Case Study: The Short Fatigue
Fatigue is a multidimensional symptom containing a cognitive (tiredness) and Physical (weakness) element or the patient may describe it as just having a lack of energy. It has a negative impact on quality of life. If a patient complains of tiredness in end stage COPD; one just has to discern if this is cognitive, leading to listlessness, low mood, loss of concentration and sleep disturbance or a physical weakness affecting ADL’s.
The professional team starts with impeccable assessment including history, examination and laboratory testing: The Brief Fatigue Inventory is a straightforward diagnostic tool and can be used to assess the severity of the fatigue. It is important to determine the presence of potentially treatable causes eg anemia, chronic pain, thyroid disorder, infection, …show more content…
The care burden should be managed and outside resources utilized where help is needed.
Medications that could be used are corticosteroids and psychostimulants, they are sometimes beneficial adjuncts to non pharmacologic interventions directed at relieving fatigue in patients nearing the end of life. Dexamethasone (Decadron), 2 to 20 mg taken orally once daily in the morning, can bring about feelings of well-being and increased energy, although these effects may diminish after the drug has been used for four to six weeks. In the end-of-life setting, the long-term side effects of morning doses of corticosteroids are usually not an issue. Of the psychostimulants, methylphenidate (Ritalin) is most commonly prescribed, although dextroamphetamine (Dexedrine) can also be used.
Antidepressants may be considered even if there is no clinical depression when the fatigue does not respond to non-pharmacologic interventions, corticosteroids or psychostimulants. In addition to elevating mood, antidepressants (particularly selective serotonin reuptake inhibitors) can have an energizing
The professional team starts with impeccable assessment including history, examination and laboratory testing: The Brief Fatigue Inventory is a straightforward diagnostic tool and can be used to assess the severity of the fatigue. It is important to determine the presence of potentially treatable causes eg anemia, chronic pain, thyroid disorder, infection, …show more content…
The care burden should be managed and outside resources utilized where help is needed.
Medications that could be used are corticosteroids and psychostimulants, they are sometimes beneficial adjuncts to non pharmacologic interventions directed at relieving fatigue in patients nearing the end of life. Dexamethasone (Decadron), 2 to 20 mg taken orally once daily in the morning, can bring about feelings of well-being and increased energy, although these effects may diminish after the drug has been used for four to six weeks. In the end-of-life setting, the long-term side effects of morning doses of corticosteroids are usually not an issue. Of the psychostimulants, methylphenidate (Ritalin) is most commonly prescribed, although dextroamphetamine (Dexedrine) can also be used.
Antidepressants may be considered even if there is no clinical depression when the fatigue does not respond to non-pharmacologic interventions, corticosteroids or psychostimulants. In addition to elevating mood, antidepressants (particularly selective serotonin reuptake inhibitors) can have an energizing