Fatigue

fatigue can be assess similar to pain and scale used can include

0-10

sleep deprivation is equivalent to effects of alcohol intoxication-- 24 hours of sustained wakefulness is equivalent to

0.10% blood alcohol concentration

There are three ways in which to create a good sleep hygiene-- these include

1) create sleep-friendy environment 2) minimal interruptions to sleep 3) sleep only when drowsy

some non-pharmacological management used for fatigue include

1) exercise 2) attention-restoring interventions 3) educational opportunities 4) strategies to promote sleep

symptoms of fatigue include

1) feeling tired and not rested 2) mood changes and irritability 3) decrease in affect 4) impaired cognitive functioning 5) poor concentration & memory 6) decrease in attention 7) slower reaction time 8) difficulty doing calculations 9) forgetting steps and procedures 10) reduced physical ability 11) complete tasks in wrong sequence 12) inability to estimate your own alertness 13) sensory impairment

some tricks to help sleep deprivation include

1) power napes 2) naps 3) caffeine 4) undisrupted sleep

there are two primary elements to defining fatigue-- these include

1) subjective perception with physical, emotional, cognitive and psychological features 2) interferes with ability to function

more current research has identified there different types

1) typical 2) treatment 3) shutdown

naps consist of what length?

1-4 hours duration

look up psychological factors and insert here in what page number

155

want to look in book to see how fatigue is assessed-- insert here-- page

160

if you have to work all night you want to go to bed

2 hours before usual waking up time to get 7-8 hours of REM sleep

greatest risks due to fatigue is between hours?

3-5 am

at what time biologically is our alertness decreased with a temperature low point (between what hours)?

3-6 am

how long does it take to fully wake up from a nap?

30 minutes

they can provide how many more waking hours?

4-5 hours

how many hours prior to sleep do you not want to have anything with caffeine?

4-6 hours

in a new zealand survey what percent reported having committed a fatigue-related error?

86%

stimulants include

CNS stimulants

does fatigue make reaction time slower or faster?

Slower

a multiple sclerosis panel described it as

a subjective lack of physical and or mental energy perceived by individuals that interferes with usual and desired activities

shorter or longer advanced disease is associated with increased fatigue?

advanced

factors which influence fatigue include

age, depression, treatment fatigue, disturbed sleep, dyspnea, and advancing stage

example of depletion hypothesis is

anemia

when you are working the night shift you want to sleep

as close to time as work as possible for maximum length of alertness

at this time our concentration is

at a low ebb

what are some ways you can create a sleep friendly environment with little interruptions?

block out shades, avoid using phones or computers (anything which is stimulating), try reading, try not to drink anything with caffeine or alcohol

adolescents will place emphasize on

both physical and mental exhaustion

fatigue affects patients in a way in which they

cannot function the same way that they used to be able to

cumulative sleep loss and circadian disruption can lead to

decreased waking alertness

there are two hypothesis associated with fatigue pathophysiology.. these include

depletion and accumulation

this places individuals with cancer at risk for

depression

fatigue is a

devastating, multidimensional symptom which involves the entire person, touching every facet of daily life

another example of a stimulant includes

dexamphetamine (dexedrine, dextrostat)

fatigue will depend on

diagnostic category, length of disease, course of treatment, complications, physical state, and psychological factors

definition of fatigue is

distressing, persistent, and subjective sense of physical, emotional, and cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning

treatment fatigue is defined as

energy loss which is greater than replenishment

depletion hypothesis is when

essential substances which are integral to muscle activity are not available or have been depleted (nutrients that we take in are not being metabolized)

chronic pain and dyspnea are

exhausting

the most common chronic symptom associate with cancer and other chronic progressive diseases includes

fatigue

the most common symptom linked to cancer and other chronic diseases is

fatigue

this results in

fatigue

what often brings client in to see the doctor prior to diagnosis?

fatigue

what symptoms possibly has the greatest potential to interfere with quality of life at the end of life?

