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Med Con II > Special Topics > Flashcards

Special Topics Flashcards

1
Q

Is CRF multidemetional does it impact ADLS, mental, emotional, social and occupation of the pt and caregivers

A

Yes

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2
Q

Is is appropriate to ask a one item fatigue scale question like since your last visit how would you rate your fatigue 1-10?

A

yes or a fatigue thermomenter

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3
Q

Explain the levels of the Eastern Cooperative Oncology Group ECOG performance Scale

A

1-normal activity
2- pt remains ambulatory, able to perform self care
3- ambulatory >50% of the time requires occasional assistance
4- ambulatory <50% of the time and requires assistance with care
5- bedridden
6- death

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4
Q

Explain the Karnofsky Perormance Scale

A

100- normal
70-50- unable to work able to live at home and care for self
50-10- unable to care for self requires equivalent hospital care
0-dead

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5
Q

What are the possible interventions for CRF?

A

Exercise- aerobic and strength
acupuncture/yoga
lymphedema management

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6
Q

How would you prescribe exercise for a cancer patient

A

50-70% HR max modified borg 3
accumulate 30 min most days of the week >3x per week

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7
Q

There are 4 conditions that we need to be cautious of perfoming exercise with?

A
  1. bone metastasis- cancer spread to the bone
  2. thrombocytopenia- low platelets increase bleed risk
  3. anemia- low RBC
  4. neutropenia- low level of neutrophils increase infection risk
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8
Q

_____ is acute exacerbation of pain of short duration on the background of stable pain pattern.

A

breakthrough pain

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9
Q

What are some common cancer pain characteristics?

A
  1. directly related to cancer
  2. related to chemo or radiation
  3. related to effects of cancer like bed sores or debility
  4. age related, comorbities
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10
Q

Compare Osteoblastic Lesion and Osteolytic lesions

A

osteoblastic- cancer has cause over production of bone (prostate)
Osteolytic- cancer has caused a breakdown or thinning; destroy bone (myeloma, renal cancer, melanoma)

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11
Q

What score on the Mirels scoring system relates to an extreme risk of fracture

A

> 8

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12
Q

Explain spinal cord compression and general SS

A

primary or secondary disease spreads to the vertebra and impinges on the spinal column
SS:
back pain- 95%
motor>sensory changes
Bowel/bladder
DTR changes

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13
Q

What is the incidence of incontinence immediately following catheter removal?

A

90%

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14
Q

Most common blood test include two things?

A

Complete blood count (CBC) and Basic Metabolic Profile

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15
Q

What is included in a Complete Blood Count

A

Red blood cells
white blood cells
hemoglobin
hematocrit
platelets

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16
Q

What is the normal value for RBC

A

male- 4.7-5.5 million
female 4.1-4.9 million

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17
Q

what is the normal value for WBC

A

4,500-11,000 cells/mm3

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18
Q

what is the normal value for hemoglobin

A

male 14.4- 16.6
female 12.4- 14.7

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19
Q

what is the normal value for hematocrit

A

male 43%- 49%
female 38-44%

20
Q

What is the normal value for platelets

A

150,000- 350,000

21
Q

Explain what makes up plasma

A

plasma is the liquid part filled with albumen, antibodies and clotting factors

22
Q

Explain what makes up the formed elements

A

RBC, WBC, platelets

23
Q

What is a critical value of severe anemia

A

hemoglobin of <7-8
need to look at the trends

24
Q

what is a critical value of hematocrite

A

<25%

25
Q

What are the signs and symptoms of anemia

A

weakness, fatigue, dyspnea
tachycardia, pallor

26
Q

Should you treat a pt who is receiving a blood transfusion?

A

no put a temporary pause of pt reactions to blood transfusions typically occur within the fist hour

27
Q

Who is at risk for a VTE?

A
  1. Hypercoaguable state
  2. decrease circulatory status
  3. Vascular wall injury
28
Q

What is a venous thromboembolism

A

Disease that includes both deep vein thrombosis and pulmonary embolism
3rd most common cardiovascular illness

29
Q

What does a D-dimer assay tell you?

A

assess blood for fibren fragments but doesnt tell you where the dvt is

30
Q

Wells Prediction Rule for DVT 10 things >2 DVT likely

A
  1. active cancer
  2. bedridden recently
  3. calf swelling >3cm compared to one side
  4. collateral veins present
  5. entire leg swollen
  6. localized tenderness
  7. pitting edema
  8. paralysis, paresis or recent plaster
  9. previously documented DVT
  10. minus 2 points alternative diagnosis to DVT is likely
31
Q

PE Criteria Wells 7 things

A
  1. previous PE or DVT
  2. heart >100bpm
  3. recent surgery within past 4 weeks or immobilization
  4. clinical signs of DVT
  5. Alternative diagnosis less likely than PE
    6.hemoptysis
  6. malignacy/cancer
32
Q

how to diagnose PE, DVT

A

PE- chest xray
DVT- ultrasound
d-dimer- tells you there is a DVT but not where

33
Q

What are the 4 hallmark clinical features of a PE?

A

1.Tachypnea- 16breaths pm
2. Tachycardia- >100bpm
3. sudden onset dyspnea
4. chest pain

34
Q

Acute PE can lead to what in the heart

A

loss of RV function
arrhythmia and/or hypotensive shock

35
Q

Should PT get a pt up and moving if they are anti-coagulated after a DVT and PE

A

Yes we can get people moving no risk of DVT turning into PE if the patient is properly anticoagulated

36
Q

Pt is on an anticoagulant called Heparin what lab value should you check?

A

heparin- PTT

37
Q

pt is on an anticoagulant called warfarin/coumadin what lab value should you check?

A

PT/ INR

38
Q

Explain common SS and Risk factors of Post Thrombotic Syndrome

A

after DVT the valves are damaged thus resulting in PTS leg becomes painful red and swollen the pt has cramps, itching tingling increased by walking/standing

Risk Factors:
-proximal DVT- above the knee
-recurrent DVT- below the knee
-prolonged symptoms
-obesity
-inadequate or delayed anticoagulation

39
Q

If a pt is adequately anti-coagulated when do they return to prior level of function?

A

immediately

40
Q

A pt had a DVT 3 months ago and never recovered they are still low energy what should be on your mind and do you refer?

A

Post PE syndrome may have functional impairments and decreased QOL up to 3-6 months

41
Q

Explain Lymphedema

A

accumulation of protein rich fluid, most often in the extremities; injury/blockage of lymphatic vessels

occurs after surgery, radiation, tumor

42
Q

What are some pt reports with lymphedema

A

tightness or heaviness in the limb
achy
pins and needles
pain of congestion
not unbearable pain

43
Q

How is lymphedema treated?

A

Complete decongestive therapy
-manual therapy
-bandaging
-compression garments
-exercise
-self care

44
Q

If lymphedema comes back what do you suspect?

A

Cancer

45
Q

What is edema a sign of?

A

heart failure

Med Con II (8 decks)

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