COMMON SYMPTOMS OF ADVANCED DISEASE
Using the scale, evaluate the following symptoms: (0=none, 10=worst possible)
- Pain
- Shortness of breath/dyspnea
- Confusion/delirium
- Nausea
- Lack of appetite
- Constipation/Fatigue/Drowsiness
- Insomnia
- Depression
- Anxiety
- Existential distress
- Itch/pruritus
- Bleeding
- Cough
- Bowel Obstruction
- Myoclonus/seizures
- Muscle Cramps/spasticity
- Wound pain and odor
Edmonton Symptom Assessment Scale Revised
Note about pain assessment:
- identify site(s), causes, severity, and impact on function, mood and quality of life.
- pain is a physical and emotional experience and can be influenced by multiple other factors.
Note about dyspnea assessment: If patient conscious, ask about shortness of breath. Patients can still be short of breath even with normal respiratory rate and oxygen saturation. If patient unconscious, look for increased respiratory rate and increased work of breathing. These signs require treatment.
Talk tip: if the patient has many symptoms, ask which symptom is bothering them the most, and manage that symptom as the top priority.
CAM tool for Delirium Assessment
The Confusion Assessment Method enables you to determine if your patient has delirium.
A diagnosis of delirium requires:
- acute onset and fluctuation
- inattention
- disorganized thinking or altered consciousness
Acute onset and fluctuation
Is there evidence of an acute change in mental status from baseline?
Does the abnormal behaviour:
- come and go
- fluctuate during the day
- increase/decrease in severity
Inattention
Does the patient
- have difficulty focusing attention?
- become easily distracted?
- have difficulty keeping track of what is said?
Disorganized thinking
Is the patient’s thinking disorganized or incoherent, i.e. does the patient have:
- rambling speech or irrelevant conversation?
- unpredictable switching of subjects
- unclear or illogical flow of ideas
Altered consciousness
Overall, what is the patient’s level of consciousness:
- alert (normal)
- vigilant (hyperalert)
- lethargic (drowsy but easily roused)
- stuporous (difficult to rouse)
- comatose (unrousable)
Immunotherapy-related adverse events (IRAE)
Immunotherapy for cancer can result in dysregulated, hyperactive immune responses that mimic autoimmune diseases
colonizing pathogens may be present, excessive immunopathological response may drive inflammation.
Any organ can be affected: most common skin, colon, adrenals, lungs, and liver.
IRAEs leading to ICU admission:
- Respiratory failure (~50%).
- Neurologic (~20%; neuromuscular weakness).
- Endocrine (~10%; DKA, adrenal crisis, hypophysitis).
- Cardiovascular (~10%).
- Colitis (~10%).
IRAE onset from 1 week to 2 years after therapy. May happen months to years after stopped. Delayed immune-related events (DIRE) challenging to diagnose.
Consult oncology, rheumatology to assist in management
Body systems, symptoms, general management one page article.