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Medcon Rehab III > Oncology: Principles In Onco Rehab Pt. 3 > Flashcards

Oncology: Principles In Onco Rehab Pt. 3 Flashcards

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1
Q

PT Imps in terms of Oncology

A
  • Type and Stage of Cx
  • Gen health
  • QOL
  • Financial and social strains
  • Preventative, Restoratitve, Supportive, Palliative
  • SEs from tx
  • Discharge planning from ALL settings
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2
Q

Blood Clots

2 that we are Concerned W/:

A
  1. DVT
  2. PE
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3
Q

Deep Vein Thrombosis

DVT

Explaiin

A
  • Clot of cellular material bound to fibrin located in DEEP VEINS
  • Sx’s:
    • ​edema
    • erythema
    • PAIN
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4
Q

Pulmonary Embolism

PE

Explain:

A

Blood clot which obstructs the Pulmonary aa/vein

  • Sx’s:
    • ​dypnea
    • LOW O2sats
    • tachycardia (reflex tachy)
    • chest pain***
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5
Q

DVT

PE

Tx’s

A
  • AntiCOAGULANTS (blood unable to clot)
  • IVC filter (Inf. Vena Cava)
    • for LE origin ONLY
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6
Q

VASCULAR

DVTs

Incidence in Cx Pts

A
  • TWICE AS LIKELY TO DEVELOP DVTs***
  • FREQ. complication
  • 2nd leading cause of death***
  • 90% of pts expe an INC in clotting activity
  • MORE COMMON:
    • ovarian
    • pancreatic
    • lymphatic
    • liver
    • stomach
    • colon cx’s
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7
Q

Vascular complications

DVTs

Causes of a Hypercoagulable State

A
  • Immobility
  • SOME tumors release subs that INC blood’s ability to clot
  • Sx OR CHEMO can injure vessel walls—> triggers blood coagulation
  • Cx therapy can DEC body’s ability to produce adequate coagulants
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8
Q

Vascular comps

DVTs

PT imps:

A
  • Awareness of Tx***
  • Monitor approp. blood values
  • Monitor SPO2 and HR***
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9
Q

Blood Clot forming

Embolus traveling thru heart INTO lung vessels

A

see pics

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10
Q

Sx Resection GOALS:

WHAT ARE THEY TRYING TO ACHIEVE?

A

CLEAN MARGINS

  • Trying to achieve clean margins
    • ​to be sure ALL cx cells removed
  • Tumor can be resected completely BUT
    • ​ALSO want to resect an area of clean tissue or non-cx tissue to see if ACTUALLY CLEAN

​

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11
Q

SEs from Sx

A
  • Loss of Function
  • disfigurement or deformities
  • PAIN
  • infection
  • Risk of bleeding or hemorrhage
  • Fatigue
  • dev. of scar tissue
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12
Q

PT Implications Following Sx

A
  • EARLY mobility and pulm hygiene
  • Respiratory Considerations:
    • ​Chest PT + Airway clearance
    • Chest wall excursion (lateral costal breathing)
  • Soft tissue restrictions:
    • ​ROM restricts
    • WB restricts
    • Scar restriction (after healing)
  • Weakness:
    • ​Nerve resections
    • Nerve traction injuries
  • **Psychosocial implications
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13
Q

Chemotherapy

Common SE’s

**remember Chemo attacks ANY rapidly dividing cells (think GI, Hair follicles)

A
  • PAIN
  • Fatigue
  • Bone marrow suppression
    • ​Infection
  • Alopecia**
    • ​remember hair follicles attacked–rapidly dividing
  • Infertility
  • GI effects**
    • ​​remember hair follicles attacked–rapidly dividing
    • nausea, vom, constipation, anorexia
  • Peripheral neuropathy
  • DECd bone density
  • skin rashes
  • Wt. gain OR loss
  • Jt pain
  • Sexual dysf
  • Hemorrhage
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14
Q

Hematological Considerations:

Bone Marrow Suppression:

3 things come from this

A
  1. Anemia
  2. Thrombocytopenia
  3. Leukopenia/Neutropenia
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15
Q

Anemia

What is it?

A

LOW RBC Count

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16
Q

Anemia

Lab values: HgB

Norms: M vs F?

