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A patient with severe dementia has developed worsening anorexia and nausea over the past 6 weeks 500mg keflex sale. You have turned your attention to symptom management. Which of the following statements accurately characterizes treatment of these complications of severe dementia? Even though this patient has severe dementia, it would be unethical to withhold nutrition and hydration ❏ C. A feeding tube will reduce the risk of aspiration pneumonia ❏ D. Prochlorperazine relieves nausea by blocking serotonin at its site of action in the vomiting center of the brain ❏ E. Impaction may explain all the symptoms Key Concept/Objective: To understand the management of nausea and anorexia near the end of life Haloperidol is highly effective against nausea and may be less sedating than many com- monly used agents, such as prochlorperazine. Because of the terminal and irreversible nature of end-stage dementia and the substantial burden that continued life-prolonging care may pose, palliative care focused predominantly on the comfort of the patient is often viewed as preferable to life-prolonging measures by a substantial proportion of nursing home patients and family members. Every physician must make his or her own decision, but it is never unethical to withhold nutrition and hydration if these are not helping the patient. There is no evidence that tube feeding reduces the risk of pneumonia in such patients, and it may even increase it. Dopamine-mediated nausea is probably the most common form of nausea, and it is the form of nausea most frequently targeted for initial symptom management. Bowel impaction could easily explain the gradually worsening anorexia and nausea in a bedrid- den patient.

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They travel together on the same roads with buses order keflex 500mg, trucks and cars in a chaotic traffic stream. Mismatched collisions between unprotected humans and the heavy vehicles cause frequent deaths and serious injury even at lower speeds. This is clearly evidenced in Malaysia where 57% of traffic fatalities are related to motorised two wheeled transport and when pedestrian and bicycle fatalities are added the total jumps to 78%. By contrast, motorised four wheeled vehicles account for 79% of fatalities in the USA (Table 8. Motor vehicle accidents resulted in a fatality in less than 1% of accidents, compared to 3% for bicycles and 10% in pedestrians. A deeper look at the numbers cautions translating these observations to the very different situations seen in the developing world. In developing countries transportation growth is centred on two wheeled transport and pedestrian travel, not automobiles. Based on the high rate of fatalities from bicycle and pedestrian related accidents in the USA, road traffic accidents in the developing world (which involve more two-wheeled vehicles and pedestrians) most certainly results in significantly more deaths and morbidity. Data from the United States Centers for Disease Control published in the national public health blueprint, Healthy People 2010, shows that motor vehicle crashes result in 15. A 30–50% reduction in these rates is the goal for the next decade. The resulting explosive 25–30% two wheeled power vehicle growth rate in many of the Asian countries will lead to doubling of the fleet in 5 years and tripling in 8 years, causing even more severe problems. This trend is clearly evident in Vietnam where 91% of vehicles are motorised two wheelers and only 9% are cars (Table 8.

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