Terms test 3 Flashcards
Cachexia
Weight loss w/ muscle wasting. Patient doesn’t eat due to lack of ability to use nutrients.
NOT weight loss due to decreased appetite, it is decreased appetite due to weight loss (caused by underlying medical illness).
Weeks to months before death
Cytokine mediated
Can be upsetting to patient and family, who perceive “starvation”
Adding nutrition tube/ feeding stimulants usually will only make matters worse. This is due to gastric dumping syndrome.
Must have weight loss (predominantly sarcopenia) and malnutrition.
May have: protein catabolism, inflammation, underlying disease, exceed the amount that can be accounted for by the increased needs of the disease.
Key associated diseases: Kidney failure, AIDS, cancer, COPD, RA, heart failure, nursing home.
Gastric dumping syndrome
Triggered nausea and vomiting when one is overly full. This happens at very low levels of food intakes for cachexic patients.
Trasnistioning
Tipping point betwen living and actively dying.
1-2 weeks before death
Changes in alertness
Picking, removing clothes, taking out IVs and other stereotyped movements (especially in middle aged men)
Third man syndrome - As brain shuts down people sense another person with them. Often associated w/ spirituality.
Active Dying
Dependent on circulation
Body protects heart and brain(stem)
Lower extremeties: color changes (pallor/cyanosis/mottling), cold, thready or absent pulses
Genitourinary system: Incontinence, urinary retention (males), decreased urine output and increased sediment (renal failure)
GI: Incontinence, constipation, poor appetite, hiccups
Mouth and esophagus: poor oral transit, weak swallow, inability to manage even own secretions (death rattle = accumulation of normal saliva)
Upper Extremeties: Very well perfused compared to legs. Cyanosis, cold, thready or absent pulses, similar time as signs of face, often not seen until right before death.
Breathing changes driven by metabolism, brain function, and end organ function
Brain: Loss of higher functions, loss of speech, slowed cognition and response, dysregulation of temp and cir rhythms, hearing is often spared until very late, pulse, bp instability.
Active Dying breathing changes
Normal Respiratory Pattern –> rapid shallow respirations –> kussmaul breathing –> cheyne stokes respirations –> ataxic respirations –> agonal respirations
Rapid, shallow respirations
Weakened diaphragm, accessory muscle tone, and early acidosis.
May be accompanied by: weak/no cough, hypophonia
Kussmaul Breathing
Hyperpnea
Late metabolic acidosis (ketones, uremia, sepsis)
Cheyne-Stokes Respiration
Crescendo-decrescendo apnea (oscillatory overcompensation)
Associated w/ damage to respiratory centers or metabolic encephalopathies.
Ataxic Respirations
Damage to medulla
Irregular pauses of irregular lengths
Frequency and length of pauses increase over time
Progresses to agonal respirations or total apnea.
Agonal Respiration
Due to cerebral ischemia
Fish out of water grasping with apnea
May be accompanied by vocalizations and myoclonus.
Advanced directive
Patient WISHES for end of life care
POLST
Physician ORDERS for life sustaining treatment. Usually hospice eligible patients.
Surrogate / proxy / Durable power of attorney
Person appointed by patient to make decisions for them if they are incapacitated. Have a varying amount of control on the decision making process depending on patent’s wishes and wording of advanced directive.
Durable power of attorney comes from attorney not advanced directive.
Use advanced directive –> substituted judgements (stand in patient’s shoes) –> best interests (acting in best interests of patients = last resort)
Guardian / Conservator
Court appointed person who makes end of life decisions for patient.
Trumps all others (advanced directives)
Guardian is more healthcare and conservator is more property based (overlap however)
Anorexia/Cacechexia Syndrome (ACS)
A multifactorial syndrome characterzed by an ongoing loss of skeletal muscle mass (sarcopenia) with or without loss of fat that cannot be fully reveresed by conventional nutritional support and least to progressive functional impairment.
Stages: Precachexia (weight loss less than 5%; reversible w/ underlying cause) , cachexia (weight loss
