Energy Conservation and Assistive Devices in Occupational Therapy Quiz

88 Questions

What is dyspnea?

A subjective sensation that does not correlate well with functional and physiologic parameters

What is the relationship between dyspnea and tachypnea?

Dyspnea is not the same as tachypnea; tachypnea refers to excessive rate of breathing

What is the first-line treatment for dyspnea control?

Opioids

What factors are correlated with higher reported prevalence of dyspnea?

Depression and anxiety

What is the dual nature of dyspnea?

Subjective experience that doesn't always correlate with functional and physiological parameters

Which type of dyspnea occurs as a result of an action or activity?

Incident dyspnea

What does the MRC Dyspnea Scale measure?

Dyspnea severity

What can accessory muscle use reflect in dyspnea?

Intensity of dyspnea

What is considered the most important variable influencing the will to live among terminally ill cancer patients?

Dyspnea intensity

Which breathing technique can help decrease dyspnea?

Pursed lip breathing

What type of environment modification can help manage dyspnea?

Low humidity room

'Social death' before physical death may occur due to what reason in patients with dyspnea?

Decreased activity to manage dyspnea

'Palliative care drugs like opioids and benzodiazepines may be used' for what purpose in managing dyspnea?

To manage anxiety and fear associated with acute dyspnea episodes

'Oxygen should never be the only therapy in moderate-severe dyspnea and first-line medications should always be used.' What does this statement suggest about oxygen therapy?

It is the only therapy recommended for moderate-severe dyspnea

What type of positioning can help avoid chest or diaphragm compression in dyspnea?

Upright or semi-high Fowlers

What type of environment modification can trigger reflexes to decrease dyspnea?

Cool air blowing on the mouth and face

Which of the following chronic diseases can also lead to Anorexia and Cachexia Syndrome (ACS)?

COPD

Why does weight loss in ACS occur?

Because the body breaks down its own muscle and fat for energy

What type of nutritional supplementation does not restore the lean body mass in ACS?

Total Parenteral Nutrition (TPN)

How do families of patients with ACS often react towards nutritional intake?

They encourage the patient to eat more

What is an important aspect in the management of anorexia and cachexia syndrome?

Supportive care and addressing underlying causes

What type of meals can be helpful for patients with anorexia and cachexia syndrome?

High protein, high calorie foods and small, frequent meals on the patient's schedule

How can creating a relaxing environment before meals benefit patients with anorexia and cachexia syndrome?

It can promote digestion

What can healthcare professionals do to help manage dyspnea and anxiety in patients?

Teach pacing and planning of activities

What is the primary cause of anorexia and cachexia syndrome?

Chronic inflammation and cytokine production

Which statement is true about cachexia?

It is a reversible condition with appropriate feeding

What is the effect of opioids such as morphine and hydromorphone in advanced disease?

They can be safely used to decrease dyspnea

Which therapy should not be the first line therapy for managing incident dyspnea?

Anxiolytics

What can contribute to weight loss in anorexia and cachexia syndrome?

Factors like fatigue, pain, dyspnea, and dysphagia

What is the relationship between cachexia and starvation?

Cachexia is a condition of appetite suppression while starvation is not

What can assistive devices like walking aids help with?

Improving breath control

Which artificial nutrition option is preferred for patients with good functional status and a prognosis of at least 2-3 months?

Enteral nutrition through jejunostomy

What is the purpose of megestrol acetate in advanced cancer patients?

To increase appetite and overall weight gain

Which pharmacological intervention can cause side effects such as adrenal suppression, hyperglycemia, and peptic ulcers?

Corticosteroids

What is the common complication in patients receiving chemotherapy or radiation therapy that affects the mouth and throat, leading to pain and difficulty swallowing?

Mucositis

What percentage of patients receiving standard dose chemotherapy will experience mouth and throat side effects?

40%

Which feeding method is not supportive of comfort and does not improve longevity at the end of life?

TPN (Total Parenteral Nutrition)

Which artificial nutrition option is only recommended for patients with head and neck cancer or dysphagia?

Parenteral nutrition (TPN)

What is the main purpose of corticosteroids in advanced cancer patients?

To increase appetite and nutritional intake

What should be encouraged for patients at the end of life regarding their nutritional needs?

Eating if desired with support as needed

What is the purpose of metoclopramide in cancer patients?

To treat nausea and increase gastric emptying

What is a common complication associated with TPN (Total Parenteral Nutrition)?

Skin excoriation

What is the impact of oral complications on cancer patients?

Increased risk of cachexia

What is dyspnea?

An uncomfortable awareness of breathing

What is the primary cause of dyspnea in advanced cancer patients?

Perception of inadequate or unsustainable respiratory muscle response

What is the most common incidence of severe/very severe dyspnea in advanced cancer patients?

Last 6 weeks of life

Which medication is considered first-line for controlling dyspnea?

