Symptom Management Care Partner Health Education & The Nebraska Medical Center 1 Sym ptom Mana geme nt START

Symptom ManagementCare Partner Health Education & The Nebraska Medical Center


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Symptom Management

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Symptom Management

Introduction

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Symptom Management

You should have:

• a copy of a patient’s Vital Signs / Intake Output record and

• a copy of a a patient’s Medication Administration Guide

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Symptom Management

Oral medications

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SM:Q1

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In order to decrease the spread of infection, what would you do before giving medications?

A) Wash your hands

B) Go into the bathroom to give the medications

C) Spray the room with an aerosol disinfectant

D) Put on gloves


SM:Q1A

A. Wash your hands

Correct

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SM:Q1B

B. Go into the bathroom to give the medications

Hand washing is the most effective way of decreasing the risk of spreading infections

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SM:Q1C

C. Spray the room with an aerosol disinfectant

Hand washing is the most effective way of decreasing the risk of spreading infections

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SM:Q1D

D. Put on gloves

Hand washing is the most effective way of decreasing the risk of spreading infections.

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Symptom Management

Suppose it is 10:08 a.m. (1008) and you realize that one of the patient’s 6 a.m. (0600) oral antibiotics was not taken. The next dose is due at noon.

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What would you do about the dose of antibiotic that was not taken?

A) Just skip it – it’s too late now!

B) Give the dose now, before it gets any later

C) Put it in some apple sauce and have the patient eat small bites over the next few hours

D) Do not give the patient the 6 a.m. (0600) dose at this time, but inform the nurse of the missed dose


SM:Q2A

A. Just skip it – it’s too late now!

Correct – but tell your nurse about the missed dose

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SM:Q2B

B. Give the dose now, before it gets any later

You should not give the dose now but tell your nurse about the missed dose

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SM:Q2C

C. Put it in some apple sauce and have the patient eat small bites over the next few hours

You should not give the dose or any part of the dose now - but tell your nurse about the missed dose

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SM:Q2D

D. Do not give the patient the 6 a.m. (0600) dose at this time but inform the nurse of the missed dose

Correct – do not give the dose now, tell your nurse about the missed dose

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Symptom Management

Look at the Medication Administration Guide provided

(insert picture of med administration guide)

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Symptom Management

These are the medications you see in the patient’s medication box:- Allopurinol- NEW AZOL- Acyclovir- Sulfamethoxazole / trimethoprim- Ranitidine- Ondasetron- Cefapime

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(Add pictures of unit doses-update med sheet)

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Symptom Management

You will be asked which of the medications listed on the Medication Administration Guide would you give to the patient at 9 a.m. (0900)?

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SM:Q3

A. Allopurinol?

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YES NO


SM:Q3A

A. Allopurinol – YES

Correct

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SM:Q3B

A. Allopurinol – NO

Allopurinol is scheduled to be given at 9 a.m. (0900)

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SM:Q4

B. NEW AZOL?

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YES NO


SM:Q4A

B. NEW AZOL – YES

Correct

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SM:Q4B

B. NEW AZOL – NO

NEW AZOL is scheduled to be given at 9 a.m. (0900)

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SM:Q5

C. Acyclovir?

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YES NO


SM:Q5A

C. Acyclovir – YES

The order for Acyclovir is not scheduled to start today.

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SM:Q5B

C. Acyclovir – NO

Correct - the order for Acyclovir is not scheduled to start today

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SM:Q6

D. Sulfamethoxazole / trimethoprim?

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YES NO


SM:Q6A

D. Sulfamethoxazole / trimethoprim? – YES

Correct

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SM:Q6B

D. Sulfamethoxazole / trimethoprim? – NO

You should give the sulfamethoxozole / trimethoprim at 9 a.m. (0900)

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SM:Q7

E. Ranitidine?

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YES NO


SM:Q7A

E. Ranitidine – YES

Ranitidine is not scheduled to be given at 9 a.m. (0900)

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SM:Q7B

E. Ranitidine – NO

Correct

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SM:Q8

F. Ondasetron?

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YES NO


SM:Q8A

F. Ondasetron – YES

Ondasetron is not scheduled to be given at 9 a.m. (0900)

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SM:Q8B

F. Ondasetron – NO

Correct

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SM:Q9

G. Sargramostim?

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YES NO


SM:Q9A

G. Sargramostim – YES

Sargramostim will be given by the nurse at 8 a.m. (0800)

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SM:Q9B

G. Sargramostim – NO

Correct

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SM:Q10

H. Cefapime?

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YES NO


SM:Q10A

H. Cefapime – YES

Cefapime is given IV and is scheduled to be given at 7 a.m. (0700) and 7 p.m. (1900)

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SM:Q10B

H. Cefapime – NO

Correct

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SM:Q11

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How will you keep track of what medications have been given?

