• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/127

Click to flip

127 Cards in this Set

  • Front
  • Back
Contrast gender stability, consistency and constancy.
Gencer stability- recognition that gender is constant over time
gender consistency- gender is invariant despite changes in appearance
gender constancy- gender is fixed and irreversible
Describe the psychoanalytic theory of gender identification.
Freud states that infants initially identify wit their mothers, then between 3-5 children a shift occurs toward same sex parent identification as a resolution to the anxiety that occured from earlier erotic attachment to the opposite sex parent.
Describe the cognitive developmental theory of gender identification.
Children develop gender sense from observations and experience. Stages include gender identity (ability to label onself), gneder stability (recognition that gender is constant over time regardless of appearance), gender constancy (gender is permanent attribute over life).
Describe Gender Schema Theory
Children learn activities, interests, personality atrributes and social scripts related to each gender. Then act according to their gender schema and wanting to match schema with their actions.
Describe the 3 biological theories of gender identification.
1. evolutionary psychology- gender roles occur from successful evolutionary adaptation to varying reproductive demands for males/females
2. hormonal influences on gender differentiation- variations in brain lateralization causing difference in skill sets ie verbal vs. matmatical/spatial
3. behavioral genetics- twin studies linking gender personality characteristics with heritability factors vs environmental factors especially peers
Describe the sociological theory of gender identification.
1 sociology- gender is a social construction rather then a biological given. cross cultural studies highlighting the extent to which gender differences are variable.
2 social cognitive theory- bi directional influences of evolutionary forces encouraging adaptation and change along with social and environmental innovations that set up new selection pressures for more specialized biological systems requiring a new response.
What is sublimation?
Sublimation is taking an unacceptable with (ie child molestation) and replacing it with an acceptable action (ie helping police discover child molesters)
What is reaction formation?
When an unacceptable wish prompts the opposite behavior. ie person is a glutton wanting to eat chocolate cake all day long, as a defense mechanism they redirect that energy toward the opposite end of the spectrum and become anorexic.
What are the 4 characterizations for child vs. caregiver.
secure- glad to see caregiver
avoidant- ignore/avoid caregiver
resistant- rejects caregiver
disorganized- inconsistent interactions
What are the developmental milestones for newborns?
motor- reflexes (moro, blink, rooting, plantar, sucking)
cognitive- sensory (sound,sight,smell)
social/emotional- social smile occuring at 6-8 weeks
What are the developmental milestones for infants 0-12 months?
motor- reaching 3 months, rolling over 4 moths, sitting 6-7 months, crawling 8-10 months, standing 10-11 months, walking 12-13 months
cognitive- facial expression mimicking at 2-3 weeks, object permanence and first words 9-12 months.
social- preference for caregivers 6-7 months, laughter 4 months, stranger anxiety 6-8 months, separation anxiety 8+ months
Freud's - Oral stage
What are the developmental milestones for toddlers 12-36 months?
motor- running, climbing, jumping, copying designs.
cognitive- "No", cause from effect, 2-3 word sentences at 24 months, name body parts and count 36 months
social- tantrums, social exchange and conflict, imaginary play at 18 months, self care skills, sleep terrors, toilet training
Freud- anal stage
What are the developmental milestones for preschoolers 3-6 years?
motor- jump with both feet, walk up stairs, skip, balance, draw a person, tie shoes at 6 years, print name, button
cognitive- letter recognition, retell stories, preoperational thinking
social-relationships with peers, social actions based on social rules, pretend play, self hygiene, solidifying sense of self
What are the developmental milestones for school age children 6-12 years?
motor- complex tasks, sculpting, sports
cognitive- deductive reasoning, hierarchies
social/emotional- friendships, understand abstract consequences of behavior
What are the developmental milestones for adolescents/adults 12-45?
motor- complex actions
cognitive- formal operations, complex reasoning
social/emotional- peer pressure, puberty, increased stupid behaviors.
What is Freud's explanation of Gender Development?
Psychoanalytic theory- child initially identifies with their mothers and then a shift toward the opposite sex parent. This anxiety of loving the opposite sex parent is resolved by firming attachments with same sex parent to resolve perceived threat.
