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1
Lippincott Williams & Wilkins., ed. Signs and symptoms. Philadelphia: Lippincott Williams & Wilkins, 2006.
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2
Chakera, Aron, William G. Herrington, and Christopher A. O’Callaghan. Disorders of acid–base balance. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0178.
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Normal metabolism results in a net acid production of approximately 1 mmol/kg day−1. Physiological pH is regulated by excretion of this acid load (as carbon dioxide) by the kidneys and the lungs. A series of buffers in the body reduces the effects of metabolic acids on body and urine pH. For acid–base disorders to occur, there must be excessive intake (or loss) of acid (or base) or, alternatively, an inability to excrete acid. For these changes to result in a substantially abnormal pH, the various buffer systems must been overwhelmed. The pH scale is logarithmic, so relatively small changes in pH signify large differences in hydrogen ion concentration. Most minor perturbations in acid–base balance are asymptomatic, as small changes in acid or base levels are rapidly controlled through consumption of buffers or through changes in respiratory rate. Alterations in renal acid excretion take some time to occur. Only when these compensatory mechanisms are overwhelmed do symptoms related to changes in pH develop. This chapter reviews the causes and consequences of acid–base disorders.
3
Springhouse. Nurse's Quick Check: Signs and Symptoms (Nurse's Quick Check). Lippincott Williams & Wilkins, 2005.
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4
Springhouse. Nurse's Quick Check: Signs and Symptoms, Philippine Edition (Nurse's Quick Check). Lippincott Williams & Wilkins, 2007.
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5
jornardolion, Alex. Vertigo Symptoms: Tinnitus - Headaches / Migraines - Loss of Balance - Spinning Head - Nausea - Sweating - Double Vision - Twitching - Walking at an Angle - Slurred Speech. Independently Published, 2020.
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6
The Book of Exercise and Yoga for Those with Multiple Sclerosis: Using Movement and Meditation to Improve Balance and Manage Symptoms of Pain and Fatigue. Sacred Space Health Center Inc., 2006.
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7
Zuxiss, Alex. Evening Primrose Oil for Your Health: Brain Function - Eczema - Relieve PMS Symptoms - Hair Care - Nerve Pain for Diabetes - Joint Pain - Skin Health - Osteoporosis - Hormone Balance - Blood Circulation. Independently Published, 2020.
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8
Carpenter, Lynne Christine. DEHYDRATION AND SYMPTOM DISTRESS (CHEMOTHERAPY, FLUID BALANCE). 1994.
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9
Albright, Robert C. Acid-Base and Electrolyte Disorders. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199755691.003.0474.
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The most important principle in understanding disorders of water balance is that sodium balance is determined by the adequacy of the effective circulating volume, while water balance is determined by osmoregulation and the interplay between vasopressin activity, renal concentrating and diluting ability, and thirst. Disorders of sodium balance can be determined only by clinical examination. Orthostatic hypotension implies volume depletion and sodium deficiency. Edema implies volume excess and sodium excess. Potassium is predominantly an intracellular cation. The intracellular balance of potassium is regulated by endogenous factors such as acidemia, sodium, adenosine triphosphatase, insulin, catecholamines, and aldosterone. Clinically, it is absolutely critical to follow a stepwise approach to acid-base disorders. Metabolic acidosis is defined as a primary disturbance in which the retention of acid consumes endogenous alkali stores. This is reflected by a decrease in bicarbonate. Metabolic alkalosis is defined as a primary disturbance in which plasma bicarbonate is increased. The signs and symptoms of metabolic alkalosis include weakness, muscle cramps, hyperreflexia, alveolar hypoventilation, and arrhythmias.
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Beattie, R. Mark, Anil Dhawan, and John W.L. Puntis. Cystic fibrosis. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569862.003.0021.
