A 9-year old male presented to the PICU with hypertension crisis due to a suspected pheochromocytoma. Physical exam revealed elevated blood pressure of 225/140 mmHg and symptoms of headache, blurred vision, palpitations, and sweating. Diagnostic tests confirmed elevated catecholamine levels in plasma and urine and imaging showed an adrenal tumor. The patient was started on antihypertensive medications, close monitoring, and nursing care to control symptoms and educate family. Surgical removal of the adrenal tumor was recommended as definitive treatment.
Soap analysis on Coronary Artery Disease: By RxVichuZ!RxVichuZ
This powerpoint deals with Coronary Artery Disease, mentioning a few details into the disease & explaining the SOAP format of a patient having this disease(in short).
Regards,
@ RxVichu! :)
This patient is a 23-year-old female who presented with generalized swelling and abdominal pain for 8 months. Her symptoms started 2 years ago with abdominal pain and obstruction, for which she was diagnosed with FMF and treated with colchicine. Over time she developed edema, ascites, hepatomegaly and thrombocytopenia. She was diagnosed with lupus based on positive ANA and anti-DNA antibodies, but subsequent tests for these were negative. Workup revealed hepatic vein and IVC thrombosis consistent with Budd-Chiari syndrome. Testing found protein C deficiency and lupus anticoagulant consistent with antiphospholipid antibody syndrome. She was started on anticoagulation, diure
This document presents a case of a 74-year-old man with COPD who presents with worsening dyspnea. Examinations reveal diffuse crackles, an elevated WBC count and inflammatory markers. A chest CT shows bilateral consolidations and ground glass opacities. A lung biopsy reveals a uniform temporal appearance with fibrosis within the airspaces, consistent with cryptogenic organizing pneumonia (COP). The diagnosis, treatment, typical presentation and pathology of COP are discussed. COP is characterized by organizing pneumonia seen on biopsy without an identifiable cause.
Three key points about managing diabetes in surgical patients:
1. Surgery causes stress responses that can worsen blood sugar control and increase insulin resistance. Tight control is important to reduce complications.
2. The document provides guidelines for managing diabetes in both major and minor surgeries, including adjusting insulin doses pre-operatively and monitoring blood sugar closely during and after surgery.
3. For major surgeries, an insulin-glucose infusion is recommended starting before surgery and continuing for at least 24 hours post-operatively to maintain tight control and prevent hyperglycemia from worsening outcomes.
Effect of hydrocortisone on development of shock amongDr fakhir Raza
effects of hydrocortisone on development of shock among patients with severe sepsis the HYPRESS Randomized Clinical Trial American Medical Association caring for the critically ill patients Surviving sepsis campaign, to determine weather hydrocortisone therapy in patients with severe sepsis prevents the development of septic shock
This document provides guidelines for managing hyperglycemia in ICU patients using insulin therapy. It recommends a target blood glucose range of 100-150 mg/dL. The guidelines describe different types of insulin, including rapid, short, intermediate and long-acting varieties. It presents a protocol for intravenous insulin therapy that involves calculating initial bolus and infusion rates based on the patient's starting blood glucose level. The protocol provides guidance on adjusting the infusion rate based on hourly blood glucose monitoring and includes steps to avoid and treat hypoglycemia.
Diagnosis and treatment of acute pulmonary embolism (VTE)Usama Ragab
By Dr. Usama Ragab, Zagazig Faculty of Medicine
PE may account for up to 15% of all post-operative deaths.
It is the commonest cause of death following elective surgery, and the commonest cause of maternal death.
This document provides guidelines for pre-operative evaluation and risk assessment. It discusses evaluating patients' medication use, medical conditions, functional status, and surgery-specific risk. Key factors that increase cardiac risk include recent heart attack, heart failure, diabetes, and poor functional status. Testing may be warranted for intermediate-high risk surgery or patients with a predicted >1% risk of major cardiac events. Continuation of most medications is reasonable. Statins, aspirin, and beta-blockers in selected patients can reduce risk. Timing of elective surgery depends on prior stenting or heart attack. The goal is to identify and optimize modifiable risks to reduce complications.
Soap analysis on Coronary Artery Disease: By RxVichuZ!RxVichuZ
This powerpoint deals with Coronary Artery Disease, mentioning a few details into the disease & explaining the SOAP format of a patient having this disease(in short).
Regards,
@ RxVichu! :)
This patient is a 23-year-old female who presented with generalized swelling and abdominal pain for 8 months. Her symptoms started 2 years ago with abdominal pain and obstruction, for which she was diagnosed with FMF and treated with colchicine. Over time she developed edema, ascites, hepatomegaly and thrombocytopenia. She was diagnosed with lupus based on positive ANA and anti-DNA antibodies, but subsequent tests for these were negative. Workup revealed hepatic vein and IVC thrombosis consistent with Budd-Chiari syndrome. Testing found protein C deficiency and lupus anticoagulant consistent with antiphospholipid antibody syndrome. She was started on anticoagulation, diure
This document presents a case of a 74-year-old man with COPD who presents with worsening dyspnea. Examinations reveal diffuse crackles, an elevated WBC count and inflammatory markers. A chest CT shows bilateral consolidations and ground glass opacities. A lung biopsy reveals a uniform temporal appearance with fibrosis within the airspaces, consistent with cryptogenic organizing pneumonia (COP). The diagnosis, treatment, typical presentation and pathology of COP are discussed. COP is characterized by organizing pneumonia seen on biopsy without an identifiable cause.
Three key points about managing diabetes in surgical patients:
1. Surgery causes stress responses that can worsen blood sugar control and increase insulin resistance. Tight control is important to reduce complications.
2. The document provides guidelines for managing diabetes in both major and minor surgeries, including adjusting insulin doses pre-operatively and monitoring blood sugar closely during and after surgery.
3. For major surgeries, an insulin-glucose infusion is recommended starting before surgery and continuing for at least 24 hours post-operatively to maintain tight control and prevent hyperglycemia from worsening outcomes.
Effect of hydrocortisone on development of shock amongDr fakhir Raza
effects of hydrocortisone on development of shock among patients with severe sepsis the HYPRESS Randomized Clinical Trial American Medical Association caring for the critically ill patients Surviving sepsis campaign, to determine weather hydrocortisone therapy in patients with severe sepsis prevents the development of septic shock
This document provides guidelines for managing hyperglycemia in ICU patients using insulin therapy. It recommends a target blood glucose range of 100-150 mg/dL. The guidelines describe different types of insulin, including rapid, short, intermediate and long-acting varieties. It presents a protocol for intravenous insulin therapy that involves calculating initial bolus and infusion rates based on the patient's starting blood glucose level. The protocol provides guidance on adjusting the infusion rate based on hourly blood glucose monitoring and includes steps to avoid and treat hypoglycemia.
