The document outlines plans for a Clinical Nutrition Specialist Program in 2025 that will uphold ethical standards, meet competence requirements, contribute to nutrition research, and provide high quality clinical nutrition services. The program aims to be a leading center of excellence and will provide comprehensive clinical training encompassing scientific, medical, and service aspects of nutrition.
This case report describes a 66-year-old obese woman admitted to the hospital for abdominal pain, nausea, vomiting and acute diverticulitis with a suspected colorectal bladder fistula. Over her 8 day hospital stay she received IV antibiotics and underwent diagnostic testing confirming diverticulitis and a colovaginal fistula. Her medical history included multiple conditions related to her obesity. She was seen by a dietitian who provided nutrition counseling and advanced her diet from clear liquids to regular foods before discharge.
This document summarizes the case of a 4-year-old boy with frequent relapse nephrotic syndrome who presented with swelling of the whole body and abdominal pain. He was hospitalized for 22 days and treated for nephrotic syndrome relapse and peritonitis. During his hospital stay, he developed hyponatremia and hypocalcemia, which caused a seizure. He was treated with IV fluids and electrolyte supplementation and discharged after his condition improved. The case highlights the importance of managing electrolyte imbalances in nephrotic syndrome patients.
Mr. Z, a 53-year-old male with necrotizing pancreatitis and multiple comorbidities, was admitted for 28 days with severe malnutrition evidenced by a 25-pound weight loss over 6 months. His nutrition care included initiating enteral nutrition via G-tube to improve immune function and wound healing for pressure ulcers. Multiple formula changes were needed due to intolerance. His condition declined and he was transferred with a critical prognosis and poor nutrition status despite nutrition interventions.
This document discusses Hirschsprung disease, a genetic birth defect where nerve cells are absent from parts of the colon. This causes blockages and requires surgery. The case study involves a 13-month-old boy with chronic constipation concerning for Hirschsprung's. Research shows patients have altered gut microbiomes with more inflammation-linked bacteria. Studies found probiotic supplementation reduced incidence and severity of a common post-surgery complication called enterocolitis. Breastfeeding was also protective through its effects on the microbiome.
PHARM-D INTERNSHIP ANNUAL REPORT PRESENTATION UNDER THE GUIDENCE OF DR.R.GO...DR. METI.BHARATH KUMAR
PHARM-D final Internship Report Presentation Under the Guidance of DR.R.Goutham Chakra
If Anyone need this they can contact me via
dr.m.bharathkumar@gmail.com
Sharmake Abdulkadir Ali, a 15-year-old male, presented with increased urination, thirst, and abdominal pain. He has a history of type 1 diabetes. On examination, he was tachycardic with muscle wasting and tonsillar enlargement. Investigations showed high blood sugar and ketones in urine. He was diagnosed with diabetic ketoacidosis and treated with insulin, fluids, and antibiotics. Over subsequent days, his parotid gland became swollen and painful. He was counseled on diabetes management and referred to ENT for further evaluation.
note for Bsc. Nursing
Case scenario
The physical exam of a male patient in ED revealed a well-nourished and five days of progressive fatigue and flu-like symptoms.
He also admitted to having produced clay colored stool, dark urine, subjective fevers, and nausea.The patient was alert and oriented.
Further examination revealed prominent bilateral yellow discoloration of the eyes (i.e., scleral icterus) and abdominal examination demonstrated a mildly distended abdomen with mild tenderness in the right upper quadrant.
UNIT-1Medical Disorders Of GI and Hepatobiliary SystemHEPATITIS
Ms. Rina Karki
Lecturer
Medical Surgical Nursing
PRE-TEST
All hepatitis viruses are RNA viruses except
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Which hepatitis virus causes chronic hepatocarcinoma?
Hepatitis C
Hepatitis D
Hepatitis E
Hepatitis G
Review Anatomy and Physiology of Hepatobiliary System
Introduction to Hepatitis
Greek word i.e. "Hepat" means "liver" and "itis" meaning "inflammation".
An inflammatory condition of the liver caused by a variety of infectious and noninfectious agents.
Self-limiting, healing on its own or can progress to scarring of the liver and can be fatal
Causes of Hepatitis
Infectious cause
bacteria, fungi, protozoa
Noninfectious agents
Causes…
Autoimmune cause
Types of Hepatitis
Acute and chronic hepatitis:
Acute: Infection lasts for 6 months. Hepatitis A and E
Chronic: Infection lasts longer than 6 months Hepatitis B
Toxic and drug-induced hepatitis
Obstructive hepatitis
Ischemic hepatitis
Types of Hepatitis…
5. Viral hepatitis
Types of Hepatitis
Types of Hepatitis
Types of Hepatitis…
Hepatitis E
Water borne Virus
Transmitted through Faecal-oral route
IP: 15-65 days.
Hepatitis G
Caused by Hep G virus (HGV)
common in HCV infected patient
Transmitted through blood, needles, body fluids.
IP: Unknown
Types of Hepatitis…
Pathophysiology
Clinical Features of Hepatitis
Acute condition: Low-grade fever is common hepatitis A and E. Hepatitis B is associated with a serum sickness–like syndrome (fever of 39.5° C to 40° C.)
