Generativity vs Stagnation in Older Adults

Chemoprevention Essay
Chemoprevention is assigned by either selecting prevention of esophageal acid exposure using
proton pump inhibitor (PPI) therapy or modulation of pro–inflammatory mechanisms45. Proton
pump inhibitors (PPIs) are used generally in the handling of acid–related disorders. They function
by permanently obstructing the hydrogen/potassium adenosine triphosphatase enzyme system (the
H+/K+ ATPase, or, more frequently, the gastric proton pump) of the gastric parietal cells. The proton
pump is the terminal stage in gastric acid secretion and is directly accountable for secreting H+ ions
into the gastric lumen, leading the pump to be an excellent target for preventing acid secretion.
Targeting the terminal step in acid production, as well as the irreversible nature of the inhibition,
results in a class of drugs that are considerably more efficient than H2 ... Show more content on
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This class of medication has been available for commercial use for almost 25 years, and it has
exceeded the use of histamine 2 receptor antagonists (H2RA) for patients with moderate to severe
gastric acid–related diseases as well as for prophylaxis of upper gastrointestinal (GI) injury (with
nonsteroidal anti–inflammatory drugs). PPI therapy can lead to partial regression of intestinal
metaplasia (IM) in BE patients, as demonstrated by the development of macroscopic islands of
squamous epithelium and the accompanying shortening of columnar epithelium, although
inconsistently46, 47. The absolute indications for PPI therapy comprise peptic ulcer disease, chronic
nonsteroidal anti–inflammatory drugs use, treatment of Helicobacter pylori, and erosive esophagitis.
Despite a substantial decrease in the risk of neoplastic progression in patients with BE on prolonged
PPI use, total eradication of BE with medical therapy alone is rarely, if ever,
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Transplant ( NODAT ) : Risk Factors For Overcome...
Abstract New onset diabetes after transplant (NODAT) is an important complication after
transplantation that increases risk for poor patient and graft outcomes. Recent studies in children
identified older age, extremes of body mass index (BMI), and corticosteroid use at discharge as risk
factors for NODAT. However, these studies were conducted in a national sample which underrated
certain patient groups like deceased donor transplants and African American recipients. The purpose
of this study was to determine the association between acute rejection (a surrogate for increased
corticosteroid exposure) and NODAT in a pediatric kidney transplant program. A retrospective chart
review was performed on a cohort of 121 consecutive pediatric kidney ... Show more content on
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The main risk factors include age ≥50 years old, male gender, family history of diabetes, and high
systolic pulmonary artery pressure (PAP) >50mmHg.1,2 A review of data from the United States
Renal Data System for primary renal transplant recipients ≤21 years old transplanted between 1995
and 2004 found the following risk factors for NODAT: African American children, BMI ≥ 30,
increased age of child at time of transplant (≥13 years old), discharged on tacrolimus, and
cytomegalovirus donor positive/recipient negative status.2 Cytomegalovirus (CMV) is herpes virus
that is present in over sixty percent of adults that generally only causes non–specific fever and flu–
like symptoms in immunocompetent hosts. In immunosuppressed transplant patients however, the
virus can develop into a systemic infection involving several organ systems and increase the risk for
transplant rejection.3 Other studies in children also identified corticosteroid use at discharge as a
risk factors for NODAT.4 There have been no studies exploring the risk factors for NODAT in a
population similar to that at Children's of Alabama, which is distinct due to a large number of
deceased donor transplants and African–American recipients with higher immunologic risk. The
purpose of this study was to determine the association between acute rejection (a surrogate for
increased corticosteroid exposure) and NODAT in this kidney transplant program. Methods Before
initiation of this research, a literature

Adverse Effect Of Isotichiin
Indications for use – "a reason to prescribe a medication or treatment, also known as drug
indication" (Mosby's, pg 916, 2017). High–risk neuroblastoma is an indication of use for Unituxin
(dinutuximab) (FDA, 2015). Desired effects – "the ability of a drug to achieve the desired effect,
also known as efficacy" (Mosby's, pg 593, 2017). Unituxin in combination with interleukin–2 (IL–
2), granulocyte–macrophage colony–stimulating factor (GM–CSF), and 13–cis–retionic acid (RA)
showed that 73 percent of the participants who received this combination were alive compared to 58
percent of those receiving the oral retinoid drug, isotretinoin (RA) (FDA, 2015). Side Effects – "any
reaction to or consequence of a medication or therapy" (Mosby's, pg ... Show more content on
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Signs or symptoms could include lumps in the abdomen, bone pain, bulging eyes, dark circles
around the eyes, swollen stomach, trouble breathing, weakness or paralysis. Once neuroblastoma
has been diagnosed, it has usually metastasized to the lymph nodes, bones, bone marrow, and liver
(NIH, n.d.). The therapeutic classification of Unituxin (dinutuximab) is a monoclonal antibody,
which is a type of immunotherapy drug. Unituxin helps the body's immune system find and destroy
cancer cells. It is used along with other treatments, which include chemotherapy, surgery, and
radiation for children who have responded to previous treatment (Simon, 2015). The indications of
use for Unituxin are used in combination with granulocyte–macrophage colony–stimulating factor
(GM–CSF), interleukin–2 (IL–2) and 13–cis–retinoic acid (RA), for the treatment of children with
high–risk neuroblastoma who achieve at least a partial response to prior first–line multi–agent,
multimodality therapy (United (c), 2017). The available form of Unituxin is 17.5 mg/mL (3.5
mg/mL) in a single–use vial. Children and Adolescents – 17.5 mg/m2/dose as an IV infusion over 10
to 20 hours on scheduled days for 5 cycles in combination with isotretinoin, sargramostim, and
aldesleukin. On cycles 1, 3, and 5: give sargramostim 250 mcg/m2/day subcutaneously (or as an IV
infusion over 2 hours) on days 1 to 14; dinutuximab on days 4, 5, 6, and 7; and isotretinoin 160
mg/m2/day PO in 2 divided doses rounded

Erikson's Stages Of Psychosocial Development
Developmental Factors: Erikson's stages of psychosocial development: Check one box and give the
textbook definition (with reference) of Erickson's developmental stage for your patient's age group:
_____ Identity vs. Role Confusion/Diffusion _____ Intimacy vs. Isolation __x__ Generativity vs.
Self–absorption/Stagnation _____ Ego Integrity vs. Despair Definition: In this stage generativity
refers to the adult 's ability to care for another person. The most important event in this stage is
parenting. Does the adult have the ability to care and guide the next generation? Generativity has a
broader meaning then just having children. Each adult must have some way to satisfy and support
the next generation. According to Erikson, "A person does best at this time to put aside thoughts of
death and balance its certainty with the only happiness that is lasting: to increase, by whatever is
yours to give, the goodwill and higher order in your sector of the world" Elements for a positive
outcome: Generativity refers to "making your mark" on the world, through caring for others, to have
and nurture children and/or become involved with future generations. Elements for a negative
outcome: Stagnation refers to the failure to find a way to contribute. An individual must deal with
issues they are concerned with or it can lead to stagnation in later life. These individuals may feel
disconnected or uninvolved with their community and with society as a whole. (Erikson,

