Special Conditions Flashcards
Definition pf Cancer related Fatigue
Distressing persistent subjective sense of emotional, cognitive exhaustion
Does CRF improve with rest?
NO, Does not improve with rest
MULTIDIMENTIONAL : multifactorial, bio-behavioral phenomenon that impacts ADLs, well being, social, behavioral, occupation
Screening tools for CRF
-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
CRF PT intervention largest treatment effect
combination to aerobic and resistance training provide the largest treatment effect
start low and progress slow but progress
Caution when performing exercise with any of the following
Bone metastases (cancer spread to bone)
Thrombocytopenia (low platelets)
Anemia(low RBC)
Neutropenia (low WBS)
(avoid env. where risk of exposure to infectious disease)
Characteristics of cancer pain
1.Directly related to cancer
2. Related to cancer therapy
3.Related to effects of cancer
4. Age related comorbidities
Breakthrough pain
An acute exacerbation of pain where it was previously stable
Two types of bone lesions
- Osteolytic - breakdown /destroy bone
- Osteoblastic - build up /overproduction
What is Mirels Scoring system
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
Pain characteristics impending fracture
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
Spinal cord compression
primary or secondary disease spreads to the vertebra and impinges on spinal column
motor> sensory changes
DTR change /bowel bladder
Post Prostectomy Incontinence
Immediately after catheter removal: 90 %
after 1 year: 5% to 40%
Plasma (55% of blood)
91% of plasma is water
made of
Albumin - ( majority) imp. for osmosis
Gobulins: immune system and transport molecules
Clotting factors: formation of blood clots
Formed elements of blood (not plasma)
- RBC: erythrocytes
- WBC leukocytes
- granulocytes - agranulocytes - Platelets
Erthrocytes (RBC)
Structure: biconcave
Components: hemoglobin, lipids, atp, carbonic anhydrase
Function: transports O2 from lungs tto tissues and CO2 back to the lungs from tissues
Anemia
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
Hematocrit (Hct)
The ratio of RBC to total volume of blood
40-50%
<25 is often the critical value
Can you have tranfusion reactions ?
Yes , different types , can be life threatening
Thrombocytes (platelets)
important role in blood clotting, prevent blood loss
decrease in number, increase bleeding risk
DVT (+ / OR) PE=
VTE : Venous thromboembolism
Pulmonary embolisms are being diagnosed ____ and rates are ____ but still remain ___
Diagnosed more, rates are declining but still remain high
Virchow’s Triad
Factors that increase risk for developing blood clots :
Includes:
1. Hypercoaguable state
2. Circulatory stress
3. Vascular wall injury
VTE is a disease of hospital and recently hospitalized patients why is this a concern for people in community?
People are getting discharged sicker and quicker. Higher risk of developing VTE
Low clinical probability of DVT what test do they use
D-dimer assay to see if there is a clotting factor present
High clinical probability of DVT test
Duplex ultrasound
Wells Prediction rule : DVT likley
Greater than or equal to 2
Wells Prediction Rule for PE
PE likely : Greater than 4
What is the Gold standard for diagnosing PE?
CT Angiography : requires contrasting agent (cant do with someone with kidney damage)
VCUS procedure
Venous compression ultrasound : looks at veins , if they collapse no clot, if they do not collapse there is a clot
Can you use ultrasound for a PE
Not recommended, CT pulm angiography is used most often , can also use a V/Q scan
Hallmark clinical features of a PE
Tachypnea
Tachycardia
Sudden onset of dyspnea
Chest pain
Other features to consider for PE
Hypotension (dizziness, lightheadedness)
Desaturation
Cough
Mechanism of PE
Blood clot occupying pulmonary vasculature , and inhibits the return of oxygenated blood to the heart
Why is pulmonary embolism so deadly ?
RV loses function due to the increase demand
Is it safe to exercise if someone has a blood clot?
Only if they are on blood thinner
* check mobilization algorithm
Intervention to decrease VTE risk
- Encourage mobility and Physical Activity
- Use of mechanical compression
- consult with physician and medication
- Provide education on VTE preventioon
Post thrombotic Syndrome (PTS) also known as venous stasis syndrome
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
Risk factors for PTS
Proximal DVT
Recurrent DVT
Prolonged symptoms
Obesity
inadequate or delayed anticoagulation
Post PE Syndrome
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
Movement of Lymph
2 modes of transport
lymphatic vessel contraction
skeletal muscle contraction
Functions of the lymphatic system
tissue drainage
fat transport
immune respons
Edama vs lymphedema
Excess fluid leakage from capillaries from the plasma to the interstitial spaces
Generalized
Local
Lymphedema
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
Lymphedema treatments
Compression garments +pneumatic pressure pumps
Surgery
Complete decongestive therapy
What stages of lymphadema require intervention
stage 2 and 3 to clear interstisial proteins .
increase risk of cellulitis
Diuretics arnt helpful
Stemmer Sign
Pinch and try to lift the skin , stemmers sign is positive if you cannot lift the skin (swelling is a positive)
What are the stages of lymphedema
0: No observable swelling
1: Spontaneously reversible
(1.5): pitting
2: spontaneously irreversible
3: Lymphostatic Elephantiasis: tissue is hard, skin is thick
S & S of Lymphedema
Achy
Tightness
heaviness
pins and needles
pain of congestion
Ways to reduce the risk of developing/worsening lymphedema?
Physical activity
Compression garments
Avoiding extremes of temp. (hot tub/sauna)
skin care
Avoid limb constriction (BP cuff)
What is complete Decongestive therapy (CDT)
- manual lymphatic drainage (MLD)
- bandaging
- exercise
- compression garments
- self care
Phase 1: decongestion
Phase 2: maintenance
MLD contraindications
acute cellulitis
acute DVT
severe cardiac insufficiency
HF
ascites
unstable hypertension
RF
SVC obstruction
tuberculosis , malaria
