M8: 2

Question 1

Deciding if fatigue is cancer related:

Things to consider

Answer 1

• look at reference ranges for RBC and HgB (watch O2 stats if low)
• are they having SOB or palpitations?
• Platelet values: low or have they got significant bleeding that may play a role?
• How long since last chemo? Consider nadir
• Any s/s of systemic infection?
• Any dull or sharp bone pain?
• Rule all other causes out

Question 2

What is the most appropriate response to a pt with cancer ℅ new onset bone pain?

Answer 2

• treat them as having metastasis to the bone until proven otherwise
• confirm with radiograph, bone scan, MRI, or CT

Question 3

What should lead a PT to suspect bony metastasis?

Answer 3

First sign: bone pain that is aching or sharp in nature

Question 4

What should be done if a bone met is confirmed?

Answer 4

Caution should be used to avoid pathologic fx

Question 5

What is the most common problem affecting cancer survivors?

Answer 5

Cancer related fatigue

Question 6

What does FEWS stand for?

Answer 6

Function
Education
Wellness
Safety

Question 7

Explain the FEWS framework

Answer 7

Assures interventions are comprehensive and can be applied to pts with all types of impairments

Question 8

FEWS

F

Answer 8

Function

Optimize pt’s functional status

Question 9

FEWS

E

Answer 9

Education

Educate pt/caregiver

Question 10

FEWS

W

Answer 10

Wellness

Promote wellness to prevent disease progression and/or development of comorbidities

Question 11

FEWS

S

Answer 11

Safety

Stress safety within the pt’s typical environments

Question 12

When should exercise programs begin for a cancer pt? How long should they continue?

Answer 12

• should begin when pt begins cancer tx

- should continue throughout active tx

Question 13

What type of program should a cancer pt have?

Answer 13

• warm-up/cool-down for each session
• flexibility
• strength
• aerobic exercise (emphasize this)
• low/mod intensity
• progress based on cardio conditioning
• exercise log
• SAFETY AT ALL COSTS

Question 14

From where should you progress a cancer patient (duration/frequency/intensity)?

Answer 14

From

15-30 mins
3-5 days/wk
Low-mod intensity » higher (intensity should NOT provoke sx)

Question 15

What is meant by low-mod intensity?

Answer 15

50-70% MHR
RPE 11-13 on Borg scale
Avoid exhaustion

Question 16

Surgery basics of breast cancer: overall types

Answer 16

1. Breast conservation
2. Mastectomy
3. Node dissection

Question 17

Breast conservation

Answer 17

• removal of tumor

- preservation of majority of normal breast tissue

Question 18

Mastectomy

Answer 18

Removal of entire breast

Question 19

Node dissection

Answer 19

• lymph nodes assessed during surgery for invasive CA

- can be removed if necessary

Question 20

PT implications for BC

Answer 20

• lymphedema
• reduced ROM
• adhesions, fibrosis, soft tissue contracture
• shoulder mm weakness
• decreased trunk strength

Question 21

Types of radiation for BC

Answer 21

Internal

External

Question 22

What is the most common type of radiation for BC?

Answer 22

External beam - radiation delivered to specific breast tissue

Question 23

PT implications for radiation tx (BC)

Answer 23

• fatigue
• impaired mobility
• adhesions

Question 24

Systemic therapy types for BC

Answer 24

• chemo
• hormonal
• biologic

Question 25

Systemic therapy for BC: PT implications

Answer 25

Peripheral neuropathy

Question 26

What are the types of breast reconstructions?

Answer 26

- TRAM - DIEP - lat dorsi flap

Question 27

TRAM =

Answer 27

Transverse abdominal myocutaneous flap

Question 28

What happens with TRAM?

Answer 28

- large elliptical transabdominal incision made | - skin, RA, and underlying fat removed and transferred to chest

Question 29

PT implications for TRAM procedure

Answer 29

- trunk weakness - abdominal wall laxity - hernia

Question 30

DIEP =

Answer 30

Deep inferior epigastric artery perforator

Question 31

What is DIEP?

Answer 31

- spares the RA | - transplants skin, fat, and perforating branches of deep inferior epigastric artery

Question 32

What is the lat dorsi flap procedure?

Answer 32

skin, subcutaneous fat, and ipsilateral lat is transplanted

Question 33

Lat dorsi flap procedure PT implications

Answer 33

decreased strength/mobility of shoulder due to adhesions of scar tissue to underlying tissue

Question 34

Which reconstruction procedures keep their original blood supplies?

Answer 34

- lat flap | - TRAM

Question 35

Which reconstruction has the least of the implications for PT and why?

Answer 35

- DIEP - doesn't cut through any muscles - Plus, you get rid of the pooch!