what are the most frequent problems that occur in patients undergoing long-term therapy?
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Ms. P. is an 80-year-old piano teacher with progressively severe right leg pain over a period of 10 years. She still teaches piano but is feeling increasing pain and fatigue. Imaging studies reveal severe osteoarthritis of the right hip. She schedules surgery for replacement of the right hip with a prosthetic joint. The surgery was completed without any complications. A few days later, Ms. P. is given low molecular weight heparin and warfarin as prophylaxis against deep vein thrombosis. Six days after the operation, she develops excruciating pain in the area of the operation. Upon examination, swelling of the right lateral hip and buttock is noted, and a complete blood count shows a reduction in hematocrit from 35% to 25%. She is taken back to surgery for evacuation of a large hematoma around the prosthetic joint. The hematoma does not appear to be grossly infected, but cultures come back positive for Staphylococcus aureus. Because prosthetic joint infections are difficult to treat without removal, Ms. P. is started on an aggressive 12-week combination antibiotic therapy. The first 2 weeks are intravenous vancomycin and oral rifampin, followed by 10 weeks of oral ciprofloxacin and rifampin. Fifteen days into therapy after surgery to evacuate the hematoma, Ms. P. develops a high fever of 103°F and extreme weakness. Aspiration of the hip reveals only a scant amount of straw-colored (nonpurulent) fluid, so she is admitted to the hospital for observation. The next morning, Ms. P. develops an extensive maculopapular rash over her chest, back, and extremities. 1. What are the classifications of low molecular weight heparin and warfarin, and how do they prevent thrombosis? 2. What was the cause of the hematoma, and what type of toxicity was this from (remember the types that we talked about in class in the toxicity section)? 3. What was the rationale for using the antibiotic treatment protocol that was used? 4. What was the cause of her fever, weakness, and rash, and what form of toxicity is this from (remember the types that we talked about in class in the toxicity section)? 5. How would you continue with the treatment of Ms. P. to give her the best chance of recovery?
Adi S.
Clinical Questions 26. What symptoms would you expect to see in a child with an anterior pituitary lobe tumor resulting in the oversecretion of growth hormone? 27. A friend of yours has been diagnosed as having a tumor in the infundibulum, which is blocking the neuronal pathway between the hypothalamus and pituitary gland but is not affecting the hypothalamic-pituitary portal system. The release of what hormone or hormones will be adversely affected by this situation, and what types of symptoms might your friend experience? 28. What clinical symptoms might you expect to see in a person experiencing hypothyroidism (lower than normal secretion of thyroid hormones)? STUDY GUIDE Principles of Human Physiology
Which of the following is considered to be a disadvantage of the intravenous root of administration?
Sanchit J.
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