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Gastrointestinal manifestations 156Management of gastrointestinal symptoms in children with CF 158Nutrition in CF 158Nutritional management 159Vitamins 160The incidence of cystic fibrosis (CF) is around 1 in 2500. Cases are diagnosed as a consequence of population screening or high-risk screening, or following presentation with clinical symptoms typical of the disorder. The basic defect is in the CFTR (cystic fibrosis transmembrane conductance regulator) protein which codes for a cyclic adenosine monophosphate-regulated chloride transporter in epithelial cells of exocrine organs. This is involved in salt and water balance across epithelial surfaces. The gene is on chromosome 7. There are multiple known mutations, the most common being ...
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Welch, Mary R., and Craig Nolan. Chemotherapy and Radiation Therapy. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0143.
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Neurotoxicity is a common problem in oncology practice and neurologists who care for cancer patients encounter a wide range of symptoms attributable to the side effects of radiation and/or chemotherapy. Complications involving the nervous system may be debilitating. Though generally improved by dose reduction or cessation of an offending agent, such symptoms can be irreversible and frequently have a profound impact on quality of life. The appropriate balance between therapeutic efficacy and drug or radiation toxicity requires close attention to the patient’s complaints as well as a thorough understanding of long-term consequences of both the disease and a given treatment’s side effects.
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Chneiweiss, Hervé. Anticipating a therapeutically elusive neurodegenerative condition: Ethical considerations for the preclinical detection of Alzheimer’s disease. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780198786832.003.0016.
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Among neurodegenerative disorders, Alzheimer’s disease has held a special position during the last 40 years. It represents a huge burden of disease with more than 40 million people affected worldwide. The economic effect it has on society is enormous, and the specific challenges of dementia are tremendous. Now that science has demonstrated that the disease starts two or three decades before any symptoms occur, possibilities exist for diagnosis or testing increasingly early through the capabilities of predictive medicine. The related ethical debate is on the multiple meanings and the impact of preclinical diagnosis of Alzheimer’s disease before the onset of symptoms. To guide this discussion, this chapter draws upon lessons from other fields of medicine and the identification of high-risk individuals bearing pathogenic genetic mutations that predispose them to the disease. It concludes with thoughts on value and choice in the complex, fine balance between anticipating, knowing, and doing.
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Luxon, Linda. Vertigo and imbalance. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569381.003.0325.
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The mechanism for maintaining balance in man is complex. Vision, proprioception, and vestibular inputs are integrated in the central nervous system, and modulated by activity from the cerebellum, the extrapyramidal system, the reticular formation, and the cortex. This integrated, modulated information provides one mechanism for control of oculomotor activity, controls posture, gait, and motor skills and allows perception of the head and body in space. Recent evidence also supports an effect upon autonomic function, cognition, and emotion. The complexity of the system is such that pathology in a variety of different bodily systems, including the endocrine system, the cardiovascular system, and the haemopoietic system, can impact upon vestibular activity, in addition to primary otological and neurological pathology.Patients with dysfunction in the vestibular end-organs or vestibular pathways commonly complain of symptoms of dizziness, vertigo, unsteadiness, light-headedness, imbalance, and a plethora of synonyms associated with a sense of instability. Not infrequently, in an attempt to define their ‘unphysiological’ experience, patients use rather vague and imprecise semantics. The clinical distinction between dizziness, a symptom of non-specific pathological significance, and vertigo, a hallucination or illusion of movement, is rarely made, although the latter is a cardinal manifestation of a disorder of the vestibular system (Dix 1973). Ten to 20 per cent of all ‘dizzy’ patients are reportedly seen in neurology clinics (Dieterish 2004), therefore it behoves the neurologist to have a clear diagnostic strategy, including knowledge of detailed neuro-otological examination, to enable appropriate diagnosis and management of the patient with vestibular symptoms.
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Burns, Tom, and Mike Firn. Who is assertive outreach for? Referrals and discharges. Edited by Tom Burns and Mike Firn. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198754237.003.0003.
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This chapter examines the characteristics of patients who need community outreach. It identifies those who most often receive it and those for whom it seems to add little extra. It considers dual diagnosis patients, offender patients, ethnic minority patients, and patients with co-occurring learning disabilities. It also considers the balance between positive and negative symptoms in psychosis and also its suitability for first-onset psychosis. It discusses the value of explicit criteria for both acceptance and discharge and the nature of step-down where that is an option. The processes of acceptance and discharge, with their necessary collaboration, are outlined.
