week 4 Flashcards
1
Q
common problems in PT and cancer
but not just cancer
A
- cancer related fatigue - most common symptom
- pain
- spinal cord compression
- pathologic fracture/bone mets/lytic lesions
- lymphedema
- altered blood counts and immunity
- venus thromboembolism (VTE: DVT + PE)
2
Q
cancer related fatigue (CRF)
A
- distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning
- associated with multiple domains: cancer, cancer treatment (chemo/radiation), surgery
- does not improve with rest
- limits QOL
- affects ability to concentrate, calculate, or remember – similar to chemo brain
- “can’t get through the day”
3
Q
subjective and objective components of CRF
A
- physical performance: weakness or tiredness
- mood: depression, anxiety
- motivation: lack of initiative
- cognition: slowing of thought processes, distraction, or memory deficits
- social functions: reduced ability to sustain social relationships
4
Q
needs for improved CRF management
A
- CRF is a multifactorial,bio-behavioral phenomenon
- impacts: ADLs/functional capacity, mental/emotional well-being, social/behavioral, occupation, caregivers
- multidimensional
- CRF is under-reported, under-diagnosed, under-treated
- fatigue should be assessed at every patient interaction
5
Q
CRF education example
A
- you have a battery/money, and you want to have enough to last all day
- going up stairs on a good day takes 5%, but on a bad day, it takes 20%
6
Q
screening
for CRF
A
- screening tools are generally unidimensional, easy to administer, easy to interpret
- often dichotomous - yes/no
- may provide simplistic evaluation for severity, but should trigger a more in depth screen
- importance: triggers need for more “in depth” assessment and referral for care for typically unmet needs and additional medical consultation
- fatigue thermometer: pick 0-10 that describes fatigue you have had in the past week including today
- one item fatigue scale: rate fatigue on scale 0-10, 0: no fatigue, 1-3: mild fatigue, 4-6: moderate fatigue, 7-10: severe fatigue
7
Q
assessment of CRF
A
- assessment tools identify extent of a problem, including impact on function and health-related QOL
- generally multidimensional in nature
- comprehensive in scope
- importance: provides greater direction for treatment plan
- multiple well-validated measures: fatigue severity scale, fatigue impact scale, brief fatigue inventory and functional assessment of chronic illness threapy - fatigue (FACIT-F)
8
Q
eastern cooperative oncology group (ECOG)
performance scale - v important
A
- ECOG scale: details
- 0: normal activity
- 1: symptoms demonstrated but patient remains ambulatory, able to perform self care
- 2: ambulatory > 50% of the time, requires occasional assistance
- 3: ambulatory < 50% of the time, requires nursing care
- 4: bedridden
- 5: death
- cancer trials use this for cutoffs
9
Q
karnofsky performance status scale
performance scale
A
- able to carry on normal activity and work, no special care needed
- 100: normal, no complaints - no evidence of disease
- 90: able to carry on normal activity, minor signs or symptoms of disease
- 80: normal activity with effort, some signs or symptoms of disease
- unable to work, able to live at home and care for most personal needs, varying amount of assistance needed
- 70: cares for self, unable to carry on normal activity or to do active work
- 60: requires occasional assistance, but is able to care for most of his personal needs
- 50: requires considerable assistance and frequent medical care
- unable to care for self, institutional or hospital care, disease may be progressing rapidly
- 40: disabled, requires special care and assistance
- 30: severely disabled, hospital admissions is indicated although death not imminent
- 20: very sick, hospital admission necessary, active supportive treatment necessary
- 10: moribund, fatal processes progressing rapidly
- 0: dead
10
Q
physical therapy interventions
A
- exercise: aerobic and strength training
- complimentary and alternative therapies: acupuncture and yoga
- lymphedema mangament
- start easy: low and progress slow, but progress
11
Q
caution performing exercise with any of the following
A
- bone metastases (cancer spread to the bone)
- thrombocytopenia (low platelets)
- anemia (low RBCs)
- neutropenia: avoid environments where the risk of exposure to infectious diseases (public swimming pools, crowded gyms)
12
Q
cancer related pain
A
- 20-50% of patients with cancer report pain as a symptom
- prevalence increases with progression of cancer and may reach 90% in terminal patients
- prevalence of 26-54% in cancer survivors
- pain is often undertreated
13
Q
characteristics of cancer pain
A
causes of cancer patients can be classified as:
1. directly related to cancer - direct invasion or compression of structures by cancer
2. related to cancer therapy - due to surgery, chemo, radiation
3. related to effects of cancers - bed sores, debility
4. age-related, comorbidities - chronic back pain, OA (not all pain is the C word)
14
Q
breakthrough pain
A
acute exacerbation of pain of short duration on teh background of stable pain pattern
15
Q
bone lesions
A
2 types:
1. osteolytic lesions: cancer has cuased bone breakdown or thinning, destroy bone material (bone is weakened, thin)
2. osteoblastic lesions: cancer has caused overproduction of bone cells (rigid, inflexible)
16
Q
mirels scoring system for pathologic fracture risk
A
- rate each area on site, pain, lesion, size (1-3) - diameter
- clinical recommendations are based on total score
