Block 3 June Flashcards
Cytokine mediated weight loss with muscle wasting:
cachexia
loss of appetite
anorexia
When is the “tipping point” between living and actively dying?
1-2 weeks before death
1st body part to “die”?
lower extremities
2nd body system to lose function during active dying?
GU/GI
3rd body system to lose function during active dying?
mouth and esohagus
Why are upper extremities preserved so long?
easy for heart to perfuse
Late metabolic acidosis causes which breathing pattern?
Kussmaul breathing
hyperpnea
Breathing pattern associated with damage to respiratory CNS centers or metabolic encephalopathies?
Cheyne-Stokes respirations
“oscillatory overcompensation”
Breathing pattern due to damage to medulla oblongata?
Ataxic respirations
-irregular pauses of irregular lengths
Breathing pattern due to cerebral ischemia?
Agonal respiration
“fish out of water”
-grunts, groans, myoclonus
Hear loss occurs when?
very late
Time of death?
cardiopulmonary arrest
Basis for dosing enteral opiates?
half-life
Biggest problem with opiate equianalgesic dosing?
incomplete cross tolerance
problems with methadone
difficult to dose (start low, go slow)
long QT syndrome (check EKG if reach 30 mg/day)
patients never build tolerance to which opiod side effect?
constipation
Pathophysiology of anorexia:
hypothalamus fails to respond to orexigenic signals
Sarcopenia
muscle wasting
two causes of cachexia:
metabolic change
reduced food intake
can anorexia/cachexia syndrome be fully reversed?
no
four primary symptoms of ACS:
muscle loss
anorexia
fatigue
early satiety
fatigue and weakness
pre-cachexia
fatigue and weakness
anorexia
> 5% weight loss
more likely to be clinically evident
cachexia
> 10% weight loss
irreversible
underlying condition is usually irreversible
Refractory cachexia
possible rx for cachexia
used as antidepressant
may increase lean body mass
methylphenidate
possible rx for cachexia
increased appetite and pleasure from eating
no change in GF/cytokines
increased fat deposition
dronabinol
possible rx for cachexia
hypothalamic stimulation
progestin analogue
adipose deposition
megestrol acetate
better alternative to pts with with advanced dementia than feeding tube:
oral assisted feeding
Meds that are dangerous in old people?
Beers list
Preferred rx for dementia/delirium?
antipsychotics
- try to avoid benzos
- like getting the person drunk–>unknown effect
Does oxygen treat dyspnea or air hunger?
no
O2 treats sats but not patient’s feeling
3 treatments for mucus management in SOB?
hydration
saline nebs
guaifenesin
what to avoid in treating SOB?
essential oils
meds for SOB?
opiates
treat anxiety
inhalers
disease modifiers
full body edema
anasarca
an unstable or crucial time or sate of affairs whose outcome will make a decisive difference for better or worse:
crisis
four stories told by people relating to coping with terminal/life threatening illness:
- signature stories
- public/private – surface/deep
- secret
- untold
what you see is not always obvious….
Iceberg theory
How people define their family:
Family mobiles
three phases associated with life threatening illness:
- period of impact
- the battle
- period of defeat – looking to the future?
four types of losses and their impact:
- loss of possesions
- loss of self
- developmental loss
- loss of significant others