Diagnosis and treatment of acute pulmonary embolism (VTE)Usama Ragab
By Dr. Usama Ragab, Zagazig Faculty of Medicine
PE may account for up to 15% of all post-operative deaths.
It is the commonest cause of death following elective surgery, and the commonest cause of maternal death.
This document provides guidelines for pre-operative evaluation and risk assessment. It discusses evaluating patients' medication use, medical conditions, functional status, and surgery-specific risk. Key factors that increase cardiac risk include recent heart attack, heart failure, diabetes, and poor functional status. Testing may be warranted for intermediate-high risk surgery or patients with a predicted >1% risk of major cardiac events. Continuation of most medications is reasonable. Statins, aspirin, and beta-blockers in selected patients can reduce risk. Timing of elective surgery depends on prior stenting or heart attack. The goal is to identify and optimize modifiable risks to reduce complications.
Journal club- Enteral Paracetamol or IV Indomethacin for closure of PDAZaheen Zehra
This randomized controlled trial compared the efficacy of enteral paracetamol and intravenous indomethacin for closing a patent ductus arteriosus (PDA) in preterm neonates. 77 preterm infants were randomly assigned to receive either paracetamol drops through a feeding tube every 6 hours for 7 days, or intravenous indomethacin once daily for 3 days. The primary outcome was PDA closure rate assessed by echocardiography. There was no significant difference in PDA closure rates or secondary outcomes like renal impairment between the two groups. The study concluded that oral paracetamol is safe but not superior to intravenous indomethacin for closing a PDA in preterm neonates
Case on type II diabetes mellitus with peripheral neuropathy with hypertensionVineetha Menon
This document describes the case of a 38-year-old female patient admitted to the hospital for giddiness, generalized weakness, burning and tingling sensations in the lower limbs, and blurry vision. She has a history of type 2 diabetes for 3 years and hypertension for 1 year. On examination, she was found to have elevated blood pressure and blood glucose levels. She was diagnosed with type 2 diabetes with peripheral neuropathy and hypertension. Her symptoms improved with treatment including medications to control her blood pressure and blood glucose over her 5 day hospital stay.
Intensive Insulin Therapy In The Medical IcuNadSamm
Intensive insulin therapy (IIT) aimed at maintaining tight glycemic control between 4.4-6.1 mmol/L significantly reduced morbidity but not overall in-hospital mortality compared to conventional insulin treatment targeting levels below 10-12 mmol/L in critically ill adult medical ICU patients. Among patients who received at least 3 days of IIT, in-hospital mortality was reduced from 21% to 14% and complications such as newly acquired kidney injury and length of stay were also lower. However, IIT did not reduce mortality in the overall intention-to-treat analysis and may have caused harm in patients treated for less than 3 days. Further research is needed to confirm these preliminary findings.
Hospital Medicine Update, VA ACP Meeting 2015Jon Sweet
This document summarizes a presentation on papers that have changed the presenter's medical practice. It discusses several clinical cases and the evidence from recent studies on how to best manage them. For a patient with upper GI bleeding admitted after endoscopic treatment, intermittent PPI therapy is shown to be non-inferior to continuous infusion PPI based on multiple randomized trials. For heart failure patients under 75, BNP-guided treatment reduces mortality and hospitalizations compared to clinical guidance alone. Lower steroid doses are associated with better outcomes for COPD patients admitted to the ICU. MRCP or EUS are recommended for evaluating the CBD in patients at intermediate risk of retained stones.
Perioperative management of a patient with diabetes mellitusrajkumarsrihari
This document discusses the perioperative management of patients with diabetes mellitus. It begins by outlining the WHO diagnostic criteria for diabetes. It then discusses the implications of surgery for diabetic patients, including risks of stress-induced hyperglycemia and hypoglycemia. The document provides guidance on preoperative evaluation and investigations for these patients. It covers anesthetic management principles including glucose control and the effects of anesthetic drugs on blood sugar. Finally, it describes diabetic emergencies like diabetic ketoacidosis and hyperosmolar hyperglycemic state.
This document discusses proton pump inhibitors (PPIs) and their interaction with the blood thinner clopidogrel. It notes that PPIs and clopidogrel are among the most commonly prescribed medications. Studies have shown that the PPI omeprazole can reduce the effectiveness of clopidogrel by inhibiting the enzyme CYP2C19 needed to activate clopidogrel. Regulatory agencies now warn against combined use of clopidogrel and omeprazole. Alternative PPIs like pantoprazole may be safer options, and future research is still needed.
managing diabetes in critically ill hospitalized patientssumitverma88
This document discusses the management of diabetes in critically ill hospitalized patients. It covers stress hyperglycemia, causes of stress-induced hyperglycemia, proposed mechanisms, effects of prolonged hyperglycemia, past approaches, results of intensive insulin therapy trials, inpatient glucose metrics, intravenous insulin protocols, hypoglycemia management, transitioning to outpatient care, and management of diabetic ketoacidosis, hyperglycemic hyperosmolar state, lactic acidosis, and perioperative care.
This document discusses the management of diabetes in surgical patients. It covers types of diabetes, glucose homeostasis, stress response and its effects on blood sugar, risks of hyper/hypoglycemia, assessment of diabetic patients before surgery, different protocols for minor vs major surgeries, intravenous insulin protocols, and postoperative care and monitoring of blood sugar levels.
This document discusses guidelines and considerations for clinical trials in hypertension. It provides information on:
1. The increasing global prevalence and costs of hypertension, with an estimated 1.6 billion hypertensive patients by 2025.
2. Guidelines for classifying and treating hypertension from organizations like JNC, WHO, and ESC/ESH. The JNC 8 guideline is evidence-based and recommends treatment thresholds, goals, and medications based on randomized controlled trials.
3. Methodological considerations for designing and conducting clinical trials to evaluate antihypertensive drugs and combinations, including study populations, measures of efficacy like blood pressure and target organ damage, safety aspects, and trial durations. Long-term safety data is important
1. Preoperative evaluation by anesthesiologists has changed from being done on the day of surgery to well in advance, due to fewer patients being admitted before surgery and increased medical comorbidities among surgical patients.
2. Anesthesiologists now play a leading role in preoperative clinics to thoroughly evaluate high-risk patients, ensure medical optimization, and plan perioperative care in order to reduce risks and complications.
3. A comprehensive preoperative history and physical examination is important for determining patient-specific risks, developing an anesthetic plan, and obtaining informed consent.
