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Management of complex patients > Week 8 > Flashcards

Week 8 Flashcards

1
Q

When thinking about risk factors for breast and ovarian cancer, how far back should family history be assessed?

A

3 generations back (mother, grandmother, or great grandmother)

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2
Q

What average of cancer is related to genetics?

A

On average about 10%, but ovarian and breast cancer is more like 70-80%

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3
Q

What are the professions that a person with a mass will present to?

A

Any one of these can be visited

PCP: 1st line of contact
Oncologist: if pre-existing relationship is present
Geritologist: If pt is older

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4
Q

What are the professions included in a cancer care team?

A
  • Physicians providing oncology care
  • Clinicians providing psychosocial support and spiritual workers
  • Palliative care clinicians (Including hospice at end of life
  • Rehab clinicians
  • Physician assistant
  • Pharmacist
  • Nurses
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5
Q

What percentage of masses are found by palpation?

A

10%

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6
Q

___ is the preferred method and the way in which we get a definitive diagnosis of cancer

A

Biopsy is the preferred method and the way in which we get a definitive diagnosis of cancer

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7
Q

What types of cancer is a bone marrow biopsy used for?

A

Leukemia, myeloma, lymphoma

liquid tumors

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8
Q

What are the characteristics of a bone marrow biopsy?

A
  • Sample of bone marrow
  • Back of your hipbone
  • Uses a long needle
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9
Q

What are the characteristics of an endoscopic biopsy?

A
  • Tube is inserted into a cavity for imaging and tissue removal
  • Allows for aspiration
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10
Q

What types of cancer is an endoscopic biopsy used for?

A

Lung, bladder, colorectal,

gastrointestinal

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11
Q

What is a needle biopsy used for?

A

To extract cells or tissue

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12
Q

What types of cancer is a needle biopsy used for?

A

Breast, liver, lung, prostate

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13
Q

What are the various types of needles that can be used in a needle biopsy?

A
  • Fine needle (most commonly used)
  • Core needle
  • Vacuum assisted
  • Image guided
  • Stereotaxy (most common. Uses imaging during to allow the proper position of the biopsy. Used for the brain, and breast)
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14
Q

What type of imaging is a mammogram?

A

Xray imaging

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15
Q

What is the criteria for being a candidate for hormone therapy?

A

The receptor status has to be positive in order to be a candidate

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16
Q

What does it mean when a cancer pt’s margins are positive?

A

There are cancer cells on the edges of the specimen that was extracted. This results in either a second biopsy, a larger procedure or extra chemotherapy

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17
Q

What percent of cancer survivors with a body structure/function issue gets referred to PT?

A

About 20%

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18
Q

What does the CoC (commission on cancer) do?

A

It says that every cancer survivor has to have a survivorship care plan, which will document some details about the pt’s cancer, the treatment, the prevalence and severity of the side effects, and how they are being managed

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19
Q

What does a CARF (Commission on Accreditation of Rehabilitation Facilities) do?

A

It gives some structure around the prospective surveillance of pts with cancer
• Response to the medical management of cancer
• Side effects they have and how they are being addressed

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20
Q

What are some examples of a CoC (commission on cancer) accredited facility?

A
  • Hospitals
  • Breast cancer centers
  • Cancer centers
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21
Q

As a PT working in a CoC accredited facility, what should be the 1st question asked?

A

Who is managing the pt’s survivorship care plan and how do I see/participate in it?

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22
Q

Under the CoC, what is the standard that mostly relates to the PT, and why?

A

E11, because it says cancer survivors have to be screened for stress at least once in the cancer care continuum. This screening includes an assessment of any physical issues the pt may be having

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23
Q

What are some of the body structure impairments found in pts with breast cancer?

A
  • ↓Range of motion
  • Muscle weakness
  • CIPN (chemotherapy induced peripheral neuropathy)
  • Lymphedema risk
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24
Q

What are some of the individual limitations found in pts with breast cancer?

A
  • Difficulty reaching
  • Difficulty lifting
  • Dizziness
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25
Q

What are some of the society limitations found in pts with breast cancer?

A

• Unable to meet specific job
demands (60% returns to work, but many report to being able to work at the same level)
• Unable to fulfill life roles

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26
Q

What are some of the environment limitations found in pts with breast cancer?

A
  • Unemployment
  • Travel Precautions
  • Housework Demands
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27
Q

What are the personal factors that impacts a pt with cancer?