Clinical Features …acute condition…
Clinical Features …chronic condition…
Persistent fatigue
Jaundice
weight loss
gastrointestinal bleeding
Ascitis
Pitting edema
bruisisng
Diagnostic Evaluation
Management of Hepatitis
Medical management and nursing management
Management of Hepatitis…Medical Management
Management of Hepatitis…Medical Management…
Poisoning mamangement example
Management of Hepatitis…Nursing Management
Nursing Management…Nursing Diagnosis
Nursing Management…
Nursing Management…
Management of Hepatitis…Nursing Management
Preventive Measures of Hepatitis
Personal Hygiene
Screening of food handling places and food handlers
screening of blood donors and skin piercing instruments
Preventive Measures…
Use safer sex
Community health education program.
Preventive Measures…
Hep A
Immunization of children (1-18 years of age) consists of 2 or 3 doses of the vaccin
NUTRITION CARE IN PATIENT ESOPHAGEAL CARCINOMA WITH RYLE'S TUBE FEEDINGnurfarahin87
Patient is a 63-year-old woman diagnosed with esophageal carcinoma who is receiving Ryle's tube feeding. Her nutrition assessment found weight loss, low hemoglobin and electrolyte levels, and inadequate calorie and protein intake from her current feeding regimen. Her nutrition diagnosis is inadequate enteral nutrition intake. The intervention aims to gradually increase her feeding volume and frequency if tolerated. Monitoring will include biochemical markers and feeding tolerance. Management of tube feeding complications like vomiting aims to minimize risks and maintain adequate nutrition support for her cancer treatment.
This case report describes a 66-year-old obese woman admitted to the hospital for abdominal pain, nausea, vomiting and acute diverticulitis with a suspected colorectal bladder fistula. Over her 8 day hospital stay she received IV antibiotics and underwent diagnostic testing confirming diverticulitis and a colovaginal fistula. Her medical history included multiple conditions related to her obesity. She was seen by a dietitian who provided nutrition counseling and advanced her diet from clear liquids to regular foods before discharge.
This document summarizes the case of a 4-year-old boy with frequent relapse nephrotic syndrome who presented with swelling of the whole body and abdominal pain. He was hospitalized for 22 days and treated for nephrotic syndrome relapse and peritonitis. During his hospital stay, he developed hyponatremia and hypocalcemia, which caused a seizure. He was treated with IV fluids and electrolyte supplementation and discharged after his condition improved. The case highlights the importance of managing electrolyte imbalances in nephrotic syndrome patients.
Mr. Z, a 53-year-old male with necrotizing pancreatitis and multiple comorbidities, was admitted for 28 days with severe malnutrition evidenced by a 25-pound weight loss over 6 months. His nutrition care included initiating enteral nutrition via G-tube to improve immune function and wound healing for pressure ulcers. Multiple formula changes were needed due to intolerance. His condition declined and he was transferred with a critical prognosis and poor nutrition status despite nutrition interventions.
This document discusses Hirschsprung disease, a genetic birth defect where nerve cells are absent from parts of the colon. This causes blockages and requires surgery. The case study involves a 13-month-old boy with chronic constipation concerning for Hirschsprung's. Research shows patients have altered gut microbiomes with more inflammation-linked bacteria. Studies found probiotic supplementation reduced incidence and severity of a common post-surgery complication called enterocolitis. Breastfeeding was also protective through its effects on the microbiome.
PHARM-D INTERNSHIP ANNUAL REPORT PRESENTATION UNDER THE GUIDENCE OF DR.R.GO...DR. METI.BHARATH KUMAR
PHARM-D final Internship Report Presentation Under the Guidance of DR.R.Goutham Chakra
If Anyone need this they can contact me via
dr.m.bharathkumar@gmail.com
Sharmake Abdulkadir Ali, a 15-year-old male, presented with increased urination, thirst, and abdominal pain. He has a history of type 1 diabetes. On examination, he was tachycardic with muscle wasting and tonsillar enlargement. Investigations showed high blood sugar and ketones in urine. He was diagnosed with diabetic ketoacidosis and treated with insulin, fluids, and antibiotics. Over subsequent days, his parotid gland became swollen and painful. He was counseled on diabetes management and referred to ENT for further evaluation.
note for Bsc. Nursing
Case scenario
The physical exam of a male patient in ED revealed a well-nourished and five days of progressive fatigue and flu-like symptoms.
He also admitted to having produced clay colored stool, dark urine, subjective fevers, and nausea.The patient was alert and oriented.
Further examination revealed prominent bilateral yellow discoloration of the eyes (i.e., scleral icterus) and abdominal examination demonstrated a mildly distended abdomen with mild tenderness in the right upper quadrant.
UNIT-1Medical Disorders Of GI and Hepatobiliary SystemHEPATITIS
Ms. Rina Karki
Lecturer
Medical Surgical Nursing
PRE-TEST
All hepatitis viruses are RNA viruses except
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Which hepatitis virus causes chronic hepatocarcinoma?
Hepatitis C
Hepatitis D
Hepatitis E
Hepatitis G
Review Anatomy and Physiology of Hepatobiliary System
Introduction to Hepatitis
Greek word i.e. "Hepat" means "liver" and "itis" meaning "inflammation".
An inflammatory condition of the liver caused by a variety of infectious and noninfectious agents.
