Exam 8 Flashcards
2 main causes of facial weakness/paralysis
- Peripheral lesion of CN 7
2. Central lesion of UMN system between cortex and pons
What happens to the face with left hemispheric damage (stroke) to the UMN system?
Paralysis of the right lower face (R upper face is fine)
What happens to the face with a L peripheral lesion of CN 7?
Paralysis of the entire R side of the face
Spasticity is generally caused by what lesions?
UMN or CST lesions (due to stroke)
Rigidity is generally caused by what lesion?
Lesion in basal ganglia system
Increased resistance that persists through the movement arc (independent of rate)
Lead-pipe rigidity
Rachetlike jerkiness
Cogwheel rigidity
Initial hypertonia giving way suddenly to relaxation
Clasp-knife resistance
Flaccidity is generally caused by what lesion?
LMN
What are the 6 steps to breaking bad news?
SPIKES
Setting Patient's perception Invitation Knowledge Exploring/Empathy Strategy/Summary
Compare palliative care and hospice with respect to eligibility.
PC: everyone with a debilitating illness
Hospice: <6 months to live
Compare palliative care and hospice with respect to payer.
PC: insurance
Hospice: Medicare
Compare palliative care and hospice with respect to setting of delivery.
PC: inpatient/outpatient
Hospice: Inpatient or home
Compare palliative care and hospice with respect to presence of other treatments.
PC: yes
Hospice: usually no
What are advanced directives?
A decision made by a person specifying preferences for medical care in the future if he/she were to lose decisional capacity
When does a power of attorney become effective?
When a patient loses capacity
True or false - a power of attorney supersedes a living will.
True
What is a signed medical order that travels with the patient to assure treatment preferences are honored across settings of care?
POLST
When should a POLST be filled out?
When death within a year would not be unexpected
If there is no POA, who is the surrogate (IL)?
- Guardian
- Spouse
- Adult children
- Parents
- Siblings
- Grandchild
- Close friend
- Guardian of estate
What does a DNR mean?
No intubation/ventilation/chest compression/defibrillation
What is excluded in selective treatment (POLST)?
Do not intubate
Who signs the POLST?
Patient
Witness
Authorized practitioner