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Zietse, Robert, and Ewout Hoorn. Approach to the patient with hypernatraemia. Edited by Robert Unwin. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0029_update_001.
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Hypernatraemia is much less common than hyponatraemia, and its prevalence is higher in certain populations, including children, the elderly, and critically ill patients. A common feature is that patients affected have been unable to drink water to correct the disorder. Hyponatraemia and hypernatraemia are both primarily disorders of water balance. Hypernatraemia is caused by a relative deficit of total body water in comparison to total body sodium. Both disorders are often associated with disturbances in the hormone governing water balance, arginine vasopressin (antidiuretic hormone). Hypernatraemia may be due to an inability to secrete vasopressin or a resistance to its actions in the kidney. The diagnostic approach relies on the assessment of the time of development, symptoms, and volume status, along with laboratory parameters such as urine sodium and urine osmolality. If hypernatraemia develop acutely, treatment should be directed towards counteracting the water shift to or from brain cells. In more chronic cases, treatment should be directed to the underlying cause while avoiding overcorrection.
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Smith, Robert C., Stefan Leucht, and John M. Davis. Maximizing response to first-line antipsychotics in schizophrenia. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198828761.003.0003.
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The choice of first-line antipsychotic treatment for patients with schizophrenia should balance considerations of differential efficacy of antipsychotics against the relative risk of different side effects. In terms of efficacy, recent meta-analyses have shown that antipsychotics are not equivalent in efficacy. Clozapine, amisulpride, olanzapine, and risperidone show small to moderate, but statistically significant, differences, indicating greater efficacy compared to a number of other antipsychotics on some primary efficacy outcome measures. Amisulpride and cariprazine have the strongest evidence for greater efficacy for treating negative symptoms relative to other antipsychotics. In terms of side effects, clozapine and olanzapine have among the highest weight gain potential and amisulpride has more effects on QTc prolongation and prolactin elevation than other commonly used antipsychotics. Adjunctive treatment with an antidepressant drug may improve response in patients with schizophrenia who also have severe depressive or negative symptoms. For a patient with an inadequate response to an adequate dose and duration of the initial antipsychotic choice, switching to another antipsychotic with a different receptor profile may improve response, although evidence is limited. There is little evidence to support using doses above the therapeutic range other than in exceptional circumstances.
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McCabe, Candy, Richard Haigh, Helen Cohen, and Sarah Hewlett. Pain and fatigue. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0012.
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Pain and fatigue are the prominent problems for those with a rheumatic disease, and are often underestimated by clinicians. Symptoms may fluctuate in quality and intensity over time and commonly will vary over the course of a day. For pain, clinical signs and symptoms will be dependent on the source of the pain and whether causative underlying pathology is identifiable or not. Fatigue may range from mild effects to total exhaustion and may include cognitive and emotional elements, with a complex, probably multicausal, pathway. Theoretical knowledge of potential mechanistic pathways for pain and fatigue should be used to inform assessment and treatment approaches. Best practice recommends a multidisciplinary and holistic treatment approach with the patient an active participant in the planning of their care, and self-management. Many patients with chronic musculoskeletal conditions will not achieve a pain-free or fatigue-free status. Medication use must therefore balance potential benefit against short- and long-term side effects. Rheumatology centres should offer specific fatigue and pain self-management support as part of routine care. Emphasis should be given to facilitating self-management strategies for both pain and fatigue to help the patient optimize their quality of life over years or a lifetime of symptoms. Interventions should include behaviour change and cognitive restructuring of pain/fatigue beliefs, as well as access to relevant self-help groups and charitable organizations. Referral for specialist advice from regional or national clinics on pain relief and management should be considered if pain interferes significantly with function or quality of life despite local interventions.
