Symptom: Weakness

Initial Grading Reminder

CTCAE Grading of Weakness:

Grade 1: Asymptomatic; clinical or diagnostic observations only; intervention not indicated
Grade 2: Moderate symptoms; limiting instrumental ADLs
Grade 3: Severe symptoms; limiting self-care ADLs

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Have you had issues with weakness in the past? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly?

Acute onset weakness is concerning for adrenal insufficiency (endocrinopathy).

Grade the symptom

Ask the patient:

How weak do you feel?  Have you fainted? Are you eating?  Are you able to do the things you want to do and/or take care of yourself?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

How much fluid are you drinking per day? Do you have diarrhea? Do you have a stiff neck or headache? Do you have any swelling in your legs? Have you had any seizures or hallucinations? Is your breath fruity? Have you been urinating (a little or a lot)? Do you have any severe abdominal (belly) pain? Do you have any numbness, slurred speech, confusion, or face drooping?

 Do you have any back pain, itching, flushing, or difficulty breathing? Do you have a fever? (These symptoms are suggestive of an allergic reaction.)

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?