Diagnostic Tests for Halitosis
Halitosis Tests: Book Excerpts
Halitosis Diagnosis: Book Excerpts
Diagnosis of Halitosis: medical news summaries:
The following medical news items
are relevant to diagnosis of Halitosis:
Diagnostic Tests for Halitosis: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Halitosis.
HALITOSIS:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine tests include a CBC and sedimentation rate to rule out chronic inflammation; a chemistry panel to rule out uremia and cirrhosis; and sputum, nose, and throat cultures to rule out chronic infections of the sinuses, nose, throat, and lungs. Cultures of any suspicious area of inflammation in the mouth, nose, and throat should be done. X-rays of the teeth, sinuses, and chest should also be done. An upper GI series and esophagogram will help diagnose reflux esophagitis, peptic ulcer, partial intestinal obstruction, and esophageal diverticula.
A 24-hr sputum collection may help differentiate bronchiectasis and lung abscesses. A tuberculin test and sputum for AFB smear, culture, and possible guinea pig inoculation may identify tuberculosis.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
ODOR:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine laboratory work includes a CBC, urinalysis, chemistry panel, blood alcohol level, and tests for serum acetone and serum amino acids. Urine for chromatography may help pick up certain keto acids. A culture of the mouth, gums, and nasopharynx may be necessary to diagnose anaerobic infections.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
ANOSMIA OR UNUSUAL ODORS:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
If the disorder is acute and associated with a URI, nothing need be done. However, if the condition has been of gradual onset, the nasopharyngeal examination is negative, and the history of drugs is negative, then a CT scan of the brain should be done. If this is negative, a workup for systemic disease should be done, and that should include a CBC and chemistry panel, thyroid profile, serum B
12
and folic acid, glucose tolerance test, and liver profile. If the anosmia or unusual odors are intermittent, a wake-and-sleep EEG should be done.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Breath with fecal odor:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient's condition permits, ask about previous abdominal surgery because adhesions can cause an obstruction. Also ask about loss of appetite. Is the patient experiencing abdominal pain? If so, have him describe its onset, duration, and location. Ask if the pain is intense, persistent, or spasmodic. Have the patient describe his normal bowel habits, especially noting constipation, diarrhea, or leakage of stool. Ask when the patient's last bowel movement occurred, and have him describe the stool's color and consistency.
Auscultate for bowel sounds — hyperactive, high-pitched sounds may indicate impending bowel obstruction, whereas hypoactive or absent sounds occur late in obstruction and paralytic ileus. Inspect the abdomen, noting its contour and any surgical scars. Measure abdominal girth to provide baseline data for subsequent assessment of distention. Palpate for tenderness, distention, and rigidity. Percuss for tympany, indicating a gas-filled bowel, and dullness, indicating fluid.
Rectal and pelvic examinations should be performed. All patients with a suspected bowel obstruction should have a flat and upright abdominal X-ray; some will also need a chest X-ray, sigmoidoscopy, and barium enema.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Breath with fruity odor:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient isn't in severe distress, obtain a thorough history. Ask about the onset and duration of fruity breath odor. Find out about changes in breathing pattern. Ask about increased thirst, frequent urination, weight loss, fatigue, and abdominal pain. Ask the female patient if she has had candidal vaginitis or vaginal secretions with itching. If the patient has a history of diabetes mellitus, ask about stress, infections, and noncompliance with therapy — the most common causes of ketoacidosis in known diabetics. If the patient is suspected of having anorexia nervosa, obtain a dietary and weight history.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Breath with ammonia odor [Uremic fetor]:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
When you detect ammonia breath odor, the diagnosis of chronic renal failure will probably be well established. Look for associated GI symptoms so that palliative care and support can be individualized.
Inspect the patient's oral cavity for bleeding, swollen gums or tongue, and ulceration with drainage. Ask the patient if he has experienced a metallic taste, loss of smell, increased thirst, heartburn, difficulty swallowing, loss of appetite at the sight of food, or early morning vomiting. Because GI bleeding is common in patients with chronic renal failure, ask about bowel habits, noting especially melanous stools or constipation.
