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46 Cards in this Set

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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
Albumin Blood Normal
3.5-5
Potassium Blood Normal
3.5-5 mEq
Sodium Blood Normal
135-145 mEq
1. Hyrdostatic Pressure
2. Osmotic pressure/pull=Oncotic Pressure/Colloid Osmotic Pressure
1. Push From Heart
2. Big M&M
CO = SV X HR
4-6L/Min = 60-80cc X 60-100/Min
Serum Osmolality
The NUMBER of dissolved particles:
(270-)300 mOsm/Kg
Nephrotic Syndrom
Does not filter Albumin, gets to urine -> Edema
Sepsis , overwhelming Gram minus infection
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!
HR
60-100/min
B/P
Systolic 90-140
Diastolic 60-90
MAP (mean Arterial Pressure)
sys+2xdis
----------
3
70-105mmHg : Under 60 Dangerous
(English) Perfusion
The process of nutritive delivery of arterial blood to a biological tissue.
(English) Precipitate
To hurry
Baroreceptors Mechanism
⇓ Stroke Volume
Renin-Aldosterone Mechanism
⇓ Renal Perfusion (also: ⇓ Na, ⇑ K, Hypovolemia, and Stress)
ADH (Osmoreceptors)
Water Retention Mechanism:
(HIGH:)Pituitary Gland secretes ADH
Urine Output
30cc/Hr Normal in a hospital setting
ANP
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.
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
Insensible Loss/Day
~1000cc
Daily Baseline Fluid Requirment
25-30ml/kg/day (less if obese, old, or head injury). Fever:15% increase.
Define:
Enteral

Parenteral
Via GI tract

Any route OTHER THAN GI tract (Intravenous)
What are:
Keofeed/Dobhoff

Salem Sump Tube
Small, single lumen tube. Cannot decompress stomach.

Larger double lumen tube. Can decompress.
Define:
Rales
What are they associated with?
Lung "crackles:. Fluid in lungs.
Secondary to: L Vent Failure or FVE
Fluid Volume Assessment
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
Define:
Pulse Pressure
Normal value?
Sys-dias
Gross Assess. for STROKE VOLUME.
Should be 60-80. If <30, FVD!
CVP
Central Vein Pressure (Subclavian or Jugular)
2-8mmHg
Less - FVD.
More FVE +R Vent Failure
PAWP
Pulmonary Arterial Wedge Pressure
6-12 mmHg
JVD
Jugular Vein Distention
Urine Specific Gravity
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.
Serum Osmolality
1. Number of dissolved substances regardless of size, weight.
2. Measured compared to BLOOD.
3. 50-290-1200 mOsm/Kg
Normal weight Loss in hospital
0.5 lb/day max is OK
Oliguria
<500cc/Day
Anuria
0cc/day
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.
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
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.
Dextran
high-molecular-weight polysacharide.
Albumin and blood replacment for plasma volume expand. Every 1cc pulls 2cc/4cc(?)
PIC
Perepheral Intravenous Catheter.
Good for 3-6 months
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.
What are:
KVO
IID
Bolus
Keep Vein Open
intermittent infusion device
IV Push
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
Urine Output Normal Calculationn
1cc/Kg/Hr
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
cirrhosis
A chronic liver disease of highly various etiology. often lead to jaundice, ascites, and hepatic failure