Opioids

What is the most important variable influencing the will to live among terminally ill cancer patients?

Refractory dyspnea

What type of positioning can help avoid chest or diaphragm compression in dyspnea?

Sitting upright or semi-high Fowlers

What does the MRC Dyspnea Scale measure?

Dyspnea severity

Which breathing technique can help decrease dyspnea?

Pursed lip breathing

What is the primary cause of anorexia and cachexia syndrome?

Underlying conditions

'Social death' before physical death may occur due to what reason in patients with dyspnea?

Decreased activity

'Oxygen should never be the only therapy in moderate-severe dyspnea and first-line medications should always be used.' What does this statement suggest about oxygen therapy?

It is not recommended for moderate-severe dyspnea

'Palliative care drugs like opioids and benzodiazepines may be used' for what purpose in managing dyspnea?

To manage anxiety, depression, and social isolation

'Dual nature of dyspnea' refers to:

The subjective experience that may not correlate with functional parameters

'Thorough physical assessment for advanced conditions like COPD is necessary to identify dyspnea causes and severity.' What does this statement emphasize?

The necessity of addressing reversible causes of dyspnea in COPD patients

What is the effect of opioids such as morphine and hydromorphone in advanced disease?

They can help manage dyspnea and anxiety

Which artificial nutrition option is preferred for patients with good functional status and a prognosis of at least 2-3 months?

Enteral nutrition through jejunostomy

What is the effect of opioids such as morphine and hydromorphone in advanced disease?

Decrease appetite and nutritional intake

Which pharmacological intervention can cause side effects such as somnolence, confusion, and dysphoria, especially in the elderly?

Cannabinoids

What type of environment modification can trigger reflexes to decrease dyspnea?

Aromatherapy

Which statement is true about cachexia?

It leads to muscle wasting and weakness

'Palliative care drugs like opioids and benzodiazepines may be used' for what purpose in managing dyspnea?

To reduce anxiety and improve comfort

What is an important aspect in the management of anorexia and cachexia syndrome?

Considering the patient's life expectancy and potential side effects

'Oxygen should never be the only therapy in moderate-severe dyspnea and first-line medications should always be used.' What does this statement suggest about oxygen therapy?

Oxygen therapy is ineffective in managing dyspnea.

What type of meals can be helpful for patients with anorexia and cachexia syndrome?

Small, frequent meals

What type of nutritional supplementation does not restore the lean body mass in ACS?

Carbohydrate supplements

What is the primary mechanism that leads to a catabolic state resulting in the breakdown of muscle and fat for energy in anorexia and cachexia syndrome?

Chronic inflammation and cytokine production

Which of the following is NOT a secondary cause of anorexia and cachexia syndrome?

Metabolic and neuroendocrine changes

In which disease populations is cachexia a significant predictor of decreased quality of life and shorter survival?

Cancer, heart failure, COPD, CKD, ESLD, and AIDS

What distinguishes cachexia from starvation?

Presence of appetite suppression

What is the primary purpose of opioids such as morphine and hydromorphone in advanced disease?

To decrease dyspnea

Which therapy should not be the first-line therapy for managing incident dyspnea?

Anxiolytics

'Palliative care drugs like opioids and benzodiazepines may be used' for what purpose in managing dyspnea?

'To provide relief from anxiety.'

What can assistive devices like walking aids help with?

Pacing and planning activities.

What is considered the most important variable influencing the will to live among terminally ill cancer patients?

Pain management.

In patients with Anorexia and Cachexia Syndrome (ACS), weight loss cannot be fully explained by anorexia alone because the body gets energy by breaking down its own muscle and fat instead. What is the term for this catabolic state?

Proteolysis

Which chronic diseases can also lead to Anorexia and Cachexia Syndrome (ACS), as mentioned in the text?

COPD, HIV, and advanced AIDS

What is the term for the assessment of potential reversible causes of weight loss, such as mucositis, constipation, and gastroparesis, as mentioned in the text?

Etiology investigation

Which pharmacological intervention can cause side effects such as adrenal suppression, hyperglycemia, and peptic ulcers, as mentioned in the text?

Corticosteroids

What type of meals can be helpful for patients with Anorexia and Cachexia Syndrome (ACS), according to the information provided?

High protein, high calorie foods and small, frequent meals

What is the term for creating a relaxing environment before meals to benefit patients with Anorexia and Cachexia Syndrome (ACS), as mentioned in the text?

Pre-prandial atmosphere adjustment

'Social death' before physical death may occur due to what reason in patients with dyspnea?

Loss of communication skills

'Palliative care drugs like opioids and benzodiazepines may be used' for what purpose in managing dyspnea?

To decrease anxiety and air hunger

'Oxygen should never be the only therapy in moderate-severe dyspnea and first-line medications should always be used.' What does this statement suggest about oxygen therapy?

'Oxygen therapy alone is insufficient for moderate-severe dyspnea.'

