55% of blood)

A

91% of plasma is water
made of
Albumin - ( majority) imp. for osmosis
Gobulins: immune system and transport molecules
Clotting factors: formation of blood clots

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14
Q

Formed elements of blood (not plasma)

A
  1. RBC: erythrocytes
  2. WBC leukocytes
    - granulocytes - agranulocytes
  3. Platelets
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15
Q

Erthrocytes (RBC)

A

Structure: biconcave
Components: hemoglobin, lipids, atp, carbonic anhydrase
Function: transports O2 from lungs tto tissues and CO2 back to the lungs from tissues

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16
Q

Anemia

A

Not enough hemoglobin
Mild, Mod, Severe
Severe 7-8 g/dl

Therapy may be contraindicated
blood transfusion probable : Hb < 7g/dl

<5g/dl increase risk of cardiac event

SS: weakness , fatigue, Dyspnea
Hx: chronic illness , HD, cancer , sx

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17
Q

Hematocrit (Hct)

A

The ratio of RBC to total volume of blood

40-50%

<25 is often the critical value

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18
Q

Can you have tranfusion reactions ?

A

Yes , different types , can be life threatening

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19
Q

Thrombocytes (platelets)

A

important role in blood clotting, prevent blood loss

decrease in number, increase bleeding risk

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20
Q

DVT (+ / OR) PE=

A

VTE : Venous thromboembolism

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21
Q

Pulmonary embolisms are being diagnosed ____ and rates are ____ but still remain ___

A

Diagnosed more, rates are declining but still remain high

22
Q

Virchow’s Triad

A

Factors that increase risk for developing blood clots :

Includes:
1. Hypercoaguable state
2. Circulatory stress
3. Vascular wall injury

23
Q

VTE is a disease of hospital and recently hospitalized patients why is this a concern for people in community?

A

People are getting discharged sicker and quicker. Higher risk of developing VTE

24
Q

Low clinical probability of DVT what test do they use

A

D-dimer assay to see if there is a clotting factor present

25
Q

High clinical probability of DVT test

A

Duplex ultrasound

26
Q

Wells Prediction rule : DVT likley

A

Greater than or equal to 2

27
Q

Wells Prediction Rule for PE

A

PE likely : Greater than 4

28
Q

What is the Gold standard for diagnosing PE?

A

CT Angiography : requires contrasting agent (cant do with someone with kidney damage)

29
Q

VCUS procedure

A

Venous compression ultrasound : looks at veins , if they collapse no clot, if they do not collapse there is a clot

30
Q

Can you use ultrasound for a PE

A

Not recommended, CT pulm angiography is used most often , can also use a V/Q scan

31
Q

Hallmark clinical features of a PE

A

Tachypnea
Tachycardia
Sudden onset of dyspnea
Chest pain

32
Q

Other features to consider for PE

A

Hypotension (dizziness, lightheadedness)
Desaturation
Cough

33
Q

Mechanism of PE

A

Blood clot occupying pulmonary vasculature , and inhibits the return of oxygenated blood to the heart

34
Q

Why is pulmonary embolism so deadly ?

A

RV loses function due to the increase demand

35
Q

Is it safe to exercise if someone has a blood clot?

A

Only if they are on blood thinner
* check mobilization algorithm

36
Q

Intervention to decrease VTE risk

A
  1. Encourage mobility and Physical Activity
  2. Use of mechanical compression
  3. consult with physician and medication
  4. Provide education on VTE preventioon
37
Q

Post thrombotic Syndrome (PTS) also known as venous stasis syndrome

A

Major complication that can develop after DVT

Thrombus creates inflammation and damage to the vein causing venous incompetence that results in blood pooling

Causes: edema, tissue hypoxia, ulcerations

develops in 20-50 % of patients within 1-2 years

38
Q

Risk factors for PTS

A

Proximal DVT
Recurrent DVT
Prolonged symptoms
Obesity
inadequate or delayed anticoagulation

39
Q

Post PE Syndrome

A

Persistent elevated pulmonary A. pressure and or RV dysfunction leading tot functional limitations and QOL

final hit: pulmonary arteriopathy and in situ thrombosis

Final result: Chronic thromboembolic pulmonary HTN

40
Q

Movement of Lymph
2 modes of transport

A

lymphatic vessel contraction
skeletal muscle contraction

40
Q

Functions of the lymphatic system

A

tissue drainage
fat transport
immune respons

40
Q

Edama vs lymphedema

A

Excess fluid leakage from capillaries from the plasma to the interstitial spaces

Generalized
Local

41
Q

Lymphedema

A

Accumulation of protein rich fluid in the interstitium most often in the extremities often accompanied by reactive fibrosis and skin changes

injury or blockage to lymphatic vessels /nodes

congenital , acquired

caused by: surgery,radiation,tumor

41
Q

Lymphedema treatments

A

Compression garments +pneumatic pressure pumps
Surgery
Complete decongestive therapy

42
Q

What stages of lymphadema require intervention

A

stage 2 and 3 to clear interstisial proteins .

increase risk of cellulitis
Diuretics arnt helpful

42
Q

Stemmer Sign

A

Pinch and try to lift the skin , stemmers sign is positive if you cannot lift the skin (swelling is a positive)

42
Q

What are the stages of lymphedema

A

0: No observable swelling
1: Spontaneously reversible
(1.5): pitting
2: spontaneously irreversible
3: Lymphostatic Elephantiasis: tissue is hard, skin is thick

43
Q

S & S of Lymphedema

A

Achy
Tightness
heaviness
pins and needles
pain of congestion

44
Q

Ways to reduce the risk of developing/worsening lymphedema?

A

Physical activity
Compression garments
Avoiding extremes of temp. (hot tub/sauna)
skin care
Avoid limb constriction (BP cuff)

45
Q

What is complete Decongestive therapy (CDT)

A
  1. manual lymphatic drainage (MLD)
  2. bandaging
  3. exercise
  4. compression garments
  5. self care

Phase 1: decongestion
Phase 2: maintenance

46
Q

MLD contraindications

A

acute cellulitis
acute DVT
severe cardiac insufficiency
HF
ascites
unstable hypertension
RF
SVC obstruction
tuberculosis , malaria

Med Conditions (6 decks)

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