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major electrolytes
- sodium
- chloride
- potassium
- calcium
- phosphate
- magnesium
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electrolytes' 3 main purposes in homeostasis
- controlling volume of body water by osmotic pressure, maintaining acid-base balance
- serving as essential minerals
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most abundant anion in extracellular fluid and helps regulate osmotic pressure between intra- and extracellular spaces
chloride
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most abundant mineral in the body and necessary for formation and function of bones and teeth
calcium
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normal calcium levels
4.5 to 5.5 mEq/L
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electrolyte associated with cardiac arrhythmias
potassium
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normal potassium levels
3.5 to 5 mEq/L
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IV fluid that contains 0.9% sodium chloride
normal saline
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most commonly used IV fluids in surgical setting
crystalloids
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when is sodium chloride used?
- when chloride loss is greater than or equal to sodium loss
- for treatment of metabolic acidosis in presence of fluid loss
- to replenish lost sodium
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IV fluid used when transfusing blood products
sodium chloride
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why is dextrose in water used in surgical patient?
- hydrate patient
- spare body protein
- enhance liver function
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physiologic salt solution used to replenish patient's electrolytes and for rehydration to stimulate renal activity
lactated Ringer solution
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primary IV tubing
contains drip chamber, injection port, and roller clamp
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secondary IV tubing
- contains drip chamber and roller clamp
- hung higher than primary IV tubing so secondary med infuses first (antibiotics)
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functions of blood
- transports oxygen, nutrients, wastes, hormones, enzymes throughout body
- maintains acid-base balance, temp and water content
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amount of circulating blood volume in average adult
approx. 70 mL/kg of body mass
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normal hemoglobin level
- adult females - 12-16 g/100 mL of blood
- adult males - 14-18 g/100 mL of blood
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volume of erythrocytes in a given volume of blood
hematocrit
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normal hematocrit levels
35% to 52%
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average blood volume to body mass ratio
17%
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3 formed elements of blood
- erythrocytes (RBCs)
- leukocytes (WBCs)
- platelets
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mediate clotting process
platelets
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what does below-normal hemoglobin level indicate?
reduced oxygen-carrying capacity
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test performed to determine compatibility between donor and recipient
blood cross-match
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what happens if unmatched blood is given?
agglutination occurs
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most common indication for blood replacement in surgery
hypovolemia (low circulating blood volume)
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other indications for blood replacement
- anemia
- maintain clotting properties (hemophilia)
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use of donor blood
homologous donation
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patient donating own blood prior to surgery
autologous donation
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patient's own blood collected and used during or after surgery
autotransfusion
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risk associated with transfusion of donor blood
transmission of blood-borne pathogens (hep B, C and HIV)
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when is whole blood transfusion indicated?
only in cases of acute, massive blood loss that requires oxygen-carrying properties of RBCs and volume expansion of plasma
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most blood transfusions
packed RBCs with synthetic volume expander (proven to be as effective as whole blood)
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how are packed cells obtained?
removing approximately 200 mL of plasma and most of the platelets from 1 unit of whole blood
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when is plasma administered?
when clotting factors are needed in addition to circulating volume
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how long after thawing does fresh frozen plasma need to be used?
within 6 hours of thawing
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why are platelets infused?
- to restore a more normal clotting process
- to help repair damaged blood vessels
- prophylactically in patients with low platelet counts (chemotherapy, leukemia)
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what must be done to platelets at room temp?
must be continually gently agitated to prevent clumping
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plasma component used in the treatment of bleeding caused by hemophilia A, von Willebrand disease, DIC, and lack of factor XIII
cryoprecipitate
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when is cryoprecipitate given in surgery?
when coagulation has been compromised
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how is autotransfusion performed?
- blood collected in suction-type device or via bloody sponges drained into a sterile basin of saline, then aspirated into the machine
- blood is collected into sterile blood collection and suction canister, washed in red cell washer, and reinfused
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what type of blood cannot be used for autotransfusion?
blood exposed to collagen hemostatic agents and some medications - clotting in the machine may occur
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why are volume expanders used?
to increase total volume of body fluid when hypovolemia occurs
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volume expander categories
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why are albumin and PPF volume expanders used?