- < 7 radiation therapy and observation
- 8 use clinical judgement
- > 8 prophylactic surgical fixation
increased lesion = increased fracture risk
17
Q
pain characteristics and fracture
impending fracture
A
- pain with:
- WB
- groin
- hip scour
- hip external rotation and abduction
- deep inspirtaion
- bance around chest wall
- supine
- with valsalva
18
Q
spinal cord compression
A
- primary or secondary disease spreads to the vertebra and impinges on the spinal column
- etiologies
- vertebral collapse (85%)
- direct invasion
- prolonged compression can disrupt of vascular supply (infarction)
- general S&S
- back pain is most frequent symptom (95%) - pain increases or is unrelieved with supine
- motor > sensory changes - DTRs change, ask about changes in bowel and bladder
19
Q
post prostatectomy incontinence
A
- the incidence of urinary incontinence after radical prostatectomy varies
- incontinence immediately after catheter removal may approach an incidence of 90%
- after one year, incontinence (very common) varies from 5% (0-1 pads daily) to 30-40%
20
Q
most common blood testes
A
- complete blood count (CBC) with differential
- basic metabolic profile (BMP, somtimes called a chem 7)
21
Q
complete blood count (CBC)
A
- **red blood cells (RBC) **
- male 4.7-5.5 mil cells/mm^3
- female 4.1-4.9 mil cells/mm^3
- white blood cells (WBC)
- 4,500-11,000 cells/mm^3
- hemoglobin (Hb)
- male 14.4-16.6 gm/dL
- female 12.2-14.7 gm/dL
- hematocrit (Hct)
- male 43-49%
- female 38-44%
- platelets (Plt)
- 150,000-350,000 platelets per microliter (mcL)
22
Q
plasma
A
- liquid part of blood (55%)
- pale yellow made up of 91% water, 9% other
- colloid: liquid containing suspended substances that don’t settle out
- albumin: important in regulation of water movement between tissues and blood (osmosis)
- globulins (anti-bodies): immune system and transport molecules
- clotting factors/fibrinogen: responsible for formation of blood clots (hemostasis), from liver
23
Q
formed elements in blood
A
- red blood cells: RBC, erythrocytes
- white blood cells: WBC, leukocytes
- granulocytes: neutrophils, eosinophils, basophils
- agranulocytes: lymphocytes, monocytes
- thrombocytes: platelets
24
Q
erythrocytes
A
- structure: biconcave, anucleate
- components:
- hemoglobin
- lipids, ATP, carbonic anhydrase
- function:
- transport oxygen from lungs to tissues and carbon dioxide from tissues to lungs
- acid:base balance
26
Q
hematocrit
Hct
A
- ratio or volume of red blood cells to total volume of blood
- male: 43-49%
- female: 38-44%
- Hct < 25% often cited as a critical value and correlates to Hb < 7-8 g/dL
30
Q
thrombocytes
platelets
A
- small fragments of megakaryocytes
- platelets contain granules that are secreted in response to “activation”
- important in preventing blood loss: platelet plugs, promoting formation and contraction of clots
33
Q
who is at risk for VTE
A
- **virchow’s triad **
- hypercoagulable state
- malignancy
- pregnancy and peri-partum pareiod
- oestrogen therapy
- truama or surgery of LE, hip, abdomen, or pelvis
- inflammatory bowel disease
- nephrotic syndrome
- sepsis
- thrombophilia
- vascular wall injury
- trauma or surgery
- venepuncture
- chemical irritation
- heart valve disease or replacement
- atherosclerosis
- indwelling catheters
- circulatory stasis
- atrial fibrillation
- left ventricular dysfunction
- immobility or paralysis
- venous insufficiency or varicose veins
- venous obstruction from tumor, obestiy, or pregnancy
35
Q
wells prediction rule for DVT and PE
A
36
Q
pulmonary embolism
A
- hallmark clinical features
- tachypnea: 16 breaths per minute or greater
- tachycardia (> 100 bpm)
- sudden onset dyspnea
- chest pain (acute onset)
- other features
- hypotension - dizziness, lightheadedness
- desaturation - decreasing pulse oximetry
- couch
38
Q
if on coumadin, check
A
INR
39
Q
if on heparin, check
A
PTT
40
Q
major complications of DVT and PE
A
- DVT: venous stasis syndrome (post-thrombotic syndrome), venous ulcer
- PE: chronic thromboembolic disease/pulmonary hypertension, post PE syndrome
41
Q
post thrombotic syndrome (PTS)
A
- develops 20-50% of patients within 1-2 years
- severe PTS results in vvenous stasis ulcer: 1/4 to 1/3 of PTS
- common symptoms: pain, heaviness, cramps, itching, tingling, aggravated by standing/walking
- physical exam: edema, hyperpigmentation, telangiectasis, varicosities
- risk factors: proximal DVT (above knee), recurrent DVT, prolonged symptoms (> 1 month post event), obesity, inadequate and/or delayed anticoagulation
43
Q
lymphedema
A
- accumulation of protein rich fluid: most often in the extremities (in area of treatment)
- injury/blockages to the lymphatic vessels, nodes, etc
- surgery, radiation, tumor
- acute or chronic
- treatments: surgery, complete decongestive therapy, pressure garments, pneumatic pressure pumps
diagnosis based on history: CA, symptoms
47
Q
stemmer sign
A
- pinch and lift skinfold at base of the second toe or middle finger
- A: if you can pinch and lift the skin, negative
- B: if you cannot life the skin, positive
- C: a negative test doesn’t always rule out lymphedema
50
Q
UE lymphedema and XRT
A
51
Q
how is lymphedema treated
A
- most common treatment for lymphedema is complete decongestive therapy (CDT)
- manual lymphatic drainage (MLD)
- bandaging
- compression garments
- exercise
- self care
53
Q
lymph nodes
A
- 600-700 lymph nodes in body
- major groupings: abdomen/intesintes, inguinal, axillary, supraclavicular
- 2-30 mm in length
- functions: filter and concentrate lymph through immune system
