Electrolytes Case Study

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

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

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

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

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

Transplant ( NODAT ) : Risk Factors For Overcome...
Abstract New onset diabetes after transplant (NODAT) is an important complication after transplantation that increases risk for poor patient and graft
outcomes. Recent studies in children identified older age, extremes of body mass index (BMI), and corticosteroid use at discharge as risk factors for
NODAT. However, these studies were conducted in a national sample which underrated certain patient groups like deceased donor transplants and
African American recipients. The purpose of this study was to determine the association between acute rejection (a surrogate for increased
corticosteroid exposure) and NODAT in a pediatric kidney transplant program. A retrospective chart review was performed on a cohort of 121
consecutive pediatric kidney... Show more content on Helpwriting.net ...
The main risk factors include age в‰Ґ50 years old, male gender, family history of diabetes, and high systolic pulmonary artery pressure (PAP)
>50mmHg.1,2 A review of data from the United States Renal Data System for primary renal transplant recipients в‰¤21 years old transplanted
between 1995 and 2004 found the following risk factors for NODAT: African American children, BMI в‰
Ґ 30, increased age of child at time of
transplant (в‰Ґ13 years old), discharged on tacrolimus, and cytomegalovirus donor positive/recipient negative status.2 Cytomegalovirus (CMV) is
herpes virus that is present in over sixty percent of adults that generally only causes non–specific fever and flu–like symptoms in immunocompetent
hosts. In immunosuppressed transplant patients however, the virus can develop into a systemic infection involving several organ systems and
increase the risk for transplant rejection.3 Other studies in children also identified corticosteroid use at discharge as a risk factors for NODAT.4 There
have been no studies exploring the risk factors for NODAT in a population similar to that at Children's of Alabama, which is distinct due to a large
number of deceased donor transplants and African–American recipients with higher immunologic risk. The purpose of this study was to determine the
association between acute rejection (a surrogate for increased corticosteroid exposure) and NODAT in this kidney transplant program. Methods Before
initiation of this research, a literature

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

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

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

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

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

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

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

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

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

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

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

Chemoprevention Essay
Chemoprevention is assigned by either selecting prevention of esophageal acid exposure using proton pump inhibitor (PPI) therapy or modulation of
pro–inflammatory mechanisms45. Proton pump inhibitors (PPIs) are used generally in the handling of acid–related disorders. They function by
permanently obstructing the hydrogen/potassium adenosine triphosphatase enzyme system (the H+/K+ ATPase, or, more frequently, the gastric proton
pump) of the gastric parietal cells. The proton pump is the terminal stage in gastric acid secretion and is directly accountable for secreting H+ ions into
the gastric lumen, leading the pump to be an excellent target for preventing acid secretion. Targeting the terminal step in acid production, as well as the
irreversible nature of the inhibition, results in a class of drugs that are considerably more efficient than H2 ... Show more content on Helpwriting.net ...
This class of medication has been available for commercial use for almost 25 years, and it has exceeded the use of histamine 2 receptor antagonists
(H2RA) for patients with moderate to severe gastric acid–related diseases as well as for prophylaxis of upper gastrointestinal (GI) injury (with
nonsteroidal anti–inflammatory drugs). PPI therapy can lead to partial regression of intestinal metaplasia (IM) in BE patients, as demonstrated by the
development of macroscopic islands of squamous epithelium and the accompanying shortening of columnar epithelium, although inconsistently46, 47.
The absolute indications for PPI therapy comprise peptic ulcer disease, chronic nonsteroidal anti–inflammatory drugs use, treatment of Helicobacter
pylori, and erosive esophagitis. Despite a substantial decrease in the risk of neoplastic progression in patients with BE on prolonged PPI use, total
eradication of BE with medical therapy alone is rarely, if ever,

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

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

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

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

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

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

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

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

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

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

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

Questions On Drug Information Services
UNIVERSITY OF RHODE ISLAND
COLLEGE OF PHARMACY
DRUG INFORMATION SERVICES
Formulary Monograph
DATE:May 2015
DRUG REQUESTED:1Posaconazole (poe–sa–KON–a–zole)
TRADE NAME:1NoxafilВ®
MANUFACTURER:1–3Merck Sharp & Dohme Corp.
PHARMACOLOGIC CLASS:1–3Azole antifungal
AHFS CLASSIFICATION NUMBER:48.14.08
EXECUTIVE SUMMARY:
Posaconazole is an azole antifungal indicated for the prevention of invasive aspergillus and candida infections in severely immunocompromised
patients, and for the treatment of oropharyngeal candidiasis in HIV patients and oropharyngeal candidiasis refractory to fluconazole and itraconazole.3
Posaconazole is available in delayed release tablets, an oral suspension, and as an intravenous injection.2
Posaconazole is approved for adults and children 13 years of age and older who are at a high risk of developing aspergillus or candida infections
including hematologic malignancies, chemotherapy induced neutropenia, and stem cell transplant recipients with graft–versus–host disease. The
Infectious Diseases Society of America recommends posaconazole as first line therapy for prophylaxis of invasive aspergillus infections in these
patients and as first line for prophylaxis in candidiasis in chemotherapy induced neutropenia and stem cell recipients with neutropenia. The IDSA

recommends posaconazole for the treatment of oropharyngeal candidiasis that is refractory to fluconazole or itraconazole, or in patients with

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

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

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

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

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

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

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

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

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

Electrolytes Case Study

Recommended

Recommended

More Related Content

More from Amy Nelson

More from Amy Nelson (20)

Recently uploaded

Recently uploaded (20)

Electrolytes Case Study