A
  • Loss of Identity
  • Body Image Changes
  • Anxiety
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28
Q

When selecting outcome measurement tools for the evaluation of pts with cancer, what is the recommendation on which ones to pick?

A

Try to pick those that are condition/region specific d/t having the sensitivity to pick up on immediate or monthly changes that the pt may see

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29
Q

When do we use generic health status outcome measure for pts with cancer?

A

For 6 months or annual assessments

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30
Q

When picking an outcome measure for a pt with cancer, we need to think about its use within the prospective surveillance model. What does this entail?

A

Is it going to be a tool that is well suited for repeated measures? (this is what we want). The prospective surveillance model is the one being recommended.

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31
Q

What are the characteristics of the prospective surveillance model?

A

• Baseline assessments
• Regular screenings
- Every 3-6 months for the first 3 years
- Every 6-12 months for the next 2 years
- Annually thereafter
• Early identification and treatment of side effects
• Multidisciplinary team approach
• Model has been recommended

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32
Q

What are the pros of the prospective surveillance model?

A
  • Increased patient education and satisfaction
  • Early identification
  • Early treatment
  • Reduced risk of disability
  • Builds patient’s trust
  • Builds patient’s self management skills
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33
Q

What are the cons of the prospective surveillance model?

A
  • Extra Encounters
  • Financial Costs
  • Human Capital
  • Referral Points
  • Documentation
  • Hypervigilance
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34
Q

What are the recommendations to keep in mind when thinking about the screening and examination of a pt with cancer?

A

• Consider using prospective surveillance for the early
identification of side effects (screening)
• Use the ICF model as your framework for evaluation and
selection of tools (examination)
• Choose Functional Reporting Tools
- Global/generic/condition measure (full systems screen)
- Impairment-specific or condition/region measures (preferred)
• Document test and measure changes over time to demonstrate progress towards goals

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35
Q

What are the side effects of chemotherapy drug methotrexate?

A

• “fever, chills, swollen lymph glands, night sweats, weight loss;
• vomiting, white patches or sores inside your mouth or on your lips;
• diarrhea, blood in your urine or stools;
• dry cough, cough with mucus, stabbing chest pain, wheezing, feeling short of breath;
• seizure (convulsions);
• kidney problems - little or no urination, swelling in your feet or ankles;
• liver problems - stomach pain (upper right side), dark urine, jaundice
(yellowing of the skin or eyes);
• nerve problems - confusion, weakness, drowsiness, coordination problems,
feeling irritable, headache, neck stiffness, vision problems, loss of movement in any part of your body; or
• signs of tumor cell breakdown - confusion, tiredness, numbness or tingling,
muscle cramps, muscle weakness, vomiting, diarrhea, fast or slow heart rate, seizure.”

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36
Q

What are the side effects of chemotherapy drug 5 FU, antimetabolite, which has a 30% rate?

A
  • Diarrhea
  • Nausea and possible occasional vomiting
  • Mouth sores
  • Poor appetite (impacts therapy)
  • Watery eyes, sensitivity to light (photophobia)
  • Taste changes, metallic taste in mouth during infusion
  • Discoloration along vein through which the medication is given
  • Low blood counts (anemia risk) (impacts therapy)
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37
Q

What are the potential structural and functional impacts of radiation therapy?

A 
• 40 Gy + results in skin effects
  - Hair loss can occur with >1Gy
  - Dryness of glands
• 50 Gy + results in bone effects
• 60 Gy + results in soft tissue effects
• 70 Gy + results in muscle and tendon effects
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38
Q

What is dose of radiation?

A

The irradiation absorbed by

each kilogram of tissue expressed as Grays (Gy) - 1 Gy = 1 J/kg of tissue.

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39
Q

What determined the total dose of radiation administered to a pt?

A

Total dose determined by tumor sensitivity and tissue

tolerance

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40
Q

How is radiation therapy usually administered?

A

The dose is usually given in a number of daily fractions, where they get 1-2 Gy each visit. Typical treatment is 1.5-2 Gy/ visit

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41
Q

In most solid tumors, which is the case in most cancers, how many Gy of radiation does the pt receive?

A

40-60 Gy, which means they are going to get between 40-60 treatments if they get 1 Gy per visit, or 20-30 treatments if they get 2 Gy per visit.

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42
Q

The goals of PT for a pt with cancer are to prevent, restore, support and to be palliative. What are we trying to prevent in a pt with cancer?

