FF - cancer, SLE, scleroderma, Lyme's, seizures, dehydration, heat exhaustion & stroke

What are the early warning signs of cancer?

• unexplained weight loss >10 lbs.

• persistent pain or fatigue

• lumps or swelling (big kids like to party = breast, kidney, liver, thyroid, prostate)

• skin ∆s (ABCDE = asymmetry, irregular borders, color variation, diameter >6mm, evolving)

• persistent cough or hoarseness

• dysphagia

• ∆s in bowel or bladder habits

• unusual bleeding or discharge

• sores that don’t heal for several weeks

What are the medical interventions for cancer?

• chemotherapy

• radiation therapy

• immunotherapy

Describe chemotherapy

• target rapidly dividing cells

• given orally, subcutaneously, intramuscularly, or intrathecally (spinal cord)

• ADE: hair loss, GI issues, bone marrow suppression leading to leukopenia

Describe radiation therapy

• to destroy cancer cells and inhibit their growth

• given pre- or post-op

• ADE: radiation sickness, burns, delayed wound healing, ROM deficits around the joints

Describe immunotherapy

• to strengthen the ability to fight cancer cells using interferons, interleukins-2, cytokinin

• includes bone marrow transplant & hormonal therapy

• ADE: steroid-induced diabetes, fluid retention, hot flashes, mm atrophy, fever

What platelet count is a contraindication to exercise?

<10,000 (normal = 150,000 - 400,000)

What WBC count is a contraindication to exercise?

<5,000 w/ fever (normal = 5,000 - 10,000)

What Hgb level is a contraindication to exercise?

What can the pt do instead?

<8 g/dL, essential ADLs only

What hematocrit level is a contraindication to exercise?

What can the pt do instead?

<25%, essential ADLs only

What body temperature is a contraindication to exercise?

fever >100.5°F

Describe SLE

• malar butterfly rash on face; can also appear over extensor surface of UE

  • rashes are non-scarring

• photosensitivity

• arthralgia & arthritis

• common in females > males

Describe scleroderma

inflammation & fibrosis of many parts of the body, including skin, blood vessels, synovium skeletal mms, internal organs

• common in Caucasian women

• CREST:

  • calcinosis: Ca2+ deposits on the skin

  • Raynaud’s phenomenon: spasm of blood vessels in response to cold or stress

  • esophageal dysfunction: acid reflux & decreased motility of esophagus

  • sclerodactyly: thickening & tightening of the skin on the fingers & hands

  • telangiectasias: dilation of capillaries causing red marks on skin surface (spider veins)

Describe Lyme’s disease

• from tick bite

• commonly affects children

• early localized stage (3-30 days after tick bite):

  • erythema migrans (EM) rash: bulls eye rash

  • flu-like Sx’s

• early disseminated stage (days to weeks after):

  • multiple EM rashes may appear on different parts of the body

  • neuro Sx’s: Bell’s palsy, numbness & tingling, shooting pain in the UE or LE, poor coordination

  • cardiac Sx’s: heart palpitations, irregular heartbeat

• late disseminated stage (months to years after):

  • severe joint pain & swelling, often the knees

  • neuro Sx’s: inflammation of brain & spinal cord, chronic pain, numbness, impaired memory & concentration

Recognition of seizures

• aura

• sudden unresponsiveness or LOC

• mm jerking or twitching

• stiffening of mms or loss of mm tone

• incontinence

How should you respond to someone who is seizing?

• remove any nearby objects that could cause injury

• turn the person to their L side (prevent choking, ensure open airway)

• note the time when the seizures starts & ends

• if lasting >5 min, CALL 911

• don’t try to hold them down or stop their movements

• don’t put anything in their mouth

Describe mild, moderate, & severe dehydration

• mild: thirst & dry mouth/lips

• moderate: very dry mouth, cracked lips, HA, sunken eyes, poor skin turgor, OH

• severe: rapid & weak pulse, confusion, lethargy, rapid breathing, seizures, inability to urinate or cry

How should you respond to dehydration?

• drink water or take oral rehydration solutions

• if nauseous → take small frequent sips rather than large amts. at once

• if severe → intravenous fluids

Describe heat exhaustion & heat stroke

exhaustion // stroke

• diaphoresis, pale skin // dry, flushed, or gray skin

• HA, nausea (both)

• rapid & weak pulse // rapid & strong pulse

• rapid & shallow breathing // labored breathing

• normal or slightly elevated temp // temp >106°F

• normal pupils // pupils constrict, then dilate

• exhaustion, collapse, LOC // same + convulsions

How should you respond to heat exhaustion?

• drink water or sports drinks

• move to cooler place

• if fully conscious → sip water

• take a cool shower or use cold compresses

• remove tight clothing or extra layers

• if vomiting continues → CALL 911

How should you respond to heat stroke?

• CALL 911

• move to a cooler place

• do NOT give fluids