Delirium is defined as an acute change in attention and cognition with the hallmark pattern of waxing and waning behaviors. Anyboy with a preexisting functional or cognitive impairment is at higher risk for develiping delirium, and the diagnosis of delirium in persons with dementia is commonly missed by clinicians because the presentations are mistakenly perceived as being part of the chronic day-to-day confusion of dementia or attributed to behaviors labeled as sundowning. Dementia increases the risk for delirium, and “sundowning” syndrome is frequently associated solely with dementia.Continue reading “Delirium in Dementia (Reading & Sharing)”
Dementia is a neurocognitive syndrome with persistent intellectual and functional decline. Patients with advanced progressive dementia due to Alzheimer’s or multiple infarcts can live a long time until they finally develop complications that take their lives. They are considered close to death when they are functionally incapacitated and complicating conditions develop.Continue reading “Dementia 老年痴呆症 (Reading & Sharing)”
Venlafaxine is a selective serotonin-norepinephrine reuptake inhibitor (SNRI) used in the palliative care setting for concurrent treatment of depressive disorders and neuropathic pain. (Neuropathic chronic pain is often resistance to standard opioid therapy and is best treated with a secondary amine tricyclic antidepressant (nortriptyline, desipramine), a selective serotonin or norepinephrine reuptake inhibitor (SSNRI) (venlafaxine, duloxetine), or a calcium channel alpha2 delta lignd (anticonvulsants) (gabapentin or pregabalin).
In the United States, there are three SNRIs that have been approved by the FDA: venlafaxine (Effexor and Effexor XR), desvenlafaxine (Pristiq), and duloxetine (Symbalta). Venlafaxine and duloxetine both block the serotonin and norepinephrine transporters, thereby inhibiting and availability to bind with the postsynaptic receptors. At lower doses, venlafazine predominantly affects serotonin reuptak, contributing to greater anxiety reduction more so than depressive symptom reduction. Duloxetine, however, appears to be a more potent and equal serotonin and norepinephrine reuptake inhibitor than venlafaxine is. These drugs are rapidly absorbed after oral intake and metabolized extensively in the liver. Time needed to reach maximum plasma concentration is 2 hours for both venlafaxine and duloxetine. Venlafaxine has a half-life of 5 hours and the active metabolite is 11 hours. Steady state is achieve in 3 to 4 days. Duloxetine has a half-life of 12 hours, reaching steady state in 3 days. Both drugs are excreted mostly in urine.Continue reading “Venlafaxine – Effexor (Selective Serotonin-Norepinephrine Reuptake Inhibitor /SNRI)”
Considered to be the largest organ system in the human body, our skin protects our internal organs and structures. The skin layers include the epidermis, dermis, and subcutaneous tissue. Although skin is only 1 to 2 mm thick, it contains 15% of the total weight for an adult and acts as the first line of defense against invading microorganisms.
- Providing protection for the underlying tissues and organs.
- Receptors in the skin sense pain, pressure, and temperature changes.
- Skin also plays a role in fluid balance, temperature regulation, and the synthesis of vitamin D.
- The subcutaneous fatty layer acts as a cushion and stores fat for energy.
Alteration in skin integrity:
- Age – As a person ages, physiological changes inherent to the aging process occur, such as reduced elasticity, loss of skin turgor, and decreased vascularity. Changes also occur in the cells at the junction of the dermis and epidermis, which may result in skin tearing more easily in elderly. Patients with a terminal illness pose a unique risk of alternations in skin integrity, and one aspect gaining attention includes the concept that skin injuries for these patient may be unavoidable and related to dying process.
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. Motor neurons are affected in certain patterns, such as cervical, thoracic, lumbar, and bulbar (facial) regions. Although initial presentations can vary, eventually upper and lower motor neurons are lost in the two types of ALS: familial and sporadic.
About 6000 people in the U.S. are diagnosed with ALS yearly. A French physician, Jean Charcot, identified ALS in 1869; initially, the disease was called “Charcot Disease.” However, in 1939, when the famous New York Yankees baseball player Lou Gehrig was diagnosed with ALS, it became known as “Lou Gehrig’s Disease”. (Gehrig died from ALS in 1941 at age 37.) It is estimated 300,000 Americans live with ALS in 2018. The median age of onset is 55, and disease indicence peaks between ages 70-75. More males are affected than females. Approximately 90% of ALS cases are determined to be sporadic, or accquired, while the remainder are considered familial, or hereditary.Continue reading “Amyotrophic Lateral Sclerosis (ALS) – Reading & Sharing”