Self-limiting, healing on its own or can progress to scarring of the liver and can be fatal
Causes of Hepatitis
Infectious cause
bacteria, fungi, protozoa
Noninfectious agents
Causes…
Autoimmune cause
Types of Hepatitis
Acute and chronic hepatitis:
Acute: Infection lasts for 6 months. Hepatitis A and E
Chronic: Infection lasts longer than 6 months Hepatitis B
Toxic and drug-induced hepatitis
Obstructive hepatitis
Ischemic hepatitis
Types of Hepatitis…
5. Viral hepatitis
Types of Hepatitis
Types of Hepatitis
Types of Hepatitis…
Hepatitis E
Water borne Virus
Transmitted through Faecal-oral route
IP: 15-65 days.
Hepatitis G
Caused by Hep G virus (HGV)
common in HCV infected patient
Transmitted through blood, needles, body fluids.
IP: Unknown
Types of Hepatitis…
Pathophysiology
Clinical Features of Hepatitis
Acute condition: Low-grade fever is common hepatitis A and E. Hepatitis B is associated with a serum sickness–like syndrome (fever of 39.5° C to 40° C.)
Clinical Features …acute condition…
Clinical Features …chronic condition…
Persistent fatigue
Jaundice
weight loss
gastrointestinal bleeding
Ascitis
Pitting edema
bruisisng
Diagnostic Evaluation
Management of Hepatitis
Medical management and nursing management
Management of Hepatitis…Medical Management
Management of Hepatitis…Medical Management…
Poisoning mamangement example
Management of Hepatitis…Nursing Management
Nursing Management…Nursing Diagnosis
Nursing Management…
Nursing Management…
Management of Hepatitis…Nursing Management
Preventive Measures of Hepatitis
Personal Hygiene
Screening of food handling places and food handlers
screening of blood donors and skin piercing instruments
Preventive Measures…
Use safer sex
Community health education program.
Preventive Measures…
Hep A
Immunization of children (1-18 years of age) consists of 2 or 3 doses of the vaccin
NUTRITION CARE IN PATIENT ESOPHAGEAL CARCINOMA WITH RYLE'S TUBE FEEDINGnurfarahin87
Patient is a 63-year-old woman diagnosed with esophageal carcinoma who is receiving Ryle's tube feeding. Her nutrition assessment found weight loss, low hemoglobin and electrolyte levels, and inadequate calorie and protein intake from her current feeding regimen. Her nutrition diagnosis is inadequate enteral nutrition intake. The intervention aims to gradually increase her feeding volume and frequency if tolerated. Monitoring will include biochemical markers and feeding tolerance. Management of tube feeding complications like vomiting aims to minimize risks and maintain adequate nutrition support for her cancer treatment.
The document presents the case of a 63-year-old male patient with end-stage renal disease secondary to diabetes who has been on dialysis for three years. He was recently hospitalized multiple times for various issues and experienced significant weight loss and decreased nutritional status. The case examines his medical history and diet during hospitalizations in order to assess his current protein-energy wasting status and recommend treatment.
CIRCULAT in Chronic Ischemic Heart Disease - 20 Pat, Diabetic Foot and Gene E...ISCHEMIC CARDIOPATHY
The document discusses a study on the effects of a complex herbal formulation called CIRCULAT in treating chronic ischemic heart disease. The study found that 85% of the initial 20 patients showed good responses to CIRCULAT therapy as measured by imaging and stress tests over periods of 6 months to 1 year. The treatment was associated with reductions in perfusion damage percentages on imaging and increases in functional capacity on stress tests for most patients.
This document discusses newborn screening programs, which screen babies for treatable genetic and metabolic conditions. It outlines the seven components of newborn screening, including education, screening, diagnosis, conveying results, follow up, management, and evaluation. The document discusses the history and development of newborn screening, beginning with Robert Guthrie's work developing a test for phenylketonuria in the 1960s. It also reviews current screening methods, conditions screened for, and challenges to implementing nationwide newborn screening in India.
A case study on Pangastritis with pancreatitis martinshaji
this case study describes about Pangastritis with pancreatitis , which details about the treatment, management , diagnosis, patient counselling, pharmacist interventions & discussions are followed in this case .
please comment
thank u
martinsuja369@gmail.com
This case report describes a 14-year-old boy diagnosed with rapidly progressive glomerulonephritis (RPGN) due to multisystem inflammatory syndrome in children (MISC). He presented with abdominal pain, decreased urination, pallor, swollen eyelids, and hypertension. Laboratory findings showed kidney injury, anemia, thrombocytopenia, and electrolyte abnormalities. He was treated with IV antibiotics, blood pressure medications, dialysis, steroids, and IVIG. Over the course of treatment his kidney function and symptoms improved however he continued to require dialysis. Ultrasound showed diffuse kidney disease and severe renal artery stenosis. He was diagnosed with RPGN due to MISC.
This case report describes an atypical case of Koch's abdomen in a 31-year-old woman. She presented with abdominal pain and swelling for 3 months. Investigations revealed a large subserosal fibroid, ascites, and left-sided pleural effusion. Further testing showed positive results for tuberculosis infection. She underwent surgery where a large subserosal myoma was removed. Her final diagnosis was subserosal leiomyoma with abdominal tuberculosis. Pseudomeigs' syndrome and Meigs' syndrome are discussed, which present with similar symptoms of ascites and pleural effusion but differ in their associated ovarian tumors.
