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190 Cards in this Set
- Front
- Back
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NORMAL LEVELS:
Blood Gas Values: Arterial pH |
7.35 – 7.45
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NORMAL LEVELS:
Blood Gas Values: Arterial PaCO₂ |
35 – 45 mmHg
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NORMAL LEVELS:
Blood Gas Values: Arterial HCO₃ |
22 – 26 mEq/L
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NORMAL LEVELS:
Blood Gas Values: Arterial PaO₂ |
80 – 100 mmHg
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Name the vital signs
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1. temperature
2. pulse 3. respiration rate 4. Blood pressure 5. O₂ Sat (6. Pain) |
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Vital Signs: Acceptable Ranges for Adults
Temperature Range |
36 – 38 °C
96.8 – 100.4 °F |
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Vital Signs: Acceptable Ranges for Adults
Pulse |
60 – 100 beats per minute
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Vital Signs: Acceptable Ranges for Adults
Respirations |
12 – 20 breaths per minute
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Vital Signs: Acceptable Ranges for Adults
Average Blood Pressure |
Average: 120/80 mm Hg
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Vital Signs: Acceptable Ranges for Adults
Pulse Pressure |
30 to 50 mm Hg
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Cardiac Output Determination Equation
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Pulse rate x Stroke volume = Cardiac output
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Name the core temperature sites
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Rectum, Tympanic membrane, esophagus, pulmonary artery, urinary bladder
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Name the surface temperature sites
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skin, oral, axillae
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Thermoregulation: The anterior hypothalamus controls ….
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Heat loss
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Thermoregulation: The posterior hypothalamus controls …
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heat production
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Mechanisms of heat loss
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sweating, vasodilation (widening) of blood vessels, and inhibition of heat production. Blood is redistributed to surface vessels to promote heat loss.
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Mechanisms of heat production
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Vasoconstriction (narrowing) of blood vessels reduces blood flow to the skin and extremities. If that doesn’t work then heat production: from voluntary muscle contraction and muscle shivering.
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Mild temperature elevations up to _____ enhance the body’s immune system.
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102.2 °F or 39 °C
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Increased temperature reduces the concentration of _____ in the blood plasma, suppressing the growth of bacteria.
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Iron
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Fever fights viral infections by stimulating _______, the body’s natural virus-fighting substance.
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Interferon
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Patterns of Fever
Sustained |
A constant body temperature continuously above 38°C (100.4°F) that demonstrates little fluctuation.
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Patterns of Fever
Intermittent |
Fever spikes interspersed with usual temperature levels. Temperature returns to acceptable value at least once in 24 hours.
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Patterns of Fever
Remittent |
Fever spikes and falls without a return to normal temperature levels.
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Patterns of Fever
Relapsing |
Periods of febrile episodes interspersed with acceptable temperature values. Febrile episodes and periods of normothermia may be longer than 24 hours.
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Classification of Hypothermia
Mild |
34 – 36 °C
93.2 – 96.8 °F |
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Classification of Hypothermia
Moderate |
30 – 34 °C
86.0 – 93.2 °F |
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Classification of Hypothermia
Severe |
< 30 °C
< 86.0 °F |
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Signs and symptoms of Hypothermia
Mild |
uncontrolled shivering, loss of memory, depression, poor judgment.
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Signs and symptoms of Hypothermia
Moderate |
heart rate, respiratory rate and blood pressure fall. Skin becomes cyanotic.
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Signs and symptoms of Hypothermia
Severe |
cardiac dysrhythmias, loss of consciousness, and unresponsiveness to painful stimuli. Patient may appear dead.
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Rectal temperatures are usually ___________ than oral temperatures.
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0.5 °C (0.9 °F) higher
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Axillary temperatures are usually _________ than oral temperatures.
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0.5 °C (0.9 °F) lower
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Formula to convert Fahrenheit to °Celsius
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subtract 32 from °F and multiply the result by 5/9
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Formula to convert Celsius to Fahrenheit
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multiply the C reading by 9/5 and add 32 to the product
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The body’s metabolism increases ___ for every degree of Celsius of temperature elevation.
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13%
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FUO
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Fever of Unknown Origin
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Malignant hyperthermia
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A hereditary condition of uncontrolled heat production, occurring when susceptible persons receive certain anesthetic drugs.
