J: EOL Intro- Lauer

Question 1

How should you talk to patients about prognosis?

Answer 1

In terms of ranges
Days-weeks
weeks-months
months-years

Question 2

What affects the trajectories of dying?

Answer 2

Primary disease state
Comorbidities
Reserve (age, fragilty, stress)
Personality

Question 3

Describe the disease trajectory for sudden death, cancer, dementia, and end-organ failure…

Answer 3

Sudden death- quick drop off
Cancer- steady decline
End organ failure- bumpy delcine! Many hills
Dementia - brain is special, doesn’t have plasticity, plautues and declines (never goes up)

Question 4

Final common pathway of death similar from person to person?

Answer 4

yes!

Question 5

Difference between anorexia and cachexia?

Answer 5

anorexia- loss of appetite

Cachexia- weight loss with muscle wasting

Question 6

What is transitioning?

Answer 6

The tipping point between living and actively dying
1-2 weeks before death
Changes in alertness
Stereotyped movements
Hallucinations

Question 7

Describe the process of active dying?

Answer 7

Dependent on circulation
(heart and head last)
-lower extremities
-Genitourinary system
-Gastrointestinal tract
-Mouth and Esophagus
-Upper Extremities (with-in hours of death)

Question 8

Breathing Changes occur throughout active dying… what drives these changes?

Answer 8

Metabolism
Brain Function
End organ function

Question 9

List the changes in breathing during active dying

Answer 9

Normal breathing
Shallow, rapid breathing
Kussmaul breathing
Cheyne-Stokes respirations
Ataxic respirations
Agonal respirations

Question 10

Characterize Kussmaul breathing

Answer 10

hyperpena (deep slow breaths)

Late metabolic acidosis

Question 11

Characterize Cheyne-Stokes respirations

Answer 11

crescendo-decrescendo apnea (osscillatory overcompensation)

*associated with damage to respiratory centers or metabolic encephalopathies

Question 12

Characterize Ataxic Respirations

Answer 12

Irregular pauses (apnea) or irregular lengths

Frequency/length of pauses increase over time

Damage to medulla oblongata

Question 13

Characterize Agonal respirations

Answer 13

“fish out of water” gasping breaths with apnea

Due to cerebral ischemia

May be accompanies by vocalization or myoclonus

Question 14

When does hearing go in the dying process?

Answer 14

LATE! Always assume the patient can hear you

Question 15

Can nurses pronounce death?

Answer 15

Yes