This case study describes a 31-year-old male with a history of Alport syndrome and kidney transplant who presented with acute renal failure secondary to transplant rejection. Key points include: the patient's medical history of ESRD due to Alport syndrome requiring dialysis and kidney transplant; presentation with elevated creatinine and signs of antibody-mediated transplant rejection; treatment involving immunosuppression medication and potential need for dialysis; and nutrition interventions focusing on meeting protein and calorie needs through a renal diet.
The patient is a 45-year-old female presenting with sudden abdominal pain for 3 hours in her epigastric and right upper quadrant areas. She reports one episode of vomiting and a subjective fever. Her vital signs show elevated blood pressure, heart rate, and temperature. Physical exam reveals tenderness in the epigastric and right upper quadrants. Based on her history and exam findings, she is suspected to have acute cholecystitis.
The first document describes two emergency cases seen at the hospital on October 6th, 2022. The first case involves a 37-year-old man brought to the emergency department for worsening lethargy and abdominal pain. On examination, he appears weak with low blood pressure and pale conjunctiva. The second case involves a 3-year-old girl brought to the emergency department for intermittent abdominal pain and vomiting blood. On examination, she appears weak with a palpable mass in her right lower abdomen. The tutor leads a discussion on identifying and discussing the problems in these cases chronologically while considering all possible diagnoses. References are also provided for some laboratory results.
1. The document summarizes a case presentation on a 32-year-old female patient admitted for abnormal uterine bleeding secondary to prolapsed submucosal myoma.
2. It includes the patient's medical history, physical assessment findings, diagnosis, treatment plan including a vaginal myomectomy, and nursing care plan.
3. The case presentation follows a specific format covering the patient's data, health history, physical assessment, definition of the disease, pathophysiology, diagnostic procedures, medical management, nursing diagnosis, and discharge plan.
This patient presented with retained placenta after a vaginal delivery. Her ultrasound and MRI showed placenta increta, where placental villi had invaded into the myometrium. She was initially managed conservatively with methotrexate injection, which led to a partial reduction in her beta-hCG levels. However, she later developed heavy bleeding and required an emergency hysterectomy. Placenta accreta spectrum (PAS) describes abnormal placental invasion that can cause life-threatening bleeding. Risk factors include prior uterine surgery. Management challenges include delayed referrals, lack of blood product availability, and counseling patients on prolonged hospitalization sometimes required.
* Case presentation: hyperosmolar hyperglycemic state (HHS)
Mortality attributed to hyperosmolar hyperglycemic state (HHS) is considerably higher than that attributed to DKA, with recent mortality rates of 5–20%.
* Agenda:
Historical perspectives and diagnosis.
Pathophysiology.
Treatment issues.
Rhabdomyolysis: an overlooked complication.
Final bottom line and take home message.
During the Dietetic Internship, the interns were assigned various disease states to conduct a case study on. I was assigned pressure ulcers and found my case study patient at a skilled nursing facility during my 3 week rotation.
LA, an 86-year-old male, was admitted with respiratory distress and mental status changes following an episode of vomiting. He was diagnosed with aspiration pneumonia that progressed to septic shock. He required antibiotics, vasopressors, and respiratory support. A nutrition consult recommended changing his enteral feeds from bolus to continuous to help meet his needs while preventing further aspiration. Risk factors for aspiration in critically ill patients like LA were addressed through feeding precautions and positioning. After 11 days of treatment, LA's condition improved and he was discharged on enteral nutrition with monitoring of aspiration risks.
LA, an 86-year-old male, was admitted with respiratory distress and mental status changes following an episode of vomiting. He was diagnosed with aspiration pneumonia that progressed to septic shock. He required antibiotics, vasopressors, and respiratory support. A nutrition consult recommended changing his enteral feeds from bolus to continuous to help meet his needs while preventing further aspiration. Risk factors for aspiration in critically ill patients like LA were addressed through feeding precautions and positioning. After 11 days of treatment, LA's condition improved and he was discharged on enteral nutrition with monitoring of aspiration risks.
Diabetic KetoAcidosis is a condition of formation of ketone bodies in body due to which body goes to acidic condition and this is due to elevated glucose levels in blood.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
The document presents the case of a 63-year-old male patient with end-stage renal disease secondary to diabetes who has been on dialysis for three years. He was recently hospitalized multiple times for various issues and experienced significant weight loss and decreased nutritional status. The case examines his medical history and diet during hospitalizations in order to assess his current protein-energy wasting status and recommend treatment.
CIRCULAT in Chronic Ischemic Heart Disease - 20 Pat, Diabetic Foot and Gene E...ISCHEMIC CARDIOPATHY
The document discusses a study on the effects of a complex herbal formulation called CIRCULAT in treating chronic ischemic heart disease. The study found that 85% of the initial 20 patients showed good responses to CIRCULAT therapy as measured by imaging and stress tests over periods of 6 months to 1 year. The treatment was associated with reductions in perfusion damage percentages on imaging and increases in functional capacity on stress tests for most patients.