Essay on lab values
Magnesium:
Normal Ranges: 1.7 to 2.2 mg/dL
A magnesium test is used to measure the level of magnesium in the blood. Abnormal levels of
magnesium are most frequently seen in conditions or diseases that cause impaired or excessive
excretion of magnesium by the kidneys or that cause impaired absorption in the intestines.
Magnesium levels may be checked as part of an evaluation of the severity of kidney problems
and/or of uncontrolled diabetes and may help in the diagnosis of gastrointestinal disorders. Since a
low magnesium level can, over time, cause persistently low calcium and potassium levels, it may be
checked to help diagnose problems with calcium, potassium, phosphorus, and/or parathyroid
hormone – another component of calcium ... Show more content on Helpwriting.net ...
T4:
Normal Ranges: 4.5 – 11.2 mcg/dL
Total T4 and free T4 are two separate tests that can help a doctor evaluate thyroid function. The total
T4 test has been used for many years to help diagnose hyperthyroidism and hypothyroidism. It is a
useful test but can be affected by the amount of protein available in the blood to bind to the
hormone. The free T4 test is a newer test that is not affected by protein levels. Since free T4 is the
active form of thyroxine, the free T4 test is thought by many to be a more accurate reflection of
thyroid hormone function and, in most cases, its use has replaced that of the total T4 test. Whichever
thyroxine measurement is ordered, it is usually ordered along with or following a TSH test. This
helps the doctor to determine whether the thyroid hormone feedback system is functioning as it
should, and the results of the tests help to distinguish between different causes of hyperthyroidism
and hypothyroidism. Sometimes a T3 test will also be ordered to give the doctor additional
diagnostic information. A T4 and TSH test may be ordered to help evaluate a person with a goiter
and to aid in the diagnosis of female infertility. If a doctor suspects that someone may

Critical Care Issue in Trauma
Trauma was the major cause of mortality and morbidity till last 2 decades but after that there have
been major improvements in management and resuscitation of trauma patients. This does not imply
only to emergency care but also ICU management.
It is well established that there is trimodal distribution of death in trauma patients. First peak is
within seconds to minutes because of head or cervical spine injury or to injury to major blood vessel
and much cannot be done about this. The second peak occurs in minutes to hours due to life
threatening injuries and prognosis depends on initial resuscitation of the patients both in the
emergency department and ICU.Then there is third peak which occurs several days to weeks and is
often due to sepsis and multiorgan dysfunction[1]. This third peak can be prevented by good ICU
management of these patients. Here comes the role of good intensivist who has experience in
managing trauma patients as trauma patients are different from other patients coming to ICU.
There are majorly two kinds of trauma patients coming to ICU; one who are still in the phase of
ongoing resuscitation coming directly from the ED or Operation Theatre [OT] after damage control
surgery. Secondly there are patients who were being treated in the ward, deteriorated and then
shifted to ICU. There are certain problems particularly seen in trauma patients. In this review we
will try to highlight certain these problems.
Resuscitation of trauma patients Resuscitataion

Dr. Osama Khayat : An Introduction About The Hospital And...
In the first week of elective, we met Dr. Osama Khayat who gave us an introduction about the
hospital and cardiology department, and he asked us some questions about our university and in
which year we are. After that pleasure meeting with Dr. Osama, he also introduced us to the medical
team, which consist of a consultant, residents, interns and nurses at the Coronary Care Unit (CCU).
After that, we started the ward rounds with them in the CCU. We began in room one, there was a
56–year–old male patient with unstable angina and diabetes, and he is a smoker. The patient was
complaining of chest pain, sweating, dyspnea, nausea, vomiting, dizziness, fatigue, and pain or
pressure in the back, neck and jaw. They have done a test for the patient and they found Creatine
Kinase MB (CK–MB) was elevated, and they have performed an electrocardiogram (ECG). The
patient was on nitroglycerin and Aspirin. After that, we went to the next room, there was a male
patient with Left Ventricular Heart Failure (LVHF), and he was a hypertensive and diabetic. He was
on nonsteroidal anti–inflammatory drugs (NSAIDs) which have been stopped because it could
worsen the condition. They gave him Angiotensin–converting enzyme inhibitor, Beta–blocker,
Digoxin and Furosemide because the patient did not have hypokalemia (low potassium level) or
hypomagnesemia (low magnesium level). In the third room, there was a male patient with an
arrhythmia. He presented with chest pain, shortness of breath and a racing

Managing Active Hemorrhage ( Mt )
Managing active hemorrhage is a particular challenge to the anesthesiologist due to derangements in
hemodynamics, coagulopathy and electrolytes. These are further complicated by anesthesia,
operational exposure and the need for intravascular volume support during resuscitation. In addition,
the anesthesiologist must attempt to prevent post–operative morbidity, especially concerning end–
organ dysfunction in patients with at–risk cardiovascular, neurovascular, pulmonary, hepatic or renal
function.
With an aging population, higher use of anticoagulants and the development of novel drugs, a new
degree of coagulopathy has been introduced previously unseen in resuscitation1. Historically, initial
resuscitation centered on the use of ... Show more content on Helpwriting.net ...
Trauma patients transferred from the field often receive crystalloid infusion. In an analysis of 8700
patients of the German Trauma Registry in 2006, 34% were overtly coagulopathic at the time of
presentation; the degree of derangement was proportional to the degree of prior crystalloid
resuscitation4. Specifically, 10% of patients were coagulopathic after receiving 500 mL or less of
crystalloid, which has been shown to be a product of both acute trauma response and factor
dilution4. In trauma, abnormal coagulation panels at the time of presentation are associated with a
3–fold increase in mortality. Specifically, patients presenting with INR >1.5 have a mortality of 30%
compared to 5% in those with normal INR4. Further research shows that factor–depleted infusions
potentiate coagulopathy of trauma5.
MT is defined as > 10 u RBC in 24 h, > 4 u RBC in 4 hours with additional anticipated need, or
replacement of 50% total blood volume (TBV) in 3 hours1. Of patients admitted to a civilian level I
trauma center, 1– 5% require a MT1,4. An increase in transfusion requirement is associated with
increased mortality. Patients receiving 10 u RBC1. Current evidence for MT practice stems from the
past 15 years of research from military trauma literature and has been widely accepted for use in
civilian trauma, obstetric emergencies, and major surgery.
Interpreted clinically to represent impending death, the lethal triad of

Treatment Of Metastatic Squamous Non Small Cell Lung Cancer
Opdivo (nivolumab)
Opdivo (nivolumab); Bristol–Myers Squibb; For the treatment of metastatic squamous non–small
cell lung cancer, Approved March 2015
WEDNESDAY, March 4, 2015 (HealthDay News) –– U.S. Food and Drug Administration approval
of Opdivo (nivolumab) has been expanded to include advanced non–small cell lung cancer
(NSCLC), the agency said Wednesday in a news release.
Lung cancer is the leading cause of cancer death in the United States, having been diagnosed more
than 224,000 times and causing more than 159,000 deaths in 2014, the FDA said. NSCLC is the
most common type, affecting seven of eight people with lung cancer.
Opdivo inhibits a protein that prevents the immune system from attacking cancer cells, the agency
said. The drug is sanctioned for people who have been treated with platinum–based chemotherapy.
Opdivo was clinically compared to another anti–cancer drug, docetaxel, in a study involving more
than 270 people with NSCLC. People who received Opdivo lived an average of 3.2 months longer
than people given docetaxel, the FDA said.
The most common side effects of Opdivo are fatigue, shortness of breath, muscle and bone pain,
loss of appetite, cough, nausea and constipation. More severe adverse effects included immune
reactions involving healthy organs, including the lungs, colon, liver, kidneys and hormone–
producing glands.
Opdivo was approved previously to treat advanced melanoma among people who don 't respond to
other medicines. ( 'FDA Expands Approved

Post Chemotherapy Essay
Cancer is the one of those diseases which has high mortality rates in Pakistan. Most of these cases
are diagnosed in advanced stages. Chemotherapy is one of the treatment components of cancer
patients and electrolyte abnormalities are one of its common side effect. Electrolyte abnormalities
are frequent and complicating element of cancer, these abnormalities may be due to underlying
malignancy, a consequence of disease response or side effect of therapeutic agents, these side effects
can be hazardous and fatal in some cases. This review presents the electrolyte abnormalities that can
occur with the use of anticancer drugs. We have retrospectively reviewed the records of last 06
months of our admitted patients who were either admitted for longer regimes of chemotherapy or for
the management of post chemotherapy side effects. In this review we have included total 110
patients out of which Breast, lung and colorectal cancers are leading malignancies followed by ...
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We found that, the patients who received Platinum–containing anticancer drugs they experience
mainly hypokalemia, hyponatremia and hypomagnesemia, the ones who received chemotherapy
with Alkylating agents have mainly developed hyponatremia, and those who received Vinca alkaloid
containing regimes are also associated with hyponatremia. Patient who received Epidermal growth
factor receptor monoclonal antibody inhibitors mainly experience hypomagnesemia, hypokalemia
and hypocalcemia. Other, monoclonal antibodies, such as Cetuximab, mainly cause hyponatremia.
All those patients who developed the drug related Tumor Lysis Syndrome their labs showed the
incidence of hyperphosphatemia, hyperkalemia and hypocalcemia. We also found the incidence of
hyponatremia and hypokalemia among those patients who received the chemotherapy with
relatively newer agents like Novolumab. Some other previous international publications are also
showed great similarity with our

