GENERAL HEALTH CHANGES

 

DEFINITIONS

FATIGUE

Fatigue is a term used to describe an overall feeling of tiredness or lack of energy. individuals often describe fatigue using a variety of terms including weary, tired, exhausted, malaise, listless, lack of energy and feeling run down.

SYMPTOMS

Fatigue is a symptom that usually has some underlying cause. Fatigue may be described by people in different ways, and may include some combination (both mental and physical) include weakness, lack of energy, constantly tired or exhausted, lack of motivation, difficulty concentrating, and/or difficulty starting and completing tasks

Other symptoms such as fainting or loss of consciousness (syncope), near-syncope, rapid heartbeat (palpitations), dizziness or vertigo may also be described as part of the fatigue experienced by the affected individual. 

CAUSE OF FATIGUE

Some common causes of fatigue are;

• Metabolic/endocrine abnormalities
• Infectious diseases
• Cardiopulmonary disorders
• Medications (antidepressants, anti-anxiety, sedative, antihistamines. Steroids)
• Mental health issues (depression, anxiety, drug/alcohol abuse, bulimia nervosa, anorexia)
• Sleep problems (apnea, insomnia, narcolepsy)
• Other; cancer, rheumatoid arthritis, lupus, fibromyalgia etc.)

CHRONIC FATIGUE SYNDROME

Chronic fatigue is defined as fatigue that lasts longer than six months, Chronic fatigue syndrome (CFS), also referred to as myalgic encephalomyelitis (ME)

SYMPTOMS

• Long term fatigue
• Worsening of symptoms with activity
• Difficulty with thinking memory
• Difficulty with sitting standing
• Muscle pain
• Headache
• Tender lymph nodes on neck or armpits
• Sore throat
• Digestive issues

CAUSE

Cardiopulmonary: congestive heart failure, chronic obstructive pulmonary disease, peripheral vascular disease, atypical angina
Disturbed sleep: sleep apnea, gastroesophageal reflux disease, allergic or vasomotor rhinitis
Endocrine: diabetes mellitus, hypothyroidism, pituitary insufficiency, hypercalcemia, adrenal insufficiency, chronic kidney disease, hepatic failure
Infectious: endocarditis, tuberculosis, mononucleosis, hepatitis, parasitic disease, human immunodeficiency virus, cytomegalovirus
Inflammatory: rheumatoid arthritis, systemic lupus erythematosus
Medication use (e.g., sedative-hypnotics, analgesics, anti-hypertensives, antidepressants, muscle relaxants, opioids, antibiotics) or substance abuse
Psychological: depression, anxiety, somatization disorder, dysthymic disorder



MALAISE

Malaise is a feeling of general discomfort, uneasiness, or pain, often the first sign of an infection or other disease

CAUSE

• Fainting
• Vasovagal response
• Hypoglycemia
• Cancer
• Stroke
• Heart attack
• Internal bleeding

MALAISE THEORY OF DEPRESSION

The malaise theory of depression constitutes a re-conceptualization and re-definition of major depressive disorder (MDD). It is proposed that the state or emotion of malaise should be considered the core symptom of depression, rather than sadness of mood.

FEVER

Fever is a physiologic disorder in which the temperature is elevated above one's normal temperature.

 An elevated body temperature may accompany any condition in which exogenous or endogenous heat gain exceeds mechanisms of heat dissipation such as occurs with vigorous exercise, exposure to a warm ambient temperature, or the use of drugs that cause excess heat production or limit heat dissipation. In these situations, the hypothalamic "thermostat" remains "set" in the normal range.

In true fever, mechanisms to regulate the body temperature above the normal set point are actively operating.

PATTERN OF FEVER

CONTINOUS FEVER; Temperature does not touch the base line and variation between maximum and minimum temperature in a day is of less than 1◦.

REMITTENT FEVER; temperature does not touch the base line and daily variation is more than 2◦

INTERMITTENT FEVER; fever is persistent for several hours followed by fever free interval.

QUOTIDIAN FEVER; bout of fever occurs daily for few hours

TERTIAN FEVER; fever occurs on alternate days

QUARTAN FEVER; fever occurs after an interval of two days

RELAPSING FEVER; fever occurs for few days followed by fever free interval of similar duration, the cycle is repeated.

CHILLS

Chills are the subjective reports of shivering or shaking associated with rapid changes in body temperature. They result from involuntary muscle contractions that occur in response to a sudden lowering of body temperature below the prevailing set point.

SWEAT

Night sweats are subjective reports of nocturnal sweating that results from an exaggeration of the normal circadian temperature rhythm.