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True Fever
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an elevated body temperature resulting from an increase in the body’s set point
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Hyperthermia
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an elevated body temperature related to the body’s inability to promote heat loss or reduce heat production
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High risk clients for heatstroke include:
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the very young, the very old, those with cardiovascular disease, hypothyroidism, medications that decrease the body’s ability to lose heat and those who exercise or work strenuously.
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Medications that decrease the body’s ability to lose heat:
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phenothiazines, anticholinergics, diuretics, amphetamines, and beta-adrenergic receptor antagonists
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Signs and symptoms of heat stroke:
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giddiness, confusion, delirium, excess thirst, nausea, muscle cramps, visual disturbances, and even incontinence. The most important is hot, dry skin. If it progresses client becomes unconscious with fixed, unreactive pupils.
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Vitals with heat stroke:
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body temp sometimes as high as 45C (113F) with increase in heart rate and lowering of blood pressure.
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NonSteroidal Antipyretics
Name them and how they work. |
Acetaminophen, salicylates, indomethacin, and ketorolac reduce fever by increasing heat loss.
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Steroidal Antipyretics
What should we know? |
corticosteroids reduce heat production by interfering with the immune system and can mask infection. Not used to treat fever but be aware of their effects of suppressing client’s ability to develop one.
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Normal adult cardiac output volume
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In an adult the heart normally pumps 5000 ml of blood per minute.
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When a client’s condition suddenly worsens, what pulse site is recommended for assessment?
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The heart will continue delivering blood through the CAROTID ARTERY to the brain as long as possible.
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What pulse site(s) are recommended for infants and children?
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The BRACHIAL or APICAL pulse is the best because other peripheral pulses are deep and difficult to palpate accurately.
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Name the pulse sites
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Temporal, carotid, apical, brachial, radial, ulnar, femoral, popliteal, posterior tibial, dorsalis pedis
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Pulse Site Location:
Temporal |
Over temporal bone of head, above and lateral to eye
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Pulse Site Location:
Carotid |
Along medial edge of sternocleidomastoid muscle in neck
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Pulse Site Location:
Apical |
Fourth to fifth intercostals space at left midclavicular line
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Pulse Site Location:
Brachial |
Groove between biceps and triceps muscles at antecubital fossa
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Pulse Site Location:
Radial |
Radial or thumb side of forearm at wrist
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Pulse Site Location:
Ulnar |
Ulnar side of forearm at wrist
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Pulse Site Location:
Femoral |
Below inguinal ligament, midway between symphysis pubis and anterisor superior iliac spine
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Pulse Site Location:
Popliteal |
Behind knee in popliteal fossa
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Pulse Site Location:
Posterior tibial |
Inner side of ankle, below medial malleolus
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Pulse Site Location:
Dorsalis pedis |
Along top of foot, between extension tendons of great and first toe
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Pulse Site Assessment Criteria:
Temporal |
Easily accessible site used to assess pulse in children
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Pulse Site Assessment Criteria:
carotid |
Easily accessible site used during physiological shock or cardiac arrest when other sites are not palpable
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Pulse Site Assessment Criteria:
apical |
site used to auscultate for apical pulse
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Pulse Site Assessment Criteria:
brachial |
Site used to assess status of circulation to lower arm
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Pulse Site Assessment Criteria:
radial |
Common site used to assess character of pulse peripherally and assess status of circulation to hand.
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Pulse Site Assessment Criteria:
ulnar |
Site used to assess status of circulation to hand; also used to perform an Allen’s test.
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Pulse Site Assessment Criteria:
femoral |
Site used to assess character of pulse during physiological shock or cardiac arrest when other pulses are not palpable; used to assess status of circulation to leg.
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Pulse Site Assessment Criteria:
popliteal |
Site used to assess status of circulation to lower leg.
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Pulse Site Assessment Criteria:
posterior tibial |
Site used to assess status of circulation to foot.
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Pulse Site Assessment Criteria:
dorsalis pedis |
Site used to assess status of circulation to foot.
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Bradycardia
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apical pulse is less than 60 beats/min
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Acceptable Ranges of Heart Rate
Infant |
120 – 160 Beats per Minute
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Acceptable Ranges of Heart Rate
Toddler |
90 – 140 Beats per Minute
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Acceptable Ranges of Heart Rate
Preschooler |
80 – 110 Beats per Minute
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Acceptable Ranges of Heart Rate
School ager |
75 – 100 Beats per Minute
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Acceptable Ranges of Heart Rate
Adolescent |
60 – 90 Beats per Minute
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Acceptable Ranges of Heart Rate
Adult |
60 – 100 Beats per Minute
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Factors Influencing Pulse Rates
EXERCISE |
Increase Pulse Rate: Short-term exercise.
