Rad Oncology Test 2

What is a patient assessment?

A clinical plan that identifies the unique needs of the patient and how those needs will be addressed by the healthcare team which provides the basis of effective cancer care. It is continuous and can change throughout treatment.

Determine the nature of the problem.

patient indicates they are having pain and you observe their body language that indicates pain.

select an intervention for the problem

nurse talks with patient and alerts the doctor that the patient may benefit from pain medication.

evaluate the effectiveness of the intervention

as a therapist we observe the patient to see if their body language is indicated that their pain is under control or we ask how is their pain.

What is the most effective type of patient assessment?

Interprofessional approach.

What is a general health assessment?

conducted by an oncology practitioner

collection of data about the patients past and present health.

self report survey.

What is a physical assessment?

Role of radiation therapist

monitoring general signs and symptoms, side effects, and critical aspects of patient assessment such a nutrition, pain, and blood count.

What is nutritional assessment?

role of oncology team members

PG-SGA (scored-patient generated subjective global assessment)

MST (malnutrition screening tool)

What percent of cancer patients have weight loss at diagnosis?

60-80%

What is the PGSGA?

(scored-patient generated subjective global assessment), gold standard full assessment tool- check list about their weight or weight loss and dietary intake symptoms functional capacity and the physician or nurse fills out parts as well.

What are the significant weight loss numbers?

over 5% loss in 1 month

over 7.5% in 3 months

over 10% in 6 months

What is cachexia?

complex metabolic syndrome associated with underlying illness and characterized by loss of muscle with or without loss of muscle fat.

What is anorexia?

loss of desire to eat. different that the eating disorder. This is when the patient has a loss of appetite that leads to the inability to eat.

What is marasmus?

calorie malnutrition. This condition occurs when the body cannot met the caloric needs and it results in 7-10% weight loss. Usually has severe muscle and fat store depletion. patients look very slim.

What is kwashiorkor?

protein malnutrition. These patients may not seem malnourished because theu are getting enough fat and carbohydrates, have extreme protein deficiencies and can result in a poor immune system.

What is the purpose of a pain assessment?

Establishes a baseline for treatment and interventions

helps the clinical team focus on best fitting interventions

enables evaluation of chosen interventions.

What are the six dimensions of pain assessment and management?

physiologic- organic cause of pain'

sensory- pain intensity, location, and quality

affective- depression and anxiety

sociocultural- cultural background and family dynamics

behavioral- medication intake and activity level.

cognitive- meaning of pain, understanding, attitudes and beleifs, level of cognition.

What are other important factors of the pain scale?

Location – important to identify where the pain is located, doctor may press on the region to find exact area.

Intensity – one-dimensional tools often used like a scale of 0-10 with 10 the worst. May also a face pictorial scale. (Examples for both are in your text page 48)

Quality – deals with the way pain feels, like does it burn? Is it dull? Is it stabbing? Is it sharp?

What is acute pain?

comes on suddenly, maybe within a few weeks, can usually identify the cause, may last of to 3 months. can come from a diagnostic or surgical procedure.

What is chronic pain?

when pain last longer than 3 months it is considered chromic. Often this may be due to tumor invading bone, soft tissue, viscera, blood and nerves.

What is the Affective Dimension?

deals with ones emotional response to pain. Depression, anxiety, and other psychological factors personality traits can be brought on by pain or increase pain. These responses can sometimes cause pain to be worse. - it can affect how they cope with pain or tolerate the pain - these may not always be considered in pain assessments

What is the cognitive dimension?

deals with the way the patient thinks about pain and how they express it to caregivers. They may feel that if you have cancer then you should have pain and they wont tell anyone or get help to manage the pain. The caregiver should make sure they explore the patient’s feelings.

What is the behavioral dimension?

– this causes changes in behavior that may increase pain or physical decline. This dimension can be observed. As therapist we can see this in our daily assessments and provide information if necessary. This will include verbal and nonverbal resonses. It may be expressed as moans and grimaces or complaints. As a therapist this type of expression of pain from a patient should be easy to pick up on. Estimates of functionality are also important aspects of pain behavior such as fatigue, ability to do chores, physical exercise.

What is the sociocultural dimension?

deals with ethnic, cultural, demographical, and spiritual ways that people deal with  and their perception of pain. Culture and religious practices have a strong influence over pain experiences. Age, gender, and race may play a role. Females and elderly may be more likely to express that they feel pain while males may be more reserved. for true pain assessment it is a multidisciplinary apporach that involves a variety of healthcare professionals

Karnofsky Performance Status

0 (death)- 100 (normal). Used to assess functional performance in patients with cancer.

ECOG

Eastern Cooperative Oncology Group Performance Status. 0 (Fully active)- 5 (Dead). Used to assess functional performance in patients with cancer.

What is myelosuppression?

Reduction in bone marrow function (can result in amenia, leukopenia, or thrombocytopenia)

What is Anemia?

Decrease in red blood cells- circulatory systems oxygen carrying capacity is impaired-decrease in hemoglobin levels (pale skin, muscle weakness, and fatigue)

What is leukopenia?

decrease in white count (increases the risk of infection) - compromised immune system from chemo or radiation to bone marrow producing areas - essential to monitor this while under treatment

What is thrombocytopenia?

decrease in platelets (increased risk of bleeding) - come from chemo or radiation, the disease, or stress

What is the most significant factor that determines the risk of bone marrow depression related to radiation therapy?