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McCabe, Candy, Richard Haigh, Helen Cohen, and Sarah Hewlett. Pain and fatigue. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199642489.003.0012_update_001.
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Pain and fatigue are the prominent problems for those with a rheumatic disease, and are often underestimated by clinicians. Symptoms may fluctuate in quality and intensity over time and commonly will vary over the course of a day. For pain, clinical signs and symptoms will be dependent on the source of the pain and whether causative underlying pathology is identifiable or not. Fatigue may range from mild effects to total exhaustion and may include cognitive and emotional elements, with a complex, probably multicausal, pathway. Theoretical knowledge of potential mechanistic pathways for pain and fatigue should be used to inform assessment and treatment approaches. Best practice recommends a multidisciplinary and holistic treatment approach with the patient an active participant in the planning of their care, and self-management. Many patients with chronic musculoskeletal conditions will not achieve a pain-free or fatigue-free status. Medication use must therefore balance potential benefit against short- and long-term side effects. Rheumatology centres should offer specific fatigue and pain self-management support as part of routine care. Emphasis should be given to facilitating self-management strategies for both pain and fatigue to help the patient optimize their quality of life over years or a lifetime of symptoms. Interventions should include behaviour change and cognitive restructuring of pain/fatigue beliefs, as well as access to relevant self-help groups and charitable organizations. Referral for specialist advice from regional or national clinics on pain relief and management should be considered if pain interferes significantly with function or quality of life despite local interventions.
19
Hoorn, Ewout J., and Robert Zietse. Approach to the patient with hyponatraemia. Edited by Robert Unwin. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0028.
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Hyponatraemia is the most common electrolyte disorder in hospitalized patients and is primarily a water balance disorder. Therefore, hyponatraemia is due to a relative excess of water in comparison with sodium in the extracellular fluid volume. Hyponatraemia is usually due to the release of vasopressin despite hypo-osmolality; this secretion is either ‘appropriate’ (i.e. due to a low intravascular volume) or ‘inappropriate’. The diagnostic approach to hyponatraemia relies on the assessment of the time of development, symptoms, and volume status, along with laboratory parameters such as urine sodium and urine osmolality. Complications are mainly neurological and usually depend on the rate of development and correction. If hyponatraemia develops acutely, treatment should be directed towards counteracting the water shift to or brain cells. Conversely, in more chronic cases of hyponatraemia, treatment should be directed at the underlying cause, while avoiding over-correction.
20
Rondinone, Troy. Nightmares. University of Illinois Press, 2017. http://dx.doi.org/10.5406/illinois/9780252037375.003.0015.
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This chapter first describes the physical toll boxing took on boxers such as Gaspar Ortega and Emile Griffith. Research shows that boxers suffer disproportionally from neurological damage. The scientific term for it is chronic traumatic brain injury. The results are permanent and progressive. Symptoms include Parkinsonism, dementia, personality changes, and cerebellum dysfunction. Gaspar began suffering from nightmares. Griffith exhibited brain damage while Don Jordan lost his mind as well. The remainder of the chapter details Gaspar's life and activities after retiring from boxing. The brain damage that wiped the joy out of the golden years of so many of this boxing cohort did not strike Gaspar. He attributes this to his defensive, slippery style. Though he is occasionally off balance when he walks, that is minor compared to the devastation that brought such misery to so many other retired fighters.
21
Neligan, Patrick J., and Clifford S. Deutschman. Pathophysiology and causes of metabolic acidosis in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0255.
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Critical illness is typically characterized by changes in the balance of water and electrolytes in the extracellular space, resulting in the accumulation of anionic compounds that manifests as metabolic acidosis. Metabolic acidosis manifests with tachypnoea, tachycardia, vasodilatation, headache and a variety of other non-specific symptoms and signs. It is caused by a reduction in the strong ion difference (SID) or an increase in weak acid concentration (albumin or phosphate). Increased SID results from hyperchloraemia, haemodilution or accumulation of metabolic by-products. A reduction in SID results in a corresponding reduction is serum bicarbonate. There is a corresponding increase in alveolar ventilation and reduced PaCO2. Lactic acidosis results from increased lactate production or reduced clearance. Ketoacidosis is associated with reduced intracellular glucose availability for metabolism, and is associated with insulin deficiency and starvation. Hyperchloraemic acidosis is associated with excessive administration of isotonic saline solution, renal tubular acidosis and ureteric re-implantation. Renal acidosis is associated with hyperchloraemia, hyperphosphataemia, and the accumulation of medley nitrogenous waste products.
