The basic information "Clinical Pathway of Pituitary Hypofunction (Version 20 17)" was commissioned by the General Office of the National Health and Family Planning Commission to organize an expert system (revised) and published on the website of the Chinese Medical Association.
3. Notice of the General Office of the National Health and Family Planning Commission on implementing the clinical pathway of related diseases
National Health Office Han Yi [20 17] No.537
Health and Family Planning Commissions of all provinces, autonomous regions and municipalities directly under the Central Government and Health Bureau of Xinjiang Production and Construction Corps:
In order to further deepen the reform of the medical and health system, standardize the diagnosis and treatment behavior, and ensure the quality and safety of medical care, our Committee continued to promote the management of clinical pathways, and entrusted the Chinese Medical Association to organize an expert system (revised) to determine the clinical pathways of 202 diseases in 23 majors. The above clinical pathways have been published on the website of Chinese Medical Association (WWW.cma.cn/kjps/jsgf/) for reference by health and family planning administrative departments and medical institutions.
General Office of the National Health and Family Planning Commission
2065438+May 3, 20071
4 Clinical Pathway The full text of the clinical pathway of anterior pituitary hypofunction (version 20 17)
4. 1 1. Clinical pathway of standard hospitalization process for pituitary hypofunction 4. 1. 1 (1) Applicable objects. The first diagnosis was hypopituitarism (ICD 10: E23.008).
4. 1.2 (II) Diagnostic basis. According to Clinical Treatment Guidelines for Endocrine and Metabolic Diseases (edited by Chinese Medical Association, People's Health Publishing House, 20 16).
1. Symptoms and signs of hypofunction of multiple endocrine target glands.
2. Laboratory examination: the level of hormone in anterior pituitary gland and related target gland hormone decreased.
3. There is a history of suspicious etiology, such as postpartum hemorrhage, pituitary adenoma, infection and trauma.
4. 1.3 (III) Basis for choosing treatment plan. According to Clinical Treatment Guidelines for Endocrine and Metabolic Diseases (edited by Chinese Medical Association, People's Health Publishing House, 20 16).
Hormone replacement therapy for endocrine target glands.
4. 1.4 (4) The standard hospitalization days are generally ≤ 14 days. 4. 1.5 (5) Entry path standard. 1. The first diagnosis must conform to the disease code ICD 10: E23.008 of hypopituitarism.
2. When the patient is accompanied by other disease diagnosis at the same time, but does not need special treatment during hospitalization and does not affect the implementation of the first-visit clinical pathway, he can enter the pathway.
4. 1.6 (6) Inspection items during hospitalization. 4. 1.6. 1. 1. Necessary examination items: (1) blood routine, urine routine and stool routine;
(2) Liver and kidney function, electrolyte, blood sugar and blood lipid;
(3) Chest X-ray, electrocardiogram and abdominal B-ultrasound;
(4) Evaluation of endocrine gland function: thyroid axis related hormone, adrenal axis related hormone, gonad axis related hormone, growth hormone, IGF 1, prolactin;
(5) Imaging related examination: CT or MRI of hypothalamus and pituitary gland.
4. 1.6.2 2. According to the patient's condition, select the examination items: (1) anterior pituitary reserve function test: insulin hypoglycemia excitation test (* * * growth hormone and prolactin secretion are risky); Luteinizing hormone releasing hormone (LHRH) challenge test;
(2) Relevant immune indicators: erythrocyte sedimentation rate, CRP, complete immunoglobulin, complete complement, autoantibodies (antinuclear antibody, ENA, dsDNA, anti-thyroid, anti-adrenal, anti-ovary, anti-parathyroid antibody, etc. ), antineutrophil cytoplasmic antibody (ANCA), rheumatoid factor and rheumatoid related antibody;
(3) If the electrolyte is disordered, check blood gas analysis if necessary;
(4) Suspected space occupying lesions: fundus and visual field examination;
(5) Related indexes of bone metabolism: bone mineral density, calcium and phosphorus (blood and urine) levels;
(6) Enhanced MRI of hypothalamus and pituitary.
