Cushing syndrome is caused by prolonged exposure to high levels of corticosteroid hormones. It can be due to excessive steroid medication use, pituitary or adrenal tumors, or other rare causes. Signs include upper body obesity, moon face, skin changes like purple striae, muscle wasting, and psychological issues. Diagnosis involves tests of urine and saliva cortisol levels. Treatment options are surgery to remove tumors, radiation, or medication. Nursing care focuses on fall and infection prevention, skin integrity, managing mood changes, and health teaching about the condition.
Cushing syndrome occurs when your body has too much of the hormone cortisol over time. This can result from taking oral corticosteroid medication. Or your body might produce too much cortisol.
Too much cortisol can cause some of the hallmark signs of Cushing syndrome — a fatty hump between your shoulders, a rounded face, and pink or purple stretch marks on your skin. Cushing syndrome can also result in high blood pressure, bone loss and, on occasion, type 2 diabetes.
Treatments for Cushing syndrome can return your body's cortisol levels to normal and improve your symptoms. The earlier treatment begins, the better your chances for recovery.
A 43 year old woman is brought to the emergency department 1 hour after a str...Neel Patel
A 43 year old woman is brought to the emergency department 1 hour after a stranger stole her purse. She is agaitated and extremely upset. She is 163 cm (5 ft 4 in) tall and weight 91 kg (200 lb); BMI is 34 kg/m2. Physical examination show no other abnormalities. Her blood glucose concentration is increased.
This lecture talk about the disturbance of adrenal gland hormones and how it affect health. it also discuss in brief how to manage such condition in your dental clinic
Cushing syndrome occurs when your body has too much of the hormone cortisol over time. This can result from taking oral corticosteroid medication. Or your body might produce too much cortisol.
Too much cortisol can cause some of the hallmark signs of Cushing syndrome — a fatty hump between your shoulders, a rounded face, and pink or purple stretch marks on your skin. Cushing syndrome can also result in high blood pressure, bone loss and, on occasion, type 2 diabetes.
Treatments for Cushing syndrome can return your body's cortisol levels to normal and improve your symptoms. The earlier treatment begins, the better your chances for recovery.
A 43 year old woman is brought to the emergency department 1 hour after a str...Neel Patel
A 43 year old woman is brought to the emergency department 1 hour after a stranger stole her purse. She is agaitated and extremely upset. She is 163 cm (5 ft 4 in) tall and weight 91 kg (200 lb); BMI is 34 kg/m2. Physical examination show no other abnormalities. Her blood glucose concentration is increased.
This lecture talk about the disturbance of adrenal gland hormones and how it affect health. it also discuss in brief how to manage such condition in your dental clinic
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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. CUSHING’S SYDROME
• Cushing’s syndrome (hypercortisolism) is a
hormonal disorder caused by prolonged
exposure high levels of steroid hormones called
glucocorticoids.
• It is commonly caused by use of corticosteroid
medications and is infrequently the result of
excessive corticosteroid production secondary to
hyperplasia of the adrenal cortex.
3. Cont…
• It may also be caused by several mechanisms,
including a tumor of the pituitary gland or less
commonly an ectopic malignancy that produces
adrenocorticotropic hormone (ACTH).
• Regardless of the cause, the normal feedback
mechanisms that control the function of the
adrenal cortex become ineffective, resulting in
over secretion of glucocorticoids, androgens,
and possibly mineralocorticoid.
5. Etiology of Cushing's syndrome
Excessive activity of the adrenal cortex
Corticosteroids / ACTH excess
Adrenal cortex hyperplasia.
6. Pathophysiology
• Normally, the production and release of cortisol
follows a precise chain of events. Corticotropin-
releasing hormone (CRH) released from the
hypothalamus causes the pituitary gland to
secrete ACTH, which in turn results in the
production of cortisol from the adrenal glands
(located just above the kidneys).
7. Cont…
• In healthy people, cortisol begins to rise between
3 and 4 am, reaches a peak between 7 and 9 am,
and then falls for the rest of the day to the lowest
levels when the person is unstressed and asleep
at midnight.
• Cortisol controls its own production and release
by switching off the hormones CRH and ACTH, a
form of hormonal regulation known as “negative
feedback”.
8. Cont…
• ACTH and cortisol become elevated in
response to stress, such as surgery, trauma,
infection or other medical illnesses. i.e. Stress
response.
9.