The volume of productive bone marrow in the radiation field- large fields monitoring blood counts is extremely important.

What is pancytopenia?

reduction in all blood cells ( can have all of the above symptoms)

Quality of life

summarizes the broad based assessment of the combined effect of the disease and treatment and the trade off between the two. a person's subjective sense of well being from personal experience of life as a while - areas of like or domains most important to individuals have the most influence on their quality of life

Anxiety

individuals response to a real or perceived threat that manifests at an emotional level.- fear, dread, uneasiness or physical level such as increased heart rate or muscle tension - can come from diagnosis or the treatment itself.

What percent is the 5 year survival rate for people with cancer?

69.3%

Depression

perceived loss of self esteem that results in a cluster of affective behavior and cognitive responses - this may be changes in appetite, sleep disturbances, lack of energy, withdrawl, and dependency or decreased ability to concentrate, indecisiveness, suicidal ideas -

What is the second most common affective response in patients with cancer?

Depression

What is the criteria for a depression diagnosis?

5 or more criteria are present every day for nearly 2 weeks.

Cancer rehab

Is the maximum restoration of physical, psychological, social, vocational, recreational, and economic functions within the limits imposed by the malignancy and its treatment.

What is cultural competence?

a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations

What is normal hemoglobin?

12-16 g/dl

What is the normal red blood cell count?

3.9-5.4 K/mm3

What is normal hematocrit?

37-47%

What is normal platelet count?

150-425 K/mm3

Normal white blood cell count

3.5-9.1K/mm3

What dose does skin reaction happen?

1600 cGy

What dose does epilation/alopecia occur at?

2000 cGy

At what dose does mouth changes occur at?

2000-3000 cGy

What dose does nausea and vomiting occur?

1000-2000 cGy

What dose does cystitis occur?

3000-4000 cGy

What dose does diarrhea occur?

2000-5000 cGy

What dose does laryngitis?

4000 cGy

What dose does dry desquamation happen?

4000-6000 cGy

How much of communication is transmitted non verbally?

2/3

What is cognitive communication?

Composed of facts and words contained in the message

What is affective communication?

Verbal or non verbal and consists of feelings, attitudes, and behaviors.

What is reflective listening?

Reflecting the specific content or implied feelings of the patients nonverbal observations or communications the patient feels has been omitted or emphasized, and involves responding with empathy.

What is empathy?

Identifying with the feelings, thoughts, and experiences of another person.

What are minimal verbal responses?

Verbal clues that indicate that the healthcare provider is listening to and understanding the patient.

What is reflecting?

communicating understanding of patients concerns by reflecting on specific content or implied feelings.

What is paraphrasing?

Verbal statement that is interchangeable with a patients statement. May be synonyms for the words the patient has used.

What is probing?

Open ended statement used to obtain more information.

What is clarifying?

Used to obtain more information about ambiguous or conflicting statements.

What is interpreting?

When the therapist adds something to the patients statement or tries to help the patient understand underlying feelings. Providers share their interpretation letting the patient confirm or deny this interpretation.

What is checking out?

When therapist are genuinely confused about their perceptions of the patients verbal or nonverbal behavior or a hunch to be examined.

What is informing?

When a therapist shares objective and factual information.

What is confronting?

Involves making the patient aware that the patient is aware their observation does not match the patients words.

What is summarizing?

Conceding and putting in order information. Helpful when patient is rambling and has trouble sequencing events.

What is 100% on Karnofsky scale?

Normal; no complaint or evidence of disease.

What is 90 on the karnofsy scale?

Ability to carry out normal activity; minor signs of symptoms and disease.

What is 80 on the karnofsky scale?

Normal activity with effort; some signs or symptoms of disease.

What is 70 on the karnofsy scale?

Self care; inability to carry on normal activity or do active work.

What is 60 on the karnofsy scale?

Occasional assistance required, but ability to care for most needs.

What is 50 on the karnofsy scale?

Considerable assistance and frequent medical care required.

What is a 40 on the karnofsy scale?

Disability; special care and assistance required

What is a 30 on the karnofsy scale?

Severe disability; hospitalization indicated, although death not eminent.

What is a 20 on the karnofsy scale?

Extreme sickness: hospitalization and active support treatment necessary.

What is a 10 on the karnofsy scale?

Moribund status; fatal process progressing rapidly.

What is a 0 of the karnofsy scale?

Death

What is a 0 on the ECOG scale?

Fully active, able to carry out all predispose activities without restriction.

What is a 1 on the ECOG scale?

Restricted in physically stenosis activity but ambulatory and able to carry out any work of light or sedementary nature.

What is a 2 on the ECOG scale?

Ambulatory and capable of all self care but unable to carry out any work activities. Up and about more than 50% of waking hours.

what is a 3 on the ECOG scale?

Capable of only limited self care, confined to bed or charred then 50% of working hours.

What is a 4 on the ECOG scale?

Completely disabled, Cannot carry out any self care. Totally confined to chair or bed.

What is a 5 on the ECOG scale?

Dead.