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.Continue reading “What is POLST?”
Addiction: Compulsive use of a substance that occurs when it is used in a way other than intended. Patients have cravings when the substance is withdrawn, with an overriding inability to control their perceived need for the substance, even though there may be an awareness that the substance, or overuse of the substance, is harmful.
Dependence: A state in which the person feels that they can only function normally when using a specific substance. Abrupt withdrawal of the substance causes withdrawal symptoms.
Pseudoaddiction: The mistaken assumption that a patient who is seeking pain relief is addicted to a substance.
Tolerance: Occurs when the patient no longer has a therapeutic response to the drug and a higher dose is required to achieve the prior effectiveness.
- Oncogenes, which are mutant genes that regulate cell proliferation. Oncogenes allow accelerated proliferation of the mutated cells, resulting in the rapid growth of cancerous tumors.
- tumor suppressor genes, which impede cell proliferation and suppress or prevent cell mutations. Cancer involves inactivation of tumor suppressor genes, allowing replication of mutated cells.
In the TNM system: Cancer patients who require hospice or palliative care generally suffer from advanced disease, which is defined as metastatic spread of the malignancy from the primary site to other areas of the body and/or massive tumor growth at the primary site. The staging of tumors commonly follows the primary tumor, lymph node, and metastasis (TNM) system.
Definition, Etiology, and Incidence
Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig disease after the famous New York Yankees baseball player, is a devastating neurologic disorder that selectively affects motor function with an unknown origin, characterized by progressive muscle atrophy with hyperreflexia that results from denervation, and results in muscle weakness, disability, respiratory insufficiency, and eventually death.
ALS is a rare, debilitating, and incurable neurologic disease, has an annual incidence of 0.5-2 per 100,000 population, is primarily a disorder of middle to late adulthood, affecting people most frequently in their fifties, with men developing the disease nearly twice as often as women. The median survival duration for patient is approximately 3 years, yet approximately 20% of patients survive greater than 5 years, and 10% will survive for greater than 10 years.
As the main area of involvement is the motor neurons of the brain and spinal cord, ALS affects motor neurons in three locations as follows: the anterior horn cells (lower motor neurons – LMNs) of the spinal cord; the motor nuclei of the brain stem, particularly the hypoglossal nuclei; and the upper motor neurons (UMNs) of the cerebral cortex. The death of the LMNs leads to denervation, with subsequent shrinkage of musculature and muscle fiber atrophy. It is this fiber atrophy, called amyotrophy, which appears in the name of the disease. The loss of nerve fibers in lateral columns of the white matter of the spinal cord, along with fibrillary gliosis, imparts a firmness or sclerosis to this CNS tissue. The term lateral sclerosis designates these changes.
A remarkable feature of the disease is that the entire sensory system, the regulatory mechanisms of control and coordination of movement, and the intellect remain intact.Continue reading “Amyotrophic Lateral Sclerosis (ALS) – Reading & Sharing”
Hypokalemia – low serum potassium level
- Potassium levels of less than 3.5 mEq/L in the blood are diagnostic of hypokalemia