This document discusses newborn screening programs, which screen babies for treatable genetic and metabolic conditions. It outlines the seven components of newborn screening, including education, screening, diagnosis, conveying results, follow up, management, and evaluation. The document discusses the history and development of newborn screening, beginning with Robert Guthrie's work developing a test for phenylketonuria in the 1960s. It also reviews current screening methods, conditions screened for, and challenges to implementing nationwide newborn screening in India.
A case study on Pangastritis with pancreatitis martinshaji
this case study describes about Pangastritis with pancreatitis , which details about the treatment, management , diagnosis, patient counselling, pharmacist interventions & discussions are followed in this case .
please comment
thank u
martinsuja369@gmail.com
This case report describes a 14-year-old boy diagnosed with rapidly progressive glomerulonephritis (RPGN) due to multisystem inflammatory syndrome in children (MISC). He presented with abdominal pain, decreased urination, pallor, swollen eyelids, and hypertension. Laboratory findings showed kidney injury, anemia, thrombocytopenia, and electrolyte abnormalities. He was treated with IV antibiotics, blood pressure medications, dialysis, steroids, and IVIG. Over the course of treatment his kidney function and symptoms improved however he continued to require dialysis. Ultrasound showed diffuse kidney disease and severe renal artery stenosis. He was diagnosed with RPGN due to MISC.
This case report describes an atypical case of Koch's abdomen in a 31-year-old woman. She presented with abdominal pain and swelling for 3 months. Investigations revealed a large subserosal fibroid, ascites, and left-sided pleural effusion. Further testing showed positive results for tuberculosis infection. She underwent surgery where a large subserosal myoma was removed. Her final diagnosis was subserosal leiomyoma with abdominal tuberculosis. Pseudomeigs' syndrome and Meigs' syndrome are discussed, which present with similar symptoms of ascites and pleural effusion but differ in their associated ovarian tumors.
This case study describes a 31-year-old male with a history of Alport syndrome and kidney transplant who presented with acute renal failure secondary to transplant rejection. Key points include: the patient's medical history of ESRD due to Alport syndrome requiring dialysis and kidney transplant; presentation with elevated creatinine and signs of antibody-mediated transplant rejection; treatment involving immunosuppression medication and potential need for dialysis; and nutrition interventions focusing on meeting protein and calorie needs through a renal diet.
The patient is a 45-year-old female presenting with sudden abdominal pain for 3 hours in her epigastric and right upper quadrant areas. She reports one episode of vomiting and a subjective fever. Her vital signs show elevated blood pressure, heart rate, and temperature. Physical exam reveals tenderness in the epigastric and right upper quadrants. Based on her history and exam findings, she is suspected to have acute cholecystitis.
The first document describes two emergency cases seen at the hospital on October 6th, 2022. The first case involves a 37-year-old man brought to the emergency department for worsening lethargy and abdominal pain. On examination, he appears weak with low blood pressure and pale conjunctiva. The second case involves a 3-year-old girl brought to the emergency department for intermittent abdominal pain and vomiting blood. On examination, she appears weak with a palpable mass in her right lower abdomen. The tutor leads a discussion on identifying and discussing the problems in these cases chronologically while considering all possible diagnoses. References are also provided for some laboratory results.
1. The document summarizes a case presentation on a 32-year-old female patient admitted for abnormal uterine bleeding secondary to prolapsed submucosal myoma.
2. It includes the patient's medical history, physical assessment findings, diagnosis, treatment plan including a vaginal myomectomy, and nursing care plan.
3. The case presentation follows a specific format covering the patient's data, health history, physical assessment, definition of the disease, pathophysiology, diagnostic procedures, medical management, nursing diagnosis, and discharge plan.
This patient presented with retained placenta after a vaginal delivery. Her ultrasound and MRI showed placenta increta, where placental villi had invaded into the myometrium. She was initially managed conservatively with methotrexate injection, which led to a partial reduction in her beta-hCG levels. However, she later developed heavy bleeding and required an emergency hysterectomy. Placenta accreta spectrum (PAS) describes abnormal placental invasion that can cause life-threatening bleeding. Risk factors include prior uterine surgery. Management challenges include delayed referrals, lack of blood product availability, and counseling patients on prolonged hospitalization sometimes required.
* Case presentation: hyperosmolar hyperglycemic state (HHS)
Mortality attributed to hyperosmolar hyperglycemic state (HHS) is considerably higher than that attributed to DKA, with recent mortality rates of 5–20%.
* Agenda:
Historical perspectives and diagnosis.
Pathophysiology.
Treatment issues.
Rhabdomyolysis: an overlooked complication.
Final bottom line and take home message.
During the Dietetic Internship, the interns were assigned various disease states to conduct a case study on. I was assigned pressure ulcers and found my case study patient at a skilled nursing facility during my 3 week rotation.
LA, an 86-year-old male, was admitted with respiratory distress and mental status changes following an episode of vomiting. He was diagnosed with aspiration pneumonia that progressed to septic shock. He required antibiotics, vasopressors, and respiratory support. A nutrition consult recommended changing his enteral feeds from bolus to continuous to help meet his needs while preventing further aspiration. Risk factors for aspiration in critically ill patients like LA were addressed through feeding precautions and positioning. After 11 days of treatment, LA's condition improved and he was discharged on enteral nutrition with monitoring of aspiration risks.