22
Fairbank, Jeremy. Management of neurogenic claudication and spinal stenosis. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.003008.
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♦ Neurogenic claudication is a common symptom♦ Back pain and leg pain occur with standing and walking♦ Spinal stenosis may be developmental or acquired or a combination of both♦ An important spinal differential diagnosis is loss of sagittal balance♦ There are many causes, both medical and orthopaedic, that may contribute to difficulty with walking and poor outcomes from surgical treatment.
23
Hill, Douglas L., and Chris Feudnter. Hope in the Midst of Terminal Illness. Edited by Matthew W. Gallagher and Shane J. Lopez. Oxford University Press, 2017. http://dx.doi.org/10.1093/oxfordhb/9780199399314.013.19.
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Although palliative and hospice care services are increasingly available, many adults and children still die without this kind of support or receive it only in the last few days of life, as many patients, family members, and clinicians equate the initiation of these services with loss of hope. This chapter presents a model of how hopeful patterns of thinking and a balance of positive and negative affect may facilitate a regoaling process in which individuals transition from cure-seeking goals to other personally meaningful goals that are attainable at the end of life or while living with a serious chronic illness. Understanding different forms of hopeful thinking, goals, and self-concepts among dying patients and their families can help clinicians provide support through this difficult experience and achieve better quality of life and symptom management for patients and better quality of life and long-term adjustment for family members.
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Baloh, Robert W. Ménière Recognizes That Vertigo Can Originate from the Inner Ear. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190600129.003.0002.
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Prosper Ménière was the first clinician to conclude that vertigo can result from diseases of the inner ear. The symptom of vertigo originally fell under the rubric of apoplectiform cerebral congestion, a disorder thought to result from overfilling of blood vessels in the brain. Ménière noted that patients with vertigo and hearing loss associated with damage to the inner ear often have a benign course, and aggressive treatments such as bleeding can be more dangerous than the underlying disease. The first hint that the semicircular canals may be related to balance rather than hearing was provided by a Frenchman, Marie Jean Pierre Flourens. He systematically cut each semicircular canal in the pigeon and noted that the animal’s head and body tended to move in the plane of the damaged canal. The gyrations of the animals described by Flourens made Ménière think that vertigo in humans might be a similar phenomenon.
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Rashid, Tayyab, and Martin Seligman. Positive Psychotherapy. Oxford University Press, 2018. http://dx.doi.org/10.1093/med-psych/9780190920241.001.0001.
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Positive psychotherapy (PPT) is a therapeutic endeavor within positive psychology that aims to alleviate symptomatic stress by way of enhancing well-being. Traditional psychotherapy does a good job of making clients feel, for example, less depressed or less anxious, but the well-being of clients is not an explicit goal. Positive psychology studies the conditions and processes that enable individuals, communities, and institutions to flourish. PPT integrates symptoms with strengths, risks with resources, weaknesses with values, and regrets with hopes, in order to understand the inherent complexities of human experience in a balanced way. This workbook contains 15 chapters (plus an introduction and conclusion) to correspond with the skills and practices clients learn in session. Each session focuses on one or more practice; every chapter also includes three things to know about the main topic, worksheets, reflection and discussion points, and “in real life” client stories. Each chapter also includes a list of relevant books, videos, and websites related to the issues discussed in the chapter.
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Rashid, Tayyab, and Martin P. Seligman. Positive Psychotherapy. Oxford University Press, 2018. http://dx.doi.org/10.1093/med-psych/9780195325386.001.0001.