Exatest
There is now a test named Exatest . With this test, magnesium levels are not determined through
blood or blood serum. It is a noninvasive procedure that determines magnesium levels in the soft
tissue, which is where 99% of magnesium is found.
The problem with this test is the price. At this time, it's too costly for most people. Therefore, the
best remedy at this time is to be proactive by taking the recommended daily dosage of magnesium,
which we'll discuss later.
In spite of this, a deficiency in this mineral may be the basis of more diseases than any other
nutrient. Magnesium is the most critical mineral required for the electrical stability of every single
cell in our bodies. Are you beginning to grasp the importance of this mineral?
One ... Show more content on Helpwriting.net ...
Norman Shealy, symptoms can be subtle initially. Most of the magnesium is stored in our tissue,
twitching and itching is frequently a first symptom. Additionally, nausea, vomiting, and fatigue are
symptoms that are commonly in the early stages of deficiency.
As the deficiency continues to worsen, you may notice tingling, numbness, a change in personality,
seizures, abnormal heart rhythms, coronary spasms, or increased fatigue.
Also according to Dr. Sidney Baker , a magnesium deficiency can affect skeletal muscles, which can
initiate symptoms such as neck pain, cramps, muscle tension and soreness, backaches, and
headaches.
Other indications are tightness in the chest feeling as if you are unable to take a deep breath.
Additionally, you may not be able to stop sighing. So if you're in a conversation and the other person
keeps sighing, it doesn't necessarily mean that you are boring him or her. That person could have a
magnesium deficiency.
The symptom of muscle contractions can in turn instigate problems such as menstrual cramps,
urinary spasms, or constipation. Other symptoms can occur for example, feeling like you have a
lump (my mother called it a frog) in your throat and you have difficulty swallowing. Some other
usual indicators could be sensitivity to loud noises, which is brought on by muscle tension in your
ear and difficulty adapting to approaching bright

AA Meeting Summary And Analysis
I was very one sided as I walked into a AA meeting. I thought that the meeting where boring and
little bit too much for people who wont to stop drinking. I couldn't understand why people look
forward to these meeting when they can simply talk to someone at home. Nevertheless, I was
wrong. Hearing these people story who suffer from alcohol addiction was very heart breaking. I
remember one story about this man losing his son to car accident. The only way he dealt with the
pain of losing his son was to drink. He stated ever night he drunk him self–asleep. He was so
adamant about telling his story because if it wasn't for the hospital staff he would have lost his life.
Alcoholism is an addiction to the consumption of alcoholic liquor or the mental illness and
compulsive behavior resulting from alcohol dependency. alcohol is the main common substance
abuse in the united states. The reported show over 16.3 million adults over 18 years older had a least
try alcohol in the life time. 71 percent reported that they drank in the past year. 4.7 percent of people
ages 18 or older reported that they engaged in binge drinking in the past month. 6.7 percent reported
that they engaged in heavy drinking in the past month. 50 percent of marriage fell due to the spouse
drinking uncontrollably (Burke, 2015) The pathophysiology of Alcohol affects virtually every organ
system in the body. Therefore, consuming to much alcohol in high

Hypokalemia Research Paper
Electrolyte Disorder – Hypokalemia The human body contains blood and fluid compounds and
elements like chloride, phosphate, potassium, calcium, sodium, and magnesium known as
electrolytes that occur naturally to control important physiologic functions. When the body levels of
electrolytes are low (hypo) or high (hyper) it results in electrolyte disorder. Depending on the
affected electrolyte(s), when body electrolytes are hyper (high) or hypo(low) it leads to electrolyte
disorder, which in turn disrupts blood ionized salts balance ( Buttaro, et al., 2017). For instance,
disruption of chloride leads to either hyperchloremia or hypochloremia, calcium (hypercalcemia or
hypocalcemia ), Potassium (hyperkalemia or hypokalemia), Magnesium disruption ... Show more
content on Helpwriting.net ...
Thiazides diuretics reduce sodium reabsorption that leads to increased fluid loss, decrease plasma
volume and extracellular fluid. (Drugs.com 2012). Other means of depleting potassium from the
body are malignant hypertension (vascular), Type 1 and 2 renal tubular acidosis (Renal), trauma, and
diarrhea (Buttarro et. al., 2017). To be able to diagnose Hypokalemia it is important to be aware of
the signs and the

Left Sided Heart Failure Research Paper
Left–Sided Heart Failure
Sayra Y. Campbell
Columbia Basin College Left–Sided Heart Failure
Heart failure is the inability of the heart to efficiently pump blood to the rest of the body. In left–
sided heart failure, it is the faulty left ventricle that is not pumping blood effectively due to
anatomical abnormalities or secondary factors that decrease its functionality. The purpose of this
research paper is to inform the reader of statistical data on the disease as well as risk factors, usual
signs and symptoms, diagnostic procedures, treatment and nursing implications.
Description
Left–sided heart failure occurs when there is damage to the left ventricle. The damage may be due
to, for example: high blood pressure, drug abuse, heart attack, ... Show more content on
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Additionally, hydralazine and isosorbide dinitrate are recommended for African American patients
with heart failure. Other additional medications that may be prescribed are: anticoagulants, statins,
and digoxin. Together ACE inhibitors and ARB's work to lower heart rate and blood pressure by
inhibiting the RAS (renin–angiotensin system) in the sympathetic nervous system. This "fight or
flight" system is activated by the heart when it senses the inability of the ventricles to pump blood,
in which cardiac output and blood pressure are decreased. These medications act by blocking this
system and therefore decreasing blood pressure and heart rate (Markaity, 2012). Commonly used
ACE inhibitors include: enalapril (Vasotec), benazepril (Lotensin), lisinopril (Prinivil, Zestril) and
captopril (Capoten). Commonly used ARBs include: losartan (Cozaar), Candesartan (Atacand),
Valsartan (Diovan) (heart.org).Common side effects of ACE inhibitors and ARBs are: dry cough,
dizziness, hypotension and hyperkalemia. Renal function tests and serum potassium levels should be
monitored periodically. ACE inhibitors and ARBs have a label of pregnancy category D while in the
second and third trimesters

Diagnosis Of Disease Of A Patient
The first step in correct diagnosis of disease of a patient is to know his medical history. Physician
should carefully ask patient information about his/her symptoms such as the onset, duration, and
possible relief. The next step is physical examination of the patient. After listening to the patient 's
description of the history of the symptoms, physicians generally conduct a physical examination.
Inspection, Palpation, Percussion and Auscultation are the four components of physical examination.
In general inspection, physician examines general body posture and proportion of the patient and
then site of injury is inspected locally. After inspection, physician uses his/her hands and fingers to
feel the body of the patient to know the body temperature as well as to feel underlying parts of body
of the patient. This procedure is known as palpation. After palpation, physician taps body parts to
get information about density of tissues and this is known as percussion. Finally, Auscultation is
listening to body sounds with the help of stethoscope.
The pressure of blood exerted on the walls of arteries is called arterial blood pressure or simply
blood pressure. It helps to propel blood at a high velocity along the arteries. Blood pressure is taken
with an instrument called sphygmomanometer and the unit of blood pressure is usually millimetres
of mercury (mm Hg). The blood pressure, by this instrument, is measured in terms of air pressure
when the air pressure becomes equal to the

