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46 Cards in this Set
- Front
- Back
1. Serous
2. Sanguinous 3. Serosanguinous 4. Purulent |
1. Clear (No Blood)
2. Bloody 3. Comb. Thin watery, pale red 4. Thick cloudy yellow/tan |
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Albumin Blood Normal
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3.5-5
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Potassium Blood Normal
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3.5-5 mEq
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Sodium Blood Normal
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135-145 mEq
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1. Hyrdostatic Pressure
2. Osmotic pressure/pull=Oncotic Pressure/Colloid Osmotic Pressure |
1. Push From Heart
2. Big M&M |
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CO = SV X HR
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4-6L/Min = 60-80cc X 60-100/Min
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Serum Osmolality
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The NUMBER of dissolved particles:
(270-)300 mOsm/Kg |
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Nephrotic Syndrom
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Does not filter Albumin, gets to urine -> Edema
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Sepsis , overwhelming Gram minus infection
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Capillary beds get so big to let plasma protein out. Water follows -> Edema
BUT!!! FVD (as is liver disease and lymphatic block. IVF is lost! |
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HR
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60-100/min
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B/P
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Systolic 90-140
Diastolic 60-90 |
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MAP (mean Arterial Pressure)
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sys+2xdis
---------- 3 70-105mmHg : Under 60 Dangerous |
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(English) Perfusion
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The process of nutritive delivery of arterial blood to a biological tissue.
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(English) Precipitate
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To hurry
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Baroreceptors Mechanism
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⇓ Stroke Volume
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Renin-Aldosterone Mechanism
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⇓ Renal Perfusion (also: ⇓ Na, ⇑ K, Hypovolemia, and Stress)
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ADH (Osmoreceptors)
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Water Retention Mechanism:
(HIGH:)Pituitary Gland secretes ADH |
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Urine Output
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30cc/Hr Normal in a hospital setting
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ANP
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Atrial Naturetic Peptide:
Counteracts Aldosterone, ADH. Hypervolemia, Hypernatrimeia -Strech of atria - vasodialation, release of Na, release of water - Lower blood volume, blood pressure, preload, afterload. |
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1. Normal Urinary Output/Day
2. How to assess total fluid output? |
1. ~1500cc.
Healthy Person: 60cc/Hr. Hospital: 30cc/Hr 2. Urine+1000cc insensible |
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Insensible Loss/Day
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~1000cc
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Daily Baseline Fluid Requirment
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25-30ml/kg/day (less if obese, old, or head injury). Fever:15% increase.
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Define:
Enteral Parenteral |
Via GI tract
Any route OTHER THAN GI tract (Intravenous) |
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What are:
Keofeed/Dobhoff Salem Sump Tube |
Small, single lumen tube. Cannot decompress stomach.
Larger double lumen tube. Can decompress. |
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Define:
Rales What are they associated with? |
Lung "crackles:. Fluid in lungs.
Secondary to: L Vent Failure or FVE |
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Fluid Volume Assessment
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1. Skin Integrity.
2. Turgor. 3. Buccal Mucosa. 4. Lung Sounds (rales. +L. Vent Failure). 5. Heart sound S3 (FVE). 6. SOB (FVE)Veins in hands. 7. Jugular Vein (+R Vent Failure) . JVD 8. BP 9. Orthostatic BP. 10. Pulse pressure. Should be >30 11. Quality of pulse 12. Weight. In hospital 0.25-0.5 loss is normal. 13. I/O ALWAYS for 24Hrs. 14. H/H 15. Serum Osmolality 16. BUN:Cr and H/H(elevated: FVD,Lowered: FVE) 17. Urine Specific Gravity 18. CVP (Central Vein Pressure) 19. PAWP (pulmonary Artery Wedge Pressure) 20. Cardiac Output/ Cardiac Index (Indexed to pt body surface) 21. Edema ONLY when coupled with JVD |
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Define:
Pulse Pressure Normal value? |
Sys-dias
Gross Assess. for STROKE VOLUME. Should be 60-80. If <30, FVD! |
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CVP
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Central Vein Pressure (Subclavian or Jugular)
2-8mmHg Less - FVD. More FVE +R Vent Failure |
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PAWP
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Pulmonary Arterial Wedge Pressure
6-12 mmHg |
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JVD
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Jugular Vein Distention
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Urine Specific Gravity
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1.Urimeter measures Number, Size, and Weight of particles.
1.001- 1.035 (1.010-1.025) 2. Fast and Inexpensive way of Objective Fluid Balance 3. Note: Renal Failure: 1.010 fixed. Unknown reason. |
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Serum Osmolality
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1. Number of dissolved substances regardless of size, weight.
2. Measured compared to BLOOD. 3. 50-290-1200 mOsm/Kg |
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Normal weight Loss in hospital
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0.5 lb/day max is OK
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Oliguria
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<500cc/Day
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Anuria
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0cc/day
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Fluid Volume Deficit:
Physical Findings |
• skin turgor - delayed
• weight loss (Unless 3rd spacing) • postural B/P, dizziness, syncope • ⇓Central Venous Pressure- the measure of right ventricular preload, • weak rapid pulse; ⇑ temperature • generally output > intake • mucous membranes dry, sunken eyeballs • flat neck veins (CVP less than 4 mm Hg) • Here’s another method to add to your bag of tricks, check the hand veins - put hands in dependent position, if it takes > 5 sec think Hypovolemia • urine concentrated (dark yellow), sp. gravity . Oliguria < cc QD. • labs Hct ⇑ (female 36-46%, male 39-55%); BUN (5-15 mg/dl) NOTE: Weight change outweighs Urine Output. |
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1. Supine
2. Fowler 3. Semi Fowler 4. Trendelendberg 5. Reverse Trendelendberg |
1. Flat on Back
2. Sit up 90 degree 3. Sit up 45 degree 4. Flat. Feet higher than head (shock, inserting/changing central line - air emboli) 5. Flat, Head Higher than Feet |
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Vasodilation
vasoconstriction Where blood goes? Hoe effect Preload? |
Dialation - More blood goes to extremities.
Constriction - Less blood to extremities, more in the core. More gets back to heart CVP increases. |
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Dextran
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high-molecular-weight polysacharide.
Albumin and blood replacment for plasma volume expand. Every 1cc pulls 2cc/4cc(?) |
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PIC
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Perepheral Intravenous Catheter.
Good for 3-6 months |
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TPN
PPN What is it? Where administered? For how long? Risks |
Ready to use nutrition. High in sugar: Bacteria+hyperglacemia.
TPN:Total Parenteral Nutrition Goes only in central line. Long term Risk of lung puncture, air emboli Replace with D10W PPN: PIC (Periph, IV, Catheter) Shorter term 3-6 motnhs Replace with D5W. |
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What are:
KVO IID Bolus |
Keep Vein Open
intermittent infusion device IV Push |
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Parkland Formula
Burn Therapy |
V ( fluids volume)= total body surface area of burn (%) x weight (kg) x 4cc
Ringer's Lactate 50% first 8 Hrs 50% next 16 Hrs |
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Urine Output Normal Calculationn
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1cc/Kg/Hr
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1. What is Bun
2. What is Creatinine? 3. Ratio? |
BUN: Blood Uria Nitrogen. Measures metabolism of protein by liver: 5-20
Creatinie: Muscle Metabolism Most should be excreted by kidnys. 0.1-1.1 Ratio 15:1 Only BUN incr -> GI bleed Both Up -> Kidny fail |
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cirrhosis
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A chronic liver disease of highly various etiology. often lead to jaundice, ascites, and hepatic failure
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