♦ Neurotransmitter deficiency

♦ Aluminum and manganese

♦ Trauma

♦ Genetic abnormality on chromosome 21

♦ Slow-growing central nervous system viruses

♦ Position emission tomography shows metabolic activity of the cerebral cortex.

♦ Computed tomography scan shows excessive and progressive brain atrophy.

♦ Magnetic resonance imaging rules out intracranial lesions.

♦ Cerebral blood flow studies show abnormalities in blood flow to the brain.

♦ Cerebrospinal fluid analysis shows chronic neurologic infection.

♦ EEG evaluates the brain’s electrical activity and may show slowing of brain waves in the late stages of the disease.

♦ Neuropsychologic tests may show impaired cognitive ability and reasoning.

♦ Arteriography shows the type, location, and degree of obstruction and any collateral circulation.

♦ Ultrasonography and plethysmography show decreased blood flow distal to the occlusion.

♦ Doppler ultrasonography has a relatively low-pitched sound and shows a monophasic waveform.

♦ EEG and computed tomography scan may show brain lesions.

♦ Segmental limb pressures and pulse volume measurements show the location and extent of the occlusion.

♦ Ophthalmodynamometry shows the degree of obstruction in the internal carotid artery.

♦ Electrocardiogram may show cardiovascular disease.

♦ Use preventive measures, such as minimal pressure mattresses, heel protectors, a foot cradle, or a footboard.

♦ Avoid constrictive clothing, including antiembolism stockings.

♦ Give prescribed drugs.

♦ Allow the patient to express fears and concerns.

♦ Determine the patient’s circulatory status.

♦ Give prescribed analgesics.

♦ Give prescribed heparin or thrombolytics.

♦ Wrap the patient’s affected foot in soft cotton batting, and reposition it frequently to prevent pressure on any one area.

♦ Strictly avoid elevating or applying heat to the affected leg.

♦ Watch the patient closely for signs of hemorrhage.

♦ If the patient has mesenteric artery occlusion, connect a nasogastric tube to low intermittent suction.

♦ Give prescribed analgesics.

♦ Assist with early ambulation, but don’t let the patient sit for a long period.

♦ After amputation, check the residual limb carefully for drainage, and note and record the color and amount of drainage as well as the time.

♦ Elevate the residual limb, as ordered.

♦ Monitor pulses, color, and temperature of affected limb.

♦ Animal dander

♦ Food additives that contain sulfites or other sensitizing substances

♦ House dust or mold

♦ Kapok or feather pillows

♦ Pollen

♦ Emotional stress

♦ Genetic factors

♦ Cold air

♦ Drugs, such as aspirin, betaadrenergic blockers, and nonsteroidal anti-inflammatories

♦ Exercise

♦ Hereditary predisposition

♦ Psychological stress

♦ Sensitivity to allergens or irritants such as pollutants

♦ Tartrazine

♦ Viral infections

♦ Arterial blood gas (ABG) analysis shows hypoxemia.

♦ Increased serum immunoglobulin E levels are caused by an allergic reaction.

♦ A complete blood count with differential shows an increased eosinophil count.

♦ Chest X-rays may show hyperinflation and areas of focal atelectasis.

♦ Pulmonary function tests may show decreased peak flow and forced expiratory volume in 1 second, low-normal or decreased vital capacity, and increased total lung and residual capacities.

♦ Skin testing may identify specific allergens.

♦ Bronchial challenge testing shows the clinical significance of allergens that are identified by skin testing.

♦ Pulse oximetry measurements may show decreased oxygen saturation.

♦ Arterial blood gas analysis shows decreased partial pressure of oxygen and normal or increased partial pressure of carbon dioxide.

♦ Sputum culture shows many microorganisms and neutrophils.

♦ Chest X-ray may show hyperinflation and increased bronchovascular markings.

♦ Pulmonary function test results show increased residual volume, decreased vital capacity and forced expiratory flow, and normal static compliance and diffusing capacity.

♦ Electrocardiography may show atrial arrhythmias; peaked P waves in leads II, III, and aVF; and right ventricular hypertrophy.

♦ Alkaline phosphatase levels and liver function test results show distant metastasis.

♦ A hormonal receptor assay determines whether the tumor is estrogenor progesterone-dependent and guides decisions about therapy that blocks the
action of estrogen, which may support tumor growth.

♦ Mammography can show a tumor that’s too small to palpate.

♦ Ultrasonography can distinguish between a fluid-filled cyst and a solid mass.

♦ Chest X-rays can pinpoint metastasis in the chest.

♦ Magnetic resonance imaging can reveal more detailed information about breast tissue, when necessary.

♦ Scans of the bone, brain, liver, and other organs can detect distant metastasis.

♦ Fine-needle aspiration and excisional biopsy provide cells for histologic examination that may confirm the diagnosis.

♦ A fecal occult blood test may show blood in the stools, a warning sign of rectal cancer.

♦ The carcinoembryonic antigen test permits patient monitoring before and after treatment to detect metastasis or recurrence.

♦ Excretory urography verifies bilateral renal function and allows inspection to detect displacement of the kidneys, ureters, or bladder by a tumor pressing against these structures.