A

• Before the development of disability
• Lessen severity or shorten
duration

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43
Q

The goals of PT for a pt with cancer are to prevent, restore, support and to be palliative. What are we trying to restore in a pt with cancer?

A

• Return to former status is expected, without handicap or
residual disease
• Return to gainful occupation

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44
Q

The goals of PT for a pt with cancer are to prevent, restore, support and to be palliative. What are we trying to support in a pt with cancer?

A

• Ongoing disease is controlled or slowly progressing
• Maintain degree of function
through training and care

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45
Q

The goals of PT for a pt with cancer are to prevent, restore, support and to be palliative. What are we trying to be palliative about in a pt with cancer?

A
  • Increasing disability is expected from relentless disease progression
  • Prevent or reduce complications
  • Allow them to control their exit
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46
Q

What are the most common cancer related side effects to screen for and how do we screen for them?

A 
• Fatigue (shortness of breath)
  - Fatigue Severity Scale
  - Figure 8 Walk Test
  - Stanford Fatigue Scale
• Anemia
  - Hemoglobin and Hematocrit
• Hair loss or integumentary issues
  - Various symptom inventory tools
• Gastrointestinal problems
  - Various symptom inventory tools
• Pain
  - Visual analog scale
  - Pain drawings
  - Numerical pains scales
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47
Q

What needs to be done in order to clear a pt with general cancer for exercise?

A

• Evaluate for comorbidities
• Exercise testing is not
generally required for walking, flexibility and weight
training
• If exercise testing is needed
for higher level aerobic activity then follow ACSM for testing and contraindications

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48
Q

What needs to be done in order to clear a pt with colon cancer for exercise?

A

Evaluate ostomy self-care

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49
Q

What needs to be done in order to clear a pt with breast cancer for exercise?

A
  • Evaluate the arm/shoulder

* Lymphedema risk

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50
Q

What needs to be done in order to clear a pt with prostate cancer for exercise?

A
  • Evaluate pelvic girdle

* Lymphedema risk

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51
Q

What needs to be done in order to clear a pt with gyn cancer for exercise?

A
  • Evaluate pelvic girdle

* Lymphedema risk

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52
Q

What needs to be done in order to clear a pt with lung cancer for exercise?

A

Evaluate pulmonary function

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53
Q

What is the possible PT intervention for a cancer pt that present with SOB?

A

Aerobic exercise, endurance training in order to be able to tolerate mod level activity

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54
Q

What is the possible PT intervention for a cancer pt that present with LE swelling?

A
  • Edema management

* Reduce lymphedema risk

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55
Q

What is the possible PT intervention for a cancer pt that present with coordination deficits?

A
  • Balance

* Coordination

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56
Q

What is the possible PT intervention for a cancer pt that present with muscle weakness?

A

Muscle strengthening

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57
Q

What is the possible PT intervention for a cancer pt that present with a neuropathy?

A
  • Aerobic exercise
  • Therapeutic agents
  • Balance
58
Q

What is the possible PT intervention for a cancer pt that present with anemia?

A

Aerobic exercise to increase RBC production and

hemoglobin

59
Q

Why would a pt on chemotherapy to be on a steroid?

A

To calm down the inflammation associated with chemotherapy

60
Q

When inflammation occurs in chemotherapy, where does it affect 1st?

A

The proximal muscles

61
Q

In patients with chemotherapy induced peripheral neuropathy (CIPN), some of the exercise interventions used include desensitization, function, balance, and safety. What are the components of the desensitization exercise interventions?

A
  • Sensory balls
  • Thera-putty
  • Kinesiotape
  • Tactile Walking Paths
  • Gloves
  • Massage
  • Low level laser
  • Electrical stimulation
62
Q

In patients with chemotherapy induced peripheral neuropathy (CIPN), some of the exercise interventions used include desensitization, function, balance, and safety. What are the components of the function exercise interventions?

A 
• Nordic Pole Walking
• Pedometer Monitored
Walking
• Brain Bike
• Hand dexterity
• Strength training
63
Q

In patients with chemotherapy induced peripheral neuropathy (CIPN), some of the exercise interventions used include desensitization, function, balance, and safety. What are the components of the balance exercise interventions?

A
  • Wii-habilitation
  • Core exercise
  • Stability ball training
  • Varied surface training
  • Vestibular training
64
Q

In patients with chemotherapy induced peripheral neuropathy (CIPN), some of the exercise interventions used include desensitization, function, balance, and safety. What are the components of the safety exercise interventions?