A) Tape the empty packages to the Medication Administration Guide

B) Leave the empty packages in the medication box

C) Cross through the time on the Medication Administration Guide

D) Write down the names of all the drugs given on a separate sheet of paper and give it to the nurse


SM:Q11A

A. Tape the empty packages to the Medication Administration Guide

You can just cross through the time on the Medication Administration Guide

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SM:Q11B

B. Leave the empty packages in the medication box


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SM:Q11C

C. Cross through the time on the Medication Administration Guide

Correct

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SM:Q11D

D. Write down the names of all of the drugs given on a separate sheet of paper and give it to the nurse


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Symptom Management

NAUSEA

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SM:Q12

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What would you do if the patient vomited after taking scheduled medications?

A) Call 911, this may be serious!

B) Call your nurse on the phone

C) Don’t call, the nurses expect problems like this

D) Call the pharmacist to obtain more 9 a.m. (0900) medications and try again


SM:Q12A

A. Call 911, this may be serious!

Call your nurse on the phone

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SM:Q12B

B. Call your nurse on the phone

Correct

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SM:Q12C

C. Don’t call, the nurses expect problems like this


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SM:Q12D

D. Call the pharmacist to obtain more 9 a.m. (0900) medications and try again


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Symptom Management

Look at the PRN medication list on the Medication Administration Guide

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SM:Q13

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Of these medications listed on the Medication Administration Guide, what medication is indicated for nausea and/or vomiting?

A) Codeine

B) Propoxyphene Napsyl

C) Allopurinol

D) Lorazepam (Ativan)


SM:Q13A

A. Codeine

Lorazepam (Ativan) is the medication ordered to treat nausea and/or vomiting

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SM:Q13B

B. Propoxyphene napsyl


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SM:Q13C

C. Allopurinol


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SM:Q13D

D. Lorazepam

Correct

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SM:Q14

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How would you keep track of what you gave the patient to treat nausea and/or vomiting

A) Just cross through the name of the medication on the Medication Administration Guide

B) Write the time you gave the medication next to the name of the medication on the Medication Administration Guide

C) Write the time on the empty package and keep it in the medication box

D) Post-it notes work if you keep them where you can see them, like on the bathroom mirror


SM:Q14A

A. Just cross through the name of the medication on the Medication Administration Guide

You would need to write the time you gave the medication next to the name of the medication

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SM:Q14B

B. Write the time you gave the medication next to the name of the medication on the Medication Administration Guide

Correct

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SM:Q14C

C. Write the time on the empty package and keep it in the medication box

You would want to write the time you gave the medication on the Medication Administration Guide

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SM:Q14D

D. Post-it notes work if you keep them where you can see them, like the bathroom mirror

Write the time you gave the medication next to the name of the medication on the Medication Administration Guide

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SM:Q15

Let’s again look at the PRN medication list on the Medication Administration Guide. Can you identify another medication that could be given if the patient has nausea and/or vomiting

A) Metoclopramide

B) Diphenhydramine

C) Morphine

D) NEW AZOL


SM:Q15A

A. Metoclopramide

Correct

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SM:Q15B

B. Diphenhydramine

Metoclopramide or Reglan is another medication ordered to treat nausea and/or vomiting

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SM:Q15C

C. Morphine


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SM:Q15D

D. NEW AZOL


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SM:Q16

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What would you do if the medication given orally did not work?

A) Try repeating both oral medications at the same time

B) Try sips of soda instead

C) Just wait until more drugs can be given

D) Call the nurse and request medications be given IV for nausea


SM:Q16A

A. Try repeating both oral medications at the same time.

You would need to call the nurse

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SM:Q16B

B. Try sips of soda


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SM:Q16C

C. Just wait until more drugs can be given


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SM:Q16D

D. Call the nurse and request medications to be given IV for nausea

Correct

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Symptom Management

BOWEL PROBLEMS

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Symptom Management

Good rectal care is important after each bowel movement. Here are some rectal care products

• Preparation H ® cream

• Fleet’s ® suppositories

• Soft toilet paper

• Softsorb towelettes ®

• Washcloth and bar of soap

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SM:Q17

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Two products on this list should NOT be used for rectal care without the doctor’s approval. Can you identify ONE of these products?

A) Preparation H® cream

B) Fleet’s ® suppositories

C) Soft toilet paper

D) Softsorb towelettes ®

E) Washcloth and bar of soap


SM:Q17A&B

A. Preparation H® cream

or

B. Fleet’s® suppositories

Correct

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SM:Q17C&D&E

C. Soft toilet paper

Soft toilet paper is okay

D. Softsorb towelettes®

Softsorb towelettes® are okay

E. Washcloth and bar of soap

A simple bar of soap and a soft clean washcloth are okay

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Symptom Management

Look at the copy of the Vital Signs / Intake Output record of a patient experiencing diarrhea

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SM:Q18

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When should this patient’s diarrhea be reported to the nurse?