DIZZINESS

VERTIGO refers to the illusion of environmental motion, classically described as "spinning" or "whirling." The sense of motion is usually rotatory—"like getting off a merry-go-round"—but it may be more linear—"the ground tilts up and down, like being on a boat at sea." Disorientation in space and some sense of illusory motion are the common denominators here. Vertigo always reflects dysfunction at some level of the vestibular system

DISEQUILIBRIUM represents a disturbance in balance or coordination such that confident ambulation is impaired. Symptomatically, some such patients clearly profess that "the problem is in my legs," but others feel "dizzy in the head, too." 

PRE-SYNCOPE means that the patient senses impending loss of consciousness. When the patient has, in fact, experienced true syncope (actual loss of consciousness)

LIGHT HEADEDNESS

Lightheadedness refers to a sensation "in the head" that is clearly not vertiginous or presyncopal, and that is not invariably related to ambulation.

This vague "negative definition" emphasizes that the lightheaded patient's description is always hazily imprecise, and even articulate patients are frustrated by the request to describe the feeling without saying "dizzy."

Some describe "floating" or feeling "like my head is not attached to my body," being "high," or "giddy."

UNEXPLAINED WEIGHT CHANGE

Unexplained weight loss is a noticeable drop in body weight that occurs even if the person is not trying to lose weight. The weight loss does not come about because of diet, exercise or lifestyle changes. Weight loss of 10 pounds or more, or five percent of body weight, over a period of 6 to 12 months is considered “unexplained.”

Unexplained weight loss can be a symptom of a serious condition or illness.

CAUSES

• Overactive/underactive thyroid gland
• Cancer
• Crohn’s disease
• Heart failure
• Addisons disease
• Parkinsons disease
• AIDS
• Depression
• Diabetes
• Eating disorder(undiagnosed)

CLINICAL CHARACTERISTICS OF WEIGHT LOSS

• Decreased intake
• Decreased absorption
• Increased metabolic requirements
• Increase loss of nutrients
• Decreased output (fluid retention)

NUMBNESS

Numbness is a loss of feeling or sensation in an area of the body. It can be complete or partial. It is usually a sign of a problem with nerves in the body, although it is a common symptom of many different medical conditions.

"Numbness" can be used by patients to describe various symptoms, including loss of sensation, abnormal sensations, and weakness or paralysis

Adverse effects of chronic numbness include

• Difficulty walking and driving
• Increased risk of falls

PARASTHESIA

Paresthesia refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body.

The sensation, which happens without warning, is usually painless and described as tingling or numbness, skin crawling, or itching.

REASON; It happens when sustained pressure is placed on a nerve.

Chronic paresthesia is often a symptom of an underlying neurological disease or traumatic nerve damage

CAUSE

Paresthesia can be caused by disorders affecting the central nervous system, such as

• stroke and transient ischemic attacks (mini-strokes),
• multiple sclerosis
• transverse myelitis
• encephalitis
• A tumor or vascular lesion pressed up against the brain or spinal cord can also cause paresthesia.
• Nerve entrapment syndromes, such as carpal tunnel syndrome, can damage peripheral nerves and cause paresthesia accompanied by pain.

TYPE OF SENSATION;

The most familiar kind of paresthesia is the sensation known as "pins and needles" after having a limb 'fall asleep'

formication, the sensation of insects crawling underneath the skin.

WEAKNESS

Weakness is loss of muscle strength, although many patients also use the term when they feel generally fatigued or have functional limitations (eg, due to pain or limited joint motion) even though muscle strength is normal

Weakness of specific muscle groups can cause disorders of eye movement, dysarthria, dysphagia, or respiratory weakness.

Common mechanisms of weakness thus include dysfunction of

• Upper motor neurons (corticospinal and corticobulbar tract lesions)
• Lower motor neurons (eg, due to peripheral polyneuropathies or anterior horn cell lesions)
• Neuromuscular junction
• Muscle (eg, due to myopathies)

FOCAL WEAKNESS

• Stroke
• Neuropathies
• Spinal root entrapment
• Spinal cord compression
• Multiple sclerosis
• Postictal paralysis

GENERALIZED WEAKNESS

• Deconditioning due to inactivity (disuse atrophy) resulting from illness or frailty, especially in the elderly
• Generalized muscle wasting due to prolonged immobilization in an ICU (ICU myopathy)
• Critical illness polyneuropathy (ICU neuropathy)
• Common myopathies (eg, alcoholic myopathy, hypokalemia, corticosteroid myopathy)
• Use of paralytic drugs in a critical care patient