Artificial life support: Use of sophisticated
machines such as ventilators and a variety of tubes placed in bladders,
veins, arteries, through chest walls to keep individuals alive longer
than their bodies can sustain them.
Artificial nutrition and hydration NG (naso-gastric)
tube: A tube inserted into the nose, through the throat and
esophagus (food pipe) and into the stomach to deliver liquid nutrients.
Possible complications are sinus infections, ulcers of the esophagus and stomach, and discomfort
such as feelings of bloating or needing
to vomit, cramps and diarrhea. Regurgitation
is common and can lead to aspiration pneumonia.
PEG (percutaneous endo-gastrostomy) or G
tube (jejunostomy): A tube threaded through the abdominal
wall into the abdominal cavity and then into the stomach. PEG tubes
can become displaced, causing liquid to empty into the abdominal
cavity. The tubes can cause bleeding, inflammation and infection
at entry sites.
Unconscious or confused patients sometimes
try to pull feeding tubes out, leading
to tying the patients arms down,
or heavy sedation, which erodes a patients
mental state and inhibits repositioning
for greater comfort.
TPN (total parenteral nutrition): Surgical
insertion of a special catheter, usually into a vein just under
the collarbone. TPN is usually given to patients with serious intestinal
disorders, in anticipation of long term use to maintain a reasonably
Anoxic brain damage: Death of brain cells
due to loss of oxygen. Damage begins about three minutes after blood
pressure or oxygen levels fall significantly (such as during cardiac
arrest). Many medically frail patients suffer some kind of brain
damage that leaves them more impaired than before cardiac arrest.
Cardiac arrest: The point at which the
heart stops beating or quivers so that it does not pump correctly.
Most cardiac arrests are caused by heart disease that cannot be
corrected by CPR. 90% of elderly patients who have cardiac arrests
die despite CPR.
CPR or Cardio-Pulmonary Resuscitation:
Mechanical compression of the chest, and artificial respiration
to sustain a pulse and breathing, often called a code.
Vigorous chest compression appropriate in cases in which
a patient may recover can and often does result in broken
ribs. Only about 3% of elderly patients with dementia who undergo
CPR leave the hospital and some of those suffer anoxic brain damage.
Death by dehydration: Before the development
of intravenous fluids most patients died in this manner, which is
not uncomfortable so long as the mouth is kept moist and clean.
Bodily waste products accumulate and blood pressure drops (hypovolemia)
until the patient simply slips away.
Decubiti or decubitous ulcers: Painful
bedsores that can occur on heels, buttocks and shoulder blades of
patients who are bedridden for prolonged periods.
DNR or Do Not Resuscitateand DNAR
or Do Not Attempt Resuscitation Order: In a hospital
a no code is issued by a physician in appropriate circumstances,
with the patients consent (or on request). It notifies providers
that CPR is not to be implemented if a patients heart stops
or (s)he stops breathing. These are called DNR Orders.
Most states, including Alabama, require different orders for hospital
and community settings. Without a pre-hospital DNAR
(do not attempt resuscitation) order, emergency personnel responding
to a home call in Alabama must administer CPR even to patients with
no hope of recovery.
Foley Catheter: A tube placed in the
bladder through the urethra (urinary tube). A balloon on the tip
of the tube is inflated after it is inserted into the bladder, to
keep it in place. Foley catheters may cause discomfort and a constant
feeling of need to urinate.
Intubation ventilator: The insertion
of a tube, about the size of a small finger, into the air pipe through
the vocal cords to allow a machine or a person to breathe for a
patient. A ventilator is a machine that helps the patient breathe
and sustain blood oxygen within normal limits. When the patient
wakes up (s)he may be unable to speak until the tube is removed.
Because of discomfort and limited motion, the tube itself, and
periodic suctioning of fluids, as well as anxiety, feelings of helplessness
and frustration, patients frequently require sedation.
Most of the definitions above
were taken directly or adapted from materials distributed by DETA,
the Dementia Education and Training Association, developed by the
Alabama Department of Mental Health. Some were adapted from materials
published by Choice in Dying, predecessor organization to Last Acts
Partnership. We thank Dr. Richard Powers for reviewing our adaptation
of the materials. Any errors that have slipped in after his review
are the fault of the editor; not Dr. Powers.