A) After the first liquid stool

B) After the second liquid stool

C) When the patient has more than 5 stools in 24 hours

D) It does not need to be reported as diarrhea is an expected problem


SM:Q18A

A. After the first liquid stool

If the patient has 5 or more liquid stools in a 24 hour period, you should notify the nurse

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SM:Q18B

B. After the second liquid stool


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SM:Q18C

C. When the patient has more than 5 stools in 24 hours

Correct

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SM:Q18D

D. It does not need to be reported as diarrhea is an expected problem


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Symptom Management

RECTAL PAIN OR BLEEDING

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SM:Q19

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What should you do if the patient experiences rectal pain or bleeding?

A) Call your nurse

B) See what the patient can take for pain

C) Watch and see if the bleeding stops within the next 24 hours

D) Have the patient apply petroleum jelly to control bleeding and reduce pain


SM:Q19A

A. Call your nurse

Correct

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SM:Q19B

B. See what the patient can take for pain

The nurse needs to be informed promptly

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SM:Q19C

C. Watch and see if the bleeding stops within the next 24 hours.


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SM:Q19D

D. Have the patient apply petroleum jelly to control bleeding and reduce pain


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Symptom Management

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PAIN

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Symptom Management

Think about the following 2 examples of the patient experiencing headache pain

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Symptom Management

Example #1:

The patient is taking a medication for nausea. A headache occurs every time after the nausea medication is taken.

Example #2

The patient complains of a sudden severe headache with blurred vision.

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SM:Q20

In which of the situations presented in the two examples would you need to notify the nurse IMMEDIATELY?

Example #1 – headache after taking nausea medication

Example #2 – sudden severe headache with blurred vision

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SM:Q20A

Example #1 – headache after taking nausea medication

A sudden sever headache with blurred vision needs to be reported to the nurse immediately

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SM:Q20B

Example #2 – sudden severe headache with blurred vision

Correct

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Symptom Management

Your patient is experiencing a headache. You call the nurse to report the headache and after describing the headache, the nurse tells you it is okay to give the patient pain medication.

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SM:Q21

You brought the patient’s pain medication from home. It has always worked well for the patient with similar pain.

Is it okay to give the patient one of his/her pain pills from home to treat this headache?

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YES NO


SM:Q21A

YES

The hospital will provide the patient with all medications

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SM:Q21B

NO

Correct

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SM:Q22

Look at the Medication Administration Guide provided. What medications could you give the patient for his/her headache?

- Lorazepam / Ativan- Metoclopramide / Reglan- Diphenhydramine / Benadryl- Codeine- One-Two-Three Oral suspension- Morphine- Propoxyphene Napsyl / Darvon

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SM:Q22?

- Codeine

- Morphine

- Propoxyphene Napsyl / Darvon

Correct

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SM:Q22?

- Lorazepam / Ativan

- Metoclopramide / Reglan

- Diphenhydramine / Benadryl

- One-Two-Three oral suspension

Codeine, Morphine, and Darvon are the medications that could be given to treat the patient’s headache pain

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Symptom Management

BREATHING

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Symptom Management

Suppose:

• Both you and the patient were awakened several times last night because the patient was coughing

• At 5 a.m. (0500), the patient wakes you because he/she is suddenly having difficulty breathing and cannot catch his/her breath

• The patient also tells you that he/she notices blood in what he/she is coughing up

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SM:Q23

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What should you do in response to this situation?

A) Call your nurse immediately

B) Encourage the patient to rest and tell the nurse in the Treatment Center when you go down at 8 a.m.

C) Wait and see if the coughing and blood continues to be a problem over the next 30 minutes

D) This is a normal occurrence during cancer treatment and does not need to be reported


SM:Q23A

A. Call the nurse immediately

Correct

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SM:Q23B

B. You can wait until the patient goes down to the Treatment Center at 8 a.m.

This warrants an immediate call to the nurse

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SM:Q23C

C. Wait and see if the coughing and blood continue to be a problem over the next 30 minutes


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SM:Q23D

D. This is a normal occurrence during cancer treatment and does not need to be reported


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Symptom Management

You and the patient are walking back to your Cooperative Care room from x-ray. When you get to the room, the patient is breathing heavily and states he/she feels like they ran the whole way.

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SM:Q24

Is it important to report this type of shortness of breath?

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YES NO


SM:Q24A

YES

Some shortness of breath after exercise is not uncommon. But if you are unsure…

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SM:Q24B

NO

Correct

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End

End

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Symptom Management Care Partner Health Education & The Nebraska Medical Center 1 Sym ptom Mana geme nt START