A

MALE==14-17 g/dL

FEMALE==12-16 g/dL

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17
Q

Anemia

S/S

(Anemic)

A
  • FATIGUE
  • irritability
  • lightheadedness
  • HA
  • Loss of concentration
  • pallor
  • SOB
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18
Q

Anemia

PT Imps:

A
  • Monitor VITALS!!!
    • RR INC, HR INC, SaO2 DEC
  • Monitor LAB VALUES/Tx
  • Monitor FATIGUE LVLS

NOTE: Have to use RPE ***

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19
Q

Thrombocytopenia

what is it?

A

LOW Plt count

  • NORM== 150,000-400,000 mm^3
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20
Q

Thrombocytopenia

LOW Plts

S/S

A
  • Bruising
  • Bleeding—if too low
  • Petechiae
    • sm. raised rash on skin
    • microtrauma to superficial blood vessels
      • _​_INAD. Plts

​

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21
Q

Thrombocytopenia

LOW Plt count

PT Imps:

A
  • Monitor LAB VALUES/Tx
  • FALL PRECAUTIONS
    • train balance but NOT high lvl
  • Focus on Functional Mobility
    • _​_NO risky activity
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22
Q

How can you remember Plts easily??

A

They are YELLOW

SEE PICS

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23
Q

Leukopenia/Neutropenia

What is this ?

A

LOW WBC Count

  • NORM== 3.5k to 10.5k cells/mcL
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24
Q

