Diagnostic Tests for Hyperhidrosis
Hyperhidrosis Tests: Book Excerpts
Hyperhidrosis Diagnosis: Book Excerpts
Diagnostic Tests for Hyperhidrosis: Online Medical Books
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DIAPHORESIS:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine diagnostic studies include a CBC, sedimentation rate, chemistry panel, electrolytes, thyroid profile, blood alcohol level, EKG, and chest x-ray. Serial EKGs and cardiac enzymes should be done if a myocardial infarction is suspected. A 24-hr urine collection for catecholamine can be done if a pheochromocytoma is suspected.
A glucose tolerance test, a 36- to 72-hr fast
, and insulin tolerance test may be done for an insulinoma. If infectious disease is strongly suspected, a workup for fever of unknown origin can be done
.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
HYPERNATREMIA:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The workup should include a CBC, urinalysis, chemistry panel, serum and urine osmolality, plasma cortisol, serum ADH, plasma volume studies, serial electrolytes, and consultation with an endocrinologist or nephrologist.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Diaphoresis:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient is diaphoretic, quickly rule out the possibility of a life-threatening cause. Begin the history by having the patient describe his chief complaint. Then explore associated signs and symptoms. Note general fatigue and weakness. Does the patient have insomnia, headache, and changes in vision or hearing? Is he often dizzy? Does he have palpitations? Ask about pleuritic pain, a cough, sputum, difficulty breathing, nausea, vomiting, abdominal pain, and altered bowel or bladder habits. Ask the female patient about amenorrhea and any changes in her menstrual cycle. Is she menopausal? Ask about paresthesia, muscle cramps or stiffness, and joint pain. Has she noticed any changes in elimination habits? Note weight loss or gain. Has the patient had to change her glove or shoe size lately? patient for diagnostic tests, such as blood tests, cultures, chest X-rays, immunologic studies, biopsy, a computed tomography scan, and audiometry. Monitor the patient's vital signs, including temperature.
Pediatric pointers
Diaphoresis in children commonly results from environmental heat or overdressing; it's usually most apparent around the head. Other causes include drug withdrawal associated with maternal addiction, heart failure, thyrotoxicosis, and the effects of such drugs as antihistamines, ephedrine, haloperidol, and thyroid hormone.
Assess the child's fluid status carefully. Some fluid loss through diaphoresis may precipitate hypovolemia more rapidly in a child than in an adult. Monitor input and output, weigh the child daily, and note the duration of each episode of diaphoresis.
Geriatric pointers
Fever and night sweats, the hallmark of TB, may not occur in elderly patients, who instead may exhibit a change in activity or weight. Also, keep in mind that older patients may not exhibit diaphoresis because of a decreased sweating mechanism. For this reason, they're at increased risk for developing heatstroke in high temperatures.
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Source: Handbook of Signs & Symptoms (Third Edition), 2006
Skin, clammy:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If you detect clammy skin, remember that rapid evaluation and intervention are paramount. (See Clammy skin: A key finding, page 564.) Ask the patient if he has a history of type 1 diabetes mellitus or a cardiac disorder. Is he taking medications, especially an antiarrhythmic? Is he experiencing pain, chest pressure, nausea, or epigastric distress? Does he feel weak? Does he have a dry mouth? Does he have diarrhea or increased urination?
Next, examine the pupils for dilation. Also, check for abdominal distention and increased muscle tension.
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Source: Handbook of Signs & Symptoms (Third Edition), 2006
Diaphoresis:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient is diaphoretic, quickly rule out the possibility of a life-threatening cause. (See When diaphoresis spells crisis, page 238.) Begin the history by having the patient describe his chief complaint. Then explore associated signs and symptoms. Note general fatigue and weakness. Does the patient have insomnia, headache, and changes in vision or hearing? Is he often dizzy? Does he have palpitations? Ask about pleuritic pain, cough, sputum, difficulty breathing, nausea, vomiting, abdominal pain, and altered elimination habits. Ask the female patient about amenorrhea and any changes in her menstrual cycle. Is she menopausal? Ask about paresthesia, muscle cramps or stiffness, and joint pain. Has she noticed any changes in elimination habits? Note weight loss or gain. Has she had to change her glove or shoe size lately?
Complete the history by asking about travel to tropical countries. Note recent exposure to high environmental temperatures or to pesticides. Did the patient recently experience an insect bite? Check for a history of partial gastrectomy or of drug or alcohol abuse. Finally, obtain a thorough drug history.
