Pain Perception And Processing In Alzheimers Disease

Pain Perception And Processing In Alzheimers Disease Alzheimers patients feel pain as powerfully as others. Pain perception and processing are not diminished in Alzheimers disease, thereby raising concerns about the current inadequate treatment of pain in this highly dependent and vulnerable patient group. Pain activity in the brain was just as strong in the Alzheimers patients as in the healthy volunteers. In fact, pain activity lasted longer in the Alzheimers patients. Pain may be even more bewildering to more severely affected patients. The experience of pain may be more distressing for these patients on account of their impaired ability to accurately appraise the unpleasant sensation and its future implications. Doctors can use a tool called the Pain and Discomfort Scale or PADS. Its a system for evaluating pain based on facial expressions and body movements. People caring for someone with Alzheimers disease or other dementias can do an even better job than doctors can. Caregivers have an incredible capacity even beyond doctors to know the behavior of the person they are caring for and to look for the times they are in discomfort or pain. The trick is to watch the facial expressions and movements of patients when they are not in pain, both during sleep and waking hours. Using this as a baseline, you should be attentive to circumstances where they seem agitated, where eye contact is altered, where there is grimacing or a facial expression indicative of discomfort. As Alzheimers disease progresses towards the later stages, the ability of the affected person to communicate becomes increasingly compromised. Caregivers can no longer ask are you comfortable? or, are you in pain? and get a reliable answer. A caregiver has to interpret what behavior means. Are shouts, screams, severe withdrawal, aggression, due to confusion, something else, or are they signs of pain?   The way in which a normal person experience pain differs. Pain is a subjective experience. People who have problems communicating are disadvantaged. Research into the prevalence of pain in elders in nursing homes is estimated at between 40 and 80 percent. There is evidence that people with cognitive disabilities may have an even higher risk of being under-medicated for pain. Painful conditions such as arthritis, cancer, urine infections are sometimes not treated with painkilling medications. Even when people can communicate effectively research suggests that observers tend to assume that people over-report pain either verbally or in their facial expressions.   Effective pain management for people with dementia is a complex issue. Families and health professionals caring for people with dementia have to acquire new skills and it can be a rather hit and miss situation. The first step in pain management is assessment of the discomfort. Acute pain syndromes commonly follow injuries, surgical procedures, etc. and require standard analgesic or narcotic management. Acute pain syndromes are expected to last for brief periods of time, i.e., less than six months. Pain that persists for over six months is termed chronic pain. Chronic non-malignant pain requires a more complex strategy to minimize the use of narcotics and maximize non- pharmacological interventions. Acute pain rarely produces other long-term psychological problems, such as depression, although acute discomfort will produce distress manifested by acute anxiety or agitation in the demented patient. Mildly demented patients can become agitated or anxious with pain because they rapidly forget explanations or reassurances provided by staff. Amnestic individuals may forget to ask for PRN non-narcotic analgesics such as acetaminophen and these patients need regularly scheduled medications. Disoriented patients do not realize they are in a health care facility and aphasic patients may not comprehend the staffs inquiry about pain symptoms. The symptoms of pain expressed by patients with moderate to severe dementia include anxiety, agitation, screaming, hostility, wandering, aggression, failure to eat, and failure to get out of bed. A small number of demented individuals with serious injury may not complain of pain, e.g., hip fractures, ruptured appendix, etc. Assessment of pain in the demented patient requires verbal questioning and direct observation to assess for behaviors that suggest pain. Standardized pain assessment scales should be used for all patients; however, these clinical instruments may not be valid in persons with dementia or psychosis. The past medical history may be valuable in assessing the demented resident. Individuals with chronic pain prior to the onset of dementia usually experience similar pain when demented, e.g., compression fractures, angina, neuropathy, etc. These individuals can be monitored carefully and non-narcotic pain medication can be prescribed as indicated, e.g., acetaminophen on a regular basis, anticonvulsants for neuropathy. The management of pain in any person requires careful consideration about the contribution of each component of the pain circuit to the painful stimulus. Neuropathic pain is produced by dysfunction of the nerve or sensory organ that perceives and transmits noxious stimulus to the level of the spinal cord. Persons with serious back disease may have herniated discs that compress specific nerve roots. This pain is often positional and produces spasms of the musculature in the back. The brain interprets pain in a highly organized systematic pattern. Discrete brain regions interpret and translate painful stimuli from specific body regions, e.g., arm, leg, etc., misfire in that discrete brain region will misinform the person that pain or discomfort is being experienced in that limb or part of the trunk. A person who loses a limb from trauma or amputation may continue to experience painful sensations in the distributions for that limb termed phantom limb pain. Management of chronic pain involves three elements (1) physical interventions, (2) psychological interventions, (3) pharmacological interventions. Physical interventions include basic physiotherapy that incorporates warm or cool compresses, massage, repositioning, electrical stimulation and many other treatments. Dementia patients need constant reminders to comply with physical treatments e.g., using compresses, sustaining proper positioning, etc., and many do not cooperate with some interventions, like nerve stimulators or acupuncture. Physical interventions are particularly helpful in older persons with musculoskeletal pain regardless of cognitive status. Psychological interventions usually require intact cognitive function e.g., relaxation therapy, self-hypnosis, etc. Demented patients generally lack the capacity to utilize psychological interventions; however, management teams should provide emotional support to validate the patients suffering associated with pain. Demented patients may experience more suffering from pain than intellectually intact individuals because they lack the capacity to understand the cause of their discomfort. Fear, anxiety, and depression frequently intensify pain. Pharmacological management begins with the least toxic medications and follows a slow progressive titration until pain symptoms are controlled. Clinicians must distinguish between analgesia and euphoria. Some medications that appear to have an analgesic or pain relieving effect actually have an euphoric effect, which diminishes the patients concern about perceived pain. The goal of pain management is to remove the suffering associated with the painful stimulus rather than making the patient euphoric or high to the point where they no longer care whether they experience pain. Euphoria-producing medications can cause confusion, irritability, and behavioral liability in patients with dementia. Narcotic addiction is not a common concern in dementia patients as these individuals have a limited life expectancy and rarely demonstrate drug-seeking behaviors. Pharmacological interventions always begin with the least toxic, i.e., least confusing, medications. A regular dose of acetaminophen up to 4 grams per day will substantially diminish most pain and improve quality of life. Clinical studies show that regular Tylenol reduced agitation in over half the treated patients. Chronic arthritic pain with inflammation of the joints may also respond to non- steroidal anti-inflammatory (NSAIDS) or Cox-2 inhibitors. The gastrointestinal toxicity associated with NSAIDS is greater than that of Cox 2 inhibitor medications. Patients who fail to respond to non-narcotic analgesics should receive narcotic-like medications, i.e., Tramadol. Patients who fail to respond to maximum doses of Tramadol, i.e., 300 mgs per day, may require narcotic medications.  