Decrease Pulse Rate: A conditioned athlete who participates in long-term exercise will have a lower heart rate at rest. |
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Factors Influencing Pulse Rates
TEMPERATURE |
Increase Pulse Rate: Fever and heat.
Decrease Pulse Rate: Hypothermia. |
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Factors Influencing Pulse Rates
EMOTIONS |
Increase Pulse Rate: Acute pain and anxiety increase sympathetic stimulation, affecting heart rate.
Decrease Pulse Rate: Unrelieved severe pain increases parasympathetic stimulation, affecting heart rate; relaxation. |
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Factors Influencing Pulse Rates
DRUGS |
Increase Pulse Rate: Positive chronotropic drugs such as epinephrine.
Decrease Pulse Rate: Negative chronotropic drugs such as digitalis; beta and calcium blockers. |
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Factors Influencing Pulse Rates
HEMORRHAGE |
Increase Pulse Rate: Loss of blood increases sympathetic stimulation.
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Factors Influencing Pulse Rates
POSTURAL CHANGES |
Increase Pulse Rate: Standing or sitting.
Decrease Pulse Rate: Lying down. |
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Factors Influencing Pulse Rates
PULMONARY CONDITIONS |
Increase Pulse Rate: Diseases causing poor oxygenation such as asthma, chronic obstructive pulmonary disease (COPD).
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Pulse Deficit
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A difference between the apical and radial pulse rates.
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Ventilation
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the movement of gases in and out of the lungs
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Diffusion
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the movement of oxygen and carbon dioxide between the alveoli and the red blood cells
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Perfusion
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the distribution of red blood cells to and from the pulmonary capillaries
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How do you assess ventilation?
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By determining respiratory rate, respiratory depth, and respiratory rhythm.
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How do you assess Diffusion and Perfusion?
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By determining oxygen saturation.
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Ventilation is regulated by levels of __________ in the arterial blood.
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CO₂, O₂ and hydrogen ion concentration (pH)
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Hypercarbia
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excess CO₂
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Hypoxemia
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low levels or arterial O₂
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During a normal, relaxed breath, a person inhales __________ of air.
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500 mL
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Tidal volume
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the amount of air a person normally inhales in one breath.
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Which is a passive process? Inspiration or Expiration?
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Expiratin is a passive process.
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Eupnea
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the normal rate and depth of ventilation
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Factors Influencing Character of Respirations
Exercise |
Exercise increases rate and depth to meet the body’s need for additional oxygen and to rid the body of CO₂.
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Factors Influencing Character of Respirations
Acute Pain |
Pain alters rate and rhythm of respirations; breathing becomes shallow. Client may inhibit or splint chest wall movement when pain is in area of chest or abdomen.
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Factors Influencing Character of Respirations
Anxiety |
Anxiety increases rate and depth as a result of sympathetic stimulation.
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Factors Influencing Character of Respirations
Smoking |
Chronic smoking changes the lung’s airways, resulting in increased rate of respirations at rest when not smoking.
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Factors Influencing Character of Respirations
Body Position |
A straight, erect posture promotes full chest expansion. A stooped or slumped position impairs ventilatory movement. Lying flat prevents full chest expansion.
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Factors Influencing Character of Respirations
Medications |
Narcotic analgesics, general anesthetics, and sedative hypnotics depress rate and depth. Amphetamines and cocaine may increase rate and depth. Bronchodilators slow rate by causing airway dilation.
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Factors Influencing Character of Respirations
Neurological Injury |
Injury to the brain stem impairs the respiratory center and inhibits respiratory rate and rhythm.
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Factors Influencing Character of Respirations
Hemoglobin Function |
Decreased hemoglobin levels (anemia) reduce oxygen-carrying capacity of the blood, which increases respiratory rate. Increased altitude lowers the amount of saturated hemoglobin, which increases respiratory rate and depth. Abnormal blood cell function (e.g., sickle cell disease) reduces ability of hemoglobin to carry oxygen, which increases respiratory rate and depth.