The STOPAH trial was a large, multicenter randomized controlled trial that compared prednisolone, pentoxifylline, both, or placebo in over 1,000 patients with severe alcoholic hepatitis. It found that neither prednisolone nor pentoxifylline reduced all-cause mortality at 28 days, the primary outcome. Prednisolone showed a non-significant mortality benefit at 28 days but no benefit at 90 days or 1 year, and was associated with increased infections. The trial demonstrated that neither medication improves short-term survival in severe alcoholic hepatitis.
This document provides an overview of preanesthesia evaluation. The key purposes are to obtain relevant medical history, assess perioperative risks, order appropriate tests, and formulate an anesthetic plan. Important components of the medical history include past and current medical problems, medications, allergies, and lifestyle factors. A physical exam focuses on vital signs, airway assessment, and systemic examination. For patients with cardiovascular or pulmonary diseases, specific evaluations and tests are recommended to optimize management and identify high-risk patients. The preanesthesia evaluation aims to detect underlying conditions, evaluate perioperative risks, and develop a customized anesthetic plan tailored to each patient's needs.
This document provides guidelines for the diagnosis of primary aldosteronism, pheochromocytoma, Cushing's syndrome, renal artery stenosis, and evaluating young hypertension. It outlines recommended screening tests and confirmatory tests for each condition. Screening tests include ARR for primary aldosteronism, plasma and urine metanephrines for pheochromocytoma, and various cortisol tests for Cushing's syndrome. Confirmatory tests include saline infusion testing, AVS and subtype evaluation for primary aldosteronism and imaging, genetic testing for pheochromocytoma. The source is then localized for ACTH dependent Cushing's syndrome. Renal artery stenosis is screened for using duplex ultrasound
1. A 35-year old male with type 1 diabetes was admitted with fever, cough, and breathlessness due to right lower lobe pneumonia.
2. Laboratory tests showed elevated HbA1c of 9.1% and fasting blood sugar of 205.5 mg/dl. Chest x-ray found right lower lobe lung consolidation.
3. He was treated with antibiotics, cough suppressants, diabetes medications, and inhalers. His symptoms improved and he was discharged on oral medications with instructions to follow up in one week.
Chlorthalidone for poorly controlled hypertension in chronic kidney diseasesShadab Ahmad
Given the central role of volume excess in the pathogenesis of hypertension in CKD, and the low cost of thiazide diuretics, there is a need to study the use of these drugs to lower BP among patients with uncontrolled hypertension and moderately advanced CKD.
This document discusses leukemia, its common treatments, and presents a case study of acute lymphoblastic leukemia (ALL) in a 15-year-old male patient. The main treatments for leukemia described are chemotherapy, biological therapy, targeted therapy, radiation therapy, and stem cell transplant. The case study provides subjective and objective data for the patient and assessments of acute lymphoblastic leukemia and current therapy management.
This session will help pharmacists enhance their expertise in managing patients with hypertension through updates on the latest hypertension guidelines, discussion on the role that pharmacists can and should play in the detection and ongoing management of hypertension and hands-on experience with blood pressure measurement devices.
The document discusses preoperative and postoperative care. It covers preoperative assessment including history taking, physical examination, and risk assessment. Preoperative preparation includes fasting, blood tests, medication administration, and informed consent. Premedication goals are to reduce anxiety, secretions, and nausea/vomiting. Common premeditations include anticholinergics like atropine and scopolamine, benzodiazepines like diazepam and midazolam, and narcotics like pethidine and morphine. Care is taken to minimize risk and ensure patient safety before, during, and after surgery.
This patient was admitted to the hospital for breathlessness, wheezing, and cough. They have a history of hypertension and type 2 diabetes for 20 years. On examination, their blood pressure was elevated and they showed signs of heart failure. Laboratory tests showed elevated blood glucose and kidney dysfunction. The patient was diagnosed with heart failure due to hypertrophic cardiomyopathy, hypertension, and type 2 diabetes with chronic kidney disease. Over the hospital stay, their symptoms improved with treatment including diuretics, insulin, and blood pressure medications. They were discharged with medications and lifestyle counseling to control their conditions.
Pre-operative medication management involves deciding whether to continue or hold chronic medications in the perioperative period. Principles include obtaining a complete medication history, continuing medications that could cause morbidity if withdrawn abruptly, and holding non-essential medications that could increase surgical risk. For many cardiovascular medications like beta blockers, calcium channel blockers, and ACE inhibitors/ARBs, the recommendation is to continue them perioperatively with close monitoring, though some may be held the morning of surgery. Diuretics are often held the morning of surgery to avoid hypotension, while digoxin and statins are generally continued. H2 blockers and proton pump inhibitors are recommended to prevent stress-related gastric issues.
1) Natriuretic peptides like BNP and NT-proBNP are the most extensively studied and used biomarkers in heart failure. They are useful for diagnosis, assessing prognosis, and monitoring response to treatment.
2) Other biomarkers like troponins, ST2, galectin-3, and inflammatory markers can provide additional prognostic information beyond natriuretic peptides.
3) Biomarkers reflect different pathophysiological processes in heart failure like myocyte injury, stress, remodeling, neurohormonal activation, and inflammation. Used together, they can improve risk stratification and guidance of therapy.
This document discusses managing hypertensive emergencies in the emergency department. It defines hypertension and hypertensive urgency versus emergency. For hypertensive urgency, when BP is markedly elevated but there are no symptoms, treatment is usually not required in the ED and patients can be referred for outpatient follow up. For hypertensive emergency, when there are progressive symptoms of end organ damage, treatment in the ED is warranted to lower BP by about 25% aiming to avoid hypotension. Goals of treatment and commonly used oral and IV antihypertensive agents are reviewed.
Journal club- Enteral Paracetamol or IV Indomethacin for closure of PDAZaheen Zehra
This randomized controlled trial compared the efficacy of enteral paracetamol and intravenous indomethacin for closing a patent ductus arteriosus (PDA) in preterm neonates. 77 preterm infants were randomly assigned to receive either paracetamol drops through a feeding tube every 6 hours for 7 days, or intravenous indomethacin once daily for 3 days. The primary outcome was PDA closure rate assessed by echocardiography. There was no significant difference in PDA closure rates or secondary outcomes like renal impairment between the two groups. The study concluded that oral paracetamol is safe but not superior to intravenous indomethacin for closing a PDA in preterm neonates
Case on type II diabetes mellitus with peripheral neuropathy with hypertensionVineetha Menon
This document describes the case of a 38-year-old female patient admitted to the hospital for giddiness, generalized weakness, burning and tingling sensations in the lower limbs, and blurry vision. She has a history of type 2 diabetes for 3 years and hypertension for 1 year. On examination, she was found to have elevated blood pressure and blood glucose levels. She was diagnosed with type 2 diabetes with peripheral neuropathy and hypertension. Her symptoms improved with treatment including medications to control her blood pressure and blood glucose over her 5 day hospital stay.