- criticism- little evidence, children are influenced by nurturant or socially powerful but not threatening.
Describe the cognitive developmental theory by Kohlberg for gender identification.
Cognitive consistency between thoughts and behaviors (I am a girl and I act like a girl) become an organizer for gender learning.
-criticism: you see little evidence, also kids exhibit gender linked behavior earlier then they are able to understand gender identity/ gender stability and gender consistency.
Describe Gender Schema Theory.
Children are motivated to act according to their gender schema incorporating knowledge of activities and social scripts to relate to their gender. "Boys do boy things while girls do girl things"
criticism- theory would predict that the more elaborated the gender knowledge the more strongly they would show preference for gender specific activities- not the case
Describe biological vs social explanations of gender identification.
Biological- gender differences are determined by what was biologically and evolutionarily successful for each sex
social- gender norms are derived from social constructs. Main criticism- people are victims of their sociocultural environments.
Dr. Jackson loves Social Cognitive Theory with two main points about the bidirectional influences of gender development. Explain.
1. evolutionary forces encourage adaptation and change but
2. social and environmental innovations set up additional complexity that have new selective pressures for evolutionary response.
- hard to test
Contrast gender identity, stability, consistency and constancy.
Gender identity- ability to label onself as male or female
gender stability- recognition that gender is fixed while aging
gender consistency- gender doesn't change with clothes or activities
gender constancy- belief that ones gender can not change.
Which is more likely abuse, subdural or epidural hemorrhage?
Subdural hemorrhage from shakingn baby. Epidural hemorrhage, less force, from falling off of couch.
How common is physical abuse vs sexual abuse.
physical abuse 2.5%
sexual abuse
boys- 15%
females 27%
What are some signs of physical abuse.
Discrepancy between Hx and presentation
delay in seeking care
stressed caregiver
pattern of child behavior triggering assaut
abuser has history of being abused
social isolation
increased severity of abuse over time
parents using multiple hospitals
any bruising in children should raise suspicions.
You suspect abuse but can not prove it. Do you report it?
Report suspected abuse always!
Main prevention of physical and sexual abuse?
Home visitations by visiting nurses showed huge decrease in rates of physical and sexual abuse!!!
-also educate kids about appropriate and inappropriate touches.
What are normal vital signs at birth?
bp (60-90)/(30-60)
hr 150-180 at birth decreasing to around 100 after 60 min
RR 40-60
heart murmurs are common
tachypnic breathing with pauses is normal
What are the phases of fetal lung development?
canalicular phase (17-27 weeks)- delineation of pulmonary acinus, development of terminal bronchioles, no alveoli close to capillaries, not many type II cells, low surfactant
Saccular phase (26-36 weeks)- development of bronchioles, thinning of intersitial space, surfactant production still not mature
alveolar phase (36 weeks- 3 years)- maturation of alveoli, surfactant production
What cells make surfactant and what is its purpose?
type II pneumocytes make surfactant. Production really kicks in at 26
Works by reducing surface tension, retaining FRC so alveoli don't have to be completely reinflated with each breath.
What lecithin to spingomylin ratio indicates lung maturity?
>2:1 = mature
What ionic change occurs in the lung due to glucocorticoids so the lung can reabsorb water and begin to inspire air.
initially pulmonary epithelium secretes fluid by actively secreting Cl- with water following it. At birth Na absorption occurs.
In C sections and with moms on B blockers this response is lessened.
Contrast primary and secondary apnea.
primary apnea- baby isn't breathing at first and then takes a breath with physical stimulation (common)
secondary apnea- baby doesn't begin breathing with physical stimulation, baby stops breathing after taking a first breath. Then you need to resuscitate baby.
What Apgar scores actually have a prognostic value?
If baby is 0-2 at 15 minutes.
How do you do the APGAR score? What is the total?
HR 2=>100
Respirations 2 = regular crying
Tone 2 = motion
Response to stimulation 2 = cough, cry
Color 2=pink
What are the 3 physiological differences in fetal circulation?