LA, an 86-year-old male, was admitted with respiratory distress and mental status changes following an episode of vomiting. He was diagnosed with aspiration pneumonia that progressed to septic shock. He required antibiotics, vasopressors, and respiratory support. A nutrition consult recommended changing his enteral feeds from bolus to continuous to help meet his needs while preventing further aspiration. Risk factors for aspiration in critically ill patients like LA were addressed through feeding precautions and positioning. After 11 days of treatment, LA's condition improved and he was discharged on enteral nutrition with monitoring of aspiration risks.
Diabetic KetoAcidosis is a condition of formation of ketone bodies in body due to which body goes to acidic condition and this is due to elevated glucose levels in blood.
Similar to (1.1)konfrens_bedah_17_Nov......pptx (20)
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Cell Therapy Expansion and Challenges in Autoimmune Disease
(1.1)konfrens_bedah_17_Nov......pptx
1. A leading center of excellence in clinical nutrition
specialist program in 2025
Clinical Nutrition Specialist Program will provide a
comprehensive clinical training program that embodies
the following characteristic:
1. Uphold scientific and medical profession ethic
2. Meet national & international standard of clinical
competence
3. Implement research in contribution towards basic and
clinical nutrition science
4. Provide high quality clinical nutrition service
2. CLINICAL NUTRITION CONFERENCE
Surgery Ward, November 17th 2022
dr. Indrawaty Alimuddin
dr. Tien Muliawati
dr. Ruwiyatul Aliyah*
dr. Christine Rogahang
dr. Utami Handayani
dr. Kaslan
dr. Meylisa
3. Patient Identity
.
999473
MR number
July 1st , 1999
Date of birth
November 12th , 2022
Admission Date
Consultation Date November 14th , 2022
Mr. F, 23 y.o. (Female)
Medical diagnosis
Medical Nutrition Diagnosis: Severe Protein Energy Malnutrition (SGA Score C)
Orthopedic Diagnosis : Low Back Pain due to destruction lumbal III due to suspect infection
process + paravertebral abscess as level as lumbal III – lumbal V + Anemia + Primary Soft Tissue
Right Knee Suspect Benign
Pulmonology Diagnosis : Pleural effusion dexta et sinistra ec suspect infection dd malignancy
4. Main Complaint
Weight loss
Fever and Seizure
There was fever since 2 days ago and no seizure
Nausea & Vomiting
Cough and Shortness of Breath
There was cough since 10 days ago with white
phlegm. There was shortness of breath sometimes
fixed without modalities
Subjective
(History taking)
Swallowing Disorders
History taking
No History
Headache
No History
since 5 months ago because of intermittent low back
pain accompanied with lump on right knee that bigger
over time. worsened in the last 2 months because of
the worsened pain and difficulty walking
There were history of nausea and vomiting since 4
days ago
No History
Decreased of oral intake
There was unintentional weight loss since 4 months
ago ± 6 kg from Initial Body Weight 45 kg (13.3%)
Epigastric and Abdominal Pain
5. Defecation
Last defecation this morning, solid
consistency, yellowish
Via diapers, changed 2 times/ day.
Seems full
Urination
Subjective
(History taking)
6. Patient Family
No history
Cerebrovascular disease
No history
Cardiovascular disease, DM
No History
Kidney and urinary disease
No History
Cerebrovascular disease
Cardiovascular disease, DM
No history
Kidney and urinary disease
No history
Hyperuricemia, hypercholesterolemia
Others Malignancy
No history
No History
lump in right knee since 5 months ago
No history
Hyperuricemia, hypercholesterolemia
7. History of PRESENT Illness
patient complain that
there is mass at right
knee. Patient underwent
a biopsy suergry at Wajo
Hospital, but the family
did not bring the tissue to
be checked
4 months
ago
patient start to control at
orthopaedic polyclinic of
UNHAS Hospital. Diagnosis:
low back pain due to
destruction on Lumbal III due
to suspect infection process
+ soft tissue tumor right knee
susp benign. Patient
complained that the pain was
getting worse. Patient was
then brought to the
emergency room of Unhas
Hospital and being
hospitalized for 2 days
2 days
ago
patient had intermittent
low back pain. There is
mass reappear at right
knee accompanied with
pain. Patient was
hospitalized at
Lamadukelleng
Hospital for 3 days and
then underoing
outpatient treatment at
polyclinic. Patient then
was referred to
Polyclinic of UNHAS
Hospital for further
treatment.
1 week ago
3 months
ago
patient was referred to
RSWS and being
hospitalized at
Orthopaedic Ward
(Lontara) until now.
