Reye’s syndrome


Reye’s syndrome is a disease characterized by:

  1. vomiting
  2. encephalopathy (disease of the brain)
  3. mental impairment
  4. personality changes
  5. deterioration of consciousness
  6. irritability, delirium and coma may accompany mental deterioration
  7. fatty degeneration of the liver

The disease usually presents after infection with varicella or influenza virus. Studies have demonstrated a strong epidemiologic association between the ingestion of aspirin during antecedent varicella or influenza-like illnesses and the subsequent development of Reye’s syndrome. The vast majority of cases present in children.


metabolic tests for:

  • hyperammonemia
  • elevated levels of alanine aminotransferase
  • aspartate aminotransferase

distinguishing test:

  • an electron micrograph
  • ultrastructural changes in liver tissue
  • specifically the proliferation of smooth endoplasmic reticulum and peroxisomes 
  • the presence of enlarged and pleomorphic mitochondria with loss of dense granules


  • Reye’s syndrome is potentially fatal
  • The recovery of adults with the syndrome is generally complete, with liver and brain function returning to normal within two weeks of the illness
  • In children, mild to severe permanent brain damage is possible, especially in infants


Ermias D., Bresee,Joseph S., Holman, Robert C, Khan, Ali S., Shahriari, Abtin, and Schonberger, Lawrence B. 1999. Reye’s Syndrome in the United States from 1981 through 1997. New England Journal of Medicine. 340 (18) :1377-1382.




Graves’ disease


Graves’ disease is an autoimmune disease affecting the thyroid gland. The thyroid gland becomes enlarged. Hyperthyroidism symptoms are the result.


  • goiter
  • tachycardia (increased heart rate)
  • hypotonia (decreased muscle tone)
  • irritability
  • distrupted sleep pattern
  • irritability



  • relatedness factors in predispostion to the disease
  • an identical twin has a 25% chance of developing the disease if their twin is affected.


  • antithyroid medications such as carbimazole or methimazole and propylthiouracil may be used to decreased thyroid activity and control hyperthyroid symptoms
  • surgical removal of part of the thyroid gland may be performed to decreased thyroid activity




Blepharoptosis is a condition where the upper eyelid droops in an abnormally low position.


Blepharoptosis repair is typically performed in an outpatient surgical setting. An anesthesiologist (MD) administers sedating medications while monitoring vital signs. The eyelid opening muscle is reattached or shortened through a small incision in the upper lid.

 Less commonly, the eyelid opening muscle is too weak to resolve the droopiness by the above technique. When this degree of muscle weakness is present, frontalis sling must be performed. This involves connecting the eyelid to the eyebrow (frontalis) muscle deep within the eyelid tissues.

 Lensink Eye Surgery. 2005. Blepharoptosis. Retrived May 27, 2009 from

Bullous pemphigoid (BP)


Bullous pemphigoid, BP is a chronic autoimmune skin disease, involving the formation of subepidermal (below the skin) blisters . The body makes antibodies against the body’s type XVII collagen.Bullous_Pemphigoid


  • Blisters appear as thin-walled sac filled with clear fluid.
  • skin is typically very itchy
  • large, red welts and hives may appear before or during the formation of blisters.
  • The blisters are widespread and usually appear on the areas of the body that flex or move (flexural areas).
  • About 15-20 percent of people with BP also develop blisters in the mouth or down the throat in the esophagus


  • via skin biopsy
  • tissue sample is taken and tested through autofluorescence for antibodies to collagen


  • used to prevent infection
  • provide symptom relief
  • antibiotics such as tetracycline and minocycline are often used
  • the use of oral steroids such as prednisone and prednilosone may be to relive symptoms in severe cases
  • immunosupressants such as Immuran, Cellcept, Methotrexate, cyclophosphamide and Neoral may be used to manage symptoms. 


Diaz, L A, Emery, D, J, Fairley, J A, Giudice, G J, Liu, Z,  Taylor,  A F  and Troy, J L. 1993. A passive transfer model of the organ-specific autoimmune disease, bullous pemphigoid, using antibodies generated against the hemidesmosomal antigen, BP180. The Journal of Clinical Investigation. 92(5): 2480–2488.

RAI Assessment Tool


The RAI or Resident Assessment Inventory tool is a standard patient assessment tool used in many countries around the world. This tool provides a common format for patient assessment, health and healing progress to increase ease of communication around patient care across the health care multi-disciplinary team.

RAI tool

General Patient Assessment tool


Patient Assessment Tool


System Assessed

Health Promoting Action


  • Wash hands pre & post care

  • overall appearance

  • height, weight, build

  • hygiene, grooming

  • body and breath odor

  • facial expression


  • Temperature

  • Pulse rate and quality

  • respiration rate and quality

  • blood pressure

  • pain


  • Reason for contact

  • past medical/surgical history

  • current & past medications

  • sleep/rest patterns

Head and Neck

  • Hair and scalp

  • Hearing aids & glasses

  • Skin: rash abrasions

  • assist with morning care

  • inspect eyes, lids & lacrimal glands

  • inspect ears, nose and mucosa

  • lymph nodes

  • ROM


  • Orientation x 3 (name, location, time)


  • LOC (alert, drowsy, unresponsive)

  • Limb strength (squeeze fingers)

  • Mini mental as needed

Thorax & Lungs

  • Breathing effort & posture (SOB/SOBe)

  • thoracic expansion

  • chest musculature

  • sputum (colour & consistency)

  • auscultation for breath sounds

  • meds = vasodilators, anti-hypertensives


  • Cystology: urine colour, odor, quantity

  • Stool: BM consistency, colour, regularity

  • continence: stool, urine – attends, foley

  • Abdominal masses

  • auscultation: bowel sounds


  • ADL’s and ROM

  • Mobility Aids: walker, wheel chair

  • inflammation, edema, weakness




  • Diet: minced, puree, fluids

  • Dentures

  • difficulty swallowing

  • allergies

  • mucus membrane moisture


  • Bed rails up

  • Call bell within reach

  • bed lowest to ground

  • water, juice, kleenex in reach





A surgical procedure to remove all or part of the stomach. The stomach is reattached at either end of the resection sites, or the intestine if the entire stomach or lower portion at the pyloric sphincter is removed. This is called an anastomosis. Anastomosis  is a surgical connection between two structures. It usually means a connection that is created between tubular structures, such as blood vessels or loops of intestine.

bilroth1 gastectomy


  • to treat stomach cancer by removal of cancerous tissue
  • to treat perforations of the stomach wall

Gastrectomy. retrieved may 22, 2009 from