Non-physical symptoms

Question 1

Give some features of fatigue

Answer 1

• associated with a general deterioration
• can be treatment related (radiotherapy/chemotherapy)
• associated with low mood.
• disease related

Question 2

What factors can contribute to fatigue?

Answer 2

• anxiety, depression, apthy
• sleep disturbance
• pain
• electrolyte disturbance
• anaemia
• poor oral intake
• cardiac/resp disease
• renal/hepatic disease
• hypothyroidism

Question 3

How can fatigue be managed?

Answer 3

Treat cause, if relevant (hypothyroidism, electrolyte disturbance)
MDT support
Pacing
Schedule important activities for time when most alert
Ensure optimal food/hydration
Prioritise important activities
Relaxation and stress management techniques

Question 4

What are some relaxation techniques which can be utilised for anxiety?

Answer 4

Guided imagery/visualisation techniques
Progressive muscular techniques (tensing then relaxing)

Question 5

Dose and characteristics for Diazepam

Answer 5

1-5mg PRN, at night.
Mixed sedative and anxiolytic.
Long half life, therefore can accumulate

Question 6

Dose and characteristics for Lorazepam

Answer 6

1-5mg PRN
Shorted acting, more addictive than diazepam

Question 7

Dose and characteristics for Midazolam

Answer 7

2.5-5mg PRN, SC or buccal
Useful for extreme panic/anxiety

Question 8

When should TCAs not be used?

Answer 8

Recent MI, heart block, cardiac arrhythmia

Question 9

What are some scales that can be used for assessing depression?

Answer 9

Hospital anxiety adn depression scale.
Brief Edinburgh Depression Scale (BEDs)

Question 10

What are some anti-muscarinic side effects seen with TCAs?

Answer 10

Hypotension
Difficulties with micturition
Dry mouth
Confusion

Question 11

Define apathy

Answer 11

Persisten lack of interest, or loss of motivation

Question 12

Give some causes of apathy

Answer 12

Loss of confidence
Social isolation
Withdrawal
Underlying conditions e.g. Parkinsons, Stroke, Huntingdon, progressive supranuclear palsy
Frontal lobe damage
Dementia

Question 13

What can be used to support people with apathy?

Answer 13

Cognitive stimulation therapy
- Daily routine
- Encouraging people to change into day clothes
- concentrate ont eh things that hte person enjoys and try to focus on the positives
- encourage and stay positive
- break down activities into chunk, so things don’t seem so overwhelming
(Acethylcholinesterase inhibitors can help in with motivation in those poepl with dementia)

Question 14

What medications can be used to treat delirium?

Answer 14

• Haloperidol
• Anti-psychotics (give less extrapyramidal side effects than haloperisol)

Question 15

What structure can be used to take a spiritual history?

Answer 15

FICA
F - Faith/belief/meaning
I - Inportance na dinfluence
C - Community
A- Address/action in care