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Positive psychotherapy (PPT) is a therapeutic endeavor within positive psychology that aims to alleviate symptomatic stress by way of enhancing well-being. Traditional psychotherapy does a good job of making clients feel, for example, less depressed or less anxious, but the well-being of clients is not an explicit goal. Positive psychology studies the conditions and processes that enable individuals, communities, and institutions to flourish. PPT integrates symptoms with strengths, risks with resources, weaknesses with values, and regrets with hopes, in order to understand the inherent complexities of human experience in a balanced way. Without dismissing or minimizing the client’s concerns, the PPT clinician empathically understands and attends to pain associated with trauma and simultaneously explores the potential for growth. This clinician’s manual contains 15 PPT sessions, with core concepts, guidelines, skills, and worksheets for practicing these skills. Each session focuses on one or more practice and includes a Fit & Flexibility section that presents various ways that PPT practices can work (without losing their core elements) given clients’ specific situations. Each session includes at least one vignette as well as cross-cultural implications.
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Kreitzer, Mary Jo, Mary Koithan, and Andrew Weil, eds. Integrative Nursing. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190851040.001.0001.
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Fully updated and revised, the second edition of Integrative Nursing is a complete roadmap to holistic patient care, providing a step-by-step guide to assess and clinically treat conditions through a variety of combined methodologies including traditional and alternative therapies with all aspects of lifestyle. This text identifies both the skills and theoretical frameworks for interprofessional systems leaders to consider and implement integrative healthcare strategies within institutions, including several case studies involving practical nursing-led initiatives. This volume covers the foundations of the field; the most effective ways to optimize wellbeing; principles of symptom management for many common disorders like sleep, anxiety, pain, and cognitive impairment; the application of integrative nursing techniques in a variety of clinical settings and among a diverse patient population; and integrative practices around the world and how they impact planetary health. The academic rigor of the text is balanced by practical and relevant content that can be readily implemented into practice for both established professionals as well as students enrolled in undergraduate or graduate nursing programs. Integrative health and medicine is defined as healing-oriented care that takes account of the whole person (body, mind, and spirit) as well as all aspects of lifestyle; it emphasizes the therapeutic relationship and makes use of appropriate therapies, both conventional and alternative. Series editor Andrew Weil, MD, is Professor and Director of the Arizona Center for Integrative Medicine at the University of Arizona. Dr. Weil’s program was the first such academic program in the U.S., and its stated goal is “to combine the best ideas and practices of conventional and alternative medicine into cost effective treatments without embracing alternative practices uncritically.”
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Lambert, Simon M. Instability. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.004007.
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♦ The fundamental principle or essence of the shoulder is concavity compression. Stability of the shoulder is the condition in which a balanced centralizing joint reaction force (CJRF) exists to maintain concavity compression of the glenohumeral joint whatever the position of the limb and hand.♦ Instability is a symptom. It can be defined as the condition of symptomatic abnormal motion of the joint. It refers to a perturbation of concavity compression. It is not a diagnosis.♦ Instability is the result of perturbations of structural factors and non-structural factors.♦ The clinical syndrome of instability is a disturbance of one or more of these factors in isolation or together. The relative importance of each factor to the syndrome can change over time. The relationship between these factors is described by the Stanmore triangle.♦ Both structural and non-structural factors can be perturbed by arrested or incomplete development (dysplasia) or by injury (disruption).♦ The aim of treatment is the restoration of (asymptomatic) stable motion by restoration of the CJRF and so restoration of the condition of concavity compression.♦ Management follows simple principles: surgery should be undertaken within the context of a well-considered rehabilitation program largely centred around optimizing rotator cuff function.♦ Failures of management are often due to failure of or incomplete diagnosis, failure of healing, inadequate attention to patient- and pathology- specific rehabilitation programs, or insufficient attention to lifestyle considerations.♦ Disrupted anatomy is restored, preferably by anatomic operations with predictably good outcomes. Dysplastic anatomy is augmented, often by non-anatomic operations with less predictable outcomes. Revision stabilizations are generally nonanatomic, and have higher failure rates.