Magnesium Disease
MAGNESIUM DEFICIENCY & SUDDEN DEATH
Written and Researched by Ronald J. Grisanti D.C., D.A.B.C.O.
An athletic 20 year man is playing basketball and suddenly collapses on the court and dies.
On a hot July day, a young and vibrant college football player suddenly makes a great tackle and
never gets up.. only to be pronounced dead 5 minutes later.
High School track runner dies after finishing second in a race.
The sad truth is 1 out of 50,000 young adults will fall victim to Sudden Death.
Most sudden deaths have been linked to a thickened, enlarged heart called hypertrophic
cardiomyopathy (HCM), or by a condition that disturbs the rhythm of the heart called an arrhythmia.
When one sweats, a significant amount of magnesium is lost. Magnesium ... Show more content on
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Best Sources of Magnesium
The best way of insuring enough magnesium is to eat a variety of whole foods, including whole
grains, nuts, seeds and vegetables, preferably food grown on naturally composted soil. The green
color of green vegetables is due to chlorophyll, which is a molecule that contains magnesium. Avoid
refined processed foods, especially white sugar and white flour products, as most magnesium is
removed from them.
Dr. Grisanti's Comments:
If you are suffering with a heart problem and have not had your magnesium checked, then I want to
urge you to have your physician order the two tests listed above. Unless you have proof that your
magnesium is within normal levels, I want you to realize that you are playing with your

Hypertension : The Most Common Chronic Disease ( Barranger )
Hypertension is one of the most common chronic disease (Barranger, 2013). Many people are
unaware of the fact that they have hypertension because they do not have any symptoms associated
with this chronic disease. Hypertension can be a major risk factor for many other chronic diseases
such as heart disease, stroke, congestive heart failure, and kidney disease. Hypertension is strongly
associated with obesity and diabetes. Hypertension caused morbidity and mortality are the highest,
occur early and more severe among African American's (Barranger, 2013).
Essential hypertension is the most common type of hypertension (Barranger, 2013). Other types of
hypertension include primary, idiopathic hypertension and secondary hypertension (when other
causes can be identified) (Barranger, 2013).
The pathophysiology of hypertension involves nervous system and/or renal system (Barranger,
2013). Centrally located beta receptors and alpha–2 receptors have effects on the production of
norepinephrine. The production of norepinephrine is stimulated and inhibited by these receptors.
When norepinephrine production is inhibited, vasodilation effects occur, therefore blood pressure
(BP) is reduced. Beta 1 receptor blockers and beta 2 receptor stimulators of the arteries and veins
will decrease blood pressure by decreasing cardiac output, peripheral resistance, and causation of
vasodilation. Baroreceptors can auto regulate blood pressure in the circulatory system by sending
impulse to the brain

Hypoparathyroidism Research Paper
Hypoparathyroidism is defined by abnormally low PTH levels. Moreover, it is usually due to
damage to the parathyroid glands during thyroid surgery. Due to the lack of circulating PTH it
results in lowered serum calcium levels and increased serum phosphate levels. So, the reabsorption
of calcium is impaired and phosphate absorption from the renal tubules are increased. Moreover,
this results in hyperphosphatemia. In addition, hypoparathyroidism can occur due to
hypomagnesemia. However, when the serum magnesium levels are normal, so is the PTH secretion.
Hypomagnesemia can be linked to; chronic alcoholism, malnutrition, malabsorption, increased renal
clearance of magnesium due to amino glycoside antibiotics or chemotherapeutic agents, or
prolonged magnesium deficient parenteral nutritional therapy. ... Show more content on
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The hypocalcemia results in a lowered threshold for both nerve and muscle excitation so that a nerve
implies can be initiated by a very slight stimulus anywhere along the length of a nerve or muscle
fiber. This produces muscle spasms, hyperreflexia, clonic–tonic convulsions, laryngeal spasms and
even death by asphyxiation. Moreover, hypocalcemia has symptoms which include; dry skin, loss of
body and scalp hair, hypoplasia of developing teeth, horizontal ridges on the nails, cataracts, basal
ganglia calcifications, bone deformities and the bowing of long bones. Phosphate retention is
associated with hypoparathyroidsm. Hyperphosphatemia occurs due to the inhibition of the renal
enzyme that is essential to the conversion of vitamin D to its most active form. Furthermore, this
lowers serum calcium levels even more by reducing gastrointestinal absorption of

Pharmacotherapy Workup Notes Care Plan
Pharmacotherapy Workup © NOTES CARE PLAN PATIENT INITIALS: JF DATE: OCT 22TH,
2014 GERD (NESA) Patient Background History JF is a 79–year–old retired female who was
brought to our attention with chief complains of ongoing cramping in her legs since 3–4 months
ago. She is about 160 cm tall and weighs ~68 Kg (BMI 26.6). The possibilities of a statin–induced
myalgia will be discussed in her dyslipidemia PCP. JF's current medical conditions include COPD,
depression, dyslipidemia (secondary prevention of cardiovascular events), hypertension (pos–MI),
and GERD. She currently takes the following medications: ramipril 5mg once daily (AM), HCTZ 25
mg once daily (AM), atorvastatin 40 mg once daily (AM), salbutamol 100 mcg 2 puffs QID,
ipratropium 20 mcg 2 puffs TID, fluticasone/salmeterol 250/25 mcg 2 puffs BID, pantoprazole 40
mg once daily (AM), escitalopram 10 mg once daily (AM), ASA 81 mg once daily (AM), diltiazem
CD 120 mg once daily (AM), and calcium carbonate/vitamin D (500 mg/800 IU BID PC). Please
see the attachments for her latest lab results. JF was diagnosed with stage 1 HTN, GERD, and
dyslipidemia ~13 years ago for which she took HCTZ 25 mg, ranitidine 300 mg, and atorvastatin 10
mg. Her past medical history include lung cancer (surgically removed a lobe from her left lung,
treated with chemotherapy in 2004), heart attack (NSTEMI, MRP thought associated with
chemotherapy, treated with

Electrolytes Case Study
Indicate which electrolytes you will be discussing.
The two electrolytes I have choose are Calcium and magnesium.
What role does each of the selected electrolytes play in cellular function and fluid balance?
Magnesium ( 1.8–2.4mEq/L) helps in maintaining a normal muscle and nerve function, it also helps
with regulation cardiac rhythm and it is involved in energy metabolism and protein synthesis.
Calcium (8–10 mg/dl). helps with nerve transmission, cardiac excitability and muscular contraction
and hormone regulation.
Story, L. (2018).
How do these electrolytes impact acid–base balance? calcium and magnesium have a synergistic
relationship so one enhances the other.
What would the nurse assess to determine if there are abnormal levels of these selected electrolytes?
Hypomagnesemia the patient becomes drowsy and lethargic and reflexes diminish. Respirations
may become so severely depressed that respiratory arrest occurs. Hypomagnesemia leads to increase
neuromuscular irritability such as muscle spasms arrhythmias and tremors. In Hypocalcemia, the
nurse will assess for tetany and muscle twitching and in hypercalcemia, the nurse will assess for
muscle weakness and deep tendon reflexes may be decreased or absent. ... Show more content on
Helpwriting.net ...
(2018).
What is the treatment for abnormal levels of these selected electrolytes? The treatment for
hypercalcemia would include avoiding food in high calcium levels and in severe cases, the patient
would be taking calcitonin to prevent bone

