User:Atrinh22/sandbox

Article: Pregnancy test Pregnancy test

Before getting any commercial or laboratory testes, there are several common early physical signs that women can use to assess their pregnancy:

- Missing one or two or more consecutive menstrual periods is the most commonly reported pregnancy symptom.

- Spoting or light bleeding also often happen due to the implantation of the fertilized egg.

- Nausea or morning sickness can show up anywhere from 2 to 8 weeks after the conception. Nausea can occur with or without vomitting and morning sickness can happen anytime during the day.

- Breast changes, including swollen or tenderness of breasts or darken of the nipples areas due to the rapid change in the hormone levels after conception.

- Other frequently observed signs of early pregnancy include fatigue, headache, food cravings or aversions, mood swings or frequent urination.

Even though these symptoms can aid the early assessment of pregnancy, they vary from woman to woman and should not be used as an indication for pregnancy. Also, the symptoms can be the result of other clinical conditions, lifestye changings or stress. Therefore, laboratory test and ultrasound are required to further evaluate the pregnancy status.

Article: Palliative sedation

- General practice:

In general, palliative care is aimed to relieve suffering and to improve the quality of life for patients, as well as their families, with serious and/or life-threatening illness in all stages of disease. Palliative can be provided either as an add-on therapy to the primary curative treatment or as a monotherapy for patients who are on end-of-life care. Palliative care mainly focuses on managing symptoms, including but not limited to pain, insomnia, mental alterations, fatigue, difficulty breathing, and eating disorders. However, patients in the advanced stage of the disease might experience physical fatigue, mental confusion or delirium which prevent them from fully cooperating with the care team, a comprehensive symptom assessment can be utilized to fully capture all symptoms as well as their severity.

There are multiple interventions that can be used to manage the patient conditions depending on the frequency and severity of the symptoms, including using medications (i.e opioid in cancer-related pain), physical therapy/modification (i.e frequent oral hygiene for xerostomia/dry mouth treatment), or reversal of precipitating causes (i.e low fiber diet or dehydration in constipation managment). Palliative sedation is often the last resort if patient is resistant to other managing therapies or if the therapies fail to provide sufficient symptom relief.

- Drugs used:

Benzodiazepines: This a drug class that works on the central nervous system to tackle a variety of medical conditions, such as seizure, anxiety, depression. As benzodiazepines suppress the activities of nerves in the brain, they also create a sedating effect which is utilized for multiple medical procedures and purposes. Among all benzodiazepine agents, Midazolam is the most frequently used medication for palliative sedation for its rapid onset and short duration of action. The main indication for the use of Midazolam in palliative sediation is to control delirium and difficulty breathing to minimize the distress as well as prevent the exacerbation of these symptoms.

Opioids: Opioid agents also work on the receptors in the central nervous system to relieve pain, induce sedation or drownsiness. However, it is more frequently used as a pain management therapy rather than a sedating agent and should not be discontinues even when sedating effect is achieved.

Even though these sedating agents provide a comforting effect for the patient, there are risks of substance abuse and diversion. Therefore, in order to maintain the quality of care and at the same time prevent the risk of drug abuse, the Clinical Practice Guidelines for Quality Palliative Care from the National Consensus Project recommends a comprehensive assessment of symptoms prior to the initiation of pharmacological therapy, on-going monitor of both efficacy and toxicity of those agents alongside with patient and family education.

In terms of the initiation of palliative sedation, it should be a shared clinical decision initiated preferrably between the patient and the care team. . If severe mental alterations or delirium is the concern for the person to make an informed decision, consent can be obtained in the early stage of the disease or upon the admission to the hospcice facility. Family members can only participate in the decision-making process if explicitly requested by the patient.