Lecture 5&6: Degenerative Disease and Coordinating Death Processes

Question 1

What is paralysis?

Answer 1

Loss of strength/control over a muscle or a group of muscles in a part of the body

Question 2

What part of the body does localized paralysis affect?

Answer 2

Affects only one part of the body such as face, hands, feet, or vocal cords

Question 3

What part of the body does generalized paralysis affect?

Answer 3

Affects a wider area of the body

Question 4

Generalized paralysis: Monoplegia

Answer 4

one limb only

Question 5

Generalized paralysis: Hemiplegia

Answer 5

one side of body

Question 6

Generalized paralysis: Diplegia

Answer 6

same area on both sides of the body

Question 7

Generalized paralysis: Paraplegia

Answer 7

both legs and sometimes parts of the trunk

Question 8

Generalized paralysis: Quadriplegia

Answer 8

both arms and legs or entire area below neck (heart, lungs, and other organs might also be affected

Question 9

What are the most common pathways to paralysis?

Answer 9

congenital, acquired (trauma), acquired (neuromuscular), acquired (infectious), and acquired (toxic)

Question 10

Congenital paralysis examples

Answer 10

Cerebral palsy, spina bifida, hydrocephalus

Question 11

Acquired (trauma) paralysis examples

Answer 11

spinal cord/head trauma, stroke, brain tumor

Question 12

Acquired (neuromuscular) paralysis examples

Answer 12

Parkinson’s, Multiple sclerosis, Muscular dystrophy, ALS

Question 13

Acquired (infectious) examples

Answer 13

polio, Spinal TB, Guillain-Barre, Acute Flaccid Paralysis, tick/mosquito-borne encephalitis, malaria, meningitis

Question 14

Acquired (toxic) examples

Answer 14

Ciguatera, botulin, puffer, mushroom, pesticides, arsenic, lead

Question 15

Complications of Paralysis and Mobility Issues (5)

Answer 15

1. Problems with blood flow, breathing, and heart rate
2. Altered function of organs/glands, urine/fecal incontinence
3. Atrophy/contractions of muscles, joints, and bones
4. Skin injuries and pressure sores; blood clots
5. Social problems: sexual, speaking, swallowing, isolation, behavior and mood changes

Question 16

What are the 3 management principles?

Answer 16

1. Address problems resulting from the tissue
2. Enable the person to live as independently as possible
3. Provide the person with a high quality of life

Question 17

What are the 2 ways to pharmaceutically manage paralysis/mobility complications?

Answer 17

1. Controlling neuropathic pain

2. Control spasticity

Question 18

Non-Pharmaceutical Management (8)

Answer 18

1. Physical therapy
2. Occupational therapy
3. Mobility aids
4. Gait training
5. Supportive devices
6. Assistive technology
7. Adaptive equipment
8. Family assessment and involvement

Question 19

physical therapy

Answer 19

heat, massage, passive/active exercise

Question 20

occupational therapy

Answer 20

concentrates on ways to perform ADL

Question 21

mobility aids

Answer 21

manual and electric wheelchairs and scooters

Question 22

gait training

Answer 22

improve mobility and reduce fall risks

Question 23

supportive devices

Answer 23

braces, canes, staffs, walkers

Question 24

assistive technology

Answer 24

voice-activated computers, lighting systems, and telephones

Question 25

adaptive equipment

Answer 25

special eating utensils and controls for driving a car

Question 26

family assessment and involvement

Answer 26

engagement of family members, addressing caregiver burden

Question 27

What is a surgical management technique?

Answer 27

deep brain stimulation

Question 28

What are the physical risk factors associated with falls? (9)

Answer 28

1. older age/muscle weakness/frailty/arthritis/low vit. D 2. mobility disorders (arthritis, paralysis, neuromuscular, injuries) 3. chronic pain, fear of falling again 4. diabetes, anemia, thyroid, cardiovascular, dehydration 5. foot disorders 6. vertigo (dizziness) or balance difficulties 7. sensory disorders, vision or hearing problems, or neuropathy in feet 8. neurodegenerative and psychiatric disorders 9. urinary incontinence/frequency

Question 29

Risk of medications for older patients (2)

Answer 29

1. medications take longer to break down and leave | 2. more numerous unexpected drug interactions

Question 30

Risks associated with lack of exercise (2)

Answer 30

1. muscles get weaker; joints ache more --> exercise is more challenging 2. staying indoors reduces sun exposure --> reduced vitamin D

Question 31

what are some environmental risk factors associated with falls? (4)

Answer 31

1. improper footwear 2. risks in the home (loose carpets, wires, stairways, dark corridors, wet floor 3. risks in the environment outside your home (uneven ground, clutter in yard, ice and snow, mud

Question 32

Risk Factors for Falls (12), list modifiable or unmodifiable/intrinsic or extrinsic