'What is the primary cause of Anorexia and Cachexia Syndrome?' is a common misconception. What is the correct explanation for weight loss in ACS as mentioned in the text?

'Body breaks down its own muscle and fat for energy.'

What can healthcare professionals do to help manage dyspnea and anxiety in patients?

Provide counseling and reassurance

Study Notes

Team approach is used to manage independent feeding options for patients with advanced cancer and stomatitis (mouth sores and painful ulcers) caused by chemotherapy or radiation.
Managing oral pain and considering artificial nutrition on an individual basis is essential.
Artificial nutrition options include enteral and parenteral nutrition. Enteral nutrition is preferred for patients with good functional status and a prognosis of at least 2-3 months, while parenteral nutrition (TPN) is only recommended for patients with head and neck cancer or dysphagia.
Enteral nutrition through tubes like NG, PEG, and jejunostomy, and parenteral nutrition through gastrostomy tubes or jejunostomy are considered only if there is a secondary condition requiring invasive nutritional interventions.
There is no evidence to support that artificial nutrition prolongs life or functional status in advanced cancer patients.
Pharmacological interventions for managing appetite and nutritional intake in advanced cancer patients include megestrol acetate, corticosteroids, metoclopramide, and cannabinoids.
Megestrol acetate is a synthetic progesterone that acts on cytokines to inhibit TNF and increases appetite and overall weight gain, but does not reverse cachexia.
Corticosteroids like dexamethasone and methylprednisolone increase appetite and nutritional intake are most effective with a life expectancy of less than 6-8 weeks, but they can cause side effects like adrenal suppression, hyperglycemia, and peptic ulcers.
Metoclopramide is used to treat early satiety in gastroparesis and increases gastric emptying and decreases nausea, but it is not an appetite stimulant.
Cannabinoids like nabilone and dronabinol increase appetite and decrease nausea but do not have evidence to recommend in advanced cancer. They can cause side effects like somnolence, confusion, and dysphoria, especially in the elderly.
Mucositis or stomatitis is a common complication in patients receiving chemotherapy or radiation therapy, affecting the mouth and throat, leading to pain and difficulty swallowing.
Oral complications like pain, taste alterations, difficulty chewing and swallowing, difficulty with speech and social isolation, and interrupted sleep can impact quality of life, contribute to functional decline, and failure to thrive.
Stomatitis goes to the back of the throat, causing pain, difficulty swallowing, and sometimes bleeding.
Approximately 40% of patients receiving standard dose chemotherapy and all patients receiving radiation therapy to the head and neck will experience mouth and throat side effects.
Oral complications can lead to anorexia and cachexia, which can further impact quality of life and contribute to death.
At the end of life, feeding is not supportive of comfort and does not improve longevity. Patients may not have the desire to eat, and if they do, small amounts of PO feeding by hand may be enough. Patients should be in an upright position and not receive TPN as it can increase morbidity and complications.
TPN is not part of the WRHA palliative care program and requires monitoring, frequent blood work, and is expensive. It can cause complications like tube placement issues, skin excoriation, infection, blood clots, dumping syndrome, refeeding syndrome, and stimulate tumor growth.
Pharmacological interventions should be used with caution, considering the patient's life expectancy and the potential side effects.
At the end of life, comfort feeding may be sufficient to meet the patient's nutritional needs. Patients should be encouraged to eat if they desire, and if not, they should be supported with appropriate measures to ensure their dignity, respect, and comfort.
Anorexia and Cachexia Syndrome (ACS) is a condition seen in advanced cancer patients where the body cannot process nutrients from food due to a catabolic state.
Weight loss in ACS cannot be fully explained by anorexia alone, as the body gets energy by breaking down its own muscle and fat instead.
Nutritional supplementation, such as Total Parenteral Nutrition (TPN), does not restore the lean body mass in ACS.
ACS can also occur in other chronic diseases such as COPD, HIV, and advanced AIDS.
Families of patients with ACS often put significant importance on nutritional intake and may exert pressure on the patient to eat more.
Assessment for potential reversible causes of weight loss, such as mucositis, constipation, and gastroparesis, is important.
Management of anorexia and cachexia syndrome involves education, supportive care, and addressing underlying causes.
High protein, high calorie foods and small, frequent meals on the patient's schedule can be helpful.
Trying various foods, textures, and seasonings, as well as providing nutrient dense liquids, can be beneficial.
Creating a relaxing environment before meals and sitting upright after eating can promote digestion.
Avoiding procedures and psychological distress prior to meals and limiting fluids before meals can also be helpful.

Test your knowledge on energy conservation techniques, the use of assistive devices such as walking aids and bathroom modifications, and the role of occupational therapy and physical therapy in managing dyspnea and anxiety in patients. This quiz covers topics related to relaxation therapy, breath control, and providing support and information to patients and their families.

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