Leukopenia/Neutropenia

LOW WBCs

S/S

A
  • Freq INFECTIONS
  • Fevers
  • Throat/mouth sores bc DECd ability to fight infections
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25
Leukopenia/Neutropenia LOW WBCs **PT implications:**
* Reverse/Protective Isolation---**Neutropenic Precautions** * **​**PROVIDER (PT) **dons PPE to _protect pt_** * Creative tx interventions
26
Bone Marrow Suppression Guidelines ## Footnote **aka Blood Counts outside normal ranges:** **WBCs**
* **\<5k--**NO EX permitted * **\>5k--**light ex, progressive to resistance
27
Bone Marrow Suppression Guidelines aka Blood Counts outside normal ranges: **HgB:**
* **\<7.5g/dL==** NO EX permitted * **7.5-10g/dL==** Lt ex, focus on _functional mobility_ * **\>10g/dL ==** Resistive ex permitted
28
Bone Marrow Suppression Guidelines aka Blood Counts outside normal ranges: **Plts:**
* **\<20k--** NO EX OR ADLs/walking * **20-30k--** Lt ex, AROM, walking * **30-50k--** MOD ex, aquatic, stationary bike * **50-150k--** Progressive resist ex's, swimming, bike * **\>150k--** Unrestricted normal act.
29
Bone Marrow Suppression Guidelines aka Blood Counts outside normal ranges: **INR**
* **\>4.0-- NO EX permitted**
30
Radiation Therapy **Common SEs** **And what can occurr from each.**
* PAIN * Fatigue * **Bone marrow suppression****​** * **​INFECTION** * Local hair loss * attacks rapidly dividing cells * **Delayed wound healing** * **DECd bone mass/strength** * Skin changes * **fibrosis** * **erythematous skin** * **fragile skin** * **myofascial adhesions** * GI changes--attacks rapidly dividing cells * **diarrhea** * **vom** * **PRO deficiency** * **anorexia** * Wt loss * **AVN:** loss of blood supply==necrosis
31
Radiation Therapy ## Footnote **Common SEs** **Radiation Myelitis**
* damage to **small blood vessels in _spinal column_** * **_​_--\> DECd blood flow** * **--\> necrosis** * **--\> demyelination** * **​--\> sensory dysf and weakness**
32
Radiation Therapy ## Footnote **Site Specific SEs** **Abdomen and Pelvis**
* Nausea * **bladder discomfort/dysf** * **Sexual dysf**
33
**Radiation Therapy** **Site Specific SEs** **Head and Neck**
* Diff eating * **dental hygiene** * **Dry mouth**
34
Radiation Therapy ## Footnote **Site Specific SEs** **Breast**
* DECd shoulder ROM * Soreness * **Lymphedema**
35
**Radiation Therapy** **Site Specific SEs** **Chest**
* **Swallowing** diff * SOB\*\*\*
36
Radiation Therapy **Considerations**
* Burns/blisters * **Radiation fibrosis/necrosis** * **​brain** * **lungs** * **trismus**
37
PT Implications following Radiation Therapy **Radiation Induced Fibrosis** **\*stuck, tight adhesions** **Specifically what/where?**
* **Trismus** * **​**unable to open mouth by 30cm or 3knuckles * Limtd **cervical ROM** * **Head drop----literally** * **Limtd chest wall excursion** * **Osteoradionecrosis** * **​**Jaw bone * Neuralgia * **loss of nerve conduction** * **loss of flexibility**
38
Radiation Therapy ## Footnote **Common SEs** **CNS Effects: 3**
1. Radiation Necrosis 2. Encephalopathy 3. Myelopathy
39
Radiation Therapy **Common SEs** **CNS effects:** Radiation Necrosis
Lg mass of **dead tissue** that forms @ SITE of **irradiated tumor**
40
Radiation Therapy **Common SEs** **CNS Effects:** Encephalopathy
**FOCAL** neuro sx's assoc'd w/ **white matter changes (DECd)**
41
Radiation Therapy **Common SEs** **CNS Effecs:** Myelopathy
Functional or pathological disturbance of **Spinal Cord** **\*\*can be _transient_** **(short term) or** **_chronic_**
42
Breast Cx: **Radiation SEs**
**LEFT=** burn + fibrosis **RIGHT=** radiation burn
43
Radiation **SEs** **Radiation desquamation + skin changes**
see pics
44
Radiation Therapy SEs ## Footnote **Pulmonary fibrosis**
* Possible after **lung or breast radiation** * **NO current tx's**
45
PT Implications ## Footnote **Radiation Therapy** **PRECAUTIONS:**
* Blood values/lab results * Infection control * PAIN * fatigue * **WB status**
46
Radiation Therapy: PT Implications ## Footnote **Interventions:**
ROM FALL PREVENTION, **Assess for approp. AD** **pt+fam edu**
47
PT implications **Following Radiation Therapy**
* Nerve injury * **weakness** * **pain** * **parasthesias** * Lymphedema * Fatigue * Compromised skin integrity * Psychosocial imps
48
Stem Cell Transplant usually **combined w/....**
HIGH DOSE CHEMO
49
SES from **Stem Cell Transplant**