1. foramen ovale - between RA and LA allowing blood to bypass the lungs
2. ductus venosus- allows umbilical blood to go directly into the vena cava bypassing the fetal liver
2. ductus arteriosis- allows blood from the pulmonary arteries to shunt into the aorta.
How do the ductus arteriosis, foramen ovale and ductus venosus revert to their post birth level of functioning.
ductus venosus- no longer any umbilical vein
foramen ovale- pressure coming from blood returning from the lungs closes the valve like hole.
ductus arteriosis closes due to NO and prostaglandins (recall that PG inhibitors keep a PDA)
An infant you just delivered has a pink head and right arm but the rest of her body is cyanotic. What is the cause and what is the diagnosis.
The infant has persistent pulmonary hypertension of the newborn. Oxygenated blood is going to the right bracheocephalic artery above the ductus arteriosis but beneath that is getting half deoxygenated blood from the ductus mixed in.
Caused by poorly formed lung vessels from intrauterine hypoxia, abnormal pulmonary musculature or often sepsis causing systemic vascular collapse.
What factors modulate pulmonary vascular resistance?
1. alveolar distention due to oxygen causes lowering of PVR
2. PVR is increased due to hypoxemia, low pH, inflammation, high CO2
What factors modulate pulmonary vascular resistance?
1. alveolar distention due to oxygen causes lowering of PVR
2. PVR is increased due to hypoxemia, low pH, inflammation, high CO2
Why do newborns get hypoglycemia, hypothermia and hypocalcemia?
hypoglycemia - relying on glucose and glycogen stores until fed. (gluconeogenesis gets ramped up) Common with diabetic mothers due to high insulin production.
hypothermia- cold out there, lots of SA for weight
hypocalcemia- fetal PTH and vitamin D levels are high.
What are some risk factors and signs of hypoglycemia.
risks: IUGR, maternal diabetes, premature birth
signs- tremors, lethargic, apnea, jitteriness, seizures
Are most birth defects chromosomal or multifactoral?
Most are multifactoral, 10% are chromosomal, 7% due to environmental factors
What are "phenocopies" in regard to birth defects?
phenocopies are similar birth defects resulting from different genetic/environmental factors
What are 2 causes of Tetralogy of Fallot?
Accutane (vit A analogue used with acne)
11q22 deletion in DiGeorge Syndrome
or mutations in JAG gene
both cause Tet of Fallot
What are the 4 main classifications of birth defects?
malformation- tissue doesn't form correctly (usually genetic)
disruption- initial tissue forms right but signaling pathways are interrupted and it doesn't develop properly
deformation- there is a later external mechanical pressure that results in the tissue not finishing forming correctly ie oligohydramnios/diaphragmatic hernia don't allow alveolar expansion causing pulmonary hypoplasia.
dysplasia- part of ti doesn't work right although it was formed correctly, ie CF where mucosal surface is fine but Cl transporters don't work right.
Name 3 common teratogens
Vitamin A analogues (accutane), Statins, Thalidomide (hyponotic), anticonvulsants , ethanol
What teratogins increase the risk for cleft lip/palate and what is the rate of recurrence if one child has it?
phenytoin (anticonvulsant), alcohol, accutane and cocaine are the culprits
rate of recurrence is 10%
How do you define a fever in the elderly?
rise or 2 degrees F or above 99 degrees. They run lower.
What is the most common presentation of acute MI in the elderly without chest pain?
dypsnea!- more non specific symptoms ie falls, confusion, weakness
Contrast ADL with IADLs
ADLs: bathing, dressing, tansferring, toileting, grooming, feeding.
IADLs: using telephone, shopping, food prep, housekeeping, using transportation, taking meds, handling finances
What is the time cut off after which you consider a patient at an increased fall risk during the get up and go screen?
> 10 sec = increased fall risk
> 20 sec ... make a referral for therapy.
How is the demographic of the elderly changing?
better infant mortality and better life expectancy... more ! No longer a pyramidal distribution of ages with the elderly being only a small proportion.
Now 12.5% population is above 65 but in 2010 it will be 22% of the population!!!