♦ Barium enema studies use dual contrast of barium and air to show the location of lesions that aren’t detectable manually or visually. This test shouldn’t precede colonoscopy or excretory urography because barium sulfate interferes with these tests.

♦ A computed tomography scan allows better visualization if a barium enema test yields inconclusive results or if metastasis to the pelvic lymph nodes is suspected.

♦ Proctoscopy or sigmoidoscopy permits visualization of the lower GI tract. It can detect up to 66% of colorectal cancers.

♦ Colonoscopy permits visual inspection and photography of the colon up to the ileocecal valve and provides access for polypectomy and biopsy of suspected lesions.

♦ Digital rectal examination can be used to detect almost 15% of colorectal cancers; specifically, it can be used to detect suspicious rectal and perianal lesions.

♦ Bowel function

♦ Complications

♦ Electrolyte levels

♦ Hydration and nutritional status

♦ Intake and output

♦ Pain control

♦ Psychological status

♦ Vital signs

♦ Wound site

♦ Serum prostate-specific antigen (PSA) level is elevated. (An elevated PSA level may indicate cancer with or without metastases.)

♦ Transrectal prostatic ultrasonography shows the size of the prostate and the presence of abnormal growths.

♦ Bone scan and excretory urography determine the extent of disease.

♦ Magnetic resonance imaging and computed tomography scan define the extent of the tumor.

♦ The standard screening tests are DRE and PSA test. Positive results on these tests identify cancer. The American Cancer Society recommends yearly screening for men older than age 40.

♦ Myocardial perfusion imaging with thallium 201 during treadmill exercise shows ischemic areas of the myocardium. These are visualized as “cold spots.”

♦ Pharmacologic myocardial perfusion imaging in arteries with stenosis shows a decrease in blood flow that’s proportional to the percentage of occlusion.

♦ Multiple-gated acquisition scanning shows cardiac wall motion and reflects injury to cardiac tissue.

♦ Electrocardiographic findings may be normal between anginal episodes. During angina, the findings may show ischemic changes.

♦ Exercise testing may be performed to detect ST-segment changes during exercise, which indicate ischemia, and to determine a safe exercise prescription.

♦ Coronary angiography shows the location and degree of coronary artery stenosis or obstruction, the collateral circulation, and the condition of the artery beyond the narrowing.

♦ Echocardiography may show abnormal wall motion.

♦ Race

♦ Obesity: BMI ≥ 27 kg/m2

♦ History of gestational diabetes, previous glucose intolerance, or delivery of an infant weighing >9 lb (4.1 kg)

♦ HDL ≤ 35 mg/dl or triglyceride level ≥ 250 mg/dl

♦ Hypertension: ≥ 140/90 mm Hg

♦ Age ≥ 45

♦ Sedentary lifestyle

Unless a diabetic woman’s glucose levels are well controlled before conception and during pregnancy, her neonate has two to three times the risk of congenital malformations and fetal distress.

♦ Rapidly developing symptoms

♦ Family history of diabetes mellitus

♦ Other endocrine diseases

♦ Pregnancy

♦ Recent stress or trauma

♦ Severe viral infection

♦ Use of drugs that increase blood glucose levels

♦ Vague, long-standing symptoms that develop gradually

♦ Fasting plasma glucose level is 126 mg/dl or greater on at least two occasions.

♦ Random blood glucose level is 200 mg/dl or greater.

♦ Two-hour postprandial blood glucose level is 200 mg/dl or greater.

♦ Glycosylated hemoglobin value is increased.

♦ Urinalysis may show acetone or glucose.

♦ Ophthalmologic examination may show diabetic retinopathy.

♦ Arterial blood gas analysis shows decreased partial pressure of oxygen;
partial pressure of carbon dioxide is normal until late in the disease.

♦ Red blood cell count shows an increased hemoglobin level late in the disease.

♦ Chest X-ray may show:

– a flattened diaphragm

– reduced vascular markings at the lung periphery

– overaeration of the lungs

– a vertical heart

– enlarged anteroposterior chest diameter

– a large retrosternal air space.

♦ Pulmonary function tests typically show:

– increased residual volume and total lung capacity

– decreased vital capacity

– reduced diffusing capacity

– increased inspiratory flow.

♦ Electrocardiography may show tall, symmetrical P waves in leads II, III, and aV_F; a vertical QRS axis; and signs of right ventricular hypertrophy late in the disease.

♦ Gram stain, stool culture (by direct rectal swab), or blood culture shows the causative agent.

♦ Barium swallow with fluoroscopy shows evidence of recurrent reflux.

♦ Ambulatory 24-hour pH monitoring shows the degree of gastroesophageal reflux and is the gold standard for diagnosis when endoscopy is negative.

♦ Gastroesophageal scintillation testing shows reflux.

♦ Esophageal manometry shows abnormal LES pressure and sphincter incompetence.

♦ The result of an acid perfusion (Bernstein) test confirms esophagitis.

♦ The results of esophagoscopy (endoscopy) and biopsy confirm pathologic changes in the mucosa in some patients.