Cushing's syndrome is caused by prolonged high levels of the hormone cortisol and results in weight gain, high blood pressure, and other signs. It can be caused by pituitary or adrenal tumors that overproduce cortisol or related hormones. Diagnosis involves blood and urine tests showing elevated cortisol levels. Treatment options include surgery to remove the tumor, medications to suppress cortisol production, and lifelong hormone replacement after adrenal removal. Nursing care focuses on managing skin integrity issues, assisting with self-care due to weakness, addressing changes in body image and mood, and providing postoperative monitoring and care.
Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin.
When your cells don't get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Ketones are chemicals that the body creates when it breaks down fat to use for energy. The body does this when it doesn’t have enough insulin to use glucose, the body’s normal source of energy. When ketones build up in the blood, they make it more acidic.
Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin.
When your cells don't get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Ketones are chemicals that the body creates when it breaks down fat to use for energy. The body does this when it doesn’t have enough insulin to use glucose, the body’s normal source of energy. When ketones build up in the blood, they make it more acidic.
Chronic kidney disease (CKD) means your kidneys are damaged and can't filter blood the way they should. The disease is called “chronic” because the damage to your kidneys happens slowly over a long period of time.
Ulcerative colitis (UC) is an inflammatory bowel disease. It causes irritation, inflammation, and ulcers in the lining of your large intestine (also called your colon). There's no cure, and people usually have symptoms off and on for life
Hepatic encephalopathy is one of the deadly complication of liver diseases, occurs due to profound liver failure and from accumulation of ammonia and other toxic metabolites in blood.
Hepatic coma is advanced stage of hepatic encephalopathy.
Image result for ulcerative colitis
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.
Chronic kidney disease (CKD) means your kidneys are damaged and can't filter blood the way they should. The disease is called “chronic” because the damage to your kidneys happens slowly over a long period of time.
Ulcerative colitis (UC) is an inflammatory bowel disease. It causes irritation, inflammation, and ulcers in the lining of your large intestine (also called your colon). There's no cure, and people usually have symptoms off and on for life
Hepatic encephalopathy is one of the deadly complication of liver diseases, occurs due to profound liver failure and from accumulation of ammonia and other toxic metabolites in blood.
Hepatic coma is advanced stage of hepatic encephalopathy.
Image result for ulcerative colitis
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.
Hirsutism is a common endocrinological disorder in clinical practice. The causes vary from simple idiopathic hirsutism to most complicated malignant ovarian and adrenal tumors. Most common cause of hirsutism in endocrine clinic is due to a disorder known as PCOS (polycystic ovarian syndrome). Hirsutism poses embarrassment to the women. The purpose of this short review is to identify the common diseases associated with hirsutism, an approach to working through the differential diagnosis, investigations helping in diagnosis and the commonly available treatment modalities for the various forms of hirsutism. The review will provide the physician about the most efficient, cost effective and safe clinical approach to management of hirsutism.
Acromegaly nursing care plan & managementNursing Path
Acromegaly is a rare, chronic, and disabling disorder of body growth and endocrine dysfunction in adults (after closure of the epiphyses) that is caused by excessive levels of growth hormone (GH).
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
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 Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
2. INTRODUCTION OF
CUSHING SYNDROME
CUSING IS THE HORMONAL DISORDER CAUSED BY PROLONGED
EXPOSURE OF THE BODIES TISSUES TO HIGH LEVEL OF THE
HORMONE CORTISOL.
ADRENAL GLANDS LOCATED RIGHT ABOVE THE KIDNEYS
THEY RELEASE CORTISOL. WHEN THEY RECEIVE A CHEMICAL
MESSAGE FROM PITUITARY GLANDS. IT IS CHARACTERIZED BY
FACIAL AND THORSE (UNEQUAL DISTRIBUTION OF FATS)
HYPERTENSION, STRETCH MARKS ON THE BELLY, WEAKNESS,
OSTEOPOROSIS AND FACIAL HAIR GROWTH IN FEMALES.
.
4. Etiological Factors
Occurs 10 times more frequently in women than in men.
Hyperplasia of both adrenal glands caused by overstimulation of
the adrenal cortex by ACTH, usually from a pituitary adenoma or
hyperplasia.
Adrenal Cushing's syndrome.
Associated with tumors of the adrenal cortex :adenoma or carcinoma.
Medication : glucocorticoid administration.
Excessive corticosteroid medications.
5. Pathophysiology
Due to use of corticosteroid medications or due to excessive
corticosteroid production by the adrenal cortex or tumor of the
pituitary gland that
Produces ACTH and stimulates the adrenal cortex to increase its
hormone secretion(glucocorticoids, mineralocorticoids, and
adrenal androgens).
Hypernatremia, hypokalemia,wt gain occur
6. Clinical Manifestations
Manifestations Caused by Excess Glucocorticoids
Weight gain or obesity (belly fat)
Heavy trunk; thin extremities.
Buffalo hump (fat pad) in neck and supraclavicular area.
Rounded face (moon face); plethoric (overly large or abundant), oily.
Fragile and thin skin, striae (stretch marks) and ecchymosis, acne.
Muscles wasted because of excessive catabolism.
Osteoporosis characteristic kyphosis, backache.
Mental disturbances mood changes, psychosis.
Increased susceptibility to infections.
Poor wound healing
Amenorrhea in females.
7. Enlarged sella turcica
Manifestations Caused by Excess Mineralocorticoids
Diabetes
Hypertension.
Hypernatremia,
hypokalemia.
Weight gain.
