Discharge And Home Healthcare Guidelines

REFERRALS. Refer patients with advanced acromegaly who experience arthritic changes and require assist devices for ambulation and activities of daily living to a physical therapist.

ACTIVITY RESTRICTIONS. Instruct the patient to avoid activities that increase intracranial pressure for up to 2 months after surgery. Toothbrushing can be resumed in 2 weeks. Instruct the patient to report increased nasal drainage. Incisional numbness and altered olfaction may occur for 4 months after surgery.

MEDICATIONS. If octreotide is prescribed, the patient will need to be able to demonstrate how to administer a subcutaneous or intramuscular injection.

FOLLOW-UP. Patients need to be monitored for development of cardiac disease, diabetes mel-litus, and gallstones and a recurrence of symptoms. Advise the patient to wear a medical identification bracelet.

Acute Adrenal Crisis DRG categ°ry: 300

Mean LOS: 6.3 days Description: MEDICAL: Endocrine Disorders with CC

^Acute adrenal crisis is a life-threatening endocrine emergency caused by a deficit of glucocorticoids (primarily cortisol) or mineralocorticoids (primarily aldosterone). The anterior pituitary gland produces adrenocorticotropic hormone (ACTH), which causes the adrenal cortex to produce corticosteroid and aldosterone hormones.

A deficiency of cortisol produces many metabolic abnormalities, such as decreases in glucose production, protein and fat metabolism, appetite, and digestion. Serious systemic effects include a decrease in vascular tone and a diminished effect of catecholamines such as epi-nephrine and norepinephrine. Normally, a body under stress releases corticosteroids. Both the decrease in the vascular tone of the blood vessels and the decreased effect of catecholamines in an individual in an adrenal crisis can cause shock. The deficiency of aldosterone results in profound fluid and electrolyte imbalances: a decrease in sodium and water retention, a decrease in circulating blood volume, and an increase in both potassium and hydrogen ion reabsorption.

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