Diagnostic Tests for Shy-Drager Syndrome
Shy-Drager Syndrome Tests: Book Excerpts
Shy-Drager Syndrome Diagnosis: Book Excerpts
Diagnostic Tests for Shy-Drager Syndrome: Online Medical Books
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HYPOTENSION, CHRONIC:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine studies include a CBC, sedimentation rate, chemistry panel, urinalysis, thyroid panel, EKG, and chest x-ray. Blood volume and arterial blood gas studies may be useful. If there is cardiomegaly or a murmur, echocardiography and venous pressure and circulation time should be done. A cardiologist should also be consulted.
If there is hyperpigmentation, a serum cortisol and ACTH stimulation test should be done. A skull x-ray can be done to rule out pituitary tumors. A visual field examination by a qualified ophthalmologist may be helpful in this regard also. Twenty-four-hr blood pressure monitoring may be useful in the workup also.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Orthostatic hypotension [Postural hypotension]:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient is in no danger, obtain a history. Ask the patient if he frequently experiences dizziness, weakness, or fainting when he stands. Also ask about associated symptoms, particularly fatigue, orthopnea, impotence, nausea, headaches, abdominal or chest discomfort, and GI bleeding. Then obtain a complete drug history.
Begin the physical examination by checking the patient’s skin turgor. Palpate peripheral pulses and auscultate the heart and lungs. Finally, test muscle strength and observe the patient’s gait for unsteadiness.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Blood pressure decrease [Hypotension]:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient is conscious, ask him about associated symptoms. For example, does he feel unusually weak or fatigued? Has he had nausea, vomiting, or dark or bloody stools? Is his vision blurred? Is his gait unsteady? Does he have palpitations? Does he have chest or abdominal pain or difficulty breathing? Has he had episodes of dizziness or fainting? Do these episodes occur when he stands up suddenly? If so, take the patient's blood pressure while he's lying down, sitting, and then standing; compare readings. (See Ensuring accurate blood pressure measurement.) A drop in systolic or diastolic pressure of 10 to 20 mm Hg or more and an increase in heart rate of more than 15 beats/minute between position changes suggest orthostatic hypotension.
Next, continue with a physical examination. Inspect the skin for pallor, sweating, and clamminess. Palpate peripheral pulses. Note paradoxical pulse — an accentuated fall in systolic pressure during inspiration — which suggests pericardial tamponade. Then auscultate for abnormal heart sounds (gallops, murmurs), rate (bradycardia, tachycardia), or rhythm. Auscultate the lungs for abnormal breath sounds (diminished sounds, crackles, wheezing), rate (bradypnea, tachypnea), or rhythm (agonal or Cheyne-Stokes respirations). Look for signs of hemorrhage, including visible bleeding and palpable masses, bruising, and tenderness. Assess the patient for abdominal rigidity and rebound tenderness; auscultate for abnormal bowel sounds. Also, carefully assess the patient for possible sources of infection such as open wounds.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Decorticate posture:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Test the patient's motor and sensory functions. Evaluate pupil size, equality, and response to light. Then test cranial nerve function and deep tendon reflexes. Ask about headache, dizziness, nausea, changes in vision, and numbness or tingling. When did the patient first notice these symptoms? Is his family aware of behavioral changes? Also, ask about a history of cerebrovascular disease, cancer, meningitis, encephalitis, upper respiratory tract infection, bleeding or clotting disorders, or recent trauma.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Orthostatic hypotension [Postural hypotension]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient is in no danger, obtain a history. Ask the patient if he frequently experiences dizziness, weakness, or fainting when he stands. Also ask about associated symptoms, particularly fatigue, orthopnea, impotence, nausea, headache, abdominal or chest discomfort, and GI bleeding. Then obtain a complete drug history.
Begin the physical examination by checking the patient’s skin turgor. Palpate peripheral pulses and auscultate the heart and lungs. Finally, test muscle strength and observe the patient’s gait for unsteadiness.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Blood pressure decrease [Hypotension]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient is conscious, ask him about associated symptoms. For example, does he feel unusually weak or fatigued? Has he had nausea, vomiting, or dark or bloody stools? Is his vision blurred? Gait unsteady? Does he have palpitations, chest or abdominal pain, or difficulty breathing? Has he had episodes of dizziness or fainting? Do these episodes occur when he stands up suddenly? If so, take the patient’s blood pressure while he’s lying down, sitting, and then standing and compare readings. A drop in systolic or diastolic pressure of 10 mm Hg or more and an increase in heart rate of more than 15 beats/minute between position changes suggest orthostatic hypotension. (See Ensuring accurate blood pressure measurement, page 104.)