Intensive Insulin Therapy In The Medical IcuNadSamm
Intensive insulin therapy (IIT) aimed at maintaining tight glycemic control between 4.4-6.1 mmol/L significantly reduced morbidity but not overall in-hospital mortality compared to conventional insulin treatment targeting levels below 10-12 mmol/L in critically ill adult medical ICU patients. Among patients who received at least 3 days of IIT, in-hospital mortality was reduced from 21% to 14% and complications such as newly acquired kidney injury and length of stay were also lower. However, IIT did not reduce mortality in the overall intention-to-treat analysis and may have caused harm in patients treated for less than 3 days. Further research is needed to confirm these preliminary findings.
Hospital Medicine Update, VA ACP Meeting 2015Jon Sweet
This document summarizes a presentation on papers that have changed the presenter's medical practice. It discusses several clinical cases and the evidence from recent studies on how to best manage them. For a patient with upper GI bleeding admitted after endoscopic treatment, intermittent PPI therapy is shown to be non-inferior to continuous infusion PPI based on multiple randomized trials. For heart failure patients under 75, BNP-guided treatment reduces mortality and hospitalizations compared to clinical guidance alone. Lower steroid doses are associated with better outcomes for COPD patients admitted to the ICU. MRCP or EUS are recommended for evaluating the CBD in patients at intermediate risk of retained stones.
Perioperative management of a patient with diabetes mellitusrajkumarsrihari
This document discusses the perioperative management of patients with diabetes mellitus. It begins by outlining the WHO diagnostic criteria for diabetes. It then discusses the implications of surgery for diabetic patients, including risks of stress-induced hyperglycemia and hypoglycemia. The document provides guidance on preoperative evaluation and investigations for these patients. It covers anesthetic management principles including glucose control and the effects of anesthetic drugs on blood sugar. Finally, it describes diabetic emergencies like diabetic ketoacidosis and hyperosmolar hyperglycemic state.
This document discusses proton pump inhibitors (PPIs) and their interaction with the blood thinner clopidogrel. It notes that PPIs and clopidogrel are among the most commonly prescribed medications. Studies have shown that the PPI omeprazole can reduce the effectiveness of clopidogrel by inhibiting the enzyme CYP2C19 needed to activate clopidogrel. Regulatory agencies now warn against combined use of clopidogrel and omeprazole. Alternative PPIs like pantoprazole may be safer options, and future research is still needed.
managing diabetes in critically ill hospitalized patientssumitverma88
This document discusses the management of diabetes in critically ill hospitalized patients. It covers stress hyperglycemia, causes of stress-induced hyperglycemia, proposed mechanisms, effects of prolonged hyperglycemia, past approaches, results of intensive insulin therapy trials, inpatient glucose metrics, intravenous insulin protocols, hypoglycemia management, transitioning to outpatient care, and management of diabetic ketoacidosis, hyperglycemic hyperosmolar state, lactic acidosis, and perioperative care.
This document discusses the management of diabetes in surgical patients. It covers types of diabetes, glucose homeostasis, stress response and its effects on blood sugar, risks of hyper/hypoglycemia, assessment of diabetic patients before surgery, different protocols for minor vs major surgeries, intravenous insulin protocols, and postoperative care and monitoring of blood sugar levels.
This document discusses guidelines and considerations for clinical trials in hypertension. It provides information on:
1. The increasing global prevalence and costs of hypertension, with an estimated 1.6 billion hypertensive patients by 2025.
2. Guidelines for classifying and treating hypertension from organizations like JNC, WHO, and ESC/ESH. The JNC 8 guideline is evidence-based and recommends treatment thresholds, goals, and medications based on randomized controlled trials.
3. Methodological considerations for designing and conducting clinical trials to evaluate antihypertensive drugs and combinations, including study populations, measures of efficacy like blood pressure and target organ damage, safety aspects, and trial durations. Long-term safety data is important
1. Preoperative evaluation by anesthesiologists has changed from being done on the day of surgery to well in advance, due to fewer patients being admitted before surgery and increased medical comorbidities among surgical patients.
2. Anesthesiologists now play a leading role in preoperative clinics to thoroughly evaluate high-risk patients, ensure medical optimization, and plan perioperative care in order to reduce risks and complications.
3. A comprehensive preoperative history and physical examination is important for determining patient-specific risks, developing an anesthetic plan, and obtaining informed consent.
The STOPAH trial was a large, multicenter randomized controlled trial that compared prednisolone, pentoxifylline, both, or placebo in over 1,000 patients with severe alcoholic hepatitis. It found that neither prednisolone nor pentoxifylline reduced all-cause mortality at 28 days, the primary outcome. Prednisolone showed a non-significant mortality benefit at 28 days but no benefit at 90 days or 1 year, and was associated with increased infections. The trial demonstrated that neither medication improves short-term survival in severe alcoholic hepatitis.
This document provides an overview of preanesthesia evaluation. The key purposes are to obtain relevant medical history, assess perioperative risks, order appropriate tests, and formulate an anesthetic plan. Important components of the medical history include past and current medical problems, medications, allergies, and lifestyle factors. A physical exam focuses on vital signs, airway assessment, and systemic examination. For patients with cardiovascular or pulmonary diseases, specific evaluations and tests are recommended to optimize management and identify high-risk patients. The preanesthesia evaluation aims to detect underlying conditions, evaluate perioperative risks, and develop a customized anesthetic plan tailored to each patient's needs.
This document provides guidelines for the diagnosis of primary aldosteronism, pheochromocytoma, Cushing's syndrome, renal artery stenosis, and evaluating young hypertension. It outlines recommended screening tests and confirmatory tests for each condition. Screening tests include ARR for primary aldosteronism, plasma and urine metanephrines for pheochromocytoma, and various cortisol tests for Cushing's syndrome. Confirmatory tests include saline infusion testing, AVS and subtype evaluation for primary aldosteronism and imaging, genetic testing for pheochromocytoma. The source is then localized for ACTH dependent Cushing's syndrome. Renal artery stenosis is screened for using duplex ultrasound
1. A 35-year old male with type 1 diabetes was admitted with fever, cough, and breathlessness due to right lower lobe pneumonia.
2. Laboratory tests showed elevated HbA1c of 9.1% and fasting blood sugar of 205.5 mg/dl. Chest x-ray found right lower lobe lung consolidation.
3. He was treated with antibiotics, cough suppressants, diabetes medications, and inhalers. His symptoms improved and he was discharged on oral medications with instructions to follow up in one week.
Chlorthalidone for poorly controlled hypertension in chronic kidney diseasesShadab Ahmad
Given the central role of volume excess in the pathogenesis of hypertension in CKD, and the low cost of thiazide diuretics, there is a need to study the use of these drugs to lower BP among patients with uncontrolled hypertension and moderately advanced CKD.