Patient was planned
for decompression and
posterior stabilization
surgery + culture
biopsy but still wait for
schedule from
orthopedic surgeon
9. Dietary History
Typical intake and usual amount of food: (before admitted to the hospital)
Intake:
Via oral
Quantity:
She eats regularly 3 times/day, 1 cups of white rice with 1 medium chunck of varied of animal side
dishes,and 1 small bowl of vegetables,1 portion of fruit
Quality:
She likes almost every food
4 months ago, she ate 3 times/day, 1/2 serving of white rice, 1/2 serving of side dishes of animal origin and 1/2
serving of side dishes of plant origin and 1/2 small bowl of vegetables
3 months ago, she ate 3 times/day, 1/2 serving of porridge , 1/2 serving of side dishes of animal origin and 1/2
serving of side dishes of plant origin
1 week ago, she ate 3 times/day, 1/4 serving of porridge , 1/4 serving of side dishes of animal origin and 1/4
serving of side dishes of plant origin, 1/4 small bowl of vegetables and fruit
4 days ago, she ate 3 times/day, 1/4 serving of porridge , 1/4 serving of side dishes of animal origin and 1/4
serving of side dishes of plant origin, 1/4 small bowl of vegetables and fruit
Neither food allergies nor lactose intolerance
10. Intake & Fluid Analysis
Last intake Energy (kcal) Protein (g) Carbohydrate(g) Fat (g)
Intake before sick 1837 66.72 339.50 22.56
4 Months Ago 343.75 24.5 68 7.5
3 Months Ago 306.24 23 60.5 7.7
1 Week Ago 271.875 12.25 23 3.75
24 hours food recall 391.75 (20.61%) 14.50 (14.81%) 72.10 (73.62%) 4.83 (11.08%)
10
• Input : Intravenous and Medication 1850 cc
• Output : urine + IWL ( 1400 +390)
• Fluid Balance : 60 cc/24 hours
11. GCS E4M6V5
Body Lenght : 162 cm
IBW : 55.8 kg
MUAC : 18 cm
Estimated MUAC BW : 39 kg
Abdominal circumference : 64 cm
Anthropometry
Blood pressure : 120/70 mmHg
Pulse : 110 beats/minute
Respiratory rate : 23 times/minute
Temperature : 36.1°C
MAP : 86.6 mmHg
Vital signs
01 02
OBJECTIVE
MODERATE ILLNESS
Handgrip Strength: 3.2 kg
Functional Status :
ECOG Score III
03
12. Physical examination
HEAD AND NECK
Conjunctivawas anemic,Sclerawas noticteric.
Therewas noenlargementoflymphnodesand thyroid gland
CHEST
Inspection :Symmetric ,there was loss of subcutaneous fat.
Palpation :No tenderness
Percussion :Sonor
Auscultation : Vesicular breathing sound. No Rhonchi and wheezing, regular heart sounds
and no murmurs
ABDOMEN
Inspection :concave appearance
Auscultation :Normal Bowel Sound
Palpation :No tenderness
Percussion :Tympanic
13. Physical examination
EXTREMITY
There was wasting at all extremities and there was edema
at lower extremities (there is a 4x4 cm mass in the right knee, painful and fixed)
16. LABORATORY FINDINGS
Laboratory
November
12th, 2022
November
13th, 2022
Normal Value
Procalcitonin 0.42 <0.05ng/ml
AST 80 <38 U/L
ALT 18 <41 U/L
Total Protein 5.6 6.6-8.7 g/dl
Albumin 3.1 3.5-5g/dl
Globulin 2.5 1.5-5g/dl
HbsAg Non-Reactive <0.13 (non-Reactive)
PT 10.8 10-14 second
INR 1.00 0.8-1.1 second
APTT 19.6 22-30 Second
17. Thorax Photo PA/AP (November 12th 2022)
- Right pleural effusion
- Normal cardio
Lumbosacral Photo AP Lateral (November 12th 2022 )
- Lumbosacral lordotic curve extends (Muscle spasm)
- Intak bones
Genu Photo AP Lateral Dextra (November 12th 2022 )
- No radiological abnormalities appear in the genu joint dextra
MRI Lumbosacral (November 8th 2022 )
- Paravertebrae masses of L2-L4 and L5 extending to intradural and subarachnoid space L3, posterior
elements of bilateral musculus psoas vertebrae, bilateral quadratus lumborum musculus accompanied by
bone marrow edema suspect DD abscess/metastasis.