A
  • Adaptive equipment

* Home modification

65
Q

Pts with cancer can choose to have a reconstruction surgery, but they come reconstruction related impairments. What are these?

A
  • Latissimus Dorsi Flap: less impact on abdominal muscles
  • TRAM Flap: poor abdominal strength and loss in trunk flexion and rotation
  • Oblique changes
66
Q

What happens in a deep inferior epigastric perforator reconstruction surgery?

A

Where they take the fat and arteries in the abdominal area to build the breast

67
Q

What are the interventions to think about for pts with breast cancer that has had reconstruction surgery?

A
  • Scapular correction or functional strengthening
  • Oblique muscle strengthening
  • Trunk stabilization
  • Breathing exercises
  • Postural corrections
  • Scar management
  • Bra fitting
68
Q

What are the energy conservation components to think about for all cancer survivors?

A
  • Prioritize
  • Planning
  • Modify your environments (home and work)
  • It’s ok to sit
  • It’s ok to nap or rest (30 mins max)
  • Necessary steps only
  • Use an assistive device
  • Use good body mechanics
69
Q

There are different service model types that can be used in the management of a cancer pt. What is included in the multidisciplinary service mode?

A

Many providers during same clinic visit

70
Q

There are different service model types that can be used in the management of a cancer pt. What is included in the Symptom, disease, or treatment specific service mode?

A
  • Long/late-term sx
  • Cancer type
  • Treatment type
71
Q

There are different service model types that can be used in the management of a cancer pt. What is included in the consultative service mode?

A
  • One or two visits

* Assess issues and develop plan

72
Q

There are different service model types that can be used in the management of a cancer pt. What is included in the integrated-care service mode?

A

Long term care is an extension of the original oncology team

73
Q

There are different service model types that can be used in the management of a cancer pt. What is included in the shared-care service mode?

A

Any combination of providers develop methods to share long-term follow up

74
Q

There are different service model types that can be used in the management of a cancer pt. What is included in the chronic disease service mode?

A

Prevention and early treatment of symptoms or risk factors

75
Q

What are the parameters to identify when considering a service model for a cancer pt?

A
  • How many survivors will be cared for?
  • Geographic area to be served?
  • Convenience of the setting?
  • Diversity of population?
  • Complexity of treatment exposures?
  • Time frame (at time of diagnosis, completion of treatment, no evidence of disease)?
76
Q

According to the canadian based cross sectional study, what are the most commonly reported symptom in pts with cancer?

A

Pain or SOB

77
Q

According to the canadian based cross sectional study, in what population of pts with cancer do we see a higher symptom burden?

A
  • Women
  • Lung cancer patients
  • Persons with lower income levels
  • Persons receiving palliative or hospice care
78
Q

What is the primary prevention used to treat pts with cancer?

A

Where we are trying to prevent the pt from getting the disease, condition or side effect

79
Q

What is the secondary prevention used to treat pts with cancer?

A

Can we identify the disease, condition or side effect earlier, in order to reduce its severity

80
Q

What is the tertiary prevention used to treat pts with cancer?

A

Trying to reduce disability burden. (PTs do a lot of this)

81
Q

When a pt with cancer presents with acute side effects, how are they managed?

A

Start with diagnosis or treatment and resolve quickly

82
Q

When a pt with cancer presents with long-term side effects, how are they managed?

A

Start with treatment and lessens or resolves over time

83
Q

When a pt with cancer presents with late-term side effects, how are they managed?

A

Start after treatment

84
Q

Side effects in pts with cancer can get better or worse. What does this depend on?

A

Depends on the type and stage of cancer, treatments received, dosing of treatments, and age at treatment

85
Q

Pain is one of the local effects of tumors. What are the characteristics of pain in pts with cancer?

A
  • May be absent until very late stages
  • Occurs when tumor is well advanced
  • Severity depends on the type of tumor
86
Q

Obstruction can be caused by a tumor and affects functions of the system affected. What are some examples of systems that can be affected and what that results in?

A
  • Ducts or tubes affects the digestive tract
  • Passageways affects air flow in bronchi
  • Blood or lymphatic flow may be restricted, causing ulcerations and edema
  • Nerve resulting in neurological symptoms
87
Q

What may tumor necrosis and ulcerations lead to?