Answer 32

1. Females (intrinsic) 2. Age > 80 (intrinsic) 3. Medications (extrinsic, modifiable) 4. Medical conditions (intrinsic, modifiable) 5. Gait and balance impairment (intrinsic, modifiable) 6. Vision and hearing impairment (intrinsic, modifiable) 7. Cognitive impairment and confusion (intrinsic, modifiable) 8. Muscle weakness (intrinsic, modifiable) 9. Inadequate diet and exercise (intrinsic, modifiable) 10. Alcohol (extrinsic, modifiable) 11. Risk taking behaviors (intrinsic, modifiable) 12. Environmental hazards (intrinsic, modifiable)

Question 33

Differences between delirium and dementia

Answer 33

Delirium: impaired function of neurons, acute/dramatic onset, global amnesia, complete loss of orientation, attention, short-term memory, multifactorial etiology, prognosis for recovery is good (reversible) Dementia: death of neurons, gradual onset, selective amnesia, short-term/attention loss more significant, symptoms worse at night, exacerbated by other conditions, prognosis is poor (irreversible)

Question 34

What are the causes delirium? (6)

Answer 34

1. Infectious 2. Metabolic 3. Hemodynamic 4. Respiratory 5. Toxic 6. Traumatic

Question 35

What are the causes of dementia? (3)

Answer 35

1. Idiopathic: Alzheimer's 2. Cumulative: multi-infarct dementia 3. Residual: untreated delirium leading to permanent neuronal damage

Question 36

How do you treat delirium?

Answer 36

treat the cause of delirium

Question 37

How do you treat dementia?

Answer 37

cholinesterase inhibitors

Question 38

What does SPIKES stand for?

Answer 38

Setting -- prepare for the meeting Perception -- assess pt's understanding of clinical situation Invitation -- ask permission to engage in convo about sensitive topic Knowledge -- info the team wishes to convey Empathy -- helping pt see through fog of his/her emotions and responding with empathy Strategy/summary -- summarize what was discussed

Question 39

Advantages of an expected death (5)

Answer 39

1. Grieving little losses along the way 2. Grief even before a loved one has died 3. Time to prepare emotionally and materially 4. Sometimes there is time to say goodbye and to complete unfinished business 5. Period of anticipation that places the death in the context of events that were predictable and made sense

Question 40

Disadvantages of unexpected death (7)

Answer 40

1. Grief not less than Expected Death, but reduced coping 2. Shock and disbelief last longer 3. Sudden destruction of the world you used to know 4. No gradual transition, no time to adjust expectations 5. Massive rift between the way the world should be and is 6. Major violation of expectations 7. Tendency to reconstruct events to allow anticipation of the death

Question 41

Advanced Care Planning: Living Will

Answer 41

1. Allows individual to have financial and medical control while alive but non-communicative 2. Specific directives about care 3. But by late 1980s, few had one 4. Sometimes limited in scope 5. May conflict with approved medical practice 6. Must be updated regularly

Question 42

What is the Patient Self-Determination Act?

Answer 42

- Hospital required to inform patients of all options | - Over 40% of Americans now have one

Question 43

Durable Power of Attorney and Healthcare Proxy (2nd Gen)

Answer 43

- Appoint someone to make decisions on your behalf - Flexible and adaptive solution - Challenging to communicate EXACTLY what you want to a proxy - Comparing next-of-kin decisions on behalf of an incapacitated person who recovered = 68% correct

Question 44

3rd Gen Proxy

Answer 44

- Medical Directive (1989): 6 common medical scenarios & interventions (Individuals forced to make medical decisions not trained to make) - “Values History” (1988): Focus less on specific treatments, more on patient’s values and goals - “Five Wishes Directive” (1998): 1. Who I want to make decisions for me 2. What kind of treatment I want or don’t want 3. How comfortable I want to be 4. How I want people to treat me 5. What I want my loved ones to know - Lifecare Advance Directive (2008): Exhaustive and thorough, based on thousands of studies Tedious to complete but most effective (so far)

Question 45

What happens to the patient when death is near? (4)

Answer 45

1. Withdraw 2. Sleep or be sleepy 3. Increase agitation and struggle 4. Spasm

Question 46

In terms of active euthanasia, which countries is it legal in?

Answer 46

- 5 states in USA, and Canada - Netherlands, Colombia, Japan, Switzerland, Luxembourg - Hinduism: Prayopavesa - Jainism: Santhara

Question 47

What is passive euthanasia?

Answer 47

pulling the plug

Question 48

What are the 6 ways to care for the patient and family members after death?

Answer 48

1. Supporting any family and carers taking part in the process 2. Honor religious/cultural wishes while meeting legal obligations 3. Preparing the deceased for transfer to the mortuary or home 4. Ensuring the deceased’s privacy and dignity 5. Protect the safety of those who come into contact with the body 6. Returning personal possessions to next of kin