Next, perform a physical examination. First, determine the extent of diaphoresis by inspecting the trunk and extremities as well as the palms, soles, and forehead. Also, check the patient’s clothing and bedding for dampness. Note whether diaphoresis occurs during the day or at night. Observe the patient for flushing, abnormal skin texture or lesions, and an increased amount of coarse body hair. Note poor skin turgor and dry mucous membranes. Check for splinter hemorrhages and Plummer’s nails (separation of the fingernail ends from the nail beds).
Then evaluate the patient’s mental status and take his vital signs. Observe the patient for fasciculations and flaccid paralysis. Be alert for seizures. Note the patient’s facial expression, and examine the eyes for pupillary dilation or constriction, exophthalmos, and excessive tearing. Test visual fields. Also, check for hearing loss and for tooth or gum disease. Percuss the lungs for dullness, and auscultate for crackles, diminished or bronchial breath sounds, and increased vocal fremitus. Look for decreased respiratory excursion. Palpate for lymphadenopathy and hepatosplenomegaly.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Skin, clammy:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If you detect clammy skin, remember that rapid evaluation and intervention are paramount. (See Clammy skin: A key finding.) Ask the patient if he has a history of type 1 diabetes mellitus or a cardiac disorder. Is the patient taking any medications, especially an antiarrhythmic? Is he experiencing pain, chest pressure, nausea, or epigastric distress? Does he feel weak? Does he have a dry mouth? Does he have diarrhea or increased urination?
Next, examine the pupils for dilation. Check for abdominal distention and increased muscle tension.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Night Sweats:
Physical examination.
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
The physical examination should address the pertinent positives noted in the patient’s medical history. Note the patient’s weight and temperature. Examination of the head, eyes, ears, nose, and throat (HEENT) should focus on common types of infection: sinusitis, pharyngitis, and otitis. A thorough examination of lymph nodes is helpful to identify infection or lymphatic abnormalities (Chapter 15.1). The cardiopulmonary examination can also signal infection, valvular disease, and stimulant use. Patients should be examined for abscesses, skin ulcers, septic joints, phlebitis, and osteomyelitis.
Testing
A. Clinical laboratory testing. For patients with a known condition, testing for exacerbations is appropriate: erythrocyte sedimentation rate (infection, osteomyelitis, and temporal arteritis), C-reactive protein (rheumatologic disorders), and hemoglobin A1C (diabetes mellitus). Depending on the patient’s symptoms or exposures, other appropriate tests can include purified protein derivative skin test for tuberculosis, free T4 level to rule out thyrotoxicosis, complete blood count with differential (infection), and follicle-stimulating hormone to investigate the possibility of menopause. Special tests may be required of patients with travel-related or STD exposures.
B. Imaging. Chest x-ray studies are useful in the evaluation of night sweats in patients with a smoking history, industrial exposure, or a cough. These patients need to be screened for occult malignancy. Computed tomography scans are generally not appropriate unless other signs or symptoms dictate further evaluation.
Diagnostic assessment
. Night sweating as a single entity is not worrisome. Explore the likelihood of exacerbation of known conditions or the onset of a new disease process. The history is the most helpful part of the patient encounter. A new medication, with perspiration as a side effect, is often the culprit. Patients may need cessation of the medication as well as a washout period. Night sweats might be an early symptom of a developing illness so watchful waiting is useful (4). Patients need to be instructed to watch for weight changes, fevers, and sleep and mood changes. Patients can complete a symptom diary, which is very helpful to the clinician in determining the need for additional evaluation. Consider illnesses that tend to be present in the patient’s age group. Screening for common malignancies through mammograms, pap smears, and fecal occult blood testing is appropriate health maintenance as well as often being a part of the evaluation of the presenting complaint of night sweats.
References
1. Smetana GW. Diagnosis of night sweats. JAMA 1993;70:2502–2503.
2. Lea MJ, Aber RC. Descriptive epidemiology of night sweats upon admission to a university hospital. South Med J 1985;78:1065–1072.
3. Babbott SF, Pearson VE. Sertraline-related night sweats. Ann Intern Med 1999;
130:242–243.
4. Chambliss ML. Frequently asked questions from clinical practice. What is the appropriate diagnostic approach for patients who complain of night sweats? Arch Fam Med 1999;2:168–169.
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Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Diaphoresis/Night Sweats:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Eccrine glands are concentrated on the palms, soles, face, and axilla. They function to cool the body through evaporation. They are under cholinergic control and may be stimulated by epinephrine. Apocrine glands are associated with hair follicles in the axilla and groin. Their secretions are viscid and produce an odor after acted on by bacteria.
Measuring the temperature during diaphoresis helps to determine whether a fever is present, which suggests infection.
Night sweats are distinguished as drenching sweats that require changing the bedclothes. “Night sweats of unknown origin” have a differential similar to “fever of unknown origin.”