A

May lead to bleeding or infection around the tumor

88
Q

Cachexia is a systemic effect f a malignant tumor, and can be an acute or chronic condition. What is cachexia?

A

Loss of body weight and muscle mass, and weakness

that occur in patients with chronic diseases, due to increased demands from tumor cells on the body

89
Q

What does cachexia result in?

A

Anorexia, pain, stress

90
Q

Why is anemia a systemic effect of malignant tumors?

A

–Due to blood loss at tumor site

–Nutritional deficits may reduce hemoglobin synthesis

91
Q

Why are infections a systemic effect of malignant tumors?

A

Occur frequently as host resistance declines

92
Q

What causes fatigue to be a systemic effect of malignant tumors?

A
  • Due to cachexia, anemia, inflammatory changes

* Stress of treatment schedule

93
Q

What causes bleeding to be a systemic effect of malignant tumors?

A

• Tumor cells may erode the blood vessels
• Bone marrow may be suppressed
- Decreased production of platelets

94
Q

What is paraneoplastic syndrome?

A

When tumor cells release cytokines, chemokines, and inflammatory markers that affect neurologic function and
may have hormonal effects

95
Q

What are the oncologic emergencies of spinal cord compression that if seen warrants immediate referral to the ED?

A 
• Pain—localized in area
or referred, radicular
• Motor deficits: loss
• Sensory impairment
• Autonomic dysfunction
96
Q

What are the oncologic emergencies of superior Vena Cava Syndrome that if seen warrants immediate referral to the ED?

A

• Initial symptoms: Facial swelling, tightness at shirt
collar, ruddy complexion,
periorbital and conjunctival edema
• Intermediate symptoms: full feeling in arms, edema in
fingers, hands, epistaxis, erythema of face, neck, upper
trunk
• Late symptoms: cardiovascular, respiratory, central nervous

97
Q

What are the oncologic emergencies of Malignant

Pericardial Effusion that if seen warrants immediate referral to the ED?

A 
• Dyspnea, cyanosis
• Engorged neck veins,
orthopnea
• Palpitations and fall in systolic BP of more than 10 mmHg with activity
• Fatigue
98
Q

What are the oncologic emergencies of Neutropenia;

Neutropenic Fever that if seen warrants immediate referral to the ED?

A

• Gastrointestinal: Nausea, vomiting, constipation, abdominal pain
• Central nervous system:
Confusion, progressive decline in mental function, psychosis, stupor, coma
• Cardiovascular, increased
heart rate, blood pressure,
arrhythmias, temp of 101 or 100.4 for more than an hour
• Renal: dehydration, polyuria, polydipsia, renal failure

99
Q

What are the oncologic emergencies of Tumor Lysis Syndrome that if seen warrants immediate referral to the ED?

A
  • Nausea, vomiting
  • Muscle weakness, arthralgia
  • Fatigue, lethargy
  • Dysrhythmias, seizures, cloudy urine

Note: symptoms not usually manifested in early stages

100
Q

What type of activity may be done with a pt that has moderate neutrophil(ANC) count?

A

Bedside activity

101
Q

What type of activity may be done with a pt that has severe neutrophil(ANC) count?

A

Hold PT. Severe is considered to be less than 500

102
Q

What are the steps found in the prospective surveillance model?

A
  • Client will have a meeting with the PT prior to surgery to acquire baseline measurements and education about some of the side effects related to the surgery
  • Pt will see PT again, early post op(around 2 weeks), do measurements again, find out side effects, pt education, low level treatment depending on pt presentation
  • Pt will come to PT at least once a quarter for the early identification of side effects, and treatment of present side effects
103
Q

What are the exercise recommendations for cancer survivors?

A
  • Mod intensity exercise for 150mins/week
  • Muscle strengthening at least 2x/week
  • Stretching
104
Q

What makes cancer exercise progression different from normal?

A

Progression is slower, and more time is allowed for the body to respond, d/t chemo inhibiting the body from having the adaptive collateralization of blood vessels needed for muscular aprotophy

105
Q

What is the hematocrit level at which low level movement is indicated, as long as symptoms are absent or manageable in pts with cancer?

A

< 25%

106
Q

What is the hemoglobin level at which low level movement is indicated, as long as symptoms are absent or manageable in pts with cancer?

A

< 8 g/dl

107
Q

What is the WBC level at which low level movement is indicated, as long as symptoms are absent or manageable in pts with cancer?

