Fatigue

1
Fatigue

• Selected slides modified from presentation by
• Julie Barrosso, RN, PhD
• Associate Professor
• UNC School of Nursing

2
What is Fatigue?

• A self-perceived state
• Like pain, it is whatever the patient says it is

3
Fatigue What may cause it?

• The chronic illness itself, the side effects of
  the illness, /or the work of the illness,
  specifically assess for
• Anemia
• Fluid/electrolyte imbalances
• Sleep disruption
• Muscle mass loss
• Infection
• Hypoxia
• (continued next slide)

4
Fatigue Potential Causes (cont.)

• Depression /or other psychosocial factors
• CNS changes
• Radiation therapy
• Pain/discomfort
• Surgery
• Body image changes
• Role changes

5
Key points about fatigue

• Complex, multidimensional problem
• Described as an overwhelming and unremitting
  feeling of a lack of energy
• Alters functional status and capacity
• Uncertainty about cause of fatigue magnifies the
  experience
• It does not mean that there is a treatment
  failure or disease progression
• Effective management is a challenge

6
Theories about fatigue

• There are four theories to explain the etiology
  of fatigue
• Theory 1 Fatigue and energetics
• examines fatigue as a metabolic imbalance when
  the bodys energetic resources are depleted
• Theory 2 Adaptation, energy and stress
• as resources are depleted, the person is forced
  to slow down or stop to recover

7
Theories about fatigue (cont.)

• Theory 3 The fatigue/inertia spiral
• the resting individual is not in a state of
  homeostasis, but is gravitating toward a state of
  less available energy
• Theory 4 The Psychobiological-Entropy Model
• One or more of the 4 sources of biological energy
  for living is depleted
• Oxygen
• food and fluid
• adequate kcal/day expenditure
• energetic capacity (Winningham, 1998) - created
  by activities that resist gravity
  (strength-training exercise)

8
Fatigue Assessment

• Many tools are available, most of which were
  developed with cancer patients
• Tests comparing different tools revealed that
  they all had good internal consistency and were
  sensitive to change (Meek et al., 2000)
• Available tools include Piper Fatigue Scale,
  General Fatigue Scale, Multidimensional
  Assessment of Fatigue

9
Clinical Assessment Guide for Fatigue

• Assess
• Normal activity levels
• Normal sleep patterns
• Pre-existing conditions
• Diagnosis
• Treatment regimen
• (cont. next slide)

10
Clinical Assessment Guide for Fatigue
(cont.)

• Assess functional work output
• Focus on changes are routine tasks getting
  harder? Have you slowed down? Have you stopped
  doing some things because of fatigue?
• Changes in everyday activities are you capable
  of complete self-care? Have you changed your
  bedtime? How much time do you spend in bed,
  resting, napping?
• (cont. next slide)

11
Clinical Assessment Guide for Fatigue
(cont.)

• Are your activity/rest patterns changing?
• Are you able to participate in family activities?
• Are you making occupation-related changes?
• Have you changed your social activities?
• Drinking/eating patterns?
• Are there other health problems?
• Diagnostic/laboratory tests include
• hemoglobin? Hydration status? Electrolyte
  imbalance, esp. potassium and magnesium?

12
Treatment of Fatigue Correct Physiology

• Correct anemia (transfusion, erythropoeitin)
• Correct hypoxia,
• Treat infection,
• Correct fluid/electrolyte imbalance
• Provide adequate nutrition frequent small
  meals

13
Treatment of Fatigue Adjust Daily Routines

• Promote sleep, rest, and a gradual program of
  exercise, i.e., energy restoration
• Identify and treat depression
• Establish priorities for safe activities
• Schedule important activities during times of
  least fatigue

14
Treatment of Fatigue- Restore Energy

• Add diversional activities
• Alleviate boredom
• Change scenery
• Plan a graduated program of exercise
• Use stress management techniques
• Increase body awareness and response to signals
• Use nature to restore - complimentary,
  alternative and integrative therapies

15
Treatment of Fatigue - Conserve Energy

• Use a hand-held shower while sitting
• Wash hair in shower
• Use a long-handled brush to reach back, feet
• Sit to dry off
• Use an elevated commode seat
• Loose fitting clothing allows easier breathing
• Organize early to avoid rushing to dress
• (cont. next slide))

16
Treatment of Fatigue - Conserve Energy (cont.)

• Wear slip on shoes
• Use reacher /or dressing stick
• Use a wheelchair for long trips
• Maintain god posture while driving use cruise
  control if possible
• Install handrails, ramps in home
• Place chairs throughout home for rest stops

17
Fatigue Research

• Has shown that
• Exercise helps
• Correcting anemia improves energy level and
  quality of life
• Has yet to establish
• effects of energy conservation or sleep rest
• impact of nutrition
• the precise relationship between physiologic
  changes and fatigue

18
An example Patterns of exercise fatigue in
physically active cancer survivors

• Exercised an average of 9 hours/week
• Decreased their activity level during treatment,
  but believed that return to regular exercise
  would make them less likely to have health
  problems
• Used exercise as a means to have more energy
• Patients with breast cancer reported more
  benefits from exercise than patients with
  non-Hodgkins lymphoma (Schwartz, 1998)