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O (also known as 
 or ) is a peptide hormone synthesized and secreted by thyrotrope cells in the
anterior pituitary gland, which regulates the endocrine function of the thyroid gland.

Normal Result:

O adults: 0.4²4.5 mIU/L or 0.4²4.5 mU/L (SI units)

O Ñabies: 3²18 mIU/L or 3²18 mU/L (SI units)

Purpose:

O used to check for thyroid gland problems

Indication:

O hypothyroidism
O hyperthyroidism

How to Prepare

O Êell your doctor if you have had any tests in which you were given radioactive materials or had X-rays that used
iodine dye within the last 4 to 6 weeks.

How It Is Done

Êhe health professional drawing blood will:

y  rap an elastic band around your upper arm to stop the flow of blood. Êhis makes the veins below the band larger so
it is easier to put a needle into the vein.
y ·lean the needle site with alcohol.
y Put the needle into the vein. More than one needle stick may be needed.
y attach a tube to the needle to fill it with blood.
y Remove the band from your arm when enough blood is collected.
y Put a gauze pad or cotton ball over the needle site as the needle is removed.
y Put pressure to the site and then put on a bandage.

Risks:
You may get a small bruise at the site, Phlebitis, Ongoing bleeding
£
  



O ·orticotropin-releasing hormone (·RH) is a 41-amino acid peptide that is the major physiologic a·ÊH. Êhere is
considerable sequence homology of ·RH among species, particularly in the amino-terminal region, which is required
for biologic activity

O originally named ½½ 
!½ ("), and also called ½½#, is a polypeptide
hormone and neurotransmitter involved in the stress response

O measures levels of cortisol in your blood before and after you are given a synthetic form of ·RH

Purpose:

O valuate the cause of a·ÊH-dependent ·ushing's syndrome

O Determine what is causing a drop or rise in a patient's adrenal hormones

Indication:

O ·ushing's syndrome

Procedure:

O Ñlood samples will be taken at intervals after the ·RH has been given, often 30, 60, 90, and 120 minutes after the
injection. a laboratory will compare these samples with the original blood sample to help a doctor determine the
cause of the hormone disorder.

Risk:

O üainting, a small bruising at the site, phlebitis, ongoing bleeding

 A 

 



½ is a hormone produced by the pituitary gland, the pea-sized gland near the base of the brain that
controls metabolism, growth, and sexual development. although prolactin is produced in small amounts in both males
and non-pregnant females, its main role is to stimulate lactation (milk production) in females during pregnancy and
maintain milk supply during breastfeeding. a prolactin test measures the amount of this hormone in the bloodstream.

O measures the amount of a hormone called prolactin in blood

O Serum prolactin level

Indication:

O It is used to evaluate and manage conditions such as pituitary adenomas (tumors), seizure conditions, and erectile
disorders in men

Purpose:

O for routine health screenings or if a disease or toxicity is suspected

O used to determine if a medical condition is improving or worsening
O used to measure the success or failure of a medication or treatment plan

Procedure:

Venous blood:

O Ñefore having blood collected, tell the person drawing your blood if you are allergic to latex. Êell the healthcare
worker if you have a medical condition or are using a medication or supplement that causes excessive bleeding. also
tell the healthcare worker if you have felt nauseated, lightheaded, or have fainted while having blood drawn in the
past.
O Êell the person doing the test if you are pregnant, and what pregnancy trimester you are in at the time of the test.

Umbilical cord blood:

O ask the healthcare worker for information about how to prepare for this test.

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O a sample of venous or umbilical cord blood may be collected for this test.

Venous blood:

 hen a blood sample from a vein is needed, a vein in your arm is usually selected. a tourniquet (large rubber strap) may be
secured above the vein. Êhe skin over the vein will be cleaned, and a needle will be inserted. You will be asked to hold very
still while your blood is collected. Ñlood will be collected into one or more tubes, and the tourniquet will be removed.  hen
enough blood has been collected, the healthcare worker will take the needle out.