This document discusses leukemia, its common treatments, and presents a case study of acute lymphoblastic leukemia (ALL) in a 15-year-old male patient. The main treatments for leukemia described are chemotherapy, biological therapy, targeted therapy, radiation therapy, and stem cell transplant. The case study provides subjective and objective data for the patient and assessments of acute lymphoblastic leukemia and current therapy management.
This session will help pharmacists enhance their expertise in managing patients with hypertension through updates on the latest hypertension guidelines, discussion on the role that pharmacists can and should play in the detection and ongoing management of hypertension and hands-on experience with blood pressure measurement devices.
The document discusses preoperative and postoperative care. It covers preoperative assessment including history taking, physical examination, and risk assessment. Preoperative preparation includes fasting, blood tests, medication administration, and informed consent. Premedication goals are to reduce anxiety, secretions, and nausea/vomiting. Common premeditations include anticholinergics like atropine and scopolamine, benzodiazepines like diazepam and midazolam, and narcotics like pethidine and morphine. Care is taken to minimize risk and ensure patient safety before, during, and after surgery.
This patient was admitted to the hospital for breathlessness, wheezing, and cough. They have a history of hypertension and type 2 diabetes for 20 years. On examination, their blood pressure was elevated and they showed signs of heart failure. Laboratory tests showed elevated blood glucose and kidney dysfunction. The patient was diagnosed with heart failure due to hypertrophic cardiomyopathy, hypertension, and type 2 diabetes with chronic kidney disease. Over the hospital stay, their symptoms improved with treatment including diuretics, insulin, and blood pressure medications. They were discharged with medications and lifestyle counseling to control their conditions.
Pre-operative medication management involves deciding whether to continue or hold chronic medications in the perioperative period. Principles include obtaining a complete medication history, continuing medications that could cause morbidity if withdrawn abruptly, and holding non-essential medications that could increase surgical risk. For many cardiovascular medications like beta blockers, calcium channel blockers, and ACE inhibitors/ARBs, the recommendation is to continue them perioperatively with close monitoring, though some may be held the morning of surgery. Diuretics are often held the morning of surgery to avoid hypotension, while digoxin and statins are generally continued. H2 blockers and proton pump inhibitors are recommended to prevent stress-related gastric issues.
1) Natriuretic peptides like BNP and NT-proBNP are the most extensively studied and used biomarkers in heart failure. They are useful for diagnosis, assessing prognosis, and monitoring response to treatment.
2) Other biomarkers like troponins, ST2, galectin-3, and inflammatory markers can provide additional prognostic information beyond natriuretic peptides.
3) Biomarkers reflect different pathophysiological processes in heart failure like myocyte injury, stress, remodeling, neurohormonal activation, and inflammation. Used together, they can improve risk stratification and guidance of therapy.
This document discusses managing hypertensive emergencies in the emergency department. It defines hypertension and hypertensive urgency versus emergency. For hypertensive urgency, when BP is markedly elevated but there are no symptoms, treatment is usually not required in the ED and patients can be referred for outpatient follow up. For hypertensive emergency, when there are progressive symptoms of end organ damage, treatment in the ED is warranted to lower BP by about 25% aiming to avoid hypotension. Goals of treatment and commonly used oral and IV antihypertensive agents are reviewed.
Systemic hypertension in children can be primary or secondary. Secondary causes include renal, cardiac, endocrine and exposure to toxins. Diagnosis involves measuring blood pressure over multiple visits and confirming with ambulatory blood pressure monitoring if needed. Treatment focuses on lifestyle modifications initially and medications if needed, with goals of lowering blood pressure below the 90th percentile. Antihypertensive drug classes include ACE inhibitors, calcium channel blockers, thiazide diuretics and others. Severe hypertension requires careful inpatient monitoring and gradual lowering of blood pressure. Long term follow up is needed to monitor blood pressure control.
This patient is a 44-year-old male with uncontrolled hypertension for 5 years on Amlodipine and Ramipril. He has grade 1 retinopathy, elevated uric acid, mild microalbuminuria, and newly diagnosed diabetes. He complains of anxiety, difficulty sleeping, palpitations, and mild ankle edema.
The next best steps are to change medications to better control his blood pressure and protect his organs. Cilnidipine should replace Amlodipine due to its additional sympatholytic and reno-protective effects. Telmisartan should replace Ramipril as it provides better blood pressure control throughout the day. A beta-blocker like Nebivolol can be
Cardiac biomarkers such as BNP and NT-proBNP are useful for diagnosing and monitoring heart failure. The document discusses several studies that found BNP-guided treatment of heart failure reduced mortality rates compared to symptom-guided treatment. Measurement of BNP levels can aid clinical decision making in both acute and ambulatory heart failure patients. While useful, biomarkers have limitations and should be interpreted in the clinical context of each patient.
1) Preoperative hypertension is common and increases the risk of perioperative complications, however well-controlled hypertension may not need surgery postponement.
2) Isolated systolic hypertension over 180 mmHg and high pulse pressure over 80 mmHg are associated with increased risk and reasonable to postpone surgery.
3) Left ventricular hypertrophy and diastolic dysfunction from long-standing hypertension increase perioperative risk and require careful fluid management during surgery.
Video at https://www.youtube.com/watch?v=2rQKMD_5po0
Part of the "Hypoxemia in the Ward Patient with COVID-19" talks in Frederick Southwick's Coursera MOOC on COVID-19, "COVID-19 - A clinical update".
"Dr. Ben Geisler, Hospitalist at Massachusetts General Hospital and Harvard Medical School faculty member reviews the current treatments for COVID-19. He first discusses the management of fluid replacement and diuretics, as well as the indications for bronchodilators and antibiotics. He emphasizes the importance of DVT anticoagulation prophylaxis. He next reviews the potential role of statins, evidence with regards angiotensin converting enzyme inhibitors, and NSAIDS. He next reviews the current indications for the agents of proven efficacy: Remdesivir and Dexamethasone. Finally he discusses the dilemma of equipoise and the best resources for staying up to date with this ever changing topic."
In this iteration, we have added baricitinib and tocilizumab/IL-6 inhibitors.
Dr. Darpan Nepali presented on the gastrointestinal system, specifically on the causes, diagnosis, and management of upper gastrointestinal bleeding. The presentation reviewed the major causes of upper GI bleeding including esophageal and gastric sources. Initial management focuses on resuscitation, risk stratification using scoring systems, and urgent endoscopy. Endoscopic findings and scoring systems can help determine need for hemostatic therapy and predict rebleeding risk. Management differs for variceal versus non-variceal bleeding sources.
