BS

Question 1

What are the 3 stages of dying that rep the signs and sxs in the 24hrs-14 days before death?

Answer 1

Early, Middle, Late

Question 2

Early stage of actively dying

Answer 2

bed bound; loss of interest and/or ability to eat/drink

Question 3

Middle stage of actively dying

Answer 3

further decline in mental status ; slow to arouse with stimulation, only brief periods of wakefulness; death rattle (pooled secretions that are not cleared due to loss of swallowing reflex)

Question 4

Late stage of dying

Answer 4

coma; fever (usually from aspiration pneumonia); altered resp pattern (periods of apnea, hyperpnea, or irregular breathing); mottled extremities

Question 5

pathophys mech of fever at end of life

Answer 5

fever is mediated by exogenous pyrogens (microbes or their products) and pyrogenic cytokines (IL-1, IL-6, IFNa, TNF) which induce the synthesis of prostaglandin E2, which increases production of cAMP, which raises the hypothalamic set point to febrile levels.

Question 6

4 mechs that can contribute to a fever at the end of life

Answer 6

infection; neoplastic fever; medication induced; DVT/PE

Question 7

higher brain death

Answer 7

brain death including cortical tissue, when the pt has irreversibly lost memories and personality

Question 8

whole brain death

Answer 8

includes the brain stem, which regulates respiration, movement and speech.

Question 9

agonal phase of dying

Answer 9

the stage of dying right before the pt expires. signs/sxs: disoriented, cannot get comfortable, can’t catch breath, death rattle, convulsions and spasms as cells in body start to lose connections

Question 10

algor mortis

Answer 10

coldness of death; the lowering of body temp occurring immediately after the heart stops beating

Question 11

rigor mortis

Answer 11

body stiffness after death occuring 2-6 hrs after death and lasting almost 2 days

Question 12

9 signs that a pt is 1-2 wks from death

Answer 12

1. increased pain
2. change in HR, RR, BP
3. loss of appetite, thirst, difficulty swallowing pills
4. decline in bowel/bladder output
5. change in sleep/wake patterns
6. temp fluctuations
7. constant fatigue
8. congested breathing due to build up of secretions
9. disorientation/altered mental status

Question 13

8 signs a person is within days or hours of dying

Answer 13

1. may not desire food/drink
2. little or no bladder/bowel activity
3. signs of pain in grimaces, groans, scowls
4. eyes may tear or become glazed
5. may drift in/out of consciousness
6. irregular pulse
7. body temp drops, and skin of hands/knees/feet become mottled
8. cheyne-stokes breathing

Question 14

most common cause of death in US for 1-24 yo

Answer 14

external causes (accidents, homicides, suicide); cancer; heart dz

Question 15

most common cause of death in US for 25-44 yo

Answer 15

accidents; cancer; heart dz; suicide; homicide

Question 16

most common cause of death in US for 45-64 yo

Answer 16

cancer; heart dz; accidents; chronic resp dz; liver dz

Question 17

most common cause of death in US for 65yo+

Answer 17

heart dz; cancer; chronic lower resp dz; stroke; alzheimer

Question 18

9 major modifiable risk factors ass’d with mortality in the US

Answer 18

1. tobacco use
2. poor diet
3. physical inactivity
4. alcohol consumption
5. injury
6. sexual behaviors
7. illicit drug use
8. microbial agents
9. toxic agents