Take the patient's vital signs. Watch for indications of hypertension (the patient with end-stage chronic renal failure is usually somewhat hypertensive) or hypotension. Be alert for other signs of shock (such as tachycardia, tachypnea, and cool, clammy skin) and altered mental status. Significant changes can indicate complications, such as massive GI bleeding or pericarditis with tamponade.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Fetor hepaticus:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient is conscious, closely observe him for signs of impending coma. Evaluate deep tendon reflexes, and test for asterixis and Babinski’s sign. Be alert for signs of GI bleeding and shock, common complications of end-stage liver failure. Also, watch for increased anxiety, restlessness, tachycardia, tachypnea, hypotension, oliguria, hematemesis, melena, or cool, moist, pale skin. Place the patient in a supine position with the head of the bed at 30 degrees or greater. Administer oxygen if necessary, and determine the patient’s need for I.V. fluids or albumin replacement. Draw blood samples for liver function tests, serum electrolyte levels, hepatitis panel, blood alcohol content, a complete blood count, typing and crossmatching, a clotting profile, and ammonia level. Intubation, ventilation, or cardiopulmonary resuscitation may be necessary. Evaluate the degree of jaundice and abdominal distention and palpate the liver to assess the degree of enlargement.
Obtain a complete medical history, relying on information from the patient’s family if necessary. Focus on factors that may have precipitated hepatic disease or coma, such as a recent severe infection; overuse of sedatives, analgesics (especially) acetaminophen, alcohol, or diuretics; excessive protein intake; or recent blood transfusion, surgery, or GI bleeding.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Breath with fecal odor:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient’s condition permits, ask about previous abdominal surgery because adhesions can cause an obstruction. Also ask about loss of appetite. Is the patient experiencing abdominal pain? If so, have him describe its onset, duration, and location. Ask if the pain is intense, persistent, or spasmodic. Have the patient describe his normal bowel habits, especially noting constipation, diarrhea, or leakage of stool. Ask when the patient’s last bowel movement occurred, and have him describe the stool’s color and consistency.
Auscultate for bowel sounds; hyperactive, high-pitched sounds may indicate an impending bowel obstruction, whereas hypoactive or absent sounds occur late in obstruction and paralytic ileus. Inspect the abdomen, noting its contour and any surgical scars. Measure abdominal girth to provide baseline data for subsequent assessment of distention. Palpate the abdomen for tenderness, distention, and rigidity. Percuss it for tympany, indicating a gas-filled bowel, and dullness, indicating fluid.
Rectal and pelvic examinations should be performed. All patients with a suspected bowel obstruction should have a flat and upright abdominal X-ray; some will also need a chest X-ray, sigmoidoscopy, and a barium enema.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Breath with fruity odor:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient isn’t in severe distress, obtain a thorough history. Ask about the onset and duration of fruity breath odor. Also ask about any changes in breathing pattern, increased thirst, frequent urination, weight loss, fatigue, and abdominal pain. Ask the female patient if she has had candidal vaginitis or vaginal secretions with itching. If the patient has a history of diabetes mellitus, ask about stress, infections, and noncompliance with therapy—the most common causes of ketoacidosis in known diabetics. If the patient is suspected of having anorexia nervosa, obtain a dietary and weight history.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Halitosis:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If you detect halitosis, try to characterize the odor. Does it smell fruity, fecal, or musty? If the patient is aware of it, find out how long he has had it. Does he also have a bad taste in his mouth? Does he have difficulty swallowing or chewing? Does he have reflux or regurgitation? Does he have pain or tenderness? Ask the patient if he has a problem with flatus. Also ask him to describe the frequency of his bowel movements and the size and consistency of his stools.
Find out if the patient smokes or chews tobacco. Have him describe his diet and daily oral hygiene. Does he wear dentures? Complete the history by asking about chronic disorders and recent respiratory tract infection. If the patient reports a cough, find out if it’s productive.
