Medical Flashcards
what are the tetracannaboids (nabilone used for at the end of life)
category: antiemetic
used for N & V associated with chemotherapy
what are the anticholinergics and what are they used for
- scoplamine
- hyoscine butylbromide
- glycopyrrolate
- used for management of excess oral secretions when death is imminent
examples of neuroleptics (antipsychotics) and what they are used for?
- Chlorpromazine
- Methotrimeprazine
- Haloperidol
- for treating delirium at the end of life
Benzodiazpeines for end of life
Midazolam: off label use is palliative sedation
Opiods for end of life
- Morphine (low doses of opiods are very effective in decreasing preception of dyspnea, presumably by decreasing sensory preception as they do with pain) & pain
- Fentanyl: Pain
Key points of DKA:
- no insulin therefore gluconeogensis & lipolysis
- production of ketone bodies (acetone breath) & ketoacidosis (can be severe)
Key points of HHS:
- insulin still present therefore gluconeogensis & lipolysis mainly inhibited
- ketones mild/absent & normal pH
Signs of approaching death?
- person will show less interest in eating or drinking
- urinary output may decrease in amount & frequency
- as body weakens patient will sleep more & begin to deattach from environment
- mental confusion will become apparent , as less oxygen available to supply brain
- vision & hearing become somewhat impaired & speech may be difficult to understand
- secretions may collect in the back of the throat & rattle & gurgle as the patient breathes through mouth
- breathing may become irregular with periods of no breathing (apnea)
- as oxygen supply to the brain decreases the patient may even become restless
- the patient may feel hot one moment & cold the next as he or she loses the ability to control body temp
- loss of bladder & bowel control may occur at time of death
- as people approach death, many times they report seeing, gardens, libraries or friends who have died
physiologic changes near the end of life?
- weakness/fatigue
- decreasing appetite/food intake, wasting
- decreased fluid intake, dehydration
- decreased blood perfusion, renal failure
- neurologic dysfunction, decreasing LOC, terminal delirium, changes in resp, loss of ability to swalloe
- loss of sphincter control
- loss of ability to close eyes
- changes in medication needs
Results of HHS & DKA
-hyperglycemic state
-osmotic diuresis mainly due to glucose
DKA: ketones & acidosis
HHS: no ketones & normal pH (but typically greater fluid loss)
Signs & symptoms of DKA
- acetone breath
- ketones in urine
- acidosis
- confusion/coma all from ketone production
- kussmaul breathing (deep rapid breathing)
- abd pain form metabolic acidosis
- polyuria from high glucose (osmotic diuresis)
- glucose in urine, polydipsia & tachycardia from dehydration
- sodium may be increased/decreased or norm
- hypotension from dehydration
Signs & symptoms of HHS
- negative ketone breath & no ketones in urine becuase no lipolysis (no breakdown of fat) therefore no ketone production
- stupor/coma from hyperosmolare state
- fluid imbalance (dehydration/sodium, polyuria form high glucose (osmotic diuresis)
- glucose in urine
- polydipsia & tachycardia form dehydration, Hypotension, profound dehydration, dry mucous membranes
what is happening with DKA & HHS
- glucagon secretion not inhibited
- elevated glucose levels continue to rise
- state of absolute or relative lack of insulin
brief on DKA
- type 1 & 2 (most common in type 1)
- can develop quickly in less than 24 hours
- BG: greater than 13.9mmol/L
how do you treat DKA
HIE
hydration
insulin
electrolyte replacement