What is life expectancy for men and women at 80, 90?
Women at 80 have 10 years left, at 90 have 5 years left.
Men at 75 have 10 years left and men at 85 have 5 years left.
Is being thin a good prognostic factor in the elderly?
No being normal or slightly over weight is actually associated with better outcomes. Obese and very skinny both mean more disability.
t/f Obesity in geriatrics (BMI > 35) decreases life expectancy?
False. obesity in the elderly increases disability but if you were lucky to make it out of your 50's (when most obese die) you're in the clear as far as your life expectancy.
Most common cause of weight loss in young vs elderly.
young = cancer
elderly = depression
If mortality from major diseases like cancer and heart disease are lowered what is the maximal live span predicted at and where is it now?
As of 2000 it's 77 years old... per Newsweek it's now 80.
Maximum expected to be 85-90 years.
What is life span and how does it differ from life expectancy?
life span is the maximum that humans can live- 110.
Life expectancy is the average age at death around 77 right now.
Incidence and mortality from cancer increase dramatically with age up to what point?
Peak of mortality from cancer is at 70.
What is progeria?
A genetic disease that causes premature aging with a life expectancy of 10 years. Due to AD mutation in lamin A/C disrupting function of nuclear lamina causing high rates of apoptosis.
What is Werner's syndrome?
Werners syndrome s a genetic disease that causes premature aging. Development of cataracts, DA, osteoperosis, cancer and heart disease result in death by age 50. Increased rate of somatic mutation and rapid telomere shortening due to DNA helicase mutation on chromosome 8.
What are 3 factors that support the Clock Theory of Aging ... that the aging process and death are programmed and controlled by genes?
1. Genetic Diseases like Progeria, Werner's and Downs Syndrome cause premature aging due to specific mutations.
2. Lovevity runs in families and is seen in monozygotic more then dizygotic twins
3. Certain somatic cells are programmed to die ie senescence after doublings like fibroblasts and the shortening of telomeres at a rate of about 50 bases per year.
Sir 2 is a NAD dependent histone deacetylase that functions in chromatin remodeling. What significance does it have?
How about Age 1 gene, Insulin like GF gene, Clk1 genes?
Longevity genes:
Sir2- overproduction increases life span by 30%
daf2 for Insulin like growth factor gene is deleted there is increased longivity.
Age1 and Clk 1 gene are both suspected to have similar results in increasing longivity.
Reduction of telomere length and loss of DNA methylation have been suggested that they could be what cause cells to age and undergo what?
Senescence.
What is lipofuscin and what theory of aging does it support?
Lipofuscin is a cross linked collagen. Along with oxidized DNA and protein lipofuscin is thought to be an indicator of aging in the Rust Theory of Aging. This theory proposed that low levels of antioxidents leads to increased degradation and mutation in cells. Some believe that Cu/Zn superoxide dismutase in high levels in drosophila promote longevity and that lowering the metabolic rate by caloric restriction will increase longivity.
How does caloric restriction increase life span?
Caloric restriction does not decrease the rate of oxygen consumption but instead the production of reactive oxygen species decreases possibly indicating a higher level or sir2 which stabilizes DNA and a more efficient metabolic system.
This substance is made of cross linked collagen and is deposited in the heart. It is considered the "wear and tear pigment" and is so common you can actually estimate the heart age depending on its prevalence.
Lipofuscin.
What is the result of over expression of Sir2?
Over expression of Sir 2 (a key gene and its protein that functions in chromatin remodeling and stabilizing DNA and down regulation of insulin like hormone) all result in increased longivity up to 30%.
What genetic disease is due to a mutated DNA helicase gene resulting in defective DNA repair where the individuals die in their early 50s due to heart disease and cancer?
Werner's syndrome.
What disease is due to an AD mutation in lamin A/C that disrupts nuclear lamina resulting in severely shortened life span of about 10 years.
Progeria
Chloramphenicol can cause grey baby syndrome because it is cleared by this phase II pathway that doesn't mature until 2-3 years of age.