10. Types of Cushing's syndrome
• Exogenous Cushing’s syndrome: caused by
taking excessive amounts of medications e.g.
prednisone, dexamethasone for chronic
asthma, rheumatoid arthritis, lupus, to
suppress immune system after transplant to
prevent rejection, other inflammatory
diseases.
• Endogenous Cushing’s syndrome: excess
cortisol produced by the adrenal glands. This
is far rarer, but if left undiagnosed & untreated
it can result in a shorter lifespan.
11. Signs and Symptoms of
Cushing's syndrome
Most people with Cushing syndrome will have:
• Upper body obesity (above the waist) and thin
arms and legs
• Round, red, full face (moon face)
12. Cont..
• Skin changes that are often seen:
a) Acne or skin infections
b) Purple/red marks (1/2 inch or more wide)
called striae on the skin of the abdomen,
thighs, and breasts
c) Thin skin with easy bruising
13. Cont…
• Muscle and bone changes include:
a) Backache, which occurs with routine activities
b) Bone pain or tenderness
c) Collection of fat between the shoulders (buffalo
hump)
d) Rib and spine fractures (caused by thinning of
the bones)
e) Weak muscles
14. Cont…
Women with Cushing syndrome often have:
• Excess hair growth on the face, neck, chest, abdomen,
and thighs
• Menstrual cycle that becomes irregular or stops
Men may have:
• Decreased or no desire for sex
• Impotence
15. Cont…
Other symptoms that may occur with this disease:
• Mental changes, such as depression, anxiety, or
changes in behavior
• Fatigue
• Headache
• Increased thirst and urination
16.
17.
18. Diagnostic measure
• Diagnosis is based on a review of a person's
medical history, a physical examination, and
laboratory tests. X rays of the adrenal or
pituitary glands can be useful in locating
tumors.
• No single lab. test is perfect and usually
several are needed. The most common tests
used to diagnose Cushing's syndrome are :-
19. 1. 24-hour urinary free cortisol level.
• In this test, a person's urine is collected several
times over a 24-hour period and tested for
cortisol. Levels higher than 50 to 100 micrograms
a day for an adult suggest Cushing's syndrome.
The normal upper limit varies in different
laboratories, depending on which measurement
technique is used.
20. 2.Midnight plasma cortisol and late-night
salivary cortisol measurements.
• The midnight plasma cortisol test measures
cortisol concentrations in the blood.
• Cortisol production is normally suppressed at
night, but in Cushing's syndrome, this
suppression doesn't occur. If the cortisol level is
more than 50 nanomoles per liter (nmol/L),
Cushing's syndrome is suspected.
21. Cont…
• The test generally requires a 48-hour hospital
stay to avoid falsely elevated cortisol levels
due to stress.
• However, a late-night or bedtime saliva
sample can be obtained at home, then tested
to determine the cortisol level. Diagnostic
ranges vary, depending on the measurement
technique used.
22. 3.Low-dose dexamethasone suppression
test (LDDST).
• In the LDDST, a person is given a low dose of
dexamethasone, a synthetic glucocorticoid, by
mouth every 6 hours for 2 days
• Urine is collected before dexamethasone is
administered and several times on each day of
the test. A modified LDDST uses a onetime
overnight dose.
23. Cont…
• Cortisol and other glucocorticoids signal the
pituitary to release less ACTH, so the normal
response after taking dexamethasone is a
drop in blood and urine cortisol levels. If
cortisol levels do not drop, Cushing's
syndrome is suspected.
24. 4.Dexamethasone-corticotropin-releasing
hormone (CRH) test.
• Some people have high cortisol levels but do not
develop the progressive effects of Cushing's
syndrome, such as muscle weakness, fractures,
and thinning of the skin.
• These people may have pseudo-Cushing's
syndrome, a condition sometimes found in
people who have depression or anxiety
disorders, drink excess alcohol, have poorly
controlled diabetes, or are severely obese.
25. Cont…
• Pseudo-Cushing’s does not have the same
long-term effects on health as Cushing's
syndrome and does not require treatment
directed at the endocrine glands.
26. Treatment/Management
The management/treatment of Cushing's syndrome can be
surgical, medical or radiation.
Treatment is usually directed at the pituitary gland
because most cases are due to pituitary tumors rather than
tumors of the adrenal cortex.
The following are the treatment/management of Cushing's
syndrome.
• Surgical removal of the tumor by transsphenoidal
hypophysectomy is the treatment of choice (80% success
rate).
27. Cont…
• Radiation of the pituitary gland is successful but takes several
months for symptom control.
• Adrenalectomy is performed in patients with primary adrenal
hypertrophy.