Eulogy for Friend :: Eulogies Eulogy

Eulogy for Friend The phone rang in the early hours of the morning. Rolf G. informed us that Michael had suffered a heart attack a few hours earlier and had not survived. My wife whispered a few words I could not hear, sat silently on the edge of the bed for a moment, then turned to me and said, "Michael passed away at the airport, its just not fair. He was doing so well." No, it was just not fair. We try to share with Michael's family, with Kathy, Molly and Tom, Molly, Clint and Wendy and their families the grief they feel, but it is not really in our power to do so. We are compelled to measure the loss of our friend and colleague, father and husband each in our own way and turn instead to what we can share, the extraordinary life that touched us all. I spoke with Michael several times well before we had actually met. When it was determined that Marilyn and I were coming to a university in far off Montana, he called us in Washington, D.C. to welcome us, to ask questions about courses I wanted to teach, shared information about students and the university. A few weeks after the Fall term began that year, he came into my office and asked me a question about a Native American tribe that lived in the Montana western border region. "How did they subsist," I think he asked. I replied that they hunted and fished and planted crops, they were a "seasonal people." He liked that phrase. "Ya, Ya" and then he was back to his typewriter. Some months later, the first addition of his book Montana: A History of Two Centuries, written with colleague Dick R., came out. He gave me a copy and I was perusing through the early chapters, when there in the middle of a discussion about Montana's native people, was "Historian Thomas R. Wessel refers to them as ‘seasonal people'." It was a small matter that hardly enhanced his scholarly reputation of mine for that matter, but I came to learn it was typical. A quiet, generous gesture followed in the years we spent together in the Department of History and Philosophy, and after, when he climbed the administrative ladder to the President's Office. I would soon learn that I was hardly alone as a recipient of Michael's generosity and concern. Eulogy for Friend :: Eulogies Eulogy Eulogy for Friend The phone rang in the early hours of the morning. Rolf G. informed us that Michael had suffered a heart attack a few hours earlier and had not survived. My wife whispered a few words I could not hear, sat silently on the edge of the bed for a moment, then turned to me and said, "Michael passed away at the airport, its just not fair. He was doing so well." No, it was just not fair. We try to share with Michael's family, with Kathy, Molly and Tom, Molly, Clint and Wendy and their families the grief they feel, but it is not really in our power to do so. We are compelled to measure the loss of our friend and colleague, father and husband each in our own way and turn instead to what we can share, the extraordinary life that touched us all. I spoke with Michael several times well before we had actually met. When it was determined that Marilyn and I were coming to a university in far off Montana, he called us in Washington, D.C. to welcome us, to ask questions about courses I wanted to teach, shared information about students and the university. A few weeks after the Fall term began that year, he came into my office and asked me a question about a Native American tribe that lived in the Montana western border region. "How did they subsist," I think he asked. I replied that they hunted and fished and planted crops, they were a "seasonal people." He liked that phrase. "Ya, Ya" and then he was back to his typewriter. Some months later, the first addition of his book Montana: A History of Two Centuries, written with colleague Dick R., came out. He gave me a copy and I was perusing through the early chapters, when there in the middle of a discussion about Montana's native people, was "Historian Thomas R. Wessel refers to them as ‘seasonal people'." It was a small matter that hardly enhanced his scholarly reputation of mine for that matter, but I came to learn it was typical. A quiet, generous gesture followed in the years we spent together in the Department of History and Philosophy, and after, when he climbed the administrative ladder to the President's Office. I would soon learn that I was hardly alone as a recipient of Michael's generosity and concern.

