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MEDS 577 PC FINAL > Lecture 5&6: Degenerative Disease and Coordinating Death Processes > Flashcards

Lecture 5&6: Degenerative Disease and Coordinating Death Processes Flashcards

1
Q

What is paralysis?

A

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

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2
Q

What part of the body does localized paralysis affect?

A

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

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3
Q

What part of the body does generalized paralysis affect?

A

Affects a wider area of the body

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4
Q

Generalized paralysis: Monoplegia

A

one limb only

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5
Q

Generalized paralysis: Hemiplegia

A

one side of body

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6
Q

Generalized paralysis: Diplegia

A

same area on both sides of the body

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7
Q

Generalized paralysis: Paraplegia

A

both legs and sometimes parts of the trunk

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8
Q

Generalized paralysis: Quadriplegia

A

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

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9
Q

What are the most common pathways to paralysis?

A

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

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10
Q

Congenital paralysis examples

A

Cerebral palsy, spina bifida, hydrocephalus

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11
Q

Acquired (trauma) paralysis examples

A

spinal cord/head trauma, stroke, brain tumor

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12
Q

Acquired (neuromuscular) paralysis examples

A

Parkinson’s, Multiple sclerosis, Muscular dystrophy, ALS

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13
Q

Acquired (infectious) examples

A

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

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14
Q

Acquired (toxic) examples

A

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

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15
Q

Complications of Paralysis and Mobility Issues (5)

A
  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
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16
Q

What are the 3 management principles?

A
  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
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17
Q

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

A
  1. Controlling neuropathic pain

2. Control spasticity

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18
Q

Non-Pharmaceutical Management (8)

A
  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
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19
Q

physical therapy

A

heat, massage, passive/active exercise

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20
Q

occupational therapy

A

concentrates on ways to perform ADL

21
Q

mobility aids

A

manual and electric wheelchairs and scooters

22
Q

gait training

A

improve mobility and reduce fall risks

23
Q

supportive devices

A

braces, canes, staffs, walkers

24
Q

assistive technology

A

voice-activated computers, lighting systems, and telephones

25
Q

adaptive equipment

A

special eating utensils and controls for driving a car

26
Q

family assessment and involvement

A

engagement of family members, addressing caregiver burden

27
Q

What is a surgical management technique?

A

deep brain stimulation

28
Q

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

A
  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
29
Q

Risk of medications for older patients (2)

A
  1. medications take longer to break down and leave

2. more numerous unexpected drug interactions

30
Q

Risks associated with lack of exercise (2)

A
  1. muscles get weaker; joints ache more –> exercise is more challenging
  2. staying indoors reduces sun exposure –> reduced vitamin D
31
Q

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

A
  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
32
Q

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

A
  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)
33
Q

Differences between delirium and dementia

A

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)

34
Q

What are the causes delirium? (6)

A
  1. Infectious
  2. Metabolic
  3. Hemodynamic
  4. Respiratory
  5. Toxic
  6. Traumatic
35
Q

What are the causes of dementia? (3)

A
  1. Idiopathic: Alzheimer’s
  2. Cumulative: multi-infarct dementia
  3. Residual: untreated delirium leading to permanent neuronal damage
36
Q

How do you treat delirium?

A

treat the cause of delirium

37
Q

How do you treat dementia?

A

cholinesterase inhibitors

38
Q

What does SPIKES stand for?

A

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

39
Q

Advantages of an expected death (5)

A
  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
40
Q

Disadvantages of unexpected death (7)

A
  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 worldshouldbe andis
  6. Major violation of expectations
  7. Tendency to reconstruct events to allow anticipation of the death
41
Q

Advanced Care Planning: Living Will

A
  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
42
Q

What is the Patient Self-Determination Act?

A
  • Hospital required to inform patients of all options

- Over 40% of Americans now have one

43
Q

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

A
  • 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
44
Q

3rd Gen Proxy

A
  • 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)
45
Q

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

A
  1. Withdraw
  2. Sleep or be sleepy
  3. Increase agitation and struggle
  4. Spasm
46
Q

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

A
  • 5 states in USA, and Canada
  • Netherlands, Colombia, Japan, Switzerland, Luxembourg
  • Hinduism: Prayopavesa
  • Jainism: Santhara
47
Q

What is passive euthanasia?

A

pulling the plug

48
Q

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

A
  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

MEDS 577 PC FINAL (6 decks)

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