• Post-operatively, temporary replacement therapy with
hydrocortisone may be necessary until the adrenal glands
begin to respond normally (may be several months).
• If bilateral adrenalectomy was performed, lifetime
replacement of adrenal cortex hormones is necessary.
28. Cont…
• Adrenal enzyme inhibitors (eg, metyrapone,
aminoglutethimide, mitotane, ketoconazole)
may be used with ectopic ACTH secreting tumors
that cannot be totally removed; monitor closely
for inadequate adrenal function and side effects.
• If Cushing syndrome results from exogenous
corticosteroids, taper the drug to the minimum
level or use alternate day therapy to treat the
underlying disease.
29. GENERAL NURSING MANAGEMENT
• Weigh each morning, using the same scale.
• Maintain an accurate record of intake and output.
• Ensure adequate lighting in the room, and wear
glasses and shoes when getting out of bed.
• Develop a written schedule of rest and activity periods.
• If agreeable, provide a private room, and restrict visitors
at this time.
30. Cont…
• Use strict medical and surgical asepsis when
providing care.
• Provide time for discussion of the disease and
treatment; encourage verbalization of feelings and
identify successful coping mechanisms used in the
past.
•Encourage turning, coughing, and deep breathing
and/or incentive spirometry every 2–4 hours
31. Complications
• If you don't receive prompt treatment for
Cushing syndrome, complications may occur,
such as:
• Bone loss (osteoporosis), which can result in
unusual bone fractures, such as rib fractures
and fractures of the bones in the feet
• High blood pressure (hypertension)
• Diabetes
32. Cont…
• Frequent or unusual infections
• Loss of muscle mass and strength
• When the cause of Cushing syndrome is a
pituitary tumor (Cushing disease), it can
sometimes lead to other problems, such as
interfearing with the production of other
hormones controlled by the pituitary.
34. DATE NURSING
DIAGNOSIS
NURSING
GOAL/OUTCOME
INTERVENTION EVALUATION
Risk for injury
related to
weakness
Decreased risk of
injury to the
patient.
1) Provide a protective
environment to prevent
falls, fractures, and
other injuries to patient.
2) Assist the patient who is
weak in ambulating to
prevent falls or colliding
into furniture.
3) Recommend foods high
in protein, calcium, and
vitamin D to minimize
muscle wasting and
osteoporosis; refer
to dietitian for assistance.
Patient has
decreased risk of
injury.
35. DATE NURSING
DIAGNOSIS
NURSING
GOAL
NURSING
INTERVENTION
EVALUATION
Risk for infection
related to
altered protein
metabolism and
inflammatory
response.
Decreased
risk of
infection.
1) Avoid unnecessary
exposure to people
with infections.
2) Assess frequently for
subtle signs of
infections (corticosteroid
s mask signs of
inflammation and
infection).
Has decreased risk of
infection
36. DATE NURSING
DIAGNOSIS
NURSING
GOAL
NURSING INTERVENTION EVALUATION
Impaired skin
integrity related
to edema,
impaired
healing, and thin
and fragile skin
Improved
skin integrity
1) Use meticulous skin care
to avoid traumatizing
fragile skin.
2) Avoid adhesive tape,
which can tear and irritate
the skin.
3) Assess skin and bony
prominences frequently.
4) Encourage and assist
patient to change
positions frequently.
Attains or maintains
skin integrity
37. DATE N.DIAGNOSIS NURSING
GAOL
NURSING INTERVENTION EVALUATION
Disturbed body
image related to
altered
appearance, imp
aired sexual
functioning, and
decreased
activity level
Improved
body image
1) Discuss the impact that
changes have had on
patient’s self-concept and
relationships with others.
Major physical changes will
disappear in time if the
cause of Cushing syndrome
can be treated.
2) Weight gain and edema
may be modified by a low-
carbohydrate, low-sodium
diet; a high-protein intake
can reduce some bother
some symptoms.
Achieves
improved body
image of the
patient.
38. DATE N.DIAGNOSIS NURSING
GOAL
NURSING INTERVENTION EVALUATION
Disturbed patient’s
mental function
related to mood
swing, response to
questions,
depression, and
awareness of
environment.
Improving
Thought
Processes
1) Explain to patient and
family the cause of
emotional instability,
and help them cope
with mood
swings, irritability, and
depression.
2) Report any psychotic
behavior.
3) Encourage patient and
family members to
verbalize feelings and
concerns.
Exhibits
improved mental
functioning
Experiences no
complications