4. 1.7 (7) Selective medication. 1. Target hormone replacement therapy
(1) Glucocorticoid: prednisone or hydrocortisone;
(2) Thyroid hormone: levothyroxine tablets;
(3) gonadal hormones: estrogen and progesterone can be used for women of childbearing age; Testosterone can be used in men; If you have fertility requirements, you can use gonadotropin therapy.
4. 1.8 (8) Emission standard. 1. To clarify the diagnosis and etiology of anterior pituitary hypofunction.
2. After treatment (endocrine hormone replacement therapy, etc. ), the condition improved or stabilized.
3. Patients with pituitary adenoma and rheumatic immune diseases. If the cause is unknown, it should be transferred to other departments for further treatment as appropriate.
4. There are no complications and/or complications that require continued hospitalization.
4. 1.9 (9) variation and its cause analysis. 1. In case of acute life-threatening complications (such as pituitary crisis, coma caused by mucinous edema, adrenal crisis, etc.). ), patients should be treated according to the corresponding path or guidance, and quit this path.
2. Patients with infection as the cause, if the hospitalization time is prolonged due to aggravated infection and septic shock, should be treated according to the corresponding path or guidelines, and quit this path.
4.2. Clinical pathway form of pituitary hypofunction: the first diagnosis was pituitary hypofunction (ICD 10: E23.008).
Patient's name: gender: age: outpatient number: hospitalization number:
Date of hospitalization:? Year? Month? Date of discharge:? Year? Month? Day? Standard residence time: ≤ 14 days
time
1 day hospitalization
Hospitalization days 2 13
Hospitalization days 10 14
(discharge date)
owner
ask
examination
treat cordially
worker
work
□? Asking about medical history and physical examination
□? Complete medical record writing
□? Perfect inspection
□? Senior physician rounds
□? Senior physician rounds
□? Complete the qualitative, functional, etiological and localized diagnosis of the examination.
□? Complete the consultation with relevant departments.
-Make a diagnosis according to the results of examination and consultation.
□? Hormone replacement therapy for patients with hypothyroidism.
□? The superior doctor makes rounds to determine whether to change majors or leave the hospital.
□? Through substitution therapy, the patient's condition can be improved and stabilized, and an account can be given to the patient and his family. According to the different causes of the disease, you can be prepared to change your major or leave the hospital.
□? Complete discharge records, the first page of medical records, discharge certificates, etc. , and explain to patients the matters needing attention after changing majors or leaving the hospital.
heavy
main points
doctor
order
Long-term doctor's advice:
□? Internal medicine nursing routine
□? Secondary nursing
□? prescribe a diet
Temporary medical advice:
□? Blood routine, urine routine, stool routine+occult blood
□? Liver and kidney function, electrolyte, blood sugar and blood lipid
□? Chest X-ray, electrocardiogram, abdominal B-ultrasound
□? Endocrine hormone examination: thyroid hormone, adrenal hormone, gonadal hormone, GH, PRL.
□? Make an appointment for hypothalamic pituitary CT or MRI
Long-term doctor's advice:
□? be the same as the above
□? Target hormone replacement therapy
□? Infection, antibiotic treatment
Temporary medical advice:
□? Perfect laboratory tests: ESR, CPP, PCT, immunoglobulin, complement, autoantibodies, ANCA, rheumatoid factor and related antibodies, blood gas analysis (if necessary).
□? Reserve function test of anterior pituitary: insulin hypoglycemia test; LHRH excitation test and TRH excitation test.
(when necessary)
□? Examination of fundus and visual field (if necessary)
□? Bone metabolism: bone density, calcium, phosphorus, etc.
□? Hypothalamic pituitary enhanced magnetic resonance imaging (if necessary)
Unloading sequence:
□? Discharge with medicine
□? According to the illness, leave the hospital or change majors.
□? Ask patients for regular follow-up and follow-up dates.
primary
nurse
work
□? Introduce the ward environment, facilities and equipment.
□? Admission nursing evaluation
□? Observe the changes of the disease to prevent accidents such as falls and infections.
□? Guide patients to go through the discharge formalities.
state of illness
change
record
□ None? □ Yes, the reason is:
1.
2.
□ None? □ Yes, the reason is:
1.
2.
□ None? □ Yes, the reason is:
1.
2.
nurse
symbol
Certified doctor
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5 clinical pathway anterior pituitary dysfunction. document