Basic science

Question 1

3 stages of actively dying

Answer 1

Early, Middle & Late

Question 2

Early dying

Answer 2

• Bed bound
• loss of interest and ability to eat/ drink
• cognitive changes

Question 3

Middle dying

Answer 3

• decline in mental status- mild to moderate reduction in alertness
• death rattle- pooled oral secretions not cleared due to loss of swallowing reflex

Question 4

Late dying

Answer 4

• coma
• fever- usually from aspiration pneumonia
• altered resp. pattern- periods of apnea, hyperpnea, irregular breathing
• Mottled extremities

Question 5

4 mechanisms for fever at end of life

Answer 5

• Infection- hx of exposure, barrier violation and neutropenia- fever lower in CA, elderly
• Neoplastic fever- leukemias
• Medication induced (abx, antipsych, opioid withdraw)- stopping resolves
• DVT/ PE- inflammation

Question 6

Whole-brain death

Answer 6

Total brain failure, including brain stem- regulation of respiration, movement and speech- cannot breathe on own

Question 7

Higher brain death

Answer 7

Absent cerebral function- where memories and personality are- intact brainstem. Loss of capacity for consciousness. Permanent vegetative state= higher brain death

Question 8

Agonal phase of dying

Answer 8

Stage prior to death- disoriented, can’t get comfortable, can’t catch breath, death rattle, convulsions, muscle spasms.

Question 9

Algor mortis

Answer 9

Reduction of body temp following death. Steady decline until matching ambient temperature

Question 10

Rigor mortis

Answer 10

Caused by chemical changes in muscle after death- limbs become stiff, rigid, difficult to manipulate

Question 11

1-2 weeks till death- 9 signs

Answer 11

• Increased pain
• Change in BP, RR, HR
• Continued loss of thirst/ appetite
• Decline in bowel/ bladder output
• Changes in speed wake patterns
• Temperature fluctuations
• Constant fatigue
• Congested breathing from built up secretions
• Disorientation/ hallucinations

Question 12

Hours of death- 8 signs

Answer 12

• No food/ drink
• No bladder/ bowels
• Pain through grimaces, groans, scowls
• glazed/ teary eyes
• drifting though consciousness
• Pulse & heart beat irregular/ difficult to detect
• Drop in body temp- extremities become blue- mottling= death in 24 hrs
• Breathing with gasping then slows to stop

Question 13

Cause of death 1-24 yrs

Answer 13

• Unintentional injury
• Homicide
• Suicide

Question 14

Cause of death 25-44

Answer 14

• Unintentional injury
• suicide
• Malignant neoplasms

Question 15

Cause of death 45-64

Answer 15

• Malignant neoplasms
• Heart disease
• unintentional injury

Question 16

Cause of death 65+

Answer 16

• Heart disease
• malignant neoplasms
• chronic lower respiratory disease

Question 17

9 modifiable risk factors assoc with mortality

Answer 17

• Tobacco
• HTN
• obesity
• high sugar, cholesterol, sodium, trans fat
• alcohol
• low omega 3
• low fruits and veg.

Question 18

Pathophys of fever

Answer 18

exogenous pyrogens (microbs) and pyrogenic cytokines (IL & TNF) -> prostaglandin E2 (PGE2)-> increase cAMP-> increase hypothalmic set point to febrile levels-> peripheral meager and arthralgia