A

• < 5,000, evaluate for
risk of infection
• < 3,000 no exercise. Might do some functional mobility

108
Q

What is the platelet level at which low level movement is indicated, as long as symptoms are absent or manageable in pts with cancer?

A

< 10,000

109
Q

What is the hematocrit level at which light exercise(light aerobic) is indicated, as long as symptoms are absent or manageable in pts with cancer?

A

> 25-30%

110
Q

What is the hemoglobin level at which light exercise(light aerobic) is indicated, as long as symptoms are absent or manageable in pts with cancer?

A

8-10 g/dl

111
Q

What is the WBC level at which light exercise(light aerobic) is indicated, as long as symptoms are absent or manageable in pts with cancer?

A

> 5,000

112
Q

What is the platelets level at which light exercise(light aerobic) is indicated, as long as symptoms are absent or manageable in pts with cancer?

A

10,000-20,000

113
Q

What is the hematocrit level at which regular exercise is indicated, as long as symptoms are absent or manageable in pts with cancer?

A

> 25% for females

> 30% full resistance for males

114
Q

What is the hemoglobin level at which regular exercise is indicated, as long as symptoms are absent or manageable in pts with cancer?

A

> 10 g/dl

115
Q

What is the WBC level at which regular exercise is indicated, as long as symptoms are absent or manageable in pts with cancer?

A

> 5,000

116
Q

What is the platelets level at which regular exercise is indicated, as long as symptoms are absent or manageable in pts with cancer?

A

> 20,000

> 50,000 full resistance

117
Q

What is the effect of edema on the body?

A

Edema will slow tissue healing, promote dysfunction, intensify pain and slow therapy progress
regardless of severity or chronicity

118
Q

What are the non-complex presentations of edema that can be treated in a general outpatient or sub acute facility by a non-certified PT?

A
  • Newly presenting, venous insufficiency based edema
  • MILD presentation, systemic issues are not present or are controlled
  • No cancer history, No acute signs of symptoms
  • Onset correlates to recent injury or surgery
  • Area of swelling is in one area of the extremities
  • Swelling present less than 1 month
119
Q

What are the complex presentations of edema that can be treated in an outpatient, acute care or skilled facility by a certified lymphedema PT?

A
  • Venous, Lymphedema or Combined/ systemic failure
  • Moderate-severe presentation
  • Onset from any cause
  • Lymphedema is in more than one region or body part
  • Patient has active cancer or in remission
120
Q

What should be done if there are any symptoms found which may be correlated to Infection, cellulitis, DVT or cancer metastasis/recurrence in a pt with lymphedema?

A

Patient must be sent back to physician ASAP! If the provider cannot see the patient right away Emergency Department may be needed.

121
Q

What are the goals of non complex edema management?

A

• Reduce edema without further damage to the skin from excessively tight compression, blood flow reduction or pain.
• Restore tissue laxity enabling greater ROM, ease of movement and less discomfort or pain.
• Improve functional movement due to decrease pain, tightness/stiffness and
improved proprioceptive input.
• Facilitate healing and recovery time due to decreased accumulation of cellular waste,
increased perfusion and improved therapy performance.
• Independent self management of variations in swelling.
• TEACH THE PATIENT SYMPTOMS OF COMPLEX EDEMA AND WHERE TO GET HELP

122
Q

What are the treatment options for non complex edema?

A

• Elevation is ok for a reasonable period of rest but it is not functional for any
therapy progress.
• Simple Massage
• (Lower leg) simple compression bandaging
• Compressive wear: should be worn when up against gravity(Velcro on garments, sports compression wear
Less than 20 mmHg)
• Avoid heat and utilize cooling agents. (avoid cooling to the point of producing hyperemic effects)
• Avoid wrapping with bandages that have “low working pressure” (wrap gives and stretches easily along the length of the bandage but tightens with rest). NO ACE or TED HOSE(d/t elasticity)
• If they are supposed to be taking diuretics ask them if they have been compliant

123
Q

True or False

Proximal compression is always less than distal

A

True, Proximal compression is ALWAYS less than distal

124
Q

What are the immediate improvements that are usually made in pts with edema?

A
  1. Improve ROM 5-10 degrees.
  2. Significant decrease in pain.
  3. Improved gait performance (cycle) and endurance.
  4. Improved sleep.
  5. Improved psychological status.
  6. Faster healing rate (soft tissue injury and bruising)
125
Q

What stage of lymphedema is considered to be complex?