* **GVHD** * **​Graft vs. Host Dis.** * **​body REJECTS stem cells** * Immunosuppression * Isolation * Delayed wound healing * Nausea and vom * **Osteoporosis** * **2\* malignancy**
50
**Graft vs. Host Disease** **GVHD**
* **Transplant Rejection:** * **​**Donor cells (graft) recognize body's cells (host) as **foreign** and implement **immulogic attack** * **skin, liver, gut** * **Tx:** * **​**INCd **immunosuppressive drugs**
51
Graft vs. Host Disease when is it **ACUTE**
w/in First 100 days
52
Graft vs. Host Disease When is it **Chronic?**
\>100 days
53
General **NEUROLOGIC Considerations** **3:**
* 1. **Cognition** * **​A&Ox4** * **2. Hydrocephalus:** INCd ICP * **3. Neuropathy/Radiculopathy:** chemo affects nerves
54
Gen **Neurologic Considerations** ## Footnote **PT Imps:**
* Safety awareness * Orientation * Ability to **follow commands** * **MEMORY**
55
Gen **NEUROLOGIC Considerations** ## Footnote **Hydrocephalus** **\*incd ICP** **PT Imps:**
* AVOID **valsalve maneuvers** * **NO excess bending or heavy lifting** * **\*\*HOB elevated to 30deg or HIGHER** * **MONITOR:** * **​**HA's * Nausea * Dizzy * **INCd BP** ## Footnote **​**
56
Gen. **NEUROLOGIC Considerations** ## Footnote **Neuropathy/Radiculopathy** **PT Imps:**
* Assess/Monitor: * **sensation to lt. touch** * **Proprio.** * **balance** * **coord.**
57
Gen. **MSK Considerations** ## Footnote **Name them**
* Bone pain * Know **WB precautions** * Bony Mets * **Pain w/ WB, not responsive to PT, pain w/ Valsalve** * Sk mm wasting * **Osteoporosis** * **Steroid Myopathy \*\*\*\*** * **Bedrest/Decond.**
58
Gen **MSK Considerations** ## Footnote **Bony Mets** **PT Imps:**
* WB status * ROM restrictions * **Spinal precautions\*\*** * **​No BLT** * **​Bending** * **Lifting** * **Twisting** * LOG ROLL
59
Gen **MSK Considerations** ## Footnote **Steroid Myopathy\*\*** **PT Imps:**
* **PROX** MM weakness * **monitor strength**
60
Gen **MSK Considerations** ## Footnote **Bedrest/Deconditioning** **PT Imps:**
* VITALS\*\*\* t/o Tx * Monitor loss of **bone density**
61
W/ **Goal Setting** **What should we keep in mind?**
* **Prognostic Indicators** * **​**be Realistic * **Communication** * **​**b/w PT, pt, family * goals may be diff!!! * **Caregiver Training** * **​**If pt returns home--may need assist * **When is PT Approp?** * **​**if achieved **max lvl of benefit** * **​**communication!!!
62
**Discharge Planning**
* **Various Settings:** * **​**acute, subacute, SNF, assist living, hospice, * HOME--may req other services * **Considerations:** * **​**prognosis * Pt/family desires * futher tx * **Immunocompromised state** * **PT's input is _extremely vital_** **to discharge process\*\*\***
63
Cancer Pain
* acute vs chronic * several etiologies * described as **Intractable**
64
Cancer Pain ## Footnote **Acute**
* BRIEF duration * **Cause usually known**
65
Cx Pain ## Footnote **Chronic**
* Extends **beyond 3mos** * **Cause may be UNknown**
66
Etiologies Cx Pain ## Footnote **Cx Pain Syndrome**
* Diff types of pain * Diff etiologies * Diff tx methods * **Can be from:** * **​sx pain** * **hardware** * **painful neuropathy from hardware** * **DIFF REASONS!!!**
67
**MOST COMMON FORM OF Cx PAIN....**
BONE PAIN
68
Cx Pain ## Footnote **Bone Pain**
MOST COMMON * Can be **primary or 2\* dis**
69
Cx Pain ## Footnote **Visceral Pain** **\*organs**
* Organs in **thoracic and abdominal areas (sx in abdomen)** * **Gnawing, Crampy, Constant, Aching, DEEP**
70
Cx Pain **Neuropathic Pain**
* FROM: * **_peripheral_ OR _central_ sensory nerve trauma** * **​**causes **abnormal firing** * CHARACTERIZED: * **Burning** * **Shooting** * **Tingling**
71
Cx Pain **From Cx Tx**
* Sx * RT * chemo \*\*ALL CAN EXACERBATE PAIN
72
Cx Pain **Pain UNRELATED to Cx**
NOTE: **Cond's other than Cx cause pain**
73
Cx pain ## Footnote **Factors affecting response to pain**
Anxiety Personal life experience Culture/Religion
74
Mgmt of **Cx Pain** ## Footnote **FIRST STEP?**
Determine **Source** Attempt to **Remove It** * **Sx** * **Radiation** * **Chemo** **\*\*BUT remember these can all CAUSE PAIN as well\*\*\***
75
Meds and Routes of Admin
* Oral * Buccal/transmucosal * Rectal * Transdermal * Subcutaneous * IV * Direct CNS admin * Pt-Controlled Analgesia * **PCA pump----LET THEM CARRY THIS DURING Tx**
76
Delivery of Pain meds and Coordinating w/ PT and scheduling
* Scheduling * **Breakthru Pain** * **​X avail all the time, Y if X not enough** * **Coord w/ Pt and other HC providers**
77
Other Methods Pain mgmt
