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Flashcards in Block 3 June Deck (42):
1

Cytokine mediated weight loss with muscle wasting:

cachexia

2

loss of appetite

anorexia

3

When is the "tipping point" between living and actively dying?

1-2 weeks before death

4

1st body part to "die"?

lower extremities

5

2nd body system to lose function during active dying?

GU/GI

6

3rd body system to lose function during active dying?

mouth and esohagus

7

Why are upper extremities preserved so long?

easy for heart to perfuse

8

Late metabolic acidosis causes which breathing pattern?

Kussmaul breathing

hyperpnea

9

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

Cheyne-Stokes respirations

"oscillatory overcompensation"

10

Breathing pattern due to damage to medulla oblongata?

Ataxic respirations

-irregular pauses of irregular lengths

11

Breathing pattern due to cerebral ischemia?

Agonal respiration

"fish out of water"

-grunts, groans, myoclonus

12

Hear loss occurs when?

very late

13

Time of death?

cardiopulmonary arrest

14

Basis for dosing enteral opiates?

half-life

15

Biggest problem with opiate equianalgesic dosing?

incomplete cross tolerance

16

problems with methadone

difficult to dose (start low, go slow)

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

17

patients never build tolerance to which opiod side effect?

constipation

18

Pathophysiology of anorexia:

hypothalamus fails to respond to orexigenic signals

19

Sarcopenia

muscle wasting

20

two causes of cachexia:

metabolic change

reduced food intake

21

can anorexia/cachexia syndrome be fully reversed?

no

22

four primary symptoms of ACS:

muscle loss

anorexia

fatigue

early satiety

23

fatigue and weakness

pre-cachexia

24

fatigue and weakness

anorexia

>5% weight loss

more likely to be clinically evident

cachexia

25

>10% weight loss

irreversible

underlying condition is usually irreversible

Refractory cachexia

26

possible rx for cachexia

used as antidepressant

may increase lean body mass

methylphenidate

27

possible rx for cachexia

increased appetite and pleasure from eating

no change in GF/cytokines

increased fat deposition

dronabinol

28

possible rx for cachexia

hypothalamic stimulation

progestin analogue

adipose deposition

megestrol acetate

29

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

oral assisted feeding

30

Meds that are dangerous in old people?

Beers list

31

Preferred rx for dementia/delirium?

antipsychotics

*try to avoid benzos
-like getting the person drunk-->unknown effect

32

Does oxygen treat dyspnea or air hunger?

no

O2 treats sats but not patient's feeling

33

3 treatments for mucus management in SOB?

hydration

saline nebs

guaifenesin

34

what to avoid in treating SOB?

essential oils

35

meds for SOB?

opiates

treat anxiety

inhalers

disease modifiers

36

full body edema

anasarca

37

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

crisis

38

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

1. signature stories

2. public/private -- surface/deep

3. secret

4. untold

39

what you see is not always obvious....

Iceberg theory

40

How people define their family:

Family mobiles

41

three phases associated with life threatening illness:

1. period of impact

2. the battle

3. period of defeat -- looking to the future?

42

four types of losses and their impact:

1. loss of possesions

2. loss of self

3. developmental loss

4. loss of significant others