Literature Review On Gout
LITERATURE REVIEW
The imbalance of trace elements was shown is involved in many disorders, such as Gout. Sixty four
elements were measured in the serum samples of Gout patients with in three regionally and healthy
control group by inductively coupled plasma–mass spectrometry (ICP–MS). An elemental profile of
Gout notably altered Al, Li, Ti, Se, Fe, Cu, Sr, Ta, Hg, U, Th, and Bi. An independent group of 39
gout patients and 13 healthy controls was further used to confirm the elemental analysis, yielding a
sensitivity of 1.00 and a specificity of 1.00 for Gout forecast. A good link was also observed
between Li, Zn, and Cu and further two risk aspects, age and serum urate concentration, in Gout
patients. Therefore it was accomplished that gout has a distinctive elemental profile despite of many
other nutritional and environmental factors [1]. ... Show more content on Helpwriting.net ...
In recent decades, studies have shown that the development of Hyperuriemia and Gout is due to
effect of lead on the tubular urate transport causing diminished urate excretion. In the case of lead
intoxication these effects were mostly linked with renal failure. The clinical features of saturnine
gout were basically same as that of primary gout; though, acute attacks were likely to occur in the
knee more recurrently. The analysis of saturnine Gout was based on the history of exposure to lead,
lead toxicity, high serum lead levels and various other abnormalities. The treatment of Gout consists
of eliminating the further exposure to lead from the patient, to utilize chelating agents for removal of
lead, and management of acute Gouty Arthritis and Hyperuricaemia

Essay on Left-Sided Heart Failure
Diagnosis: Left–Sided Heart Failure
Left–sided heart failure is the most common type of heart failure, and it is a result of left–ventricular
dysfunction. This disease poses a significant threat to patients because the primary function of the
left side of the heart is to provide sufficient oxygenated blood to satisfy the metabolic demands of
the body's cells. Understanding the main function of this portion of the heart will help with the
understanding of other complications associated with this diseased. Left–sided heart failure is
usually the result of the loss of heart muscle function, specifically in the left ventricle secondary to
coronary artery disease, prolonged hypertension, or myocardial infection (Lewis et al. 2014, 766).
The ... Show more content on Helpwriting.net ...
As this disease progresses and the workload of the heart is consistently increased, ventricular
hypertrophy occurs. At first, the hypertrophied heart muscles will increase contractility, thus
increasing cardiac output; however, as hypertrophy of the ventricular myocardial cells continues, it
begins to have poor contractility, requires more oxygen to perform, and has poor circulation from
the coronary arteries. This can result in heart tissue ischemia and lead into cardiac dysrhythmias
(Lewis et al. 2014, 768).
After a period of time, the heart muscles of the left ventricle begin to weaken. The weakening of the
left ventricle will lead to decreased empting of the heart (systolic heart failure) which results in
decreased cardiac output again. Since the left ventricle does not empty completely, blood begins to
back up into the left atrium and then to the pulmonary circulation thus resulting in pulmonary
congestion and dyspnea (Story 2012, 104). If left untreated, the blood will back up and affect the
right side of the heart causing biventricular heart failure (both right and left heart failure). In right
sided heart failure, the right ventricle weakens and cannot empty completely. This incomplete
emptying causes blood to back up into the systemic circulation causing systemic edema (Lewis et al.
2014, 771). After discussing the pathophysiology of

The Effect Of Alcohol And The Aftermath Thereof Essay
One after the other, the bottles flew to the ground. All I could do was stand back and watch as my
father consumed each drink and yell explicit words to my mother. I was only seven. . .
"What 's with your face?!" he yelled.
"Nothing, please don 't hurt me again." I said with terror.
"Just leave him alone!" my mother exclaimed.
Another beating to me and my mother caused by the intoxication of my father. From that day
forward I realized I would never drink a substance like that in my life. To see how it changes the
individual during the process of consumption and the aftermath thereof, I knew I would never even
take a sip. I could never imagine the effects that it would take on him and others around who
dissipate liquor for "fun". Now I know, liquor has been around for centuries and the way it has been
made varies the amount of "intoxicated" such individual will be, but the backlash on the individual
causes arousal into what alcoholism really means and what it does. Addictive substances have been
available for thousands of years (Horvath, Andrew Tom, and Misra Kaushik. "A Brief History of
Alcoholism."), and everyday we pass by regular people consuming one kind of substance or the
other. Although we never realize how easy it is for such items to become a form of addiction, such
as alcoholism, As Tom Horvath states, ¨Once we became able to produce alcohol and grow other
addictive substances in larger quantities it then becomes possible for addiction to arise.¨ The
eventuality

A Report on ACLS
Sophisticated heart life support or Advanced Cardio Life Support (also known as ACLS) identifies a
collection of clinical treatments for the immediate treatments for cardiac event, heart stroke along
with other life–threatening health–related crisis situations, along with the understanding and
capabilities to utilize those treatments (Field et al, 2010). Sophisticated capabilities Substantial
medical information as well as demanding hands–on practice and training are needed to master
ACLS. Only certified medical service providers can offer ACLS, because it necessitates the
capability to handle the person's airway, start IV access, examine and translate electrocardiograms,
as well as comprehend crisis pharmacology; included in this are doctors (DOs as well as MDs),
pharmacy technicians (PharmDs), dental practitioners (DDS as well as DMDs), midlevel
professionals (PAs as well as NPs), nurse practitioners (RNs), along with paramedics. Many other
crisis responders might also be prepared. Several health care professionals, and even lay rescuers,
might be educated in fundamental or basic life service (BLS), particularly cardiopulmonary
resuscitation or perhaps CPR. Whenever a sudden cardiac event happens, instant CPR is a crucial
interconnection in the sequence of coping and surviving. Another essential interconnection is
actually early defibrillation that has enhanced significantly with all the prevalent accessibility to
AEDs (Hazinski et al, 2010). Electrocardiogram

Hypomagnesemia Research Paper
Hypomagnesemia Hypomagnesemia is a condition in which the level of magnesium in the blood is
low. Magnesium is a mineral found in many foods. It is used in many different processes in the
body. Hypomagnesemia can affect every organ in the body. It can cause life–threatening problems.
CAUSES Causes of hypomagnesemia include: Not getting enough magnesium in your diet.
Malnutrition. Problems absorbing magnesium from the intestines. Dehydration. Alcohol abuse.
Vomiting. Severe diarrhea. Some medicines, including medicines that make you urinate more.
Certain diseases, such as kidney disease, diabetes, and overactive thyroid. SIGNS AND
SYMPTOMS Involuntary shaking or trembling of a body part (tremor).

Questions On Drug Information Services
UNIVERSITY OF RHODE ISLAND
COLLEGE OF PHARMACY
DRUG INFORMATION SERVICES
Formulary Monograph
DATE: May 2015
DRUG REQUESTED:1 Posaconazole (poe–sa–KON–a–zole)
TRADE NAME:1 Noxafil®
MANUFACTURER: 1–3 Merck Sharp & Dohme Corp.
PHARMACOLOGIC CLASS:1–3 Azole antifungal
AHFS CLASSIFICATION NUMBER:4 8.14.08
EXECUTIVE SUMMARY:
Posaconazole is an azole antifungal indicated for the prevention of invasive aspergillus and candida
infections in severely immunocompromised patients, and for the treatment of oropharyngeal
candidiasis in HIV patients and oropharyngeal candidiasis refractory to fluconazole and
itraconazole.3 Posaconazole is available in delayed release tablets, an oral suspension, and as an
intravenous injection.2
Posaconazole is approved for adults and children 13 years of age and older who are at a high risk of
developing aspergillus or candida infections including hematologic malignancies, chemotherapy
induced neutropenia, and stem cell transplant recipients with graft–versus–host disease. The
Infectious Diseases Society of America recommends posaconazole as first line therapy for
prophylaxis of invasive aspergillus infections in these patients and as first line for prophylaxis in
candidiasis in chemotherapy induced neutropenia and stem cell recipients with neutropenia. The
IDSA recommends posaconazole for the treatment of oropharyngeal candidiasis that is refractory to
fluconazole or itraconazole, or in patients with