Behavioral intervents **Modalities** * **Modalities** * **​**Cutaneous Stim (STM's) * heat, cold * TENS
78
**Cx PAIN** **PT Role**
* ROM, gen therex * mobs * Positioning * ADs * Bracing * Modals
79
PT Imps: Cx Pain **Considerations**
Assessment of Pain (1-10) **Pre-medication of pt (for comfort during tx)** **SEs of meds\*\*\***
80
Cx FATIGUE \***Overwhelming fatigue\*\***
"Distressing, persistent, subjective, sense of physical, emotional and/or cognitive tiredness or exhaustion **related to cx or its Tx** that is **not proportional to recent activity** and **interferes w/ usual functioning"** **\*present in those indiv's w/ advanced cx**
81
Cx Fatigue ## Footnote **ACUTE**
* **Expected occurrence** after energy is expended * when you SHOULD feel tired, you do...but it is still overwhelmingly tired * **SHORT duration** * **_Usually alleviated by REST_**
82
Cx Fatigue ## Footnote **CHRONIC**
* Abnorm or **Excessive** * Can involve ENTIRE BODY * NOT **alleviated by rest** * **Can be overwhelming** **\*\*Fatigue that takes over you**
83
Pathophys of Cx Fatigue ## Footnote **Contributing factors?**
Cx itself Progress. of dis.
84
Pathophys of Cx Pain **Physical Factors that influence**
* sleep/rest patterns * nutrition * GI probs * bone marrow suppression * mult meds * **overall phys condition\*\*\*** * tx * infection * Meds SEs
85
Pathophys of Cx Fatigue ## Footnote **Psychosocial Factors that influence**
* Depress/isolation * anxiety * appearance * lack of control * relationship changes * sexual dysf * finances
86
Measuring Fatigue ## Footnote **Clinical S/S**
* DEC strength * INC dyspnea * rate, depth * Tachycardia * Diff concentrating * DEC ability to perform ADLs * DEC nutritional intake * Change in sleep/rest cycles
87
PT Imps **Cx Fatigue** ## Footnote **Considerations:**
* Help det possible **causes** of fatigue * refer out * RD * sleep docs * **Measure VITALS!!!**
88
PT IMPS **Cx Fatigue** **PT Role**
* Daily energy log * **EXERCISE----#1 WAY TO TX FATIGUE!!!** * **energy conservation** * **ADs**
89
Physiotherapy Program Reduces Fatigue In Pts w/ Adv Cx Receiving Palliative Care: RCT Psyzora A, Budzynski J, et al.
See Study below
90
Lymphedema ## Footnote **What is it?**
Disruption in **lymphatic system** which results in a **chronic accumulation of lymphatic fluid** ## Footnote **\*PRO-rich lymphatic fluid**
91
Lymphedema ## Footnote **Risk factors**
1. Lymph node **dissection** 2. **Radiation** to lymph nodes 3. **Tumor** impeding lymph flow
92
Common areas for **Lymphedema**
* Breast, arm, trunk following **ALND (Axillary Lymph Node Dissection)** * Head and Neck following **RND (Radical Neck Dissection)** * LEs and Genitals following **PLND (Pelvic Lymph Node Dissection)**
93
Lymphedema Prevention + Education
* Maint **healthy wt.** * **PREVENT any trauma to affected area** * **​cuts, scrapes, burns** * **AVOID BP in Affected Extremity** * **AVOID** IVs, injections, needles in affected extremity * Proper **nail and skin care** * **​AVOID cutting cuticles** * Avoid tight fitting jewelry, clothes, bags
94
**Complete Decongestive Therapy** **For _Lymphedema_** **Components of this?**
* 1. Manual Lymphatic drainage----**must be trained** * 2. **Compression**--bandaging * 3. Self-care * **exercise** * **skin care** * 4. Compression Garments * **TEDS** ## Footnote **​**
95
Axillary Web Syndrome ## Footnote **\*Think _Palpable Cord\*\*\*\*\*\*_**
* Visible web of **axillary skin** which overlies a **palpable cord of tissue** including blood vessels, nerves, lymphatics * MAY extend to medial ipsilat arm, antecubital space, base of thumb * **Pain w/ shoulder FLEX and ABD**
96
Effects of a PT Program Combined w/ MLD on Shoulder Function, QOL, Lymphedema Incidence, and Pain In Breast Cx Pts w/ Axillary Web Syndrome Following Axillary Dissection
see study below
97
Superior Vena Cava (SVC) Syndrome ## Footnote **what is it and what will you see?**
* Invasion of tumor (**typ lung tumor) INTO SVC** causing **edema of neck and face** * **​**Thoracic vein distention * Tachypnea (\>20breaths/min) * Cyanosis (blue) * Edema of UEs * paralyzed vocal cords
98
SVC Syndrome ## Footnote **Tx**
EBRT (Ext Beam Radiation Therapy) and Chemo (less common option) **Steroids for edema**
99
Head and Neck Cx ## Footnote **Trismus**
* Impaired **mouth ROM** * Impaired **jaw mobility** * INCd PAIN
100
Head and Neck Cx ## Footnote **Sx can cause**
immobility and pain scar tissue
101
