High-quality palliative care also requires special expertise in honest, compassionate communication. In addition to enhancing the patient's and family's experience, these skills help to establish trust and overcome barriers to adequate care and relief of symptoms. Several communication tasks are especially important: conveying accurate prognostic information while maintaining hope, eliciting information about symptoms, decision making about curative and palliative treatments, handling emotions, and dealing with requests from patients and families who have unrealistic goals [34, 35, 36] . The challenges of communicating effectively are discussed later in this course.
A reasonable initial panel of tests in the elderly patient with unintentional weight loss includes the following: a fecal occult blood test to screen for cancer; a complete blood count to look for infection, deficiency anemia or lymphoproliferative disorder; a chemistry profile to look for evidence of diabetes mellitus, renal dysfunction or dehydration; an ultrasensitive thyroid-stimulating hormone test to look for hypothyroidism or hyperthyroidism; and a urinalysis to look for evidence of infection, renal dysfunction or dehydration. Upper gastrointestinal studies (radiography or endoscopy) may be warranted in patients with symptoms referable to the gastrointestinal system or in patients with persistent weight loss.
Steroids - no intoxication effects
high blood pressure; blood clotting and cholesterol changes; liver cysts; hostility and aggression; acne; in adolescents—premature stoppage of growth; in males—prostate cancer, reduced sperm production, shrunken testicles, breast enlargement; in females—menstrual irregularities, development of beard and other masculine characteristics
Inhalants - (varies by chemical) stimulation; loss of inhibition; headache; nausea or vomiting; slurred speech; loss of motor coordination; wheezing