Edema.
polyuria
Manifestations Caused by Excess Androgens
Women experience virilism (masculinization).
Hirsutism : excessive growth of hair on the face and midline of trunk.
Breasts: atrophy.
Voice: masculine.
Loss of libido.
Males: loss of libido.
8.
9. Diagnostic Evaluation
Excessive plasma cortisol levels( assess in case of hypercotisolism
urine of 24 normal value more than 100 mcg/24hr.
An increase in blood glucose levels and glucose intolerance.
Decreased serum potassium level.
Elevated urinary 17-hydroxycorticoids and 17-ketogenic steroids.( it
is measure androgen metabolities in urine and evaluate
adrenocortical and gonadal function so collection of 24 urine)
Normal value: 6-16mcg/24hr
Elevation of plasma ACTH in patients with pituitary tumors
10. CT scan and MRI detect location of tumor Low plasma ACTH levels with
adrenal tumor.
Ultrasonography
X-rays of the skull detect erosion of the sella turcica(covering of
pituitary gland) by a pituitary tumor.
Overnight DST (steriod), possibly with cortisol urinary excretion
measurement.
Unsuppressed cortisol level in Cushing's syndrome caused by adrenal
tumors.
Suppressed cortisol level in Cushing's disease caused by pituitary tumor.
(In a healthy patient, the administration of dexamethasone will inhibit
corticotropin secretion and will cause cortisol levels to fall below normal).
.
11. Management
Surgical treatment and Radiation therapy.
Tumor (adrenal or pituitary) is removed or treated with irradiation.
Transsphenoidal adenomectomy (TSA)or hypophysectomy
(pituitary removal)
Transfrontal craniotomy may be necessary when pituitary tumor
has enlarged beyond sella turcica
Hyperplasia of adrenals: bilateral adrenalectomy.
Replacement Therapy Postoperatively.
12.
13. Medical Management
If patients cannot undergo surgery, cortisol synthesis-inhibiting
medications may be used.
Metyrapone (Metopirone)
Aminoglutethimide (Cytadren) blocks cholesterol conversion
to pregnenolone, effectively blocking cortisol production.
Adrenalectomy patients require a lifelong replacement therapy
with the following:
A glucocorticoid: cortisone (Cortef).
A mineralocorticoid: fludrocortisone ( Florinef ).
Potassium replacement is usually required.
14. Complications
Possibility of recurrence in patients with adrenal
carcinoma.
Fractures
Renal colic.
Gastric ulcers.
Pancreatitis.
Infections.
15. Nursing Diagnoses with
Nursing INTERVENTIONS
Impaired Skin Integrity related to altered healing, thin and fragile
skin, and edema.
• Maintaining Skin Integrity
• Assess skin frequently to detect reddened areas, breakdown or
tearing of skin, excoriation, infection, or edema.
• Handle skin and extremities gently to prevent trauma; protect from
falls by use of side rails.
• Avoid use of adhesive tape to reduce risk of trauma to skin on its
removal.
• Encourage patient to turn in bed frequently or to ambulate to
reduce pressure on bony prominences and areas of edema.
• Use meticulous skin care to reduce injury and breakdown.
• Provide foods low in sodium to minimize edema formation.
• Assess intake and output and daily weight to evaluate fluid retention.
16. Dressing, Grooming, Toileting Self-Care Deficit related to muscle
wasting, osteoporosis, weakness, and fatigue
Encouraging Active Participation in Self-Care
Assist patient with ambulation and hygiene when weak and fatigued.
Assist patient in planning schedule to permit exercise and rest.
Encourage patient to rest when fatigued.
Encourage gradual resumption of activities as the patient gains strength.
Identify for patient the signs and symptoms indicating excessive exertion.
Instruct patient in correct body mechanics to avoid pain or injury during
Use assistive devices during ambulation to prevent falls and fractures.
Encourage foods high in potassium (bananas, orange juice, tomatoes), and
administer potassium supplement as prescribed to counteract weakness related
hypokalemia.
17. Disturbed Body Image related to altered physical appearance and
emotional instability
• Strengthening Body Image
• Encourage the patient to verbalize concerns about illness, changes
appearance, and altered role functions.
• Identify situations that are disturbing to patient and explore with
patient ways to avoid or modify those situations.
Be alert for evidence of depression; in some instances this has
progressed to suicide; alert health care provider of mood changes,
sleep disturbance, change in activity level, change in appetite, or
of interest in visitors or other experiences.
• Refer for counseling, if indicated.
• Explain to patient who has benign adenoma or hyperplasia that,
proper treatment, evidence of masculinization can be reversed.
18. continued…
Anxiety related to surgery
• Reducing Anxiety
• Answer questions about surgery and encourage
thorough discussion with health care provider if patient
is not well informed.
• Describe nursing care to expect in postoperative
period.
19. Risk for Injury related to surgical procedure
• Providing Postoperative Care
• Provide routine postoperative care for patient with abdominal
surgery or hypophysectomy.
• Monitor closely for infection because glucocorticoid
administration interferes with immune function; maintain aseptic
technique, clean environment, and good hand washing.
• Monitor thyroid function tests and provide hormone
replacement therapy as ordered after hypophysectomy.
• Monitor fluid intake and output and urine specific gravity to
detect DI caused by ADH deficiency after hypophysectomy.
20. THANKYOU FOR YOUR
ACTIVE LISTENING AND
ATTENTION..
IF ANY QUERY REGARDING THE TOPIC
KINDLY ASK….
THE END.