Begin the physical examination by examining the patient’s mouth, throat, and nose. Look for lesions, bleeding, drainage, obstruction, and signs of infection, such as redness and swelling. Check for tenderness by percussing and palpating over the sinuses. Then auscultate the lungs for abnormal breath sounds. Auscultate the abdomen for bowel sounds, and percuss it, noting any tympany. Finally, take vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Breath with ammonia odor [Uremic fetor]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
When you detect ammonia breath odor, the diagnosis of chronic renal failure will probably be well established. Look for associated GI symptoms so that palliative care and support can be individualized.
Inspect the patient’s oral cavity for bleeding, swollen gums or tongue, and ulceration with drainage. Ask the patient if he has experienced a metallic taste, loss of smell, increased thirst, heartburn, difficulty swallowing, loss of appetite at the sight of food, or early morning vomiting. Because GI bleeding is common in patients with chronic renal failure, ask about bowel habits, noting especially melena or constipation.
Take the patient’s vital signs. Watch for any indications of hypertension (the patient with end-stage chronic renal failure is usually somewhat hypertensive) or hypotension. Be alert for other signs of shock (such as tachycardia, tachypnea, and cool, clammy skin) and altered mental status. Any significant changes can indicate complications, such as massive GI bleeding or pericarditis with tamponade.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Fetor hepaticus:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient is conscious, closely observe him for signs of impending coma. Evaluate deep tendon reflexes, and test for asterixis and Babinski’s reflex. Be alert for signs of GI bleeding and shock, common complications of end-stage liver failure. Also, watch for increased anxiety, restlessness, tachycardia, tachypnea, hypotension, oliguria, hematemesis, melena, or cool, moist, pale skin. Place the patient in a supine position with the head of the bed at 30 degrees. Administer oxygen if necessary, and determine the patient’s need for I.V. fluids for albumin replacement. Draw blood samples for liver function tests, serum electrolyte levels, hepatitis panel, blood alcohol count, a complete blood count, typing and crossmatching, a clotting profile, and ammonia level. Intubation, ventilation, or cardiopulmonary resuscitation may be necessary. Evaluate the degree of jaundice and abdominal distention, and palpate the liver to assess the degree of enlargement.
Obtain a complete medical history, relying on the patient’s family if necessary. Focus on any factors that may have precipitated liver disease or coma, such as a recent severe infection; overuse of sedatives, analgesics, (especially acetaminophen), alcohol, or diuretics; excessive protein intake; or recent blood transfusion, surgery, or GI bleeding.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Halitosis:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Physical examination should be undertaken with an emphasis on the evaluation of the oral cavity, particularly looking for ulceration, dryness, trauma, postnasal drainage, infections, cryptic tonsils, or neoplasms.
B. Techniques for localizing the odor source (systemic versus oral cavity).
1. Seal lips and blow air through the nose. If fetid odor is noted, this is suggestive of a systemic source.
2. Pinch nose with lips closed. Hold respiration and exhale gently through the mouth. Odors detected in this fashion, generally are local in origin.
Testing
For most patients with complaints of halitosis, clinical laboratory testing and diagnostic imaging are unnecessary and should only be pursued on the basis of specific findings indicated by the history and physical examination. The Schirmer’s test may be useful in identifying xerophthalmia and associated xerostomia seen with Sjögren’s syndrome and some other rheumatologic conditions (Chapter 12.1). If indicated, radiologic studies and imaging procedures of the sinuses, thorax, and abdomen may be used to identify infectious processes, neoplasms, and GERD with its complications.
