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Healthgates.net
Healthgates.net MedSurg- Blood and Lymph
| Question | Answer |
|---|---|
| The hematopoietic system is composed of all of spleen, lymph nodes, and __________. | Bone marrow |
| The average range of hemoglobin in adults is approx... | 12-16 gm per 100 mL |
| Hematocrit describes the percentof space (volume) in a given quantity of blood that is occupied by: | red blood cells |
| The normal hematocrit in adults is approximately between | 35-50% |
| The normal white blood count per cubic millimeter of blood | 5,000-10,000 mm3 |
| If a patient has leukopenia, he/she has a | low white blood count |
| What type of disorder would require a transfusion of factor VIII, cryoprecipitate? | hemophilia A |
| Lymph only carries fluids away from tissues | True |
| Normal bleeding time is less than 3 minutes. | False |
| Taking iron with vitamin C enhances its absorption. | True |
| What are the four mechanisms of heat loss? | 1. radiation^2. evaporation^3. convection^4. conduction |
| What are the three broad causes of body temp alteration? | 1. disruption of hypothalamic function^2. excessive environmental exposure^3. resetting of hypothalamic setpoint |
| What is the most common mechanism of temp change in surgical patients? | reset of hypothal setpoint (frequently because of endogenous pyrogen |
| How does endogenous pyrogen (IL-1) change hypothal setpoint? | increases synthesis of prostaglandins in the hypothalmus which increases cAMP synthesis and then which resets the setpoint |
| how accurate is rectal temp? | it may be higher by 1.4F vice right heart. But is best routine measure |
| what is the most likely cause of fever 0-2days postop | atelectasis |
| what are the likely causes of fever 2-4days postop? | 1. atelectasis^2. UTI^3. IV line infection^4. pneumonia^5. DVT |
| what are the most likely causes of fever 5-10d postop? | 1. wound infection^2. wound dehiscience^3. anastamotic leak |
| What should be remembered as a cause of fever in the 5-10 days postop range? | 1. acalculous cholecystitis^2. intra-abdombinal abcess |
| what are the criteria for a definitive dx of disseminated fungal sepsis? | 1. culture of organism from tissue^2. endopthalmitis^3. burn wound invasion (per biopsy results)^4. culture of organism from peritoneal fluid |
| what are the criteria for a definitive dx of disseminated fungal sepsis? | 1. culture of organism from tissue^2. endopthalmitis^3. burn wound invasion (per biopsy results)^4. culture of organism from peritoneal fluid |
| What are criteria for likely disseminated fungal sepsis | 1. two positive blood cultures taken 24hrs apart^2. two positive blood cultures with the second obtained 24hrs after removal of IV catheter^3. three or more colonized sites (by wound biopsy) |
| What are causes of postoperative hypothermia ? | 1. hypovolemia^2. hypothalamic dysfunction^3. excessive environmental heat loss |
| What are the causes of hypothermia several days postop? | sepsis^ ^and/or ^ ^evaporative heat loss |
| in what clinical setting do you see persistent environmental heat loss? | patients with large area skin injury^ i.e. burn patients |
| What percentage of body weight is total body water? | 60%% |
| What percent of total body water is ECF? | 33%% |
| What helps maintain negative pressure in lymphatic channels? | anchoring fibers |
| Where, anatomically does most lymph return to blood circulation? | Most lymph returnsvia thoracic duct, although there may be multiple other channels |
| What is the basic function of the lymph according to Davis et al in Surgery: Problem Solving Approach? | to maintain intersitial and intravascular colloid pressures |
| What determines the kidney's ability to rapidly respond to volume and osmolality changes? | changes in glomerular filtration rate (GFR)<MC2>changes in tubular reabsorption |
| What extrarenal signals does the kidney respond to? | hemodynamics (perfusion pressure and renal blood flow)<MC2>neural activity<MC3>alteration in blood composition<MC4>hormones |
| What does total ECF ultimately depend on? | quantity of total body sodium |
| What is the essence of cellular volume regulation? | energy dependent active exclusion of sodium from the ICF |
| What are the principal defense mechanisms of serum sodium concentration? | ADH (antidiuretic hormone -or-vasopressin) secretion |
| How is intravascular volume controlled versus osmotic composition ? | Via thirst and ADH secretion; but through anatomically separate systems |
| When is thirst a symptom of acute hypovolemia? | Rarely, unless as an emotional response. Need 10-20%% volume deficit before thirst mechanism is activated |
| What effect does hypovolemia have on the response to osmolality changes in the serum? | Accentuates ADH release |
| What is the first line of defense for "effective intravascular volume"? | The mechanoreceptors in great veins of thorax/atria/ventricular walls |
| How do thoracic mechanoreceptors signal volume status? | continuous "tonic" signals. |
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