A 28-year-old woman was found to have a rare dopamine-secreting pheochromocytoma in her left adrenal gland. She presented with abdominal pain but was otherwise asymptomatic. Testing found significantly elevated dopamine levels in her serum and urine. Preoperative treatment with an alpha-blocker caused hypotension and palpitations. Surgery was performed and she experienced major blood pressure fluctuations, eventually stabilizing after vasopressor therapy. Histopathology and genetic testing confirmed a dopamine-secreting pheochromocytoma without mutations. These tumors are harder to diagnose due to vague symptoms and have a higher risk of malignancy than other pheochromocytoma types.
Hypertension Emergencies and their managementpptxUzomaBende
This Presentation talks about Hyprtension, the mode of presentation of hypertensive crisis and the effective management of hypertensive crisis to prevent case fatalities.
Patient under dialysis with uncontrolled hypertension Haytham Ghareeb
This patient has uncontrolled hypertension despite being on dialysis twice a week and taking multiple antihypertensive medications. There were several issues with his treatment: he was not placed on fluid or sodium restrictions; his interdialytic weight gain was too high; and dialysis frequency and duration were insufficient. Additionally, lifestyle factors like a high salt diet were not addressed. The nephrologist made changes to the dialysis protocol and recommended the patient follow dietary sodium and fluid restrictions to achieve better volume control. Drug therapy was also optimized based on pharmacokinetic properties during dialysis. The goal is to control hypertension while avoiding overly low blood pressure, as both can increase mortality risk in dialysis patients.
Pulmonary embolism (PE) is a blockage in one of the pulmonary arteries in the lungs. The document discusses guidelines and considerations for diagnosing and treating PE. It provides details on:
- Symptoms of PE like shortness of breath and signs like tachycardia.
- Using clinical prediction rules like the Wells criteria to determine pre-test probability and decide on testing.
- Tests like CT scans, VQ scans, and echocardiograms to diagnose PE.
- Risk stratifying patients as low, intermediate, or high risk to guide treatment decisions.
- Initial treatment with anticoagulants like heparin or newer oral medications.
- Long term treatment and
This document outlines the design of a randomized controlled trial testing the effects of empagliflozin versus placebo in patients with heart failure with preserved ejection fraction. Over 5,900 patients were enrolled and followed for a median of 26 months. The primary outcome was a composite of cardiovascular death or hospitalization for heart failure. Empagliflozin reduced the primary outcome compared to placebo and was generally well tolerated aside from higher rates of genital infections.
Vericiguat is a novel oral soluble guanylate cyclase stimulator being studied for the treatment of heart failure. The VICTORIA trial investigated vericiguat for reducing cardiovascular death or heart failure hospitalization in patients with recent worsening of chronic heart failure. The trial found that vericiguat reduced the primary composite outcome compared to placebo with an absolute risk reduction of 4.2 events per 100 patient-years. Vericiguat was well-tolerated overall but increased risks of hypotension and syncope compared to placebo. The results suggest vericiguat may be an effective additional treatment for reducing heart failure hospitalizations and cardiovascular death in patients with recent heart failure decompensation.
A 67-year-old female presented with right upper quadrant abdominal pain following meals and diarrhea for two weeks. Imaging studies including CT, MRI, and MIBG scan revealed bilateral adrenal masses consistent with pheochromocytoma. Laboratory tests showed markedly elevated urine and plasma metanephrines levels confirming the diagnosis. Pheochromocytoma is a rare catecholamine-secreting tumor that arises from chromaffin cells of the adrenal medulla or extra-adrenal paraganglia. It is usually benign but can be malignant in 10% of cases.
Case Report : Integrating Review Inflammation and Commorbid diseasesSoroy Lardo
Diabetes is associated with atherosclerosis and COPD contributed to the chronic inflammation within the systemic vascular. Management of CVI with diabetes and COPD requires multi-disciplinary approach
This document discusses a case of hypertension in a child. It provides details of the child's medical history and symptoms. On examination, elevated blood pressure and signs of end organ damage including retinal changes were found, indicating a hypertensive emergency. Initial investigations revealed mild left ventricular hypertrophy and dysfunction. Biochemical tests supported a diagnosis of pheochromocytoma as the underlying cause of the child's hypertension. The document outlines the goals of treatment for hypertensive emergencies in children and managing the specific case.
Dr Ashling Lillis, National Director's Clinical Fellow Macmillan Support, final year trainee in Acute Oncology
Dr Clare Philliskirk, Trainee in Acute Medicine, West Midlands
Dr Sarbit Clare, Acute Medical Consultant, Sandwell and West Birmingham Hospitals
This document discusses recommendations for treating acute chest syndrome (ACS) in patients with sickle cell disease. It presents a case study of a 31-year-old male patient who presents with symptoms of ACS including chest pain and oxygen saturation of 93%. The document recommends antibiotics of IV cephalosporin and oral macrolide to treat infection. It also recommends simple blood transfusion for patients with ACS and a hemoglobin drop of 1 g/dL or more from baseline, and exchange transfusion for rapidly progressing ACS with oxygen saturation below 90% or increasing respiratory distress.
Approach to secondary hypertension in young patientsNilesh Jadhav
The document discusses the evaluation and management of secondary hypertension in young patients. It is important to take a thorough history, conduct a full physical exam, and order initial tests to identify risk factors and the potential cause of hypertension. While secondary hypertension accounts for about 10% of cases in young patients, an extensive workup is not needed for all newly diagnosed patients. The most common causes of secondary hypertension include renal, renovascular, mineralocorticoid excess, catecholamine excess, and vascular issues. Lifestyle changes and medication are effective for treatment, with the goal of maintaining a blood pressure under 140/90 mmHg.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
-------------------------------------------------------------------------------
Find out more about ISO training and certification services
Training: ISO/IEC 27001 Information Security Management System - EN | PECB
ISO/IEC 42001 Artificial Intelligence Management System - EN | PECB
General Data Protection Regulation (GDPR) - Training Courses - EN | PECB
Webinars: https://pecb.com/webinars
Article: https://pecb.com/article
-------------------------------------------------------------------------------
For more information about PECB:
Website: https://pecb.com/
LinkedIn: https://www.linkedin.com/company/pecb/
Facebook: https://www.facebook.com/PECBInternational/
Slideshare: http://www.slideshare.net/PECBCERTIFICATION
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
Reimagining Your Library Space: How to Increase the Vibes in Your Library No ...Diana Rendina
Librarians are leading the way in creating future-ready citizens – now we need to update our spaces to match. In this session, attendees will get inspiration for transforming their library spaces. You’ll learn how to survey students and patrons, create a focus group, and use design thinking to brainstorm ideas for your space. We’ll discuss budget friendly ways to change your space as well as how to find funding. No matter where you’re at, you’ll find ideas for reimagining your space in this session.