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Acceptable Range of Respiratory Rates for Age:
Newborn |
30 – 60 Breaths per Minute
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Acceptable Range of Respiratory Rates for Age:
Infant (6 months) |
30 – 50 Breaths per Minute
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Acceptable Range of Respiratory Rates for Age:
Toddler (2 years) |
25 – 32 Breaths per Minute
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Acceptable Range of Respiratory Rates for Age:
Child |
20 – 30 Breaths per Minute
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Acceptable Range of Respiratory Rates for Age:
Adolescent |
16 – 19 Breaths per Minute
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Acceptable Range of Respiratory Rates for Age:
Adult |
12 – 20 Breaths per Minute
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Alterations in Breathing Pattern:
Bradypnea |
Rate of breathing is regular but abnormally slow (less than 12 breaths per minute).
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Alterations in Breathing Pattern:
Tachypnea |
Rate of breathing is regular but abnormally rapid (greater than 20 breaths per minute).
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Alterations in Breathing Pattern:
Hyperpnea |
Respirations are labored, increased in depth, and increased in rate (greater than 20 breaths per minute). Occurs normally during exercise.
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Alterations in Breathing Pattern:
Apnea |
Respirations cease for several seconds. Persistent cessation results in respiratory arrest.
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Alterations in Breathing Pattern:
Hyperventilation |
Rate and depth of respirations increase. Hypocarbia may occur.
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Alterations in Breathing Pattern:
Hypoventilation |
Respiratory rate is abnormally low, and depth of ventilation may be depressed. Hypercarbia may occur.
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Alterations in Breathing Pattern:
Cheyne-Stokes respiration |
Respiratory rate and depth are irregular, characterized by alternating periods of apnea and hyperventilation. Respiratory cycle beings with slow, shallow breaths that gradually increase to abnormal rate and depth. The pattern reverses, breathing slows and becomes shallow, climaxing in apnea before respiration resumes.
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Alterations in Breathing Pattern:
Kussmaul’s respiration |
Respirations are abnormally deep, regular, and increased in rate.
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Alterations in Breathing Pattern:
Biot’s respiration |
Respirations are abnormally shallow for tow or three breaths followed by irregular period of apnea.
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Factors Affecting Determination of Pules Oxygen Saturation (SpO₂):
Interference with Light Transmission Outside Light |
Outside light sources can interfere with the oximeter's ability to process reflected light.
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Factors Affecting Determination of Pules Oxygen Saturation (SpO₂):
Interference with Light Transmission Carbon Monoxide |
Carbon Monoxide (caused by smoke inhalation or poisoning) artificially elevates SpO₂by absorbing light similar to oxygen.
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Factors Affecting Determination of Pules Oxygen Saturation (SpO₂):
Interference with Light Transmission Client Motion |
Client motion can interfere with the oximeter’s ability to process reflected light.
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Factors Affecting Determination of Pules Oxygen Saturation (SpO₂):
Interference with Light Transmission Jaundice |
Jaundice may interfere with the oximeter’s ability to process reflected light.
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Factors Affecting Determination of Pules Oxygen Saturation (SpO₂):
Interference with Light Transmission Intravascular Dyes |
Intravascular dyes (methylene blue) absorb light similar to deoxyhemoglobin and artificially lower saturation.
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Factors Affecting Determination of Pules Oxygen Saturation (SpO₂):
Reduction of Arterial Pulsations atherosclerosis |
Peripheral vascular disease (atherosclerosis) can reduce pulse volume.
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Factors Affecting Determination of Pules Oxygen Saturation (SpO₂):
Reduction of Arterial Pulsations Hypothermia |
Hypothermia at assessment site decreases peripheral blood flow.
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Factors Affecting Determination of Pules Oxygen Saturation (SpO₂):
Reduction of Arterial Pulsations Drugs |
Pharmacological vasoconstrictors (epinephrine, phenylephrine, dopamine) will decrease peripheral pulse volume.
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Factors Affecting Determination of Pules Oxygen Saturation (SpO₂):
Reduction of Arterial Pulsations Low cardiac output or hypotension |
Low cardiac output and hypotension decrease blood flow to peripheral arteries.
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Factors Affecting Determination of Pules Oxygen Saturation (SpO₂):
Reduction of Arterial Pulsations Peripheral edema |
Peripheral edema can obscure arterial pulsation.
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Factors Affecting Determination of Pules Oxygen Saturation (SpO₂):
Reduction of Arterial Pulsations Tight probe |
Tight probe will record venous pulsations in the finger that complete with arterial pulsations.
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Blood pressure (BP) depends on the cardiac output (CO) and peripheral vascular resistance (R). Show equasion.