Diagnostic assessment
The key to diagnosis and management of halitosis is a thorough history and focused physical examination with a particular emphasis on diseases and disorders of the oral cavity. Because 80% to 90% of all malodorous conditions can be traced to oral causes, simple examination maneuvers as described previously can be diagnostically helpful in excluding the likelihood of more distant or complex systemic sources. Salivation, mastication, and swallowing all lead to a decreased propensity to generate bad breath. Conversely, conditions or medications that reduce salivation or promote masticatory inactivity favor production of fetid breath. Because the key to treatment of halitosis of oral origin, beyond the limitation of aggravating factors, is proper oral hygiene, an evaluation of the patient’s toothbrushing and flossing regimens is imperative. Brushing should include gingival, tongue, and palatal surfaces because vigorous tongue brushing twice daily has been demonstrated in several studies to reduce the severity of malodorous morning breath (5).
References
1. Replogle WM, Keebe DK. Halitosis. Am Fam Physician 1996;53:1215–1223.
2. Spielman AI, Bivona P, Refkin BR. Halitosis: a common oral problem. N Y State Dent J 1996;62:36–42.
3. Ben-Aryeh H, Horowitz G, Nir D, Laufer D. Halitosis: an interdisciplinary approach. Am J Otolaryngol 1998;19:8–11.
4. Amir E, Shimonov R, Rosenberg M. Halitosis in children. J Pediatr 1999;134:
338–343.
5. Johnson BE. Halitosis, or the meaning of bad breath. J Gen Intern Med 1992;7:
649–656.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Shortness of Breath:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
In the physical examination, focus on signs of respiratory or cardiac disease. For the respiratory system, this means a careful examination starting at the nose. Specifically, on head, eyes, ear, nose, and throat examination look for evidence of obstruction, infection, or postnasal drip. Exclude obstruction, subcutaneous emphysema, or tracheal deviation. On cardiac examination, look for evidence of cardiomegaly, S3 gallop, or hepatojugular reflux (HJR). In this setting, HJR is very specific for CHF (1). Assess the lungs for abnormal breath sound intensity, rales, wheezing, rhonchi, or tachypnea. Examine the chest for abnormal movements or deformities. Exclude abdominal masses, ascites, pregnancy, or abdominal distention. Evaluate the extremities for edema, tenderness, or asymmetry. Do a complete neurologic examination, and screen for weakness atrophy, sensory loss, and fasciculations.
Testing
Most patients require a CXR study and pulse oximetry to screen for cardiac and pulmonary diseases. Use an arterial blood gas (ABG) analysis to confirm hypoxia, hypercapnia, hypocapnia, and acidosis. Complete blood count (CBC), electrolytes, thyroid-stimulating hormone (TSH), and drug screens are useful for suspected cases of anemia, acidosis, hyperthyroidism, hypothyroidism, or drug ingestions.
Pulmonary function studies (PFTs) are important to document the presence of obstructive or restrictive lung diseases. A methacholine challenge test is used if the symptoms are intermittent, the patient is aged less than 40 years, or if lung disease is suspected and the PFTs are normal. In this setting, the results will confirm or exclude asthma (3). In dyspneic patients, a lung diffusion capacity (DLCO) has a high positive predictive value and a high negative predictive value for interstitial lung disease (3). Low maximal inspiratory and expiratory pressures suggest neuromuscular disease.
The cardiac causes of dyspnea are CHF, intracardiac shunts, valvular heart disease, pulmonary hypertension, and pericardial disease. They have abnormal or characteristic findings on echocardiography and Doppler echocardiography. An electrocardiogram (ECG) or exercise stress test (EST) screens for arrhythmias and ischemic heart disease. Warning: A negative EST does not exclude ischemia in dyspneic patients (3) (Chapter 7.1).
Other tests are used in selected patients. High resolution computerized tomography (CT) of the chest detects early interstitial lung disease in patients with normal CXR films. Electromyogram (EMG) and nerve conduction studies are useful for confirming and differentiating the most common neuromuscular problems: myasthenia gravis and Guillain-Barré syndrome. A therapeutic response to H2 blockers confirms gastroesophageal reflux disease (GERD) in most dyspneic patients (2). Screen for acute or chronic pulmonary embolism with a nuclear medicine ventilation and perfusion (·V/Q·) scan.