Osteoporosis And Treatment Of Osteoporosis Essay
Osteoporosis is one of the most prevalent bone diseases worldwide (Mulcahy, et al.). It is
characterised as a disease which leads to the loss of bone mass due to bone deterioration, therefore
leading to bones becoming more brittle and fragile (U.S. Department of Health and Human services,
2004). Physiologically, bone is constantly re–modelled by concerted and coordinated interactions
between osteoclasts, type of cells that are involved in resorption of the bones, and osteoblasts, which
ensure bone formation and mineralization. Osteoporosis results from an imbalance between bone
deposition and resorption (Castiglioni, et al., 2013)
Osteoporosis affects millions of people worldwide, but the groups that are at highest risks include
elderly and post–menopausal women (International Osteoporosis Foundation, 2015). As
osteoporosis is associated with aging, it becomes a major health concern as the aging population will
double over the next decade (Age UK, 2016). Due to that fact, there has been an increase in an
interest in development of the preventive strategies for decreasing the incidence of osteoporosis.
One of most important strategies is dietary intervention, as there are nutritious factors that play a
key role in formation and development of the bones. Majority of the previous studies were
concentrated on relationship between calcium, vitamin D and density of the bones. But recent
studies have mentioned the importance of Magnesium, chemical element which plays a key role in

Fluid Balance Essay
Case 1
1. The first way in which this patient's fluid balance is altered is by the presence of vomiting noted
by the emergency department. Vomiting can cause a significant loss of electrolytes as well. The
patient also has a fever of 102.3, which has probably caused some heat release by sweating leading
to fluid loss. The doctor notes the patient is breathing quickly which indicates he may be losing fluid
through hyperventilation. The large quantity of alcohol consumed by this patient also contributes to
the alteration of fluid balance by inhibiting the pituitary gland from secreting anti–diuretic hormone
(ADH) which acts directly on the kidneys to reabsorb water. When ADH levels are reduced, the
kidneys produce more urine resulting in an increased ... Show more content on Helpwriting.net ...
The osmolal gap is elevated in this case.
7. The calculated osmolality with ethanol compensation was = [2*[Na+] + ([BUN] / 2.8) +
([Glucose] / 18) + ([Ethanol] / 4.6)]: 352 mEq/L
The osmolal gap: Serum osmolality – Calculated osmolality: 28 mEq/L. The osmolal gap is elevated
in this case.
8. The clinician repeated the chemistry panel and ethanol level when the serum osmolality was
obtained so that the osmolal gap could be calculated from that particular blood sample. In order to
calculate the osmolal gap, concentrations of BUN, glucose, serum osmolality, and ethanol level are
needed.
9. Based on laboratory results, this patient has co ingested a toxic alcohol i.e. methanol, eythlene
glycol, isopropyl alcohol. Other lab tests that could be ordered to confirm diagnosis include
measuring blood levels for methanol or ethylene glycol. Urine can also be obtained to see if calcium
oxalate crystals are present to confirm diagnosis of ethylene glycol ingestion. I could also request
for a blood lactate to rule out lactic acidosis which could be explained by the decrease in
bicarbonate and metabolic

Serum Concentration Essay
Serum Na+ concentration was greater than 145 mmol/L, accompanied by increased plasma osmotic
concentration, which could be diagnosed as high sodium. Hypernatronemia is often accompanied by
the increase of plasma osmotic concentration, and the whole body with sodium content can be
increased, normal or decreased, ECF capacity can be normal, reduce or increase.
Potassium metabolism disorder
The normal value of serum potassium is 3.5mmol/L ~ 5.5 mmol/L. Serum potassium concentration
was lower than 3.5mmol/L, which can be diagnosed as kaliopenia, while lower than 2.5mmol/L was
severe kaliopenia. Diagnosis should be combined with medical history, symptoms and signs. In
clinical work, the serum potassium concentration was 3 mmol/L, which is the dividing line between
patients undergoing elective surgery or not.
Serum potassium concentration was greater than 5.5mmol/L, which is hyperpotassemia. Diagnosis
should be combined with medical history, electrocardiogram and serological tests.
Calcium metabolism disorders
Normal serum calcium concentration was 2.25–2.75 mmol/L, a fairly constant. The serum calcium
concentration lower than 2 mmol/L have diagnostic value, which can be diagnosed as hypocalcemia
combined with ... Show more content on Helpwriting.net ...
The clinical manifestations include bleached, tired, disappearance of tendon reflex and decrease of
blood pressure, etc. Respiratory depression, lethargy and coma, and even cardiac arrest can occure
in advanced stage. It should be treated with intravenous infusion 10–20 ml of 10% calcium
phosphate or calcium chloride solution in order to fight against the inhibition of magnesium on the
heart and muscle. And it should actively correct the acidosis and water shortage at the same time. If
the effect is not so good, it need to be treated by

A Brief Note On Diabetes And Low Physical Activity
Diabetes is one of the most common non–communicable diseases in the world with currently 347
million people living with the condition and was the direct cause of approximately 1.5 million
deaths in 2012 (WHO). It is a condition that occurs when the body cannot provide enough insulin or
cannot use the insulin that is produced effectively. Insulin is what allows glucose to enter the body's
cells for energy so without it, too much glucose stays in the blood stream. The insulin is what
regulates blood sugar and without it, it can cause damage to the body. There are two types of
diabetes, Type 1 is caused when the pancreas cannot produce insulin and is less common in diabetic
patients. Type 2 diabetes (NIDDM) is caused when the body does not ... Show more content on
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Legumes are an important component in a healthy diet especially in developing countries and play a
much less significant role in the diet of western countries. Within Britain it is baked beans that are
extremely popular, however there sweet tomato sauce is usually high in sugar, and in the Far East
soya beans are staple part of their diet (Lean, 2006). It is said that leguminous plants should be a key
component in a healthy diabetic diet to control and manage the patient's diabetes. Regular
consumption of legumes should occur as they have various properties that can contribute to
protecting from obesity, cardiovascular disease and of course NIDDM. It is said that a serving a day
of legumes (1/2 a cup) can have positive effects on health, this being the minimum that should be
consumed. Mirmiran et al (2014) claims that this food commodity is a supportive functional food
that should be permanent in a diabetic's diet because of their low glycaemic index, high fibre and
phytochemical content that will help reduce the risk of complications associated with spikes in
blood glucose. This is one of the main reasons why people with diabetes or pre–diabetes should
have a high legume diet. It has been shown that lower glycaemic index (GI) diet has been associated
with improved control over diabetes. The GI is a ranking of carbohydrate containing foods based on
their overall effect of blood glucose levels by their

Heart Failure By Cambria Diehl
Heart Failure
Cambria Diehl
California State University, Chico
Heart failure, HF, is a result of one's heart inefficiently pumping blood out to the body (Lewis,
Dirksen, Heitkemper and Bucher, 2014, p.766). A healthy heart will pump blood out of the left and
right ventricles rhythmically and simultaneously, creating an even flow of blood from the heart to
the pulmonary arteries and the aorta (Lewis et al., 2014, p.769). Someone with heart failure has a
ventricular dysfunction in either one or both ventricles; the ventricles are not filling or contracting
properly. The failure of one ventricle to properly function leads to an overcompensation of the
opposite ventricle as well as a disruption in normal blood flow that leads ... Show more content on
Helpwriting.net ...
The right side of heart will increase in size as the muscle builds up and the heart rate will increase
due to compensation for the left ventricle. With auscultation, the lungs will sound crackly from the
liquid in the alveoli and interstitial space and when assessing respiration rate it is likely to be above
thirty breaths per minute (Lewis et al., 2014). The patient may report that they are experiencing
dyspnea, nocturia, fatigue, and a productive coughing. They may appear anxious and their skin may
look pale (Lewis et al., 2014). On the other hand, if the right side of the heart fails, then it will cause
a portion of the blood from the ventricle to flow backward creating problems in venous circulation.
Blood pressure in the veins will cause edema in multiple areas of the body. Peripheral edema may be
visible in the lower extremities of the patient as they will appear swollen in this area, like the
abdominal region (Lewis et al., 2014). The swelling of the spleen and the liver may not be visible
but it can be present depending on the progress of HF. The jugular vein will look bulging from
pressure built up called jugular venous distention (Lewis et al., 2014). The heart will have a murmur
and tachycardia may be present. A few other signs of heart failure are liver failure and weight gain
associated with kidney failure (Lewis et al.,

