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