Genetic Engineering Tutorial

Chapter 14 Genetic Engineering Choose the best answer for each question. 1. Using this key, put the phrases in the correct order to form a plasmid carrying the recombinant DNA. Key: 1) use restriction enzymes 2) Use DNA ligase 3) Remove plasmid from parent bacterium 4) Introduce plasmid into new host bacterium. A. 1, 2, 3, 4C. 3, 1, 2, 4 B. 4, 3, 2,1 D. 2, 3, 1, 4 2. Which is not a clone? A. a colony of identical bacterial cells B. identical quintuplets C. a forest of identical trees D. eggs produced by oogenesis E. copies of a gene through PCR 3.Restriction enzymes found in bacterial cells are ordinarily used A. during DNA replication B. to degrade the bacterial cell’s DNA C. to degrade viral DNA that enters the cell D. to attach pieces of DNA together 4. Recombinant DNA technology is used A. for gene therapy B. to clone a gene C. to make a particular protein D. to clone a specific piece of DNA E. All of these are correct 5. In order for bacterial cells to express human genes , A. the recombinant DNA must not contain introns. B. reverse transcriptase is sometimes used to make complementary DNA from an mRNA molecule.C. bacterial regulatory genes must be included. D. All of these are correct. 6. The polymerase chain reaction A. utilizes RNA polymerase B. takes place in huge bioreactors C. utilizes temperature insensitive enzyme D. makes lots of nonidentical copies of DNA E. All of these are correct 7. DNA fingerprinting can be used for which of these? A. identifying human remains B. identifying infectious diseases C. finding evolutionary links between organisms D. solving crimes E. All of these are correct 8. DNA amplified by PCR and then used for fingerprinting could come from A. ny diploid or haploid cell B. only white blood cells that have been karyotyped C. only skin cells after they are dead D. only purified animal cells E. both B and D are correct 9. Which of these pairs is incorrectly matched? A. DNA ligase – DNA fingerprint B. Restriction en zymes – Cloning C. DNA fragments – DNA fingerprinting D. DNA polymerase – PCR 10. Which of these is an incorrect statement? A. bacteria secrete the biotechnology product into the medium B. plants are being engineered to have human proteins in their seeds. C. nimals are engineered to have a human protein in their milk. D. animals can be cloned, but plants and bacteria cannot. 11. Which of these is not needed in order to clone an animal? A. sperm from a donor animal B. nucleus from an adult animal cell C. enucleated egg from a donor animal D. host female to develop the embryo E. All of these are needed 12. Because the human genome Project, we know or will know the A. sequence of the base pairs of our DNA B. sequence of genes along the human chromosomes C. mutations that lead to genetic disorders D.All of these are correct 13. The restriction enzyme called EcoRI has cut double stranded DNA in the following manner. The piece of foreign DNA to be inserted has what ba ses from the left and from the right? 14. Which of these is a true statement? A. Plasmids can serve as vectors B. Plasmids are linear DNA found in viruses C. Plasmids can replicate in the host cell D. Both A and C are correct 15. Which of these is a benefit of having insulin produced by biotechnology? A. It is just as effective B. It can be mass produced C. It is less expensive D. All of the above

The s Views On Same Sex Marriage Essay - 1753 Words

Question 1a. One example reflecting Mulholland’s views is the Marriage (Definition of Marriage) Amendment Act 2013. I selected this Act since New Zealand was one of the first countries in Oceania to enact this legislation, before which it was illegal for same-sex couples to marry. This recognises a significant change in our societies values. Homosexual male sex was illegal before the passing of the Homosexual Law Reform Act 1986. The values of our society have certainly changed evidenced by the fact that same-sex couples (male and female) can now marry after the 2013 Act was passed, before which it was illegal. Question 1b. i. ‘Ethics’ involves rules that define right and wrong conduct especially in business. ii. ‘Law’ is a set of rules administered and enforced by the state. iii. ‘Morality’ involves rules that define acceptable behaviour for members of a society. Question 1c. i. Civil law indicates that the wrongdoing is only of concern to parties directly affected, e.g. breach of contract and torts. Criminal law indicates that the wrongdoing should be of concern to all members of society, e.g. murder, rape and robbery. ii. According to Miller (pg 7, 2014), public law involves matters affecting the State as a community, e.g. constitutional law and criminal law. Private law involves matters that affect the rights and duties of individuals among themselves, e.g. contract law and tort law. Question 1d. i. The change in NZ to MMP (Mixed-Member Proportional) has diminishedShow MoreRelatedThe Presidential Election : Abortion And Same Sex Marriage860 Words   |  4 Pagesâ€Å"right wing†. Their opinions on certain subjects can be classified into these factors. Bernie Sanders, and Donald Trump, are two candidates that disagree on topics such as abortion, and same sex marriage, whilst agreeing on higher taxation for the wealthy. 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