Why Is Hf So Dangerous
Dangers of Hydrofluoric Acid Hydrofluoric Acid is one of the most dangerous acids known.
It needs to be treated differently than even strong acids like Sulfuric and Hydrochloric.
Hydrofluoric Acid is an acid like no other.
It is so potent that contact with it may not even be noticed until long after serious damage has been
done.
Even very strong acids, and mixtures of acids, like Aqua Forte and Aqua Regia, do not have the
power to cause death and injury in the way that Hydrofluoric Acid can.
Why is HF so Dangerous?
HF has two mechanisms that cause tissue damage: Corrosive Burns from free hydrogen ions
Chemical Burns from tissue penetration of the fluoride ion. Fluoride ions penetrate and form
insoluble salts with calcium and magnesium. Soluble salts are also formed with other cations but
dissociate rapidly. ... Show more content on Helpwriting.net ...
HF is similar to other acids in that the initial extent of a burn depends on the concentration, the
temperature, and the duration of contact with the acid. HF Mortality/Morbidity Local effects include
tissue destruction and necrosis. Burns may involve underlying bone. Systemic fluoride ion
poisoning, from severe burns is associated with hypocalcemia (low calcium levels), hyperkalemia
(high potassium levels), hypomagnesemia (low magnesium levels) and sudden death. Deaths have
been reported from concentrated acid burns involving as little as 2.5% Body Surface Area (BSA).
Dangers of Hydrofluoric Acid:
It is one of the most dangerous acid and needs to be treated differently as compared to Hydrochloric
or Sulfuric Acid.
Causes corrosive burns and chemical burns.
Hydrofluoric acid can readily penetrate the skin, causing destruction of deep tissue layers, including
the bone
May result in limb lost or even death
The extend of the burn depends on the length of time, temperature and duration of contact with the

Creatinine Case Summary
CC
Follow up diabetes, hypertension, hypomagnesemia, renal insufficiency.
S
The patient is a 75–year–old female who did see a new pulmonologist (Daniel Kim, DO) as Elvira
Aguila, MD left this area. She did have a CT scan done of her lungs. She was told to hold her
metformin and had blood work done because of IV contrast. Her creatinine did go up to a high of
1.5, but then on repeat came back to 1.37 with a BUN of 14. I did have her decrease her dose of
metformin from 1000 mg b.i.d. to 500 mg b.i.d. She did have a BUN and creatinine done in
December of 2014, which showed creatinine of 1.46, BUN of 35. Repeat in March of 2015 showed
creatinine of 1.1 with a BUN of 49. The patient has also been found to have proteinuria with a urine
microalbuminuria/creatinine ... Show more content on Helpwriting.net ...
A/P
Diabetes mellitus type 2, hemoglobin A1c has improved. As noted above, her creatinine did go up to
high of 1.5. We did hold the dose of her metformin and when her creatinine did get better, we did
decide to decrease the dose to 500 mg b.i.d., given that her hemoglobin A1c was excellent at 6.0. I
think we are safe to do this. I would rather have her hemoglobin A1c be higher given her renal
insufficiency.
Renal insufficiency, proteinuria. The patient has seen a nephrologist in the past for a kidney lesion. I
do think it would be a good idea to check in with the nephrologist, once again. She will get me his
name and we will go ahead and set this up. When I did this.
Hypomagnesemia, magnesium has improved with 250 mg b.i.d. of magnesium. We will have her
increase this to t.i.d. We will recheck prior to next appointment.
Healthcare maintenance. The patient has not had a physical in years. We will set her up to come
back for this at next appointment. She is not had cholesterol done for quite some time. She does
continue on TriCor for her hypertriglyceridemia. We will plan on doing blood work to include a
vitamin D, CMP, magnesium, lipid panel, hemoglobin A1c, prior to her appointment in three
months. She is seeing Christine Wasilewski, MD for her B12 deficiency and anemia. I will not
therefore order test for

The Mad Cow Disease Epidemic
Twenty years after the wind down of the infamous Mad Cow Disease epidemic and thirty years
following its first appearance in British cattle, Bovine Spongiform Encephalopathy continues to
impact thousands. In 1996, it was discovered that bovine spongiform encephalopathy could be
transmitted to humans in the form of Variant Creutzfeldt–Jakob disease (vCJD), most commonly
through the ingestion of beef contaminated with BSE. Of the roughly 229 reported cases of vCJD,
it's believed that at least 3 cases contracted the fatal neurodegenerative disease through blood
transfusions. In an effort to protect the U.S. blood supply, the FDA has banned blood donation from
any person that had spent more than six months in the UK between 1980 and 1997. ... Show more
While dysfunction of prion proteins remains the most widely accepted etiology of BSE, the USDA
suggests there may be two other possible theories that could better explain the manifestation of
BSE: the virino theory and the virus theory. However, both theories pale in comparison to the robust
evidence in support of the prions theory. A major argument that works against both the virino theory
and virus theory is that throughout several studies, the use of various treatments known to damage
or inhibit nucleic acids have had no effect on the transmissibility of BSE. Interestingly, prion
proteins lack nucleic acids – making them an excellent candidate as the infectious agent responsible
for the development of bovine spongiform encephalopathy.
Bovine Spongiform Encephalopathy is characterized by an unusually long incubation period ranging
from 2–8 years. During the incubation period, an infected animal may not show any clinical signs
suggesting it is in anyway unhealthy. This is a major reason several countries placed precautionary
bans on blood donors. Experts believe it is entirely possible that a person could have contracted the
infectious disease during the BSE outbreak and could be carrying the disease through an incubation
period possibly extending beyond the suggested 2–8 year span without showing any clinical signs.
Since no diagnostic test currently exists to test a person for vCJD while they are living, there is

Autoimmune Disorders: Celiac Disease
Celiac disease (CD), one of the most common autoimmune disorders in the world, is also one of the
most underdiagnosed, in no small part thanks to the many different ways it can present in the clinic.
Celiac disease was thought of as a children's malabsorptive disease and was characterized by
chronic diarrhea, abdominal distension, fatigue, and vomiting. But celiac diease patients can
experience many non–gastrointestinal symptoms, including the effect of the reproductive of health
of women. "The problem with celiac disease and pregnancy is that you have poor absorption of
nutrients, because you have all of this constant diarrhea and an inflammatory reaction in your
bowels," says Michelle Collins, CNM, an assistant professor of nurse–midwifery ... Show more
Have the person with celiac disease wash their hand prior to eating. Wash eating surface and chairs
prior to meals to free of gluten particles or crumbs. (Anderson 4). Provide person with celiac disease
adequate eating space to avoid cross–contamination from others. Avoid touching plate with utensils
while serving food. Supervise other children who may cross–contaminate the eating area or utensils
during the meal. Keep separate containers designated as gluten free. Use a separate cutting
board/work space for food preparation. Have a designated gluten free toaster. Use separate pan,
water and utensils for cooking.
Nursing diagnosis for Celiac Disease: Risk for Imbalanced Nutrition: less than body –requirements.
Risk for Fluid Volume Deficit related to poor gastrointestinal absorption of nutrients related to
diarrhea. Ineffective coping related to chronicity of condition and lack of definite

