Special Topics Flashcards
what is cancer related fatigue
-associated w surgery, chemom, raidation
-cumulative
-does not improve with rest
-limits quality of life
-affects ability to concentrate
what are the subjective and objective compponents of CRF
-physical: weak/tired
-mood: depression/anxiety
-motvation: lack of
-cognition: slow
-social: reduced ability to sustain relationships
how do you screen fatigue
-fatigue thermometer
-one item fatigue scale
what is a 0 on the ECOG scale
normal activity
what is a 1 on the ECOG scale
symptoms demonstrated, but pt remainds ambulatory and able to perform self care
what is a 2 on the ECOG scale
ambulatory >50% of the time and requires occasional assistance
what is a 3 on the ECOG scale
ambulatory <50% of the time and requires nursing care
what is a 4 on the ECOG scale
bedridden
what is a 5 on the ECOG scale
death
on the Karnofsky performance status scale, which number range is normal?
80-100
on the Karnofsky performance status scale, which number range is unable to work/able to live at home and care for most personal needs/minimal assistance?
50-70
on the Karnofsky performance status scale, which number range is unable to care for self/progressive disease?
0-40
what should the exercise intensity be for CRF?
50-70% max HR
Borg 12-14
modified borg: 3
what should the strength intensity be for CRF?
30-50% 1RM
how long should CRF workout?
accumulate 30 min most days per week
at least 3 days
what cautions should you watch for w cancer?
-bone metastases
-thrombocytopenia
-anemia
-neutropenia
what is an osteolytic lesion
cancer has caused bone breakdown or thinning; destroys bone material
what is an osteoblastic lesion
cancer has caused overproduction of bone cells which makes them rigid and inflexible
talk about spinal cord compression
-primary or secondary disease spreads to the vertebra and impinges on the spinal column
-etiologies: vertebreal collapse, direct invasion, prolonged compression can disrupt vascular supply
signs and symp:
-back pain
-motor> sensory changes
-bowel/bladder
-DTR
what is post prostatectomy incontinence
-immediately after catheter removal
what are the norms for RBC
M: 4.7-5.5
F: 4.1-4.9
what are the norms for WBC
4,500-11,000
what are the norms for hemoglobin
M: 14.4-16.6
F: 12.2-14.7
what are the norms for hematocrit
M: 43-49
F: 38-44
what are the norms for platelets
150,000-350,000
what is plasma
liquid part of blood 55%
-pale yellow made of 91% water
colloid: liquid containing suspended substacnes that dont settle out
what does albumin do
important in regulation of water movement between tissues and blood
what do globulins do
immune system and transport molecules
what do clotting factors/fibringogen do
responsible for formation of blood clots
what makes up formed elements
- RBC
- WBC: granulocytes and agranulocytes
- thrombocytes
talk about erythrocytes
componenets: hemoglobin, lipids, ATP, carbonic
function:
-transport oxygen from lungs to tissues and carbon dioxide from tissues to lungs
-acid base balance
what is mild anemia
> 10-11.9
therapy as indicated; no precautions
what is moderate anemia
8-9.9
-decreased cardio reserve/endurance
-monitor VS closely
-patient symptoms: exercise intolerance/DOE/tachycardia/pallor
what is severe anemia
<7-8
-therapy may be contraindicated
-blood transfucsion
<5=increased risk of cardiac event
what is hematocrit
ratio of volume of RBC to total volume of blood
what is a crtiical value for hematocirt
<25%
what are the signs of anemai
weakness, fatigue, dyspnea
tachycardia., pallor
what are some transfusion reactions
- febrile non-hemolytic reaction=most common, fever, chills SOB
- acute hemolytic reaction-rapid destruction of donor erythrotyes= decreasing H&H
- anaphlactic reaction
- transfuction associated acute lung injury
talk about thrombocytes
-small fragments of megakaryocytes
-platelets contain granules that are secreted in response to activation
-important in preventing blood loss= platelet plugs
what value is thrombocytopenia
<150,000
what value is thrombocytosis
> 350,000
what can you do for exercise when thrombocytopenia is 50,000-149,999?
low intensity
what can you do for exercise when thrombocytopenia is 30,000-50,000?
not associated w spontaneous bleeding
-AROM exercise, walking
what can you do for exercise when thrombocytopenia is <10,000-20,000?
risk of spontaneous bleeding
therapy contraindicated
what can you do for exercise wtih thrombocytosis
no distinct rec
-increased risk of bleeding
what is VTE
disease that includes both DVT and PE
3rd most common CV illness
what is Wells criteria for PE
- prevoius PE or DVT
- heart >100 bpm
- recent surgery within past 4 weeks or immobilization >3 days
- clinical signs of DVT
- alternative diagnosis less likely than PE
- hemoptysis
- malignancy/cancer
what are the hallmark clinical features of a PE
- tachypnea (16 breahs per minute or greater)
- tachycardia
- sudden onset dyspnea
- chest pain
call 911, if you suspect PE
what are the other features to consider with a PE?
- hypotension, dizzy, lighthead
- desaturation
- cough
what are the long term complications of a DVT
-venous stasis syndrome
-venous ulcer
what are the long term compilcations of a PE
-chronic thromboembolic disease/pulmonary hypertension
-post PE syndrome
what is post thrombotic syndrome
-developts in 20-50% of patients within 1-2 years
-severete PTS results in venous stasis ulcers
what are common symptoms of post thrombotic syndrome
-pain: heaviness, cramps, itching, tingling
-aggravated by standing or walking
physical exam:
-edema, hyperpigmentation, varicostiies
what are the risk factors for PTS
-proximal DVT
-recurrent DVT
-prolonged symptoms
-obseity
-inadequate coagulation
what are the functions of the lymphatic system
-tissue drainage
-fat transport
-immune responses
how does lymph move
-lymphatic vessel contraction
-skeletal muscle contraction compression to lymph vessels
what is lymphedemea
-accumulation of protein rich fluid; often in extremities
-injury/blockage to lymphatic vessels
-surgery, radiation, tumor
-acute or chronic
tx:
-surgery
-complete decongestive therapy
-pressure garments and pumps
define edema
excess fluid in body tissues which is a result of abnormal leakage of fluid across capillaries from the plasma to interstitial spaces
define lymphedema
abnormal accumulation of protein rich fluid in the interstitium and often accompanised by reactive fibrosis and skin changes
what is stage 0 of lymphedema
latent, sub clinical
what is stage 1 of lymphedema
spontaneously reversib le
-present during day but not at night
-no skin changes
-pitting starts bertween stage 1 and 2
what is stage 2 of lymphedema
spontaneously irreversible
-does not fully reduce overnight
-skin hard
-+ Stemmers sign, swelling
what is stage 3 of lymphedema
change in limb morphoolohy
more advanced skin changes
which stages of lymphedema requires intervention
stages 2 and 3
-increased risk of cellulitis
-diuretics aren’t helpful
how is lymphedema treated
complete decongestive therapy (CDT)
-manual lymph drainage
-bandagin
-compression
-exercise
-self care