- Solid mass of left adneksa
- Ascites
RADIOLOGIC FINDINGS
18. November 12th, 2022
• Mild hyponatremia 134
November 13th , 2022
• Hypochrome Microcytic Anemia 6.6
• Thrombocytopenia 63.000
• Mild hypoalbuminemia 3.1
• Increased Procalcitonin 0.42
• Increased of NLR 3.3
Metabolical status
Functional
GI- Tract status
Functional Status ECOG SCORE III
HYDRATION STATUS Normovolemic
Assesment
19. Diagnosis & Prognosis
Prognosis
Vitam: Dubia ad bonam
Functionam: Dubia ad bonam
Sanactionam: Dubia ad bonam
22
Medical Nutrition Diagnosis: Severe Protein Energy Malnutrition (SGA Score C)
Orthopedic Diagnosis : Low Back Pain due to destruction lumbal III due to suspect infection
process + paravertebral abscess as level as lumbal III – lumbal V + Anemia + Primary Soft Tissue
Right Knee Suspect Benign
Pulmonology Diagnosis : Pleural effusion dexta et sinistra ec suspect infection dd malignancy
20. Basal Energy Expenditure : 1220 Kcal
Total Energy Expenditure : 1900 Kcal
Macronutrient Composition:
• Protein 1.5 g/kgIBW/day : 83.7 g (17.6%)
• Carbohydrate 50% : 237.5 g
• Fat 32.4% : 68.6 g
Medical Nutrition Therapy is given according to the management of refeeding syndrome 15
Kcal/kgBW/day = 585 Kcal (Equivalent to 30% TEE) via enteral:
- Blenderized food 246 Kcal
- ONS Peptisol 250 Kcal
- VCO 80 Kcal
Fluid requirements 1200 - 1400 cc/24 hours
Correction of hyponatremia by sodium intake (Deficit 117 + 78 = 195 mEq)
correction of hypoalbuminemia with protein intake of 1.5 g/kgBW
Planning
23
21. • Supplementation via enteral :
B. Complex 2 tabs/8 hours
Zinc 20mg/ 24 hours
Curcuma 400mg/8 hours
Thiamin 100mg/8 hours
• Monitoring and evaluation
Haemodynamic
Daily intake
Gastrointestinal tolerance
• Nutritional education:
Follow the meal according to the schedule
Insert NGT when there are no contraindications
• Lab : UUN, Magnecium, Calcium, Phosphat
• Agree to join multidisciplinary care
Planning
24
23. LABORATORY FINDINGS
Laboratory
November
13th, 2022
November
14th, 2022
Normal Value
Lactat 1.8 0.5-2.2 mmol
Sodium 137 135 – 145 mmol/L
Potassium 3.9 3.5 – 5.0 mmol/L
Chloride 103 97 – 111 mmol/L
CRP 59.2 <5mg/l
PT 10.3 10-14 second
INR 0.95 0.8-1.1 second
APTT 20.2 22-30 Second
24. Subjective Objective Assessment Planning
Intake via oral, There
was no nausea and
Vomiting. There was
low back pain
Defecation was
yesterday, seem to
be normal
Urination : Via diapers,
3 times change
1st day
Follow Up
(November 15th,
2022)
General Condition :MODERATE ILLNESS GCS E4M6V5
Vital sign :
Blood pressure : 120/60 mmHg
Pulse : 109 beats/minute
Respiratory rate : 23 times/minute
Temperature : 37.1°C
Anhtropometry
Body Length : 162 cm
Actual Body Weight : 44 kg
Ideal Body Weight : 55.8 kg
Estimated MUAC BW : 39 kg
MUAC : 18 cm
Food Recall 24 hours via Oral
Energy : 287.5 Kcal (15%)
Protein : 13.75 gr (19.1%)
Carbohydrate : 49 gr (68.2%)
Fat : 3.75 gr (11.7%)
Physical Examination:
HEAD AND NECK
Conjunctiva was anemic, Sclera was not icteric
Oxygen was not supported
Nasogastric tube was not inserted
There was no enlargement of lymph nodes and thyroid gland
CHEST
Inspection : Symmetric, There was loss of subcutaneous fat
Palpation : No tenderness
Percussion : Sonor
Auscultation : Vesicular breathing sound.There was no rhonchi and
wheezing, regular heart sounds and no murmurs
ABDOMEN
Inspection : Concave Appearance
Auscultation : Normal Bowel Sound
Palpation : Liver and spleen was not pappable
Percussion : Tympanic
EXTREMITY
There was wasting in all extremities and there was edema
At lower extremities (there is a 4 x4 cm mass in the right knee, painful and
fixed)
November 14th , 2022
• Increased CRP 59.2
• Improve of sodium 137 134
November 13th , 2022
• Hypochrome Microcytic
Anemia 6.6
• Thrombocytopenia 63.000
• Mild hypoalbuminemia 3.1
• Increased Procalcitonin 0.42
• Increased of NLR 3.3
Medical Nutrition Diagnosis:
Severe Protein Energy
Malnutrition (SGA Score C)
Orthopedic Diagnosis : Low
Back Pain due to destruction
lumbal III due to suspect
infection process +
paravertebral abscess as level
as lumbal III – lumbal V +
Anemia + Primary Soft Tissue
Right Knee Suspect Benign
Pulmonology Diagnosis :
Pleural effusion dexta et sinistra
ec suspect infection dd
malignancy
BEE : 1220 Kcal
TEE : 1900 Kcal (1.2/1.3)
Macronutrient Composition:
Protein 1.7 g/kgIBW/day : 95.2 g (20.0%)
Carbohydrate 45% : 214 g
Fat 35% : 74 g
Medical Nutrition Therapy is given according to the
management of refeeding syndrome 15 Kcal/kgBW/day
= 585 Kcal (Equivalent to 30% TEE) via enteral:
- Blenderized food 246.7 Kcal
- ONS Peptisol 250 Kcal
- Egg white 37.5 Kcal
- VCO 120 Kcal
Fluid requirements 1600 cc/24 hours
correction of hypoalbuminemia with protein intake of 1.7
g/kgBW
Supplementation via Enteral :
-Zinc 20mg/24jam/oral
- B comp 2 tab/8 hours
-Curcuma 400mg/8 hours
-Thiamin 100mg/8 hours
-Antasida Syrup 10ml/8 hours
Monitoring and evaluation
-Haemodynamic
-Daily intake
-Gastrointestinal tolerance
Nutritional education:
Follow the meal according to the schedule
Insert NGT
Lab : Waiting for Magnecium, Calcium, Phosphat and UUN