Diagnostic assessment
The initial assessment usually requires a clinical evaluation, CXR study, and pulse oximetry. This identifies about 70% of the underlying diseases (1). For the remainder, a systematic evaluation for the most common diseases will correctly identify the cause. If appropriate, consider obtaining an ECG, CBC, TSH, and electrolytes. If theses are nondiagnostic, then further testing is indicated.
Exclude pulmonary diseases if the initial evaluation is nondiagnostic, or if pulmonary diseases are suspected, which account for 75% of the cases (3). Start with PFTs and an ABG. If the PFTs are normal, then order a methacholine challenge test to rule out asthma. If interstitial lung disease is suspected or if the PFTs show a restrictive pattern, then order a DLCO. Abnormally low maximal inspiratory and expiratory pressures suggest neuromuscular disease. Confirm the diagnosis with an EMG.
When pulmonary disease has been excluded, or if cardiac disease is suspected, the next step should be a cardiac evaluation. An echocardiogram will suggest or identify most of the cardiac causes. If the echocardiogram is normal, consider exercise stress testing or a Holter monitor. If these are normal, then most patients will have either GERD, deconditioning, or psychogenic disorders. Other low frequency causes of shortness of breath that need further evaluation include neuromuscular diseases, pulmonary emboli, postnasal drip, and sleep apnea. With a clinical suspicion of these disorders, obtain an EMG, ·V/Q· scan, or polysomnogram. Otherwise, they are not indicated.
References
1. Mulrow CD, Lucey CR, Farnett LE. Discriminating causes of dyspnea through clinical examination. J Gen Intern Med 1993;8:383–392.
2. DePaso WJ, Winterbauer RH, Lusk JA, Dreis DF, Springmeyer SC. Chronic dyspnea unexplained by history, physical examination, chest roentgenogram, and spirometry. Chest 1991;100:1293–1299.
3. Pratter MR, Curley FJ, Dubois J, Irwin RS. Cause and evaluation of chronic dyspnea in a pulmonary disease clinic. Arch Intern Med 1989;149:2277–2282.
4. Schmitt BP, Kushner MS, Wiener SL. The diagnostic usefulness of the history of the patient with dyspnea. J Gen Intern Med 1986;1:386–393.
5. Mahler DA, Harver A, Lentine T, Scott JA, Beck K, Schwartzstein M. Descriptors of breathlessness in cardiorespiratory diseases. Am J Respir Crit Care Med 1996;154:1357–1363.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Breath with fecal odor:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Auscultate for bowel sounds — hyperactive, high-pitched sounds may indicate impending bowel obstruction, whereas hypoactive or absent sounds occur late in obstruction and paralytic ileus. Inspect the abdomen, noting its contour and any surgical scars. Measure abdominal girth to provide baseline data for subsequent assessment of distention. Palpate for tenderness, distention, and rigidity. Percuss for tympany, indicating a gas-filled bowel, and dullness, indicating fluid. Rectal and pelvic examinations should be performed.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Breath with fruity odor:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin by taking your patient’s vital signs. Then proceed with a complete physical assessment.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Halitosis:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin the physical examination by examining the patient’s mouth, throat, and nose. Look for lesions, bleeding, drainage, obstruction, and signs of infection, such as redness and swelling. Check for tenderness by percussing and palpating over the sinuses. Then auscultate the lungs for abnormal breath sounds. Auscultate the abdomen for bowel sounds; percuss, noting any tympany. Finally, take vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Breath with fecal odor:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient's condition permits, ask about previous abdominal surgery because adhesions can cause an obstruction. Ask about loss of appetite. Is the patient experiencing abdominal pain? If so, have him describe its onset, duration, intensity, and location. Ask if the pain is intense, persistent, or spasmodic. Have the patient describe his normal bowel habits, especially noting constipation, diarrhea, or leakage of stool. Ask when the patient's last bowel movement occurred, and have him describe the stool's color and consistency.
