Multiple sclerosis (MS) is the most frequent inflammatory demyelination disorder of the central nervous system. The clinical picture reflects the pathological mechanism of inflammation, demyelination, and axon degeneration.
Specific challenges in MS patients:
Continue reading “End Stage Neurological Disorders – Multiple Sclerosis 多发性硬化症 (MS) (Learning about Hospice)”
Stroke is the 3rd leading cause of death in the United States, making the need for hospice care for many victims essential.
A stroke takes time to manifest its full effect, and some early symptoms might be transitory. The physician might consider a referral to hospice if the patient remains comatose or has a severely reduced level of consciousness (obtundation) with abnormal muscle contraction (myoclonus) for 3 days or longer.
Patients who survive 4 weeks and regain significant function during that time are more likely to need active rehabilitation than palliative care.
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ALS is a rapidly progressing degenerative neuromuscular disease with an unknown origin, results in muscle weakness, disability, respiratory insufficiency, and eventually death. The median survival duration for patients is approximately 3 years, yet 10% will survive for > 10 years.
Continue reading “End Stage Neurological Disorders – Amyotrophic Lateral Sclerosis 肌萎缩侧索硬化 (ALS) (Learning about Hospice)”
Parkinson’s disease is a fairly common disease of the central nervous system. It is a chronic, progressive neurodegenerative disease defined by the classic trial of tremor, rigor 僵直, and akinesis 运动消失 (There is a slow progression of motor skill complications, including resting tremors, excessive slowness in activity, and rigidity). Classic signs include pill-rolling movements in the hands, loss of facial expression, difficulty initiating movements, and gait changes. Because of its slow progression, patients may initially present with generalized weakness, aching, fatigue, and malaise. A slight tremor of an extremity may also be noted. Symptoms result from an imbalance between dopamine-activated and acetylcholine-actived neural pathways in the basal ganglia and are generally found in people older than 65 years. Parkinson-like symptoms can also be caused by medication toxicity, head trauma, or other degenerative conditions.
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The skin is normally populated with bacteria, and under healthy normal circumstances these bacteria do not routinely lead to infection. When there is an interruption to skin integrity or underlying immunocompromise however, these bacteria can cause an infection such as impetigo (VanRavenstein, Durham, Williams, & Smith, 2017). Ferri (2018) defines impetigo as a common bacterial superficial skin infection that is generally caused by streptococcal or staphylococcal bacteria. Skin lesions can be described a bullous when multiple vesicles form on the skin, enlarge, and weep a yellow honey-like crust due to a toxin produced at the site of the infection (Ferri, 2018). As the weeping lesions become contagious and spread to the others, a dry scaly boarder forms to replace the old fluid-filled vesicle (Ferri, 2018). Non-bullous impetigo begins as a single red papule, usually around the nose or mouth, weep and produce a honey-like crust (Ferri, 2018).
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