Next, continue with a physical examination. Inspect the skin for pallor, sweating, and clamminess. Palpate peripheral pulses. Note a paradoxical pulse—an accentuated fall in systolic pressure during inspiration—which suggests pericardial tamponade. Then auscultate for abnormal heart sounds (gallops, murmurs), rate (bradycardia, tachycardia), or rhythm. Auscultate the lungs for abnormal breath sounds (diminished sounds, crackles, wheezing), rate (bradypnea, tachypnea), or rhythm (agonal or Cheyne-Stokes respirations). Look for signs of hemorrhage, including visible bleeding, palpable masses, bruising, and tenderness. Assess the patient for abdominal rigidity and rebound tenderness; auscultate for abnormal bowel sounds. Also, carefully assess the patient for possible sources of infection such as open wounds.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Decorticate posture [Decorticate rigidity, abnormal flexor response]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Test the patient’s motor and sensory function. Evaluate pupil size, equality, and response to light. Then test cranial nerve function and deep tendon reflexes. Ask family members if the patient experienced headache, dizziness, nausea, changes in vision, numbness, or tingling. When did the patient first notice these symptoms? Is his family aware of any behavioral changes? Also, ask about a history of cerebrovascular disease, cancer, meningitis, encephalitis, upper respiratory tract infection, bleeding or clotting disorders, or recent trauma.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Orthostatic Hypotension:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Dysautonomia is characterized by orthostatic hypotension (postural lightheadedness, fainting, dim vision, weakness, unsteady gait), urinary dysfunction (frequency, urgency, stress incontinence), sexual dysfunction (impotence, retrograde ejaculation), bowel dysfunction (nocturnal diarrhea, incontinence), and/or decreased sweating. It is most easily recognized by the presence of orthostatic hypotension without reflex tachycardia. Within 2 to 5 minutes of quiet standing there will be a 20 mm Hg drop in systolic pressue, a 10 mm Hg drop in diastolic pressure, or symptoms of cerebral hypoperfusion.
With gastrointestinal hemorrhage, an orthostatic blood pressure change of 10 mm Hg suggests a loss of at least 20% of intravascular volume.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Orthostatic hypotension:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin the physical assessment by checking the patient’s skin turgor. Palpate peripheral pulses, and auscultate the heart and lungs. Finally, test muscle strength and observe the patient’s gait for unsteadiness.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Decorticate posture:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Test the patient’s motor and sensory functions. Evaluate pupil size, equality, and response to light. Test cranial nerve function and deep tendon reflexes. Then perform a neurologic examination.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Orthostatic hypotension [Postural hypotension]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient is in no danger, obtain a history. Ask the patient if he frequently experiences dizziness, weakness, or fainting when he stands. Also ask about associated symptoms, particularly fatigue, orthopnea, impotence, nausea, headaches, abdominal or chest discomfort, and GI bleeding. Then obtain a complete drug history.
Begin the physical examination by checking the patient's skin turgor. Palpate peripheral pulses and auscultate the heart and lungs. Finally, test muscle strength and observe the patient's gait for unsteadiness.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Blood pressure, decreased [Hypotension]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient is conscious, ask him about associated symptoms. For example, does he feel unusually weak or fatigued? Has he had nausea, vomiting, or dark or bloody stools? Is his vision blurred? Is his gait unsteady? Does he have palpitations? Does he have chest or abdominal pain or difficulty breathing? Has he had episodes of dizziness or fainting? Do these episodes occur when he stands up suddenly? If so, take the patient's blood pressure while he's lying down, sitting, and then standing; compare readings. (See Ensuring accurate blood pressure measurement.)
A drop in systolic or diastolic pressure of 10 to 20 mm Hg or more and an increase in heart rate of more than 15 beats/minute between position changes suggest orthostatic hypotension.
Next, continue with a physical examination. Inspect the skin for pallor, sweating, and clamminess. Palpate peripheral pulses. Note paradoxical pulse—an accentuated fall in systolic pressure during inspiration—which suggests pericardial tamponade. Then auscultate for abnormal heart sounds (gallops, murmurs), rate (bradycardia, tachycardia), or rhythm. Auscultate the lungs for abnormal breath sounds (diminished sounds, crackles, wheezing), rate (bradypnea, tachypnea), or rhythm (agonal or Cheyne-Stokes respirations). Look for signs of hemorrhage, including visible bleeding and palpable masses, bruising, and tenderness. Assess the patient for abdominal rigidity and rebound tenderness; auscultate for abnormal bowel sounds. Carefully assess the patient for possible sources of infection such as open wounds.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Decorticate posture [Decorticate rigidity, abnormal flexor response]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Test the patient's motor and sensory functions. Evaluate pupil size, equality, and response to light. Then test cranial nerve function and deep tendon reflexes. Ask the patient about headache, dizziness, nausea, changes in vision, and numbness or tingling. When did the patient first notice these symptoms? Is his family aware of behavioral changes? Also ask about a history of cerebrovascular disease, cancer, meningitis, encephalitis, upper respiratory tract infection, bleeding or clotting disorders, or recent trauma.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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