Auscultate for bowel sounds—hyperactive, high-pitched sounds may indicate impending bowel obstruction, whereas hypoactive or absent sounds occur late in obstruction and paralytic ileus. Inspect the abdomen, noting its contour and any surgical scars. Measure abdominal girth to provide baseline data for subsequent assessment of distention. Palpate for tenderness, distention, and rigidity. Percuss for tympany, indicating a gas-filled bowel, and dullness, indicating fluid.
Rectal and pelvic examinations should be performed. All patients with a suspected bowel obstruction should have a flat and upright abdominal X-ray; some will also need a chest X-ray, sigmoidoscopy, and barium enema.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Breath with fruity odor:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient isn't in severe distress, obtain a thorough history. Ask about the onset and duration of fruity breath odor. Find out about changes in breathing pattern. Ask about increased thirst, frequent urination, weight loss, fatigue, and abdominal pain. Ask the female patient if she has had candidal vaginitis or vaginal secretions with itching. If the patient has a history of diabetes mellitus, ask about stress, infections, and noncompliance with therapy—the most common causes of ketoacidosis in known diabetics. If the patient is suspected of having anorexia nervosa, obtain a dietary and weight history.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Breath with ammonia odor [Uremic fetor]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
When you detect ammonia breath odor, the diagnosis of chronic renal failure will probably be well established. Look for associated GI symptoms so that palliative care and support can be individualized.
Inspect the patient's oral cavity for bleeding, swollen gums or tongue, and ulceration with drainage. Ask the patient if he has experienced a metallic taste, loss of smell, increased thirst, heartburn, difficulty swallowing, loss of appetite at the sight of food, or early morning vomiting. Because GI bleeding is common in patients with chronic renal failure, ask about bowel habits, noting especially melanous stools or constipation.
Take the patient's vital signs. Watch for indications of hypertension (the patient with end-stage chronic renal failure is usually somewhat hypertensive) or hypotension. Be alert for other signs of shock (such as tachycardia, tachypnea, and cool, clammy skin) and altered mental status. Significant changes can indicate complications, such as massive GI bleeding or pericarditis with tamponade.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Fetor hepaticus:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient is conscious, closely observe him for signs of impending coma. Evaluate deep tendon reflexes, and test for asterixis and Babinski's sign. Be alert for signs of GI bleeding and shock, common complications of end-stage liver failure. Also, watch for increased anxiety, restlessness, tachycardia, tachypnea, hypotension, oliguria, hematemesis, melena, or cool, moist, pale skin. Place the patient in a supine position with the head of the bed at 30 degrees or greater. Administer oxygen if necessary, and determine the patient's need for I.V. fluids or albumin replacement. Draw blood samples for liver function tests, serum electrolyte levels, hepatitis panel, blood alcohol content, a complete blood count, typing and crossmatching, a clotting profile, and ammonia level. Intubation, ventilation, or cardiopulmonary resuscitation may be necessary. Evaluate the degree of jaundice and abdominal distention and palpate the liver to assess the degree of enlargement.
Obtain a complete medical history, relying on information from the patient's family if necessary. Focus on factors that may have precipitated hepatic disease or coma, such as a recent severe infection; overuse of sedatives, analgesics (especially acetaminophen), alcohol, or diuretics; excessive protein intake; or recent blood transfusion, surgery, or GI bleeding.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Sneezing in the sitting room? Coughing in the kitchen? Many common allergens occur primarily indoors and can make your life miserable. Join our panel...
Lung Cancer, the leading cause of cancer death for both men and women in the US, will be diagnosed in over 169,000 people this year. Avoiding tobacco...
Stenting is a common procedure used to keep clogged arteries open. To ensure long-term success additional treatments are necessary after surgery....
Listen to asthma specialist Dr. Nancy Ostrom discuss the use of inhaled steroids in children with asthma.
See full list of 12 related videos
» Next page: Diagnosis of Halitosis
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
