Special Conditions Flashcards by Gabriella Jordan

Definition pf Cancer related Fatigue

Distressing persistent subjective sense of emotional, cognitive exhaustion

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Does CRF improve with rest?

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

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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

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CRF PT intervention largest treatment effect

combination to aerobic and resistance training provide the largest treatment effect

start low and progress slow but progress

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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)

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Characteristics of cancer pain

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

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Breakthrough pain

An acute exacerbation of pain where it was previously stable

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Two types of bone lesions

Osteolytic - breakdown /destroy bone
Osteoblastic - build up /overproduction

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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

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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

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Spinal cord compression

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

motor> sensory changes
DTR change /bowel bladder

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Post Prostectomy Incontinence

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

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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

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Formed elements of blood (not plasma)

RBC: erythrocytes
WBC leukocytes
- granulocytes - agranulocytes
Platelets

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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

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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

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Hematocrit (Hct)

The ratio of RBC to total volume of blood

40-50%

<25 is often the critical value

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Can you have tranfusion reactions ?

Yes , different types , can be life threatening

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Thrombocytes (platelets)

important role in blood clotting, prevent blood loss

decrease in number, increase bleeding risk

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DVT (+ / OR) PE=

VTE : Venous thromboembolism

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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

1. Encourage mobility and Physical Activity 2. Use of mechanical compression 3. consult with physician and medication 4. 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)

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