Glucuronidation clears chloramphenicol and that phase II pathway does not mature until 2-3 years of age
Contrast clearance of phenobarbital and caffeine vs phenytoin in the neonate.
Phenobarbital and caffine are not metabolized for the first few weeks of life as they are cleared by phase I pathways (CYP1A2) that mostly aren't active until 4-5 months. In contrast phenytoin is metabolized more efficently as an infant and these little people will require higher doses as the CYP2C9/3A4 pathway is ramped up until 1 year.
Which of the following phase 1 pathways are ramped up at birth and which don't mature until later?
lower:
CYP1A32- caffeine and theophyline, adult level at 4-5 months
CYP3E1- alcohol
CYP2D6- adult levels at 10 years (SSRIs, opioids, antipsychotics)
higher
CYP 3A4- greater levels then adults
CYP2C9- higher then adult levels until teen
10% of caucasians have a defect where they can't activate opioids due to a defect in this phase I pathway.
CYP2D6. opioids, antipsychotics, analgesics, SSRIs
What is an example of a drug that needs renal dosing for the infant?
Aminoglycosides need to be dosed with the consideration of low GFR in infants.
What changes more with age, the loading dose or the maintenance dose?
I infants the loading dose is very similar but they may vary widely in their clearance and so maintenance doses mucst consider how fast there is heaptic and renal clearance.
Would you feel more comfortable dosing a hepaticaly eliminated drug in children or a renaly eliminated drug?
Hepatic dosing widely fluxates. Renal dosing is more predictable and in general are more rapidly cleared.
What special consideration do you have to be aware of when dosing corticosteroids and psychoactive agents in children?
The effect on growth, anti-inflamatories and some psychoactive substances may influence. growth potential
What are the reccomendations about dosing tetracyclines and salicylates in children?
tetracyclines are counter indicated in pregnant women and children due to effects on bone and teeth
Salicylates like aspirin are not recomended as they can cause Reyes syndrome with fatty liver and actue encephalopathy (also in pepto bismol)
T/F 13 % of the US population uses 40% of its drugs
true. Soon will be even more when population % increases to 20-25% over 65 in 2030
How does decreased gastric acid production achlorydia influence absorption in geriatirc patients?
Decreased absorption of weak acids (ie warfarin and penicillin) and increased absorption of weak bases ie tricyclic antidepressants, opioids, anticonvulsants.
Explain the relationship between Volume of distribution and half life with regard to clearance in the elderly.
CL = Vd/ t1/2
Increase in adipose, decrease in lean body mass and decrease in total body water.
Results in decrease in Vd for water soluble drugs causing higher plasma concentrations ie (digoxin, lithium)
Increase in Vd for lipid soluble drugs causing prolonged elimination and rgus accumulation (diazepam and chlordiazepoxide)
Decreases in albumin with aging results in what change in drug levels.
Less protein means less drug is protein bound causing higher concentration of active free drugs. (phenytoin, phenobarbital, warfarin, diazepam)
Is phase I or phase II hepatic metabolism changed more in the elderly?
phase II is minamally affected (lorazepam, oxazepam, temazepam).
phase I depends on first pass metabolism which relies on renal blood flow. This is decreased with age and so high levels of chlordiazepoxide and diazepam can result.
Is it better to use lorazepam and oxazepam or diazepam and chloridazepoxide in the elderly, and why?
use lroazepam and oxazepam as they are phase II hepatically elimianted.
In calculating creatinine clearance as an estimation of GFR age is a factor. What is the Cockroft Gault equation?
CrCl (ml/min) = (140-age) x weight in kg x 0.85 (female)
all over (SerumCreatinine x 72)
When SCr < 30-50 begin renal dosing.
What drugs have renal elimination which can result in high levels in the elderly with low GFR?
digoxin, aminoglycosides, H2 receptor antagonists, allopurinol, penicillins, cephalosporins, amantadine, lithium, mtrolopramide
What drugs worsen incontinence in the elderly?
- Overflow (urinary retention): worse by anticholinergics ie antihistamines, smooth muscle relaxants, alpha adrenergic agonists.