Umbilical cord blood:

Êo collect an umbilical cord blood sample after an infant is born, the healthcare worker may use a needle and syringe to draw
blood from the umbilical cord while the cord is still attached to the infant. Ñlood samples may also be collected from the part
of the umbilical cord that has been detached from the infant.

after birth, an infant's body does not need the attached umbilical cord stump or its blood vessels, but they may be used
temporarily for medical purposes. If the infant has a catheter inserted in a vessel of the umbilical cord, the blood sample may
be collected through the existing catheter.

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Êhe amount of discomfort you feel will depend on many factors, including your sensitivity to pain. ·ommunicate how you are
feeling with the person doing the test. Inform the person doing the test if you feel that you cannot continue with the test.

Venous blood:

During a blood draw, you may feel mild discomfort at the location where the blood sample is being collected.

Umbilical cord blood:

Êhere are several different ways that a cord blood sample may be collected. Depending on the procedure used to obtain the
sample, the test may be uncomfortable. ask the healthcare worker to explain how the test may feel.

Risks:

O You may get a small bruise at the site, phlebitis, ongoing bleeding




O examination of the duodenum by an endoscope

Indication:

O Upper gastrointestinal bleeding as evidenced by hematemesis or melena

O Surveillance of gastric ulcer or duodenal ulcer
O Occasionally after gastric surgery

Procedure:

O NPO for at least 4-6 hours.

O Informed consent is obtained.
O Êhe patient lies on his/her left side with the head resting comfortably on a pillow.
O a mouth-guard is placed between the teeth to prevent the patient from biting on the endoscope. Êhe endoscope is
then passed over the tongue and into the oropharynx. Êhis is the most uncomfortable stage for the patient. Quick and
gentle manipulation under vision guides the endoscope into the esophagus.
O Êhe endoscope is gradually advanced down the esophagus making note of any pathology. xcessive insufflation of the
stomach is avoided at this stage.
O Êhe endoscope is quickly passed through the stomach and through the pylorus to examine the first and second parts of
the duodenum. Once this has been completed, the endoscope is withdrawn into the stomach and a more thorough
examination is performed including a J-maneuver. Êhis involves retroflexing the tip of the scope so it resembles a 'J'
shape in order to examine the fundus and gastroesophageal junction. any additional procedures are performed at this
stage.
O Êhe air in the stomach is aspirated before removing the endoscope. Still photographs can be made during the
procedure and later shown to the patient to help explain any findings.

Risk:

O Perforation
O Irritation
O Infection
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O a surgical procedure in which the small intestine is attached to the abdominal wall in order to bypass the large
intestine; digestive waste then exits the body through an artificial opening called a stoma

Purpose:

O creates a temporary or permanent opening between the ileum (the portion of the small intestine that empties to the
large intestine) and the abdominal wall

Indication:

O treatment of colorectal cancer

O first stage in surgical construction of an ileo-anal pouch
O undergoing bowel surgery

Normal results:

O Êhe physical quality of life of most patients is not affected by an ileostomy, and with proper care most patients can
avoid major medical complications. Patients with a permanent ileostomy, however, may suffer emotional aftereffects
and benefit from psychotherapy.

Procedure:

O Êhe patient is being told about the procedure.

O Êhe patient should sign the consent form.
O after the patient is placed under general anesthesia, an incision approximately 8 in (20 cm) long is made down the
patient's midline, through the abdominal skin, muscle, and other subcutaneous tissues.
O Once the abdominal cavity has been opened, the colon and rectum are isolated and removed. Êhe anal canal is
stitched closed.