Head and Neck Cx ## Footnote **Radiation can cause:**
**Fibrosis** of **jaw mm's, skin, fascia**
102
Trismus ## Footnote **Tx's**
* Myofascial Release * Intra & Extraoral massage * Jt mobilization * Therex * Splinting (see pics) * **Dynasplint** * **LLPS---Low Load Prolonged Stretch**
103
Pediatric Considerations
* **Long term SEs (for survivors as children)** * **​**Cardiac or Pulm toxicity * **QOL** * **​**developmental OR educational delay * MSK considerations and growth * fertility * **Long term survival and Gen health follow-ups!!!**
104
Outpatient Oncology Services
To manage the MSK, NMSK, integumentary and CP rehab needs of pts resulting from the tx of cx. This includes acute or chronic sequela of cx tx such as sx, RT, chemo.
105
PT Dx's oncology pts in Outpatient setting
see list below:
106
Outpatient: **Tx Interventions Cx Pts**
see list below
107
Assesment of PT Strategies for Recovery of Urinary Incontinence after Prostatectomy
see study below
108
Outpatient Modalities for Cx pts ## Footnote **Indications (when to use):**
* MAY reduce pain and spasm * **NOT proven effective for tx of deep cx pain or bone pain**
109
Outpatient cx pts: Modalities **ABSOLUTE _Contraindications_** **DO NOT USE WHEN:**
* DIRECTLY over tumor * Bleeding or hemorrhage * **long term corticosteroid or chemo** * **Damaged OR regenerating nerves** * **​RT or chemo induced** * ​they cannot give you response to modality!!! * **Implants** in Tx area
110
Recognizing **Red Flags** ## Footnote **Examples**
* Recognizing **skin cx's** * **​PTs VERY close to pts---we see all over body--ex. back where pt may not see** * Palpation of abnorm tissue * Pain * Neurologic changes
111
Red Flags ## Footnote **PAIN related...**
* Insidious onset (just crept up) * **Worse @ night, _interferes w/ sleep_----this is HUGE Red Flag\*\*** * **Unable to _reproduce_ w/ positioning**
112
Recognizing Red Flags ## Footnote **Neurologic Changes**
* Mm weakness * Numb/tingling * **Loss of B&B control** * Burning or shooting pain
113
Skin Cx's ## Footnote **2 Types:**
* 1. Melanoma-- * **occurs in DEEPEST part of epidermis** * 2. Basal Cell Carcinoma-- * **occurs in epidermis**
114
Skin Cx ## Footnote **Melanom** **DEEPEST part of epidermis**
* **Pigmented _blackish_ or** **_brownish_ color** * **IRREGULAR, ill-defined borders** * Spreads QUICKLY to skin **and other parts of body**
115
Skin Cx ## Footnote **Basal Cell Carcinoma** **\*in epidermis**
* **PEARLY ROUND appearance OR _darkly pigmented_**
116
Skin Cx's ## Footnote **ABCDE**
* **A:** **A**symmetry * one half of mole or birthmark NOT match other half * **B: B**order * edges **irreg, ragged, notched, blurred** * **C: C**olor * color NOT same all over--**brown, black, sometimes patches of pink, red, white, blue** * **D: D**iameter * spot **LARGER than 6mm _across_** (1/4in--size of pencil eraser) * **NOTE:** melanomas CAN BE smaller than this * **E: E**volving * mole is **changing in size, shape, color** ## Footnote **​**
117
**CARDINAL SIGNS for Cx OCCURRENCE**
* **Unusual, non-reducible** fatigue * fever * **Unexplained** wt loss * weakness * PAIN * skin changes * Night sweats
118
**Oncology considerations for PT intervents** Considerations of **Cx Hx**
* explanation of _current rehab_ Dx * \***Common PRIMARY cx's to develop _Bony Mets_** * **_​_**Breast * Prostate * Lung * Kidney
119
\*Common PRIMARY cx's to develop Bony Mets
​Breast Prostate Lung Kidney
120
Oncology considerations for PT Intervention ## Footnote **Dev of Mets**
* Altered **mental status** * Altered **balance** * Unresolved **pain** * **Bone pain----common loc. for mets** * **Nerve pain** * SUDDEN onset of **weakness** * **​SC compression** * SOB
121
PT Imps ## Footnote **Bony Mets** **PRECAUTIONS**
* PAIN * MMT * WB status * Cautions of **Patho fx's \*\*\***
122
PT Imps ## Footnote **Bony Mets** **INTERVENTIONS**
* Therex * **Orthotics** * **​support/prevent Fx's** * ADs * pt edu/safety
123
CNS Mets Disease **Cx that has spread to brain** **\*NOTE:** usually NOT the other way around\*\*\* **PRESENTATION?**
* HA's * Mm weakness * Sensation changes * Impaired **balance/coord** * Behavioral changes
124
CNS Mets Disease ## Footnote **INTERVENTIONS**
* Orthotics, ADs * Therex * NMSK re-ed * safety assess/fam training
125
Cx Pts **Multidisciplinary TEAM** ## Footnote **COMMUNICATION IS _KEY_\*\*\***
SEE LIST OF TEAM Mbrs

Medcon Rehab III (6 decks)

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