Clinical and Nutritional Assessment in the Patient with Short Bowel Syndrome
John K. DiBaise, Carol Rees Parrish, Jon S. Thompson in Short Bowel Syndrome Practical Approach to Management, 2017
Fluid accumulation may be generalized or localized and should be assessed using both inspection and palpation. Fluid retention may result from excessive fluid intake, excess sodium intake, organ failure (i.e., heart, renal, hepatic) or malnutrition and can be appreciated as fluid accumulation in the extremities, face, neck, abdomen, hips, and back. Note if the patient is bedridden and lying with his or her head and feet elevated or if he or she is ambulatory, as edema is body position dependent and tends to pool at the lowest point of gravity. The clinician should evaluate for lower extremity edema starting at the foot and moving up toward the hip. Edema is characterized as pitting or nonpitting. To evaluate for edema, the clinician should press the pad of the fingertip or thumb on the area of the patient’s body that is being assessed with moderate pressure for at least 5 seconds, then remove and observe for the depth of the indentation and time it takes for the surface of the skin to return to normal. Pitting edema is identified when the indentation stays once the fingertip is removed. Pitting edema is further categorized by most clinicians subjectively as mild (1+), moderate (2+), and severe (3+ to 4+) depending on the depth of indentation and amount of time the indentation persists (Figure 9.6) [16]. Nonpitting edema does not leave an indentation after pressure is applied. Fluid can also accumulate in the abdominal cavity (i.e., ascites) and around the lungs and heart (i.e., pleural and pericardial effusion, respectively). These conditions generally require imaging studies to detect.
Steroids (glucocorticoids, corticosteroids)
Ann Richards in Nursing & Health Survival Guide, 2014
Increase with increased dosage. Exaggeration of normal effects of steroids occurs. If given systemically for a period over three weeks adrenal suppression occurs and need to be withdrawn slowly.Hypertension and fluid retention.Muscle wasting, fat redistribution, diabetes mellitus.Osteoporosis and fractures with long-term use.Increased susceptibility to and severity of infections.Occasional psychiatric reactions, e.g. euphoria, nightmares, insomnia, mood swings.
Drug therapy
Jeremy Playfer, John Hindle, Andrew Lees in Parkinson's Disease in the Older Patient, 2018
Amantadine is an unusual drug. Its anti-parkinsonian effect was discovered by chance when it was being used as an anti-viral agent.46 Pharmacologically amantadine resembles anticholinergic drugs. It also appears to have effects modulating dopamine re-uptake and the releasing of dopamine stores. More recently amantadine has been shown to have anti-NMDA receptor activity, blocking the action of glutamate within the basal ganglia circuitry.47 There are reports that it may be beneficial in reducing levodopa-induced dyskinesias.48 The recommended dose for amantadine is 100 mg daily, increased after one week to 100 mg twice daily to a maximum of 400 mg. The drug must be used in caution with the elderly and a daily dose over 200 mg has a significant risk of psychiatric side effects. Amantadine is best used as adjunct therapy. It can give a short-term boost to anti-Parkinson treatments on special occasions for the patient. There are many cautions and potential interactions with this drug. In particular, it should be avoided in patients with hepatic or renal impairment. It may cause significant fluid retention. Gastro-intestinal disturbances, insomnia and anxiety, vasculitis (livedo reticularis) and visual disturbance are side effects which frequently curtail the use of amantadine. In longer-term use it is difficult to withdraw and side effects such as weight loss, cognitive impairment and hallucinations become more evident.
Management of fluid status and cardiovascular function in patients with diffuse skin inflammation
Published in Journal of Dermatological Treatment, 2019
Arash Taheri, Amanda D. Mansouri, Parisa Mansoori, Rahimullah Imran Asad
Patients with chronic, widespread skin inflammation, such as erythroderma, usually develop their pathology and vascular changes gradually over time. First, there is a mild reduction in blood pressure. Patients with access to water and good nutrition will compensate for this reduction in blood pressure by retaining salt and water. Fluid retention leads to an increase in intravascular and extravascular volume and presents as peripheral edema. After adequate compensations, these patients have sufficient preload and venous return to the heart and do not require intravascular fluid infusion. However, the blood pressure of most of these patients remains lower than their baseline due to peripheral vasodilation in the skin. Most patients with good cardiac reserve function can compensate for peripheral vasodilation and blood shunting with increased cardiac output and blood pumping (1). They can maintain their blood pressure at a level sufficient for internal organ perfusion. However, if the heart cannot support increased cardiac output, the patients’ blood pressure may remain too low. Patients with heart failure or reduced cardiac reserve cannot pump more blood to compensate for the shunting of blood through the skin. The resulting hypotension and internal organ hypo-perfusion cause severe compensatory fluid retention, which leads to a significant increase in central venous pressure and pulmonary vascular pressure, decompensated congestive heart failure, and pulmonary edema (17). This condition is called high-output heart failure (12).
Potential clinical value of catheters impregnated with antimicrobials for the prevention of infections associated with peritoneal dialysis
Published in Expert Review of Medical Devices, 2023
Hari Dukka, Maarten W. Taal, Roger Bayston
Peritonitis is associated with significant morbidity and mortality. The treatment of peritonitis requires intra-peritoneal (IP) antibiotics such as vancomycin, second-generation cephalosporins, or aminoglycosides. IP antibiotics are needed for at least 2 weeks and if dialysate white cell count remains greater than 100/µL after day 5 of treatment, then catheter removal is indicated [16]. Catheter removal is generally needed for fungal peritonitis, as it has a high mortality risk [16]. Management of peritonitis is usually conducted in an outpatient setting, unless a patient is septic and/or needs catheter removal. About 20% of peritonitis cases require catheter removal, which is more commonly associated with S. aureus and gram-negative organisms. In one study, peritonitis was associated with a 95% increase in all-cause mortality [5,24]. This is more commonly associated with S. aureus, gram-negative organisms, and fungal peritonitis. Catheter removal also requires transfer to HD at least on a temporary basis, which may compromise a patient’s quality of life especially if they are elderly and comorbid. Peritonitis may also lead to decreased volume of fluid removal due to change in transport status of the peritoneal membrane [25]. This may be temporary or a permanent effect and may lead to significant fluid retention in patients, which has a high risk of mortality.
Subjective Global Assessment of Nutritional Status in Head and Neck Cancer Patients Treated with Radiotherapy – A Prospective Observational Study from North East India
Published in Nutrition and Cancer, 2022
Hima Bora, Mouchumee Bhattacharyya, Apurba Kumar Kalita, Partha Pratim Medhi, Gautam Sarma, Jyotiman Nath, Manoj Kalita, Dimi Ingtipi, Biswajit Sarma
Physical examination: Three features suggestive of nutritional deficiency were to be noted and graded during physical examination of patients. These were, firstly, the Loss of Subcutaneous Fat- to be evaluated over the triceps, under the eyes, at the mid-axillary line over lower ribs, lower back and sides of the trunk. Secondly, the Loss of bulk and tone of muscles (Muscle Wasting) over the temple, clavicle, shoulder, scapula/ribs, quadriceps and interosseous muscle of hand were observed. Lastly, the Presence of edema over the ankles and/or sacral region along with presence of ascites was to be recorded as features of fluid retention. The presence of ascites was verified with 3 weekly whole abdomen ultrasonography. The findings were classified as None, Mild/Moderate and Severe for all the three features as described in SGA form.
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