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Flashcards in Block 3 June Deck (42)
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1
Q

Cytokine mediated weight loss with muscle wasting:

A

cachexia

2
Q

loss of appetite

A

anorexia

3
Q

When is the “tipping point” between living and actively dying?

A

1-2 weeks before death

4
Q

1st body part to “die”?

A

lower extremities

5
Q

2nd body system to lose function during active dying?

A

GU/GI

6
Q

3rd body system to lose function during active dying?

A

mouth and esohagus

7
Q

Why are upper extremities preserved so long?

A

easy for heart to perfuse

8
Q

Late metabolic acidosis causes which breathing pattern?

A

Kussmaul breathing

hyperpnea

9
Q

Breathing pattern associated with damage to respiratory CNS centers or metabolic encephalopathies?

A

Cheyne-Stokes respirations

“oscillatory overcompensation”

10
Q

Breathing pattern due to damage to medulla oblongata?

A

Ataxic respirations

-irregular pauses of irregular lengths

11
Q

Breathing pattern due to cerebral ischemia?

A

Agonal respiration

“fish out of water”

-grunts, groans, myoclonus

12
Q

Hear loss occurs when?

A

very late

13
Q

Time of death?

A

cardiopulmonary arrest

14
Q

Basis for dosing enteral opiates?

A

half-life

15
Q

Biggest problem with opiate equianalgesic dosing?

A

incomplete cross tolerance

16
Q

problems with methadone

A

difficult to dose (start low, go slow)

long QT syndrome (check EKG if reach 30 mg/day)

17
Q

patients never build tolerance to which opiod side effect?

A

constipation

18
Q

Pathophysiology of anorexia:

A

hypothalamus fails to respond to orexigenic signals

19
Q

Sarcopenia

A

muscle wasting

20
Q

two causes of cachexia:

A

metabolic change

reduced food intake

21
Q

can anorexia/cachexia syndrome be fully reversed?

A

no

22
Q

four primary symptoms of ACS:

A

muscle loss

anorexia

fatigue

early satiety

23
Q

fatigue and weakness

A

pre-cachexia

24
Q

fatigue and weakness

anorexia

> 5% weight loss

more likely to be clinically evident

A

cachexia

25
Q

> 10% weight loss

irreversible

underlying condition is usually irreversible

A

Refractory cachexia

26
Q

possible rx for cachexia

used as antidepressant

may increase lean body mass

A

methylphenidate

27
Q

possible rx for cachexia

increased appetite and pleasure from eating

no change in GF/cytokines

increased fat deposition

A

dronabinol

28
Q

possible rx for cachexia

hypothalamic stimulation

progestin analogue

adipose deposition

A

megestrol acetate

29
Q

better alternative to pts with with advanced dementia than feeding tube:

A

oral assisted feeding

30
Q

Meds that are dangerous in old people?

A

Beers list

31
Q

Preferred rx for dementia/delirium?

A

antipsychotics

  • try to avoid benzos
    • like getting the person drunk–>unknown effect
32
Q

Does oxygen treat dyspnea or air hunger?

A

no

O2 treats sats but not patient’s feeling

33
Q

3 treatments for mucus management in SOB?

A

hydration

saline nebs

guaifenesin

34
Q

what to avoid in treating SOB?

A

essential oils

35
Q

meds for SOB?

A

opiates

treat anxiety

inhalers

disease modifiers

36
Q

full body edema

A

anasarca

37
Q

an unstable or crucial time or sate of affairs whose outcome will make a decisive difference for better or worse:

A

crisis

38
Q

four stories told by people relating to coping with terminal/life threatening illness:

A
  1. signature stories
  2. public/private – surface/deep
  3. secret
  4. untold
39
Q

what you see is not always obvious….

A

Iceberg theory

40
Q

How people define their family:

A

Family mobiles

41
Q

three phases associated with life threatening illness:

A
  1. period of impact
  2. the battle
  3. period of defeat – looking to the future?
42
Q

four types of losses and their impact:

A
  1. loss of possesions
  2. loss of self
  3. developmental loss
  4. loss of significant others