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
1. Management of hypertension crisis
( Pheochromocytoma ) in PICU
CASE PRESENTATION
GHADA EISSA ALMUWALLAD, RN, BSN
NURSING RESIDENCY TRANSITION TO
PRACTICE PROGRAM (PICU)
2. Outlines
•Biographical Data.
•Case Report & Past Medical- Surgical History.
•Physical Assessment.
•Medical Treatment.
•Nursing Care Plan.
•Patient & Family Teaching.
•Alternative Treatment.
•Conclusion.
4. Case Report
Past Medical –Surgical
History
Family-
social History
Al-Madinah
26/December/2018
To 1 north
Endocrine
Suspect case of
“Pheochromocytoma
Chief Complaints
PRRT 27/December2018 due to
hypertension 225/140mmHg.
No medical – surgical history.
No history of inherited disorder.
Child living with their parents, with
moderate socioeconomic status.
(www.heart.org, 2017)
6. Definition
• Pheochromocytoma is a rare cancer that originates
in neural crest cell in the (center medulla) of the
adrenal glands.
(The Cancer Genome Atlas - National Cancer Institute, 2017)
(Farrugia et al., 2017) & (MD Anderson Cancer Center, 2013)
7.
8. Clinical manifestations
•High blood pressure(hypertension).
•Fatigue.
•Muscle weakness or spasms.
•Weight gain or loss.
•Insomnia or other sleep disorders.
•Low potassium levels.
•Headache.
• Rapid or irregular heartbeats.
• Feelings of anxiety, panic, fear.
• Pallor (paleness).
• Dizziness/lightheadedness with standing.
• Tremor.
• Sweating.
(The Cancer Genome Atlas - National Cancer Institute, 2017)
9. Statistic
•Each year, between 2 and 8 people per million worldwide are diagnosed with
paraganglioma and pheochromocytoma.
•Ten percent of all cases occur in children.
In both adults and children, pheochromocytoma is more common than paraganglioma.
•Approximately 90 percent of pheochromocytoma are benign
(The Cancer Genome Atlas - National Cancer Institute, 2017)
10. Physical Assessment
Neurological system Cardiovascular system
• Glasgow Coma Score:
15/15
• Pupil reaction:
Bilateral reactive, regular
, brisk 3 cm
• Headache
• ECG Rhythm : Sinus Tachycardia
• Heart Rate : 140 b/min.
• Blood Pressure : 225/140 mmHg
• Map : 147 mmHg
• Heart Sounds : S1S2
• Neck Veins: Flat
• Pulses: All Strong
• Peripheral Temperature: Warm
• Capillary Refill: Less Than 3
Second
• Palpitation
15. Diagnostictest
Abdomen ultrasound:
There is a heterogeneous pelvic mass adjacent to the urinary bladder that measures up to 5.5 cm. Recommend
MRI for further evaluation.
Abdomen magnetic resonance imaging :
There is a left pelvic presacral mass that measures up to 5.4 cm, likely represents adrenal Pheochromocytomas;
other less likely differential is metastasis.
27/12/2018
30/12/2018
16. Pharmacological
ConsiderationIndicationDoseMedication
Pain assessment.
Respiratory assessment.
Control pain1 mg , IV, prnMorphine
Monitor serum potassium before and
periodically during therapy
Symptoms of hyperkalemia .
Replacement15 mmol, oral, dailyPotassium-chloride
Monitor BP- HR closely. Hypotension
is a common side effect that may
require intervention.
Reduces blood pressure0.13mg, Oral,q6rCentrally acting alpha-
agonist Clonidine
Monitor BP- HR closely. Hypotension
is a common side effect that may
require intervention.
Control blood pressure15mg, Oral, q8hPropranolol
Medical Treatment
17. ConsiderationIndicationRate / DoseInfusion
Measure blood sugar.
Na serum level.
Maintenance50 ml/hr.Dextrose 5% and 0.45% NaCl
1000 mL
Monitor BP- HR closely.
Hypotension is a common
side effect that may require
intervention.
Reduces blood pressure and
heart rate
4 mcg/kg/min, IVNonselective α-adrenergic
antagonist Phentolamine
Overdosage of nitroprusside.
Administration consideration.
Reduces blood pressure
and heart rate
3 mcg/kg/min, IVNitropress , Nitroprusside
Medical Treatment Pharmacological
18. Nursing Care Plan
Assessment Diagnosis Plan Nursing Interventions Outcomes
Subjective
cues:
Headache
Blurred vision
Pain
Objective cues:
High blood
pressure
225/140 mmHg
Decreased
cardiac output
related to
increased
peripheral
vascular
resistance
secondary to
hypertension as
evidence by BP
225/140,.
patient
complaining of
blurred vision,
and headache.
After
intervention the
patient will:
• Maintain BP
within
individually
acceptable
range.
• Verbalize an
absent in a
headache
and blurred
vision within
12 hours.
1. Non- pharmacological:
Dietary management.
2. Pharmacological:
• Administer centrally acting alpha-agonist as
prescribed Clonidine.
• Administer nonselective α-adrenergic
antagonist as prescribed Phentolamine.
• Administer Vasodilator Nitropress as
prescribed Nitroprusside.
• Assessment
after
medication
administion
will reveal
normal Blood
pressure.
• Verbalization
absent of
headache and
blurred vision
within 12
hours.
19. Nursing Care Plan
Assessment Diagnosis Plan Nursing Interventions Outcomes
Subjective cues:
Palpitation
Nausea
Objective cues:
Diaphoresis
Anxiety secondary
to hormonal level
change as evidence
by diaphoresis &
patient verbalized
of experience
palpitation
& nausea.
After intervention the
patient will:
• Appear relaxed and
report anxiety is
reduced to a
manageable level.
• Verbalize awareness of
feelings of anxiety.
• Identify health ways to
deal with and express
anxiety.
1. Non- pharmacological:
Promote comfortable environment
by ( spiritual care, relaxation,
position, light, noisy etc.).
2. Pharmacological:
Administer antihypertension
medication .
Re- assess after
30 minutes, the
patient will
reports relief of
anxiety and
discomfort.
20. Nursing Care Plan
Assessment Diagnosis Plan Nursing Interventions Outcomes
Subjective
cues:
Blurred vision
Objective cues:
Blood Presser :
225/140
mmHg
Risk for fall secondary
to visual difficulties .
After intervention the
patient will:
• Patient will not
sustain fall.
• Patient will
demonstrate
prevention measures.
• Patient and caregiver
will implement
strategies to increase
safety and prevent
fall.
1. Using standard assessment tools,
the level of risk and fall
precautions can be determined.