What Is Chronic Kidney Disease?
Chronic kidney disease is associated with the aging population, whereby the kidneys are impaired in
terms of functionality (Giordano et al., 2016). The basic role of the kidney is to maintain a balance
of fluids in the body and remove waste products from blood. The symptoms of CKD appear in
stages and in it severity state causes insomnia, body weakness, dry and itchy skin, loss of appetite,
fluid retention leading to swelling of feet among others.
Chronic kidney disease is linked with the following fluids and electrolyte imbalance; fluid retention,
hyperkalemia, hypernatremia, and hypomagnesemia (Kohan & Barton, 2014). Hyperkalemia is the
accumulation of potassium ions in the blood which leads to muscle weakness, tiredness, and
cramping of the abdomen (Nyhan, 2017). On the other hand, ... Show more content on
Helpwriting.net ...
It is associated with problems such as insomnia, lack of appetite, weak muscles, lack of
concentration/ confusion, and nausea. It therefore, explains the reason as to why the patient in this
case scenario is complaining of sleepless nights and appetite loss. Hyperkalemia grounds abdominal
cramping, tiredness, muscle weakness or paralysis. Severe hyperkalemia slows down the cardiac
impulses and can lead to cardiac arrest. Hypernatremia can lead to puzzlement, muscle twitching,
increased blood pressure, and weakness. An excess of magnesium affects the central nervous
system, muscles and cardiac system: blood pressure drops, heart rate slows down, and in severe
cases coma and cardiac arrest can occur. Low levels of calcium

Nivolumab Case Study
Opdivo (nivolumab)
Lung cancer is the leading cause of cancer death in the United States, having been diagnosed more
than 224,000 times and causing more than 159,000 deaths in 2014, the FDA claims. NSCLC is the
most common type, affecting seven of eight people with lung cancer.
A new drug has come out for treatment of metastatic squamous non–small cell lung cancer. Opdivo
(nivolumab) the company that came out with it is Bristol–Myers Squibb. The approval came March
2015 for public use and became available on the market for consumer purchase. The U.S. Food and
Drug Administration approval of Opdivo (nivolumab) has given the drug and expanded base of
usage to include advanced non–small cell lung cancer (NSCLC), the agency said in a news release.
... Show more content on Helpwriting.net ...
The first thing we will want to review is the mechanism of action: Nivolumab is an inhibitory
ligand–blocking antibody against the programmed death receptor. In contrast to traditional
chemotherapies and targeted anti–cancer therapies, which exert their effects by direct cytotoxic or
tumor growth inhibition, nivolumab acts by blocking a negative regulator of T–cell activation and
response thus allowing the immune system to attack the tumor.[5][6] This is an example of immune
checkpoint blockade. The indications of nivolumab is indicated for the treatment of patients with
metastatic squamous non–small cell lung cancer (NSCLC) with progression on or after platinum–
based chemotherapy . There are a few cautions that need to be addressed immune–mediated
pneumonitis, melanoma, immune mediated colitis, hypothyroidism and hyperthyroidism, immune–
mediated nephritis and renal dysfunction just to name a few. Immune–mediated colitis reported;
withhold for moderate or severe and permanently discontinue for life–threatening colitis. Immune–
mediated hepatitis observed in clinical trials; monitor for changes in liver function; withhold for
moderate and permanently discontinue for severe or life–threatening transaminase or total bilirubin
elevation. Immune–mediated nephritis and renal dysfunction may occur; monitor for changes in
renal function; withhold for moderate and permanently discontinue for severe or life–threatening
serum creatinine elevation. Immune–mediated hypothyroidism and hyperthyroidism reported;
monitor for changes in thyroid function and initiate thyroid hormone replacement as needed. Other
clinically significant immune–mediated adverse reactions (eg, rash, encephalitis) can occur after
therapy discontinuation. Severe infusion reactions reported (rare, <1%); discontinue if severe or life
threatening, interrupt or slow infusion rate if mild or moderate reaction. It can

Sensory Case Studies
A 50 years old lady was admitted to our hospital with complaints of generalized body aches,
cramping sensation of forearms and calves, followed in a day by weakness in all limbs and difficulty
in walking and carrying out daily activities seven days prior to hospital admission. There was no
preceding history of trauma, intensive physical exercise, use of medicinal or illicit drug abuse, fever,
seizures, loose stools, nausea, vomiting or decreased urine output. She used to take hadia (local
country liquor) on social occasions for 3 years and had consumed about 150 ml to 200 ml of hadia
about 7 days before her symptoms started. She was hypertensive but had stopped taking anti
hypertensives 6 months prior to the admission without doctor's advice. ... Show more content on
Helpwriting.net ...
Examination of central nervous system revealed normal higher mental functions, normal cranial
nerves, power of 3/5 in all four limbs, hypotonia, absent deep tendon reflexes in both upper and
lower limbs, and downgoing plantars. Sensory system examination was normal. Examination of
other systems was normal. Blood parameters on admission showed hemoglobin of 9.9gm/dl, MCV
66.5 fl, PDW 20.7fq, total leucocyte count of 8,800/cu mm with 71% neutrophils, 5% monocytes
and 17% lymphocytes, 6% eosinophils, platelet count 2.5 lakhs/cu mm. Her biochemical tests
showed blood urea, 30.5 mg/dl, serum creatinine 1.1 mg/dl, serum sodium 137mmol/L, serum
potassium 4.1mmol/L, serum calcium 8.0 mg/dl, serum magnesium 1.2 mg/dl, TSH 3.16 µIU/ml,
serum amylase 64.6U/L, and serum LDH 3486.4U/L. Her liver function test revealed serum
bilirubin 1.5mg/dl, ALT 369.4U/L, AST 1113.4U/L, ALP 145.3U/L, total proteins 6.47g/dl, serum
albumin 3.4g/dl, serum globulin 3.07g/dl, INR 1.1, serum TSH 4.2mIU/L, serum iron 10.3mcg/dl,
serum ferritin 45µg/L, 25–hydroxy D3 11.4 ng/ml (normal range:50–70 ng/ml) and PTH 112 pg/ml
(normal range:12–88pg/ml). Her RA factor and ANA were negative. Urine examination was positive
for occult blood

Essay On Familial Hypomagnesaemia
Familial hypomagnesaemia with hypercalciuria and nephrocalcinosis (FHHNC) is a disease of renal
tubular disorder. The symptoms of FHHNC generally present in children or before adolescence.
Mutations of CLDN16 or CLDN19 is the main reason of this infrequent disease. Claudin–16 is
encoded by CLDN–16 and CLDN19 encode the claudin–19. (1) Michelis et al. was the first person
to find this disease, he reported that the feathers are excessive magnesium and calcium losses with
urinary, bilateral nephrocalcinosis and progressive chronic renal failure. (11) In this essay, I will
discuss the role of tight junction proteins in familial hypomagnesaemia with hypercalciuria and
nephrocalcinosis (FHHNC).
Magnesium is the fourth most cation in the body, its ... Show more content on Helpwriting.net ...
Felix Claverie–Martin, 2015, Familial hypomagnesaemia with hypercalciuria and nephrocalcinosis:
clinical and molecular characteristics, Clinical Kidney Journal.
2. R Swaminathan, 2003, Magnesium Metabolism and its Disorders, The Clinical Biochemist
Reviews
3. Rodríguez–Soriano J, Vallo A, García–Fuentes M. 1987. Hypomagnesaemia of hereditary renal
origin. Pediatr Nephrol.
4. Andrea Hartsock and W.James Nelson, 2008, Adherens and Tight junctions: Structure, Function
and Connections to the Actin Cytoskeleton, Biochim Biophys Acta.
5. Kiuchi–Saishin Y, Gotoh S, Furuse M, Takasuga A, Tano Y, Tsukita S. Differential expression
patterns of claudins, tight junction membrane proteins, in mouse nephron segments.
6. Konrad M, Schaller A, Seelow D, et al. Mutations in the Tight–Junction Gene Claudin 19
(CLDN19) Are Associated with Renal Magnesium Wasting, Renal Failure, and Severe Ocular
Involvement. American Journal of Human Genetics. 2006;79(5):949–957.
7. Hou J, Paul DL, Goodenough DA. 2005Paracellin–1 and the modulation of ion selectivity of tight
junctions. J Cell Sci.
8. Hou J, Renigunta A, Konrad M, et al. 2008. Claudin–16 and claudin–19 interact and form a
cation–selective tight junction complex. J Clin

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