fatigue

these studies suggest that

fatigue causes clinical impairment

will they be great or have forgetfulness in communicating information?

forgetfullness

in these two studies-- what percent of anesthesia caregivers reported fatigue related errors?

greater than 50%

there have been studies done which compare patients with cancer to those without(control group), it showed that patients with cancer will

have more fatigue, have worse sleep quality, more disrupted circadian rhythm, worse quality of life, and lower activity levels

will their decision making be impaired or made better?

impaired

will they be able to accurately or inaccurately do calculations?

inaccurately

if depression and dyspnea are present this

increases fatigue

low dose steroids can be used, they are good for

increasing energy and increasing appetite

fatigue in patients versus fatigue in workers?

it is different

an example of accumulation hypothesis fatigue is during

kidney failure when kidneys are not working well and there is accumulation of waste byproducts

power naps consist of

less than 45 minutes of sleeping

does the individual with fatigue have higher or lower level of vigilance?

lower (they might not be as careful)

this can be done through

maintaining balance between restorative rest and restorative activity

when managing fatigue you want to manage it on two different levels. The first level is

manage symptoms which contribute to fatigue

what domains of life does fatigue affect?

mental, emotional, social, physical, psychological, and spiritual (affects all aspects of life)

more or less disturbed sleep is associated with fatigue?

more

has any study proven that fatigue is part of why health care providers caused errors that harm clients

no

typical tiredness is

normal ebb and flow of energy

do adolescent oncology patients or their peers express significantly more fatigue than their peers without chronic disease?

oncology patients

which reports more symptoms of depression associated with quality of life?

oncology patients

fatigue in patients with advanced cancer is closely related to

pain, dyspnea, anorexia, constipation, sleep disturbances, depression, anxiety and other mood states

look at what restorative activity is

pg 161

there are differences between children and adolescents definitions. Children will often place emphasize on

physical sensation such as weakness

being tired might prevent you from

picking up on changes in patients status

an example of a low dose steroid which is used is

prednisone

the second level is

prevent additional or secondary fatigue

shutdown fatigue is defined as

profound, sustained loss of energy

examples of reduced impairment includes

reduced hand-eye coordination in surgeons and reduced visual memory in interns

common CNS stimulant is

ritalin (very common and very effective)

some things which you can do to promote sleep include

shut out light, reduce noise, do not use stimulants such as TV, phone, do not drink caffeine 4-6 hours before sleep, do not drink alcohol..

example of fatigue is

sitting in car after cancer treatment. social worker taps on window and asks if help is needed. yes please call my son to pick m up as I don't have energy to put my car in gear

some attention-restoring interventions include

spending time outdoors, gardening, writing, music, and ones favorite hobbies

There are three different types of medications which can be given for fatigue-- these include

stimulants, antidepressants, and low dose steroids

you should use caffeine

strategically

look at notes on page 155 in

stuff to do with advanced cancer and insert here

fatigue is a

subjective response

fatigue is

symptom of advanced disease and can seriously impact quality of life

anxiety, depression and other mood states are

underlying psychiatric problems which may contribute to fatigue

accumulation hypothesis is when

waste products collect and outpace our ability to dispose of them

some questions you can ask people to assess how fatigued they are include

what can you do during the day, what were you used to be able to do during the day, ask about sleep patterns and emotional well being

it is

what the patient says it is

there was an anesthesiology studied conducted-- these showed that

when working fatigue there is significant risk for clients

will they or will they not have memory problems?

will

do female residents have increased risk for incidence of pregnancy-induced hypertension, per-term labor and small-for-age infants?

yes

has fatigue been associated with increased risk for post-shift automobile accidents?

yes

will fatigue impair performance?

yes

does being fatigued increase the risk for sustaining a blood borne pathogen exposure during the night shift?

yes, for medical residents its 50%

sometimes you will be so tired that

you cannot fall asleep

if you are having disrupted sleep this means that

your circadian rhythm is broken

it can sometimes be measured on

zero to ten scale