Excessive sweating with vasoconstriction (cold and clammy skin) may be caused by insulin hypoglycemia, dumping syndrome, drug withdrawal, shock, vasovagal states, or intense pain.
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Source: Field Guide to Bedside Diagnosis, 2007
Diaphoresis:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
First, determine the extent of diaphoresis by inspecting the trunk and extremities as well as the palms, soles, and forehead. Also, check the patient’s clothing and bedding for dampness. Note whether diaphoresis occurs during the day or at night. Observe the patient for flushing, abnormal skin texture or lesions, and an increased amount of coarse body hair. Note poor skin turgor and dry mucous membranes. Check for splinter hemorrhages and Plummer’s nails (separation of the fingernail ends from the nail beds).
Then evaluate the patient’s mental status and take his vital signs. Observe the patient for fasciculations and flaccid paralysis. Be alert for seizures. Note the patient’s facial expression, and examine the eyes for pupillary dilation or constriction, exophthalmos, and excessive tearing. Test visual fields. Also, check for hearing loss and for tooth or gum disease. Percuss the lungs for dullness, and auscultate for crackles, diminished or bronchial breath sounds, and increased vocal fremitus. Look for decreased respiratory excursion. Palpate for lymphadenopathy and hepatosplenomegaly.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Skin, clammy:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Take vital signs and perform a cardiovascular assessment. Then proceed with the remainder of a complete physical assessment. Be sure to examine the pupils for dilation. Also, check for abdominal distention and increased muscle tension.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Sweating:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Historyand physical exam are often diagnostic when excessive sweating isthe presenting complaint. In many cases, physiologic causes areimplicated.With suspected hypoglycemia, bloodglucose concentration should be determined.Although fever suggests infection,it also can occur with salicylate poisoning and neonatal drug withdrawalsyndrome.Hypertension may occur with thyrotoxicosis,pheochromocytoma, and familial dysautonomia.
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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Diaphoresis:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient is diaphoretic, quickly rule out the possibility of a life-threatening cause. Begin the history by having the patient describe his chief complaint. Then explore associated signs and symptoms. Note general fatigue and weakness. Does the patient have insomnia, headache, and changes in vision or hearing? Is he often dizzy? Does he have palpitations? Ask about chest pain, a cough, sputum, difficulty breathing, nausea, vomiting, abdominal pain, and altered bowel or bladder habits. Ask the female patient about amenorrhea and any changes in her menstrual cycle. Is she perimenopausal or menopausal? Ask about paresthesia, muscle cramps or stiffness, and joint pain. Has she noticed any changes in elimination habits? Note weight loss or gain. Has the patient had to change her glove or shoe size lately?
Complete the history by asking about travel to tropical countries. Note recent exposure to high environmental temperatures or pesticides. Did the patient recently experience an insect bite? Check for a history of partial gastrectomy or of drug or alcohol abuse. Finally, obtain a thorough drug history.
Next, perform a physical examination. First, determine the extent of diaphoresis by inspecting the trunk and extremities as well as the palms, soles, and forehead. Also, check the patient's clothing and bedding for dampness. Note whether diaphoresis occurs during the day or at night. Observe the patient for flushing, abnormal skin texture or lesions, and an increased amount of coarse body hair. Note poor skin turgor and dry mucous membranes. Check for splinter hemorrhages and Plummer's nails (separation of the fingernail ends from the nail beds).
Evaluate the patient's mental status and take his vital signs. Observe him for fasciculations and flaccid paralysis. Be alert for seizures. Note the patient's facial expression, and examine the eyes for pupillary dilation or constriction, exophthalmos, and excessive tearing. Test visual fields. Also, check for hearing loss and for tooth or gum disease. Percuss the lungs for dullness, and auscultate for crackles, diminished or bronchial breath sounds, and increased vocal fremitus. Look for decreased respiratory excursion. Palpate for lymphadenopathy and hepatosplenomegaly.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Skin, clammy:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If you detect clammy skin, remember that rapid evaluation and intervention are paramount. (See Clammy skin: A key finding, page 562.) Ask the patient if he has a history of type 1 diabetes mellitus or a cardiac disorder. Is he taking medications, especially an antiarrhythmic? Is he experiencing pain, chest pressure, nausea, or epigastric distress? Does he feel weak? Does he have a dry mouth? Does he have diarrhea or increased urination?
Next, take the patient's vital signs and pulse oximetry. Examine the pupils for dilation and check his level of consciousness. Note respiratory rate. Assess for respiratory distress. Auscultate the heart and lungs. Place the patient on a cardiac monitor and assess heart rhythm. Also, check for abdominal distention and increased muscle tension.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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