Treat with alpha adrenergic antagonists
-Stress: worsened by alpha adrenergic antagonists like prazosin and doxazoin which open tubes
Urge (not enough spinctor activity)- worse by cholinergics and diruetics. Treat with antimuscarinics like tolterodine.
Avoid over-sedation with sedatives/hypnotics
What controls the detrussor muscle of the bladder?
Detrusser muscle is cholinergic. It is activated by ACh. Antimuscarinics block this ACh - R helping prolong continence with urge incontenance /sphincter insufficency.
What controls the urethral sphinctor opening/ closing?
opening = muscarinic
closing = alpha ARs
flowmax is an alpha adrenergic antagonist which helps with stress incontenance.
How do you determine steady state?
rate in = rate out
MD/ tau (dosing interval) = Clearance x plasma concentration at steady state
Is bioavailability of drugs in the elderly changed by their variable absorption?
No the time it takes for them to absorb the drug may vary due to gastirc emptying and achlorydia but in teh end the bioavailability will be about constant.
What is the cause of stress incontenence?
Stress due to force ie laughing. Need to strengthen the inner sphinctor and avoid spasticity of detrussor.
Muscarinic antagonists may be helpful to block detrussor and avoid premature relaxation of inner urethral sphinctor
What is the cause of over flow incontenance?
cant open the sphinctor to void. Need help relaxing it. Muscarinic agonists or alpha adrenergic antagonists.
What is the cause of urge incontenence?
overactive detrussor use anti mucscarinics to treat
What is the equation for relative risk reduction/
(incidence in control - incidence in treatment group)/ incidence in control
What is the equation for absolute risk reduction and how do you calculate NNT?
ARR = incidence in control - incidence in treatment group
NNT = 1/ ARR
Is spironalactone a good drug for treating CHF in the elderly?
Nope. Higher incidence of hyperkalemia due to impaired renal function in the elderly. Also keep a close eye on Beta blockers as B1 receptors are less sensitive in elderly and you can cause syncope.
Contrast hospice care and palliative care.
Hospice is a subset of palliative care. In hospice you forgo curative treatment and you doctor says you have less then 6 months to live. Palliative care focuses on making the patient comfortable and filling GAPS in care:Goals or care, supporting Advance directive, providing Psychosocial support, managing Symptoms
Furosemide + diazepam = (?) in the elderly
incontinence, you have to pee like crazy but are disoriented and slowed down from the sedative
S/E of Beta blockers
worsens asthma if non specific (B2)
bradycardia
lethargy/depression
lipophilic- stays on board for longer in the elderly who have a larger volume of distribution for fat loving drugs.
Your patient is on indomethacin, theophylline, aspirin and cimetidine for stomach pain. What drug drug interactions are you concerned about?
Indomethacin is an NSAID mostly for gout and also causes Na retention and renal problems. Worry about GI ulcers as you are combining it with aspirin. Stomach pain may indicate bleed. Cimetidine H2 blocker may help
Your patient is on indomethacin, theophylline, aspirin and cimetidine for stomach pain. What drug drug interactions are you concerned about?
Indomethacin is an NSAID mostly for gout and also causes Na retention and renal problems. Worry about GI ulcers as you are combining it with aspirin. Stomach pain may indicate bleed. Cimetidine H2 blocker may help. Also think that theophylline (for COPD) may cause dyspepsia and cause food to taste bad.
Your patient is on a TCAD Amitriptyline. What s/e profile should you be aware of?
Anticholinergic effects- no see, no pee, no spit, no shit. Give a stool softener.
You are concerned about parksinonian symptoms in your patient on this promotility drug for nausea. What is the drug?
Metoclopramide- antimotility drug acts as an anti dopamergic, crosses BBB and can cause parkinsonian like disease
pseudoephdrine + antihistamines + BPH = ?
inability to pee. Anti-muscarinic effects inhibit detrussor contraction and loosening of internal sphinctor. Alpha agonist keep internal sphincter tight too! D/c one or the other or no peeing.
For which individual is it easiest to predict their death?