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BP = CO x R
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BP = CO x R means what?
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Blood pressure (BP) depends on the cardiac output (CO) and peripheral vascular resistance (R).
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pulse pressure
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the difference between systolic and diastolic pressure
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systolic blood pressure
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the peak of maximum pressure when ejection occurs is the SYSTOLIC blood pressure.
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diasolic blood pressure
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When the ventricles relax, the blood remaining in the arteries exerts a minimum or DIASTOLIC pressure.
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Normal blood volume for an adult
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5000 mL
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Percentage of red blood cells in the blood
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hematocrit
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What determines the viscosity of our blood?
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the hematocrit
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If the hematocrit rises, blood flow ____ and arterial blood pressure ______.
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slows, increases
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The heart must ________ to move viscous blood through the circulatory system.
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contract more forcefully
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Classification of Blood Pressure for Adults 18 and Older
Normal |
Systolic (mmHg): < 120
Diastolic (mmHg): < 80 ** treatment based on highest category ** |
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Classification of Blood Pressure for Adults 18 and Older
Pre-hypertension |
Systolic (mmHg): 120 – 139
Diastolic (mmHg): 80 – 89 ** treatment based on highest category ** |
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Classification of Blood Pressure for Adults 18 and Older
Stage 1 Hypertension |
Systolic (mmHg): 140 – 159
Diastolic (mmHg): 90 – 99 ** treatment based on highest category ** |
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Classification of Blood Pressure for Adults 18 and Older
Stage 2 Hypertension |
Systolic (mmHg): > 160
Diastolic (mmHg): > 100 ** treatment based on highest category ** |
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Classification of Blood Pressure:
What does it mean when we say "treatment based on highest category"? |
Example: If a patient has a systolic pressure that falls in the Stage 1 range and a Diastolic that falls in the Pre-hypertention range, the client's treatment is based on the Stage 1 finding, as Stage 1 is a higher category than pre-hypertension.
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Antihypertension Medications:
Diuretics Name them |
Furosemide (Lasix)
spironolactone (Aldactone) metolazone polythiazide benzthiazide |
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Antihypertension Medications:
Beta-adrenergic blockers Name them |
Atenolol (Tenormin)
nadolol (Corgard) timolol maleate (Blocadren) propranolol (Inderal) |
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Antihypertension Medications:
Vasodilators Name them |
Hydralazine hydrochloride (Apresoline)
minoxidil (Loniten) |
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Antihypertension Medications:
Calcium channel bolckers Name them |
Diltiazem (Cardizem, Dilacor XR)
verapamil hydrochloride (Calan SR) nifedipine (Procardia) nicardipine (Cardene) |
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Antihypertension Medications:
Angiotensin-converting enzyme (ACE) inhibitors Name them |
Captopril (Capoten)
enalapril (Vasotec) lisinopril (Prinivil, Zestril) benazepril (Lotensin) |
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Antihypertension Medications:
Diuretics Action |
Lower blood pressure by reducing reabsorption of sodium and water by the kidneys, thus lowering circulating fluid volume.
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Antihypertension Medications:
Beta-adrenergic blockers Action |
Combine with beta-adrenergic receptors in the heart, arteries, and arterioles to block response to sympathetic nerve impulses; reduce heart rate and thus cardiac output.
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Antihypertension Medications:
Vasodilators Action |
Act on arteriolar smooth muscle to cause relaxation and reduce peripheral vascular resistance.
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Antihypertension Medications:
Calcium channel blockers Action |
Reduce peripheral vascular resistance by systemic vasodilation.
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Antihypertension Medications:
Angiotensin-converting enzyme (ACE) inhibitors Action |
Lower blood pressure by blocking the conversion of angiotensin I to angiotensin II, preventing vasoconstriction; reduce aldosterone production and fluid retention, lowering circulating fluid volume.
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Common Mistakes in Blood Pressure Assessment
Bladder or cuff too wide Effect |
False low reading
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Common Mistakes in Blood Pressure Assessment
Bladder or cuff too narrow Effect |
False high reading
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Common Mistakes in Blood Pressure Assessment
Cuff wrapped too loosely or unevenly Effect |
False high reading
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Common Mistakes in Blood Pressure Assessment
Deflating cuff too slowly Effect |
False high diastolic reading
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Common Mistakes in Blood Pressure Assessment
Deflating cuff too quickly Effect |
False low systolic and false high diastolic reading.