- to provide volume expansion when crystalloid solutions are not adequate (massive hemorrhage)
- treatment of hypovolemic shock (burn patients)
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what does Dextran do?
expands plasma volume by drawing fluid from interstitial space to intravascular fluid space
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what is Dextran 40 used for?
used prophylactically for thrombosis and embolism
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what is Dextran 70 or 75 used for?
to expand plasma volume in impending hypovolemic shock
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what is Hetastarch used for?
- needed to circulate RBCs, which carry oxygen to tissues
- acts as albumin in management of shock
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names of oxygen therapeutics
- Hemopure
- Oxygent
- PolyHeme
- Hemospan
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irrigation solution that can be used for TURB but not for TURP
sterile water
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balanced electrolyte solution used as sterile irrigant for wounds, washing and rinsing purposes, and as irrigant for body joints
Physiosol
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used as irrigating fluid for urinary bladder because it provides a high degree of visibility without conducting heat and current
Sorbitol
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what is Sorbitol sometimes used in combination with?
Purisole for transurethral procedures and hysteroscopy
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sterile, nonconducting fluid used to irrigate body cavities
Glycine 1.5%
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32% solution of dextran 70 suspended in glucose
Hyskon - used to distend uterus during hysteroscopy and to irrigate blood and tissue debris
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irrigant for joints during arthroscopic surgeries and synovial fluid substitute
Viscoseal
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most commonly used irrigator in open procedures
Asepto syringe
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abnormal growth/tumor
neoplasm
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agents that fight cancer
antineoplastic agents
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for what are antineoplastic agents used?
remission, palliative effects, and/or to prolong life
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this means to harm normal cells as well as malignant cells
cytotoxic
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abatement of symptoms and possible cure
remission
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relief of symptoms without a cure
palliative
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antineoplastic agent categories
- alkylating agents
- antimetabolites
- mitotic inhibitors
- antineoplastic antibiotics
- hormones
- hormone antagonists
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largest group of anticancer agents that are toxic to tissues that grow rapidly
alkylating agents
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first antineoplastic drug
nitrogen mustard
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how do alkylating agents work?
kills by directly damaging DNA strands and keeping cancer cells from reproducing
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examples of alkylating agents
- Cytoxan
- Paraplatin
- Temodar
- BiCNU
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how do antimetabolites work?
disrupt cells' metabolic processes by interfering with DNA and RNA growth
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examples of antimetabolites
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how do mitotic inhibitors work?
block cell division by preventing chromosomes from dividing and migrating to the ends of the cells
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examples of mitotic inhibitors
- Taxol
- Taxotere
- Velban
- Oncovin
- Toposar
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anti-tumor antibiotic used to prevent recurrence of pterygium
Mitomycin
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corticosteroids primarily used for treatment of cancers of breast, endometrium and prostate
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main functions of biologic response modifiers
- enhance body's immunologic function
- destroys or interferes with tumor activities
- inhibit protein and RNA synthesis
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2 BRM agents used to treat chemo side effects by stimulating RBC production
- erythropoietin (Epogen)
- filgrastim (Neupogen)
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science that studies factors that determine and influence frequency, distribution, and cause of disease, and seeking to find a cure
epidemiology
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leading sites of fatal cancers in women
lung, breast, colon, and rectum
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cause of disease
etiology
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most important known carcinogen in the US
tobacco
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area of science and technology that focuses on atomic- and molecular-scale structures
nanotechnology
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7 warning signs of cancer
- C - change in bowel or bladder habits
- A - a sore that will not heal
- U - unusual bleeding or discharge
- T - thickening or lump in breast or elsewhere
- I - indigestion or difficulty swallowing
- O - obvious change in wart or mole
- N - nagging cough or hoarseness
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ABCs for detecting skin cancer
- A - asymmetry
- B - border - jagged, blurry or irregular
- C - color changes
- D - diameter - greater than 1/4 inch
- E - elevation
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