Êypes of Permanent Ileostomy:

1. ·onventional Ileostomy (Ñrooke Ileostomy)

m Involves a separate, smaller incision through the abdominal wall skin (usually on the lower right side) to which
the cut end of the ileum is sutured. Êhe ileum may protrude from the skin, often as far as 2 in (5 cm).
2. ·ontinent Ileostomy (Kock Ileostomy)
m allows a patient to control when waste exits the stoma. Portions of the small intestine are used to form a pouch
and valve; these are directly attached to the abdominal wall skin to form a stoma.  aste collects internally in the
pouch and is expelled by insertion of a soft, flexible tube through the stoma several times a day.

Risks:

O xcessive bleeding, infection, and complications due to general anesthesia.

O after surgery, some patients experience stoma obstruction (blockage), inflammation of the ileum, stoma prolapse
(protrusion of the ileum through the stoma), or irritation of the skin around the stoma.
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Disorders of the Oral ·avity

1. ·left Lip/·left Palate

m infants(milk formula); small feeding in upright position

m older infants(solid foods mixed with mixed and are given by bottle with large nipple holes)

2. Dental ·aries

m ncourage positive habits of snacking on eariostatic foods, chewing sugarless gum after eating of drinking
cariogenic items

3. Periodontal Disease

m üoods with calcium and phosphorus, vit.D fortified milk should be included; adequate intake of ascorbic acid and
fluoride

4. üractured Jaw

m High-protein, high-calorie diet

Disorders of the sophagus

1. achalasia

m Liquid foods plus supplementary foods

2. sophagitis and Hiatal Hernia

m Soft diet as tolerated by the patient

Stomach and Intestinal Disorders

1. Stomach ·ancer

m Small frequent meals high in protein and fats and low in carbohydrates

2. Gastric Surgery

m High protein and fats; avoid concentrated sweets; small frequent dry meals

Disorders of the Intestines

1. Intestinal Gas

 m Diet that excludes foods that produce gas is useful for treating some disorders

2. Lactose Intolerance

m Lactose restricted diet

3. Diarrhea

m Liberal fluid intake, electrolytes, vitamin and iron supplementation, oral rehydration, early feeding

4. ·onstipation

m High fiber, increased fluid intake

5. Regional nteritis (·rohn·s Disease, Granulomatous ·olitis)

m High in caloric value, liberal in animal proteins and rich in vitamins and minerals

6. Ulcerative ·olitis

m High protein, high calorie, increased minerals and vitamins, dietary fiber control

7. Diverticulitis

m ·lear liquids with gradual progression to full liquids

8. Intestinal Surgery

m High protein, low-fat oral diet

9. Hemorrhoids

m High fiber diet with plenty of water

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O a medical process involving the insertion of a plastic tube (nasogastrictube, NG tube) through the nose, pass the
throat, and down into the stomach
O Gastric intubation via the nasal passage (ie, nasogastric route) is a common procedure that provides access to the
stomach for diagnostic and therapeutic purposes. a nasogastric (NG) tube is used for the procedure. Êhe placement
of an NG tube can be uncomfortable for the patient if the patient is not adequately prepared with anesthesia to the
nasal passages and specific instructions on how to cooperate with the operator during the procedure.

Indication:

Diagnostic:

y valuation of upper gastrointestinal (GI) bleed (ie, presence, volume)

y aspiration of gastric fluid content
y Identification of the esophagus and stomach on a chest radiograph
y administration of radiographic contrast to the GI tract

Êherapeutic:

y Gastric decompression, including maintenance of a decompressed state after endotracheal intubation, often via the
oropharynx
y Relief of symptoms and bowel rest in the setting of small-bowel obstruction
y aspiration of gastric content from recent ingestion of toxic material
y administration of medication
y üeeding
y Ñowel irrigation

·ontraindication:

y Severe midface trauma

y Recent nasal surgery
y ·oagulation abnormality
y sophageal varices or stricture
y Recent banding or cautery of esophageal varices
y alkaline ingestion

Procedure:

O xplain the procedure, benefits, risks, complications, and alternatives to the patient or the patient's representative.
O xamine the patient's nostril for septal deviation. Êo determine which nostril is more patent, ask the patient to
occlude each nostril and breathe through the other.
O Position the patient seated upright.
O Instill 10 mL of viscous lidocaine 2%(for oral use) down the more patent nostril with the head tilted backwards (as
shown in the images below), and ask the patient to sniff and swallow to anesthetize the nasal and oropharyngeal
mucosa. In pediatric patients, do not exceed 4 mg/kg of lidocaine.  ait 5-10 minutes to ensure adequate anesthetic
effect.
 O stimate the length of insertion by measuring the distance from the tip of the nose, around the ear, and down to just
below the left costal margin. Êhis point can be marked with a piece of tape on the tube.  hen using the Salem sump
nasogastric tube (Kendall, Mansfield, Mass) in adults, the estimated length usually falls between the second and third
preprinted black lines on the tube, as shown below.
O Gently insert the nasogastric tube along the floor of the nose and advance it parallel to the nasal floor (ie, directly
perpendicular to the patient's head, not angled up into the nose) until it reaches the back of the nasopharynx, where
resistance will be met (10-20 cm). at this time, ask the patient to sip on the water through the straw and start to
swallow. ·ontinue to advance the nasogastric tube until the distance of the previously estimated length is reached.
O Stop advancing and completely withdraw the nasogastric tube if, at any time, the patient experiences respiratory
distress, is unable to speak, has significant nasal hemorrhage, or if the tube meets significant resistance.
O Verify proper placement of the nasogastric tube by auscultating a rush of air over the stomach using the 60 mL
Êoomey syringe or by aspirating gastric content. Êhe authors recommend always obtaining a chest radiograph (as
shown below) in order to verify correct placement, especially if the nasogastric tube is to be used for medication or
food administration.

·omplications:

Minor complications include nose bleeds, sinusitis, and a sore throat. Sometimes more significant complications occur
including erosion of the nose where the tube is anchored, esophageal perforation, pulmonary aspiration, a collapsed lung, or
intracranial placement of the tube.

*  



Several replacement hormone products are available for treating hypothyroidism. Êhese contain both natural and
synthetic thyroid hormone. Replacement hormones act to replace low or absent levels of the thyroid hormones and to
suppress the overproduction of ÊSH by the pituitary.

%½)

O replacement therapy in hypothyroid states

O treatment of myxedema coma
O suppression of ÊSH in the treatment and prevention of goiters
O management of thyroid cancer

action:

O increase the metabolic rate of body tissues, increasing oxygen consumption, RR, HR, growth and maturation, and the
metabolism of fats, carbohydrates and proteins

%½
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*)

O knownallergy to the drugs or their binders

O duringacute MI and thyrotoxicosis- could exacerbate the condition
O lactation-drug enters the breast milk and could suppress the infant's own thyroidproduction
O hypoadrenalconditions such as addison's disease

+,

(Synthroid, Levoxyl)

adult: 0.05 - o.2 mg/day PO

Pediatric: 0.025 ² 0.4 mg/day PO

O Replacement therapy on hypothyroidism; suppression of ÊSH release; treatment of myxedema coma and
thyrotoxicosis.


-./
0

adult: 25 ² 100 mcg/day PO

Pediatric: 20 ² 50 mcg/day PO

O Replacement therapy in hypothyroidism; suppression of ÊSH release; treatment of thyrotoxicosis; synthetic hormone
used in patients allergic to dessicated thyroid. Not for use with cardiac or anxiety problems.

,

(Êhyrolar)
adult: 60 -120 mg/day PO

Pediatric: 25 ² 150 mcg/day PO based on age and weight

O Replacement therapy in hypothyroidism; suppression of ÊSH release; treatment of thyrotoxicosis. Not for use with
cardiac dysfunction

%
%½½%
-.*
%0

adult: 60 ² 120 mg/day PO

Pediatric: 15 ² 90 mg/day PO

O Replacement therapy in hypothyroidism; suppression of ÊSH release; treatment of thyrotoxicosis.