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Common Mistakes in Blood Pressure Assessment
Arm below heart level Effect |
False high reading
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Common Mistakes in Blood Pressure Assessment
Arm above heart level Effect |
False low reading
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Common Mistakes in Blood Pressure Assessment
Arm not supported Effect |
False high reading
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Common Mistakes in Blood Pressure Assessment
Stethoscope that fits poorly or impairment of the examiner’s hearing, causing sounds to be muffled Effect |
False low systolic and false high diastolic reading
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Common Mistakes in Blood Pressure Assessment
Stethoscope applied too firmly against antecubital fossa Effect |
false low diastolic reading
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Common Mistakes in Blood Pressure Assessment
Inflating too slowly Effect |
false high diastolic reading
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Common Mistakes in Blood Pressure Assessment
Repeating assessments too quickly Effect |
false high systolic reading
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Common Mistakes in Blood Pressure Assessment
Inaccurate inflation level Effect |
false low systolic reading
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Common Mistakes in Blood Pressure Assessment
Multiple examiners using different Korotkoff sounds for diastolic readings Effect |
false high systolic and low diastolic reading
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Client Conditions Not Appropriate for ELECTRONIC Blood Pressure Measurement
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irregular heart rate
peripheral vascular obstruction (e.g., clots, narrowed vessels) shivering seizures excessive tremors inability to cooperate blood pressure less than 90 mmHg systolic |
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Client Conditions Not Appropriate for ELECTRONIC Blood Pressure Measurement
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irregular heart rate
peripheral vascular obstruction (e.g., clots, narrowed vessels) shivering seizures excessive tremors inability to cooperate blood pressure less than 90 mmHg systolic |
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Client Teaching: Temperature
Hypothermia and Frostbite |
Teach clients risk factors for hypothermia and frostbite: fatigue; malnutrition; hypoxemia; cold, wet clothing; alcohol intoxication.
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Client Teaching: Temperature
Heat Stroke |
Teach clients risk factors for heat stroke: strenuous exercise in hot, humid weather; tight-fitting clothing in hot environments; exercising in poorly ventilated areas; sudden exposures to hot climates; poor fluid intake before, during, and after exercise.
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Client Teaching: Temperature
Respirations – Hypoxeia symptoms |
headache, somnolence, confusion, dusky color, shortness of breath, dyspnea.
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Arterial Blood gas norms:
SaO₂ |
95% - 100%
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SpO₂ abnormal level:
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less than 85% is abnormal
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Complete Blood Count (CBC) Normal adult values:
Hemoglobin - Male |
14 to 18 g/100 mL
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Complete Blood Count (CBC) Normal adult values:
Hemoglobin - Female |
12 to 16 g/100 mL
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Complete Blood Count (CBC) Normal adult values:
Hematocrit - Male |
40% to 54%
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Complete Blood Count (CBC) Normal adult values:
Hematocrit - Female |
38% to 47%
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Complete Blood Count (CBC) Normal adult values:
Red blood cell count - Male |
4.7 to 6.1 million/mL
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Complete Blood Count (CBC) Normal adult values:
Red blood cell count - Female |
4.2 to 5.4 million/mL
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Why do we assess
ARTERIAL BLOOD GASES (ABGs)? |
Arterial blood gases measure arterial blood pH, partial pressure of O₂ and CO₂, and arterial O₂ saturation, which reflects client's oxygenation status.
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Why do we assess
PULSE OXIMETRY (SpO₂)? |
SpO₂ less than 85% is often accompanied by changes in respiratory rate, depth, and rhythm.
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Why do we assess
Complete blood Count (CBC)? |
Complete blood count measures red blood cells, and concentration of hemoglobin, which reflects client's capacity to carry O₂.
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Assessment of Characteristic Odors:
Odor of Alcohol in the Oral Cavity |
Ingestion of alcohol, diabetes
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Assessment of Characteristic Odors:
Odor of Ammonia in the Urine |
Urinary tract infection
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Assessment of Characteristic Odors:
Body Odor in the Skin, particularly in areas where body parts rub together (eg, underarms, and under breast) |
Poor hygiene, excess perspiration (hyperhidrosis), foul-smelling perspiration (bromhidrosis)
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Assessment of Characteristic Odors:
Body Odor in a wound site |
wound abscess
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Assessment of Characteristic Odors:
Body Odor in vomitus |
Undigested food
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