Chronic renal dysfunction/COPD
Cancer
Dementia
Cancer is easiest, good straight line then severe curve with decreased function. COPD or renal disease means intermittent exacerbations of which who knows which will be their last. Dementia means your patient is at the bottom of the curve of dysfunction and might stay there for who knows how long with a really crappy quality of life.
Your palliative care patient hasn't eaten anything except a few saltines for the last week, are you concerned?
Anorexia is a normal part of dying and may actually ease their pain. Feeding at this point does not promote health.
What is more frequently a cause of demenita, pain or main meds?
Surprisingly pain is actually more often the cause of dementia.
Name 5 common symptoms for end of life?
decreased RR and TV. Hypotension , vradycardia, skin molting due to low perfusion, loss of radial pulse. Decreased urine output. Decreased LOC, delerium. Death rattle. Loss of reflexes. Loss of use of accessory jaw muscles.
Contrast normal and complicated grief.
normal- up to 6 months, can include hearing the other person talking at night, feeling sad, significant impairments.
Complicated- lasts more then 6 months, signs of severe depression including thoughts of hurting self or others
What is the most common reason that patients ask for physician assisted suicide?
Fear and sense of a loss of control
Are physicians able to accurately predict mortality?
Nope. On average physicians overestimate by a factor of 5. Only 1/5 predictions are accurate as defined by a 30% margin of time. No variation in this across specialties or for different diseases.
How might you manage the anxiety provoking symptom of dypsnea in your palliative care patient?
nasal canula with room air or oxygen (equally effective)
fans to more air and stimulate respiratory drive
oral and iv low dose opioids
-appropriately dosed opioids do not hasten death.
-benzodiazepines are not recommended as first line therapy as they used to be
What are the 5 criteria to declare brain death?
irreversible coma
no branstem reflexes
no EEG activity
no response to painful stimuli
apnea
What are 5 manners of death?
natural
suicide
accidental
homicide
undetermined
when does a death have to be examined by the medical examiner?
Anything that wasn't a natural death especially SIDS and also all deaths within 24 hours of a hospital admission to rule out malpractice
Where do you report a death to?
Provide death certificate to the county medical examiner in Aurora is Adams County.
How do you hash out cause of death? How does immediate differ from underlying from mechanism of death?
Person dies from lung cancer
Cause of death= lung cancer
immediate cause = acute bronchopneumonia
intervening cause = emphysema
mechanism of death = cardiopulmonary arrest
manner of death = natural
What are the stages for pressure ulcers?
stage 1- erythema and intact skin
stage 2- partial thickness skin less involving epidermis or dermis or both, ulcer is still superficial as a small crater
stage III- full thickness skin loss, necrosis of sub Q tissue
stage IV- full thickness skin loss with extensive destruction, necrosis , damage to muscle, bone and fascia
You note a lesion that is weeping that tunnels through the overriding skin. What stage skin ulcer is this.
Would be a II or III depending on depth. If its getting deep toward the fascia is more of a stage III.
Your patient has suffered a stroke and now is depressed and uninterested in rehabilitation. What drug might you prescribe.
Ritalin has been shown to be very effacious in these circumstances. (methylphenidate) helps with lethargy, apathy and anorexia. Give low dose around 5 -20 mg/day.
What is the recommended dosage of Ca and Vit D3.
Ca 1000 mg and D 600 IU
Taking a PPI might decrease levels of what vitamin?
Vit B12 can be decreased with achlorydia along with PPI use
What is the most easily modifiable risk factor for falls? As a second step what would you prescribe?
Medication- make changes and reduce the number
Get physical therapy and or wear hip protectors.
Are mammograms and pap smears still appropriate in an 80 year old woman?
Mammograms are still indicated if the patient has an expected 5 years left to live. Thus the average health 80 year old has 9-10 years left and should be screened. Pap smears however do not need to be done on women over 65 who have had 3 consecutive normal smears.
Are mammograms and pap smears still appropriate in an 80 year old woman?
Mammograms are still indicated if the patient has an expected 5 years left to live. Thus the average health 80 year old has 9-10 years left and should be screened. Pap smears however do not need to be done on women over 65 who have had 3 consecutive normal smears.