Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States.
Conventional COPD treatments:
Inhaled bronchodilator therapy: metered-dose inhalers and spacers, dry powder inhalers, or wet nebulizers
Inhaler technique should be assessed to ensure that a patient is able to use a device effectively.
The combination of a long-acting anticholinergic with an as-needed short-acting beta-agonist is a standard initial approach.
For many patients with advanced COPD, the addition of a combination inhaler containing a long-acting beta-agonist and an inhaled corticosteroid to a long-acting anticholinergic agent provides benefit in terms of symptom management and quality of life.
Death rattle – as patients near death, they are unable to cough to clear secretions that begin to pool in the oropharynx and bronchi, resulting in rales (“death rattles”). Because the sound is often distressing to family members, an anticholinergic (glycopyrrolate or atropine) may be given subcutaneously to relieve respiratory distress. A hyoscine hydrobromide transdermal patch is also available, but action is slower, 12 hours compared to 1 minute for injections. Risks associated with anticholinergics include xerostomia (dry mouth), increased sedation, and increased delirium. Elevating the head of the bed or turning the patient to the side may also relieve rattling. Patients normally stop taking fluids as they near death, resulting in dehydration and drying of the mucous membranes of the mouth. The death rattle also begins to lessen.
Palliative care is a form of specialized medical care which aims to optimize the quality of life and alleviate the suffering of patients through early identification and treatment of new symptoms along with management of those that prove refractory.
Excessive secretions can cause the frequently noted ” death rattle” in patients that are actively dying. This is caused by relaxation of the oropharyngeal muscles leading to a pooling of secretion in the throat. While it is typically not distressing for the patient, it does often make family members and other visitors uncomfortable. Anticholinergic agents, especially sublingual atropine drops, can be administered to assist in secretion reduction. Anticholinergic agents have multiple side effects, including decreased/ absent bowel sounds, decreased sweating, hot skin, and mydriatic pupils (dilated pupils).
POLST is a physician order for life-sustaining treatment, which is called a medical order for life-sustaining treatment in some states. This form is created during a conversation with a medical provider and lays out the patient’s end-of-life wishes. It is considered a medical order, and is most useful in times of emergency. Typically, POLST or MOLST forms are intended for patients who have a life expectancy of 1 year or less, and the POLST is a doctor’s order for the specific instructions the patient has given the physician about what to do in possible future situations.
Atopic dermatitis is a common inflammatory skin disease that mostly occurs in children and E (IgE) is secreted in response to environmental or food allergens. Typically dermatitis and eczema are used interchangeably when the patient has an acute flare-up. The condition is non-contagious and is characterized by dry, itchy skin, but in chronic or severe cases it can cause thick plaques, slightly raised, watery exudate to form or become infected which can affect the patient’s quality of life. So, therefore, because eczema is a common skin disorder seen in primary care the discussion will include the incidence, prevalence of the disease and pathophysiology from the primary provider perspective. As well as the physical assessment and exam, treatment plan, patient education, follow up and evaluation.