2. Assess the patient’s environment
factors known to increase fall
risk such as unfamiliar setting,
inadequate lighting, wet
surfaces, and objects on the
floor than adjust it .
Patient and
caregiver prevent
any falling event .
22. Alternative treatment
• There are two types of surgical
intervention to remove the adrenal gland
tumor
(Endocrinediseases.org, 2017) & (Baudin et al., 2014)
• Cytotoxic chemotherapy and
palliative are the first intervention for
malignant cell tumors.
23. Evidence base practice
•The use of metoclopramide is contraindicated in patients with pheochromocytoma. In a study involving patients
with essential hypertension, intravenously administered metoclopramide was shown to induce the release of
catecholamines. Hypertensive crises may occur in patients with pheochromocytoma due to induction of
catecholamine release from the tumor.
Metoclopramide ↔ pheochromocytoma
26. References
•Baudin, E., Habra, M., Deschamps, F., Cote, G., Dumont, F., Cabanillas, M., Arfi-Roufe, J., Berdelou, A., Moon, B., Al
Ghuzlan, A., Patel, S., Leboulleux, S. and Jimenez, C. (2014). THERAPY OF ENDOCRINE DISEASE: Treatment of
malignant pheochromocytoma and paraganglioma. European Journal of Endocrinology, 171(3), pp.R111-R122.
•Bashir, O. (n.d.). Adrenal gland | Radiology Reference Article | Radiopaedia.org. [online] Radiopaedia.org. Available at:
https://radiopaedia.org/articles/adrenal-gland [Accessed 16 Mar. 2019].
•Endocrinediseases.org. (2017). Treatment of Pheochromocytoma. [online] Available at:
http://endocrinediseases.org/adrenal/pheochromocytoma_treatment.shtml [Accessed 16 Mar. 2019].
•Farrugia, F., Martikos, G., Tzanetis, P., Charalampopoulos, A., Misiakos, E., Zavras, N. and Sotiropoulos, D. (2017).
Pheochromocytoma, diagnosis and treatment: Review of the literature. Endocrine Regulations, 51(3), pp.168-181
27. •The Cancer Genome Atlas - National Cancer Institute. (2017). Paraganglioma & Pheochromocytoma. [online] Available at:
https://cancergenome.nih.gov/cancersselected/ParagangliomaPheochromocytoma [Accessed 4 Mar. 2019].
•NORD (National Organization for Rare Disorders). (2019). Pheochromocytoma - NORD (National Organization for Rare
Disorders). [online] Available at: https://rarediseases.org/rare-diseases/pheochromocytoma/ [Accessed 11 Mar. 2019].
•MD Anderson Cancer Center. (n.d.). Adrenal Tumors. [online] Available https://www.mdanderson.org/cancer-types/adrenal-
tumors.html [Accessed 4 Mar. 2019].
•Ramachandran, R. and Rewari, V. (2016). Current perioperative management of pheochromocytomas. Indian Journal of Urology,
0(0), p.0.
•www.heart.org. (2017). Understanding Blood Pressure Readings. [online] Available at: https://www.heart.org/en/health-topics/high-
blood-pressure/understanding-blood-pressure-readings [Accessed 31 Mar. 2019].
References
Editor's Notes
all things have We created in proportion and measure
The adrenal (suprarenal) glands are paired organs of the endocrine system, often asymmetric in shape.
Gross anatomy
the right adrenal gland is usually more pyramidal in shape while the left adrenal gland is more crescentic 7.
The right adrenal gland has a maximum width of 6.1 mm and the left adrenal gland has a maximum width of 7.9 mm 6. Proportionately, the adrenal size is larger in neonates and infants, being almost one-third of the size of the kidney 2-4.
The adrenal gland consists of two portions: an outer cortex and an inner medulla. The gland is covered by a collagenous capsule.
Pheochromocytomas (PHEOs) and extra adrenal paragangliomas (EAP) are neural crest cell tumors associated with catecholamine production and assessed by a metanephrine measurement.
Paraganglioma forms outside of the adrenal gland, along blood vessels and nerves in the head and neck, is called extra-adrenal paraganglioma, or simply paraganglioma.
Reason For Exam
To rule out pheochromocytoma or other malignancy
Elevation of plasma fractionated Normetanephrine -metanephrines.
24-hour urinary Normetanephrine –metanephrines
system suppressant and works by activating alpha 2 adrenergic receptors in the brain and inhibiting norepinephrine release. It reduces blood pressure and heart rate. inhibits renin release from kidneys. Clonidine is used commonly as a sympathetic nervous
Monitor serum potassium before and periodically during therapy. Monitor renal function, serum bicarbonate, and pH. Determine serum magnesium level if patient has refractory hypokalemia; hypomagnesemia should be corrected to facilitate effectiveness of potassium replacement. Monitor serum chloride because hypochloremia may occur if replacing potassium without concurrent chloride. ● Toxicity and Overdose: Symptoms of toxicity are those of hyperkalemia (slow, irregular heartbeat; fatigue; muscle weakness; paresthesia; confusion; dyspnea; peaked T waves; depressed ST segments; prolonged QT segments; widened QRS complexes; loss of P waves; and cardiac arrhythmias)
Phentolamine: prevents hypertension resulting from elevated levels of circulating epinephrine or norepinephrine.
Overdosage of nitroprusside can be manifested as excessive hypotension or cyanide toxicity or as thiocyanate toxicity
Altered cerebral function
Anti hypertsion medication can cause fall
1- disease .
2- diagnostic.
3- medication.
4- fall
all things have We created in proportion and measure
The adrenal (suprarenal) glands are paired organs of the endocrine system, often asymmetric in shape.
Gross anatomy
the right adrenal gland is usually more pyramidal in shape while the left adrenal gland is more crescentic 7.
The right adrenal gland has a maximum width of 6.1 mm and the left adrenal gland has a maximum width of 7.9 mm 6. Proportionately, the adrenal size is larger in neonates and infants, being almost one-third of the size of the kidney 2-4.
The adrenal gland consists of two portions: an outer cortex and an inner medulla. The gland is covered by a collagenous capsule.
all things have We created in proportion and measure
The adrenal (suprarenal) glands are paired organs of the endocrine system, often asymmetric in shape.
Gross anatomy
the right adrenal gland is usually more pyramidal in shape while the left adrenal gland is more crescentic 7.
The right adrenal gland has a maximum width of 6.1 mm and the left adrenal gland has a maximum width of 7.9 mm 6. Proportionately, the adrenal size is larger in neonates and infants, being almost one-third of the size of the kidney 2-4.
The adrenal gland consists of two portions: an outer cortex and an inner medulla. The gland is covered by a collagenous capsule.