A

Lymphedema stage 2+ or CEAP C3 or higher

126
Q

What are the presentations of a pt with complex lymphedema?

A
  • 2 secs or more pitting edema
  • Extremity that does not return to 100% normal even upon waking up or with prolonged elevation
  • Persistent color changes (milky white or darker)
  • More than one body are involved(lower and upper leg)
  • Oncology based pts (active or remission)
  • If non pitting, the area is more than 3-4 cm larger than the unaffected site(means that fibrosis has set in)
127
Q

When should a lymphedema pt be referred to a certified lymphedema therapist?

A

Once the swelling persists longer than 3-4 weeks, because it can damage other structures and become chronic

128
Q

When you refer your pt to a certified lymphedema therapist, they undergo Complete Decongestive Therapy. What does this include?

A

• Manual Lymph Drainage
• Multi-layer compression bandaging with low
elastic properties.
• Daily use of compression garments
• Exercises for improved lymphatic return
• Excellent skin care and hygiene

129
Q

There are 2 phases in addressing a pt with complex lymphedema. Phase 1 is reduction and phase 2 is Containment, Independent Maintenance, Self Care & Compression Garments. Phase 1 includes Manual Lymph Drainage, what is the purpose of this?

A 
• Stimulates lymphatic vessels
to uptake proteins and transport them to regional
lymph nodes.
• Empties Lymph nodes and
increases their lymph processing.
• Re-routes lymph flow across
watersheds when a lymph
region is damaged and
cannot receive lymph.
• Usually for 30-40 mins
130
Q

There are 2 phases in addressing a pt with complex lymphedema. Phase 1 is reduction and phase 2 is Containment, Independent Maintenance, Self Care & Compression Garments. Phase 1 includes Manual Lymph Drainage, after which we have Multi-layered Compression Bandaging. What is the purpose of this?

A

• Creates a palpable compression gradient from the distal to proximal end of the affected body area, promoting fluid and proteins transport towards receiving lymph
node beds.
• When done well, bandaging creates a functional, effective, comfortable and durable compression environment.

131
Q

How often do we have pts come in the clinic for phase 1 of Complete Decongestive Therapy?

A

4-5x a week for a couple of weeks or months

132
Q

What are the core elements of phase 2 care of Complete Decongestive Therapy?

A

Containment, Independent Maintenance, Self Care & Compression Garments

133
Q

Successful containment of lymph and venous return requires ____ that can be comfortably worn throughout the day and often at night. Style, fit and fabric type must be correct to achieve these goals.

A

Successful containment of lymph and venous return requires high quality, gradient
compression garments that can be comfortably worn throughout the day and often at night. Style, fit and fabric type must be correct to achieve these goals.

134
Q

What are the components of phase 2 of Complete Decongestive Therapy?

A 
Teach the pt:
• Daily Self Lymph Clearing
• Stress Reduction 
• Flexitouch (pneumatic compression) 
• Low Impact exercise
135
Q

What are the goals of lymphedema treatment for pts in the diagnosis and pre-medical intervention phase of cancer?

A
  • Teach them what Lymphedema is and to respect it
  • Prevention (avoid triggers)
  • Detection
  • Establish Baseline function and girth
136
Q

What is the timeframe of interventions for pts in the diagnosis and pre-medical intervention phase of cancer in regards to lymphedema?

A

Before Medical Interventions occur

137
Q

What are the goals of lymphedema treatment for pts in the Active Medical Treatment phase of cancer?

A
  • Surveillance for Lymphedema
  • Reinforce Education about avoiding triggers, good prevention and self care
  • Initiate CDT ASAP with earliest warning signs
138
Q

When do we start the Surveillance for Lymphedema in pts in the Active Medical Treatment phase of cancer?

A
  • After surgery/before radiation

* Week 3 radiation

139
Q

When do we start to reinforce Education about avoiding triggers, good prevention and self care in pts in the Active Medical Treatment phase of cancer?

A

All medical professionals should
promote this during cancer
treatment.

140
Q

When do we start to Initiate CDT ASAP with earliest

warning signs in pts in the Active Medical Treatment phase of cancer?

A

Immediate treatment with CLT

141
Q

What are the goals of lymphedema treatment for pts in the survivorship phase of cancer?

A 
Surveillance for Lymphedema
• Patient Advocates for their needs
• Support and education
• Empowerment
• Initiate CDT ASAP with earliest
warning signs

Management of complex patients (7 decks)

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