Pathophysiology
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| Define Pathophysiology | The study of how normal physiological processes are altered by disease (Taber, 1993) The study of disordered or altered functions e.g. the physiological changes caused by disease in a living organism (Price and Wilson, 1997)
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| Define disease | A pathologic condition of the body that presents a group clinical signs, symptoms and laboratory findings peculiar to it and that sets the condition apart as an abnormal entity differing from other normal of pathological states
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| Define illness | perception and response of a person to not being well
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| define health | a state of complete physical, mental, and social well being; not merely the absence of disease; reflects a person’s biological, psychological, spiritual, and sociological state
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| define holistic health | views patient as a whole person (social, sexual, emotional, spiritual, etc.)
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| What is the health continuum | anything from wellness to illness (death)
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| Define homeostasis | The body’s tendency to maintain a steady state (internal environment) in the face of continual environmental (external) variation
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| What factors affect homeostasis | temperature, cardiac output, blood pressure, oxygen, CO2 levels acid-base, fluid volume, electrolyte composition are all closely regulated to maintain homeostasis
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| Define etiology | cause
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| Define pathogenisis | mechanism of development
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| What are morphological changes | structural alterations induced in the cell and organs
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| Define clinical significance | functional consequences of the morphological changes
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| what is the progression of cellular response due to increased pathophysiological stress? | Cellular adaptation (hypertrophy, atrophy) Reversible cell injury Irreversible cell injury Cell death
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| Define sequela | Outcome of the disease such as a movement disorder; a condition following and resulting from the disease (Taber, 1993).
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| define complications | A new or separate process that may arise secondarily to the original process. e.g. surgery complicated by pneumonia; pulmonary embolism and bedrest; aspiration due to decreased swallowing following a CVA (stroke)
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| What are the stages of illness? | acute sub-acute chronic
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| Define acute | Relatively rapid onset and short duration
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| The healing time of an acute illness is dependent on what? | Time since onset Overall health of the individual Type and extent of disease Present environment and access to appropriate care
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| What are the stages of acute illness | 1. Physical symptoms: SOB, fatigue, fever 2. Cognitive awareness: it has some meaning to the patient 3. Emotional response: denial, fear, anxiety 4. Sick role: person realizes that they need medical assistance 5. Dependency:
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| Define a sub-acute illness | Between acute and chronic Longer than a few days, less than a few months
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| Chronic conditions include an illness with one of what three characteristics? | Permanent impairment or disability Residual physical or cognitive disability Need for special rehab or long-term medical management
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| Chronic illnesses fluctuate in intensity due to what? | acute exacerbations
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| Define Body functions and structures: | physiologic or psychologic functions of body systems or anatomic parts
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| Define Impairments: | problems in body function or structure
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| Define Activity: | execution of specific tasks or actions by an individual
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| Define Activity limitations: | difficulties that individual might have in executing activities
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| Define Participation: | individual’s involvement in life situations
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| Define Participation restrictions: | problems the individual might have in real life situations
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| Define Primary Prevention: | risk factor identification and management to prevent occurrence of the disease
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| Define Secondary Prevention: | early detection and treatment of disease with goal of minimizing the progression of the disease
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| Define Tertiary Prevention: | reduction of disability through treatment and rehabilitation
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| What risk factors? | 1. Conditions that place the person at higher risk than if risk factors didn’t exist 2. Modifiable or non-modifiable
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| Types of Risk factors | Heart disease Lung cancer Chronic obstructive pulmonary disease (COPD) Diabetes HIV Accidents Obesity Emotional/Psychological: eating disorder, domestic violence
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| Healthy People 2020 | Physical activity Overweight and obesity Tobacco use Substance abuse Responsible sexual behavior Mental health Injury and violence Environmental quality Immunization Access to Health Care
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| What individual beliefs impact behavior and Decision making? | Cultural Religious Personal Psychological
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| What are the steps toward a behavior change? | Pre contemplative Contemplative Preparation Action Maintenance
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| clinical manifestations of substance abuse | associated with spousal and child abuse increased sexually transmitted disease teen pregnancy motor vehicle crashes multiple medical sequelae can impair or slow the rehab process
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| clincal manifestations of eating disorders | electrolyte imbalance edema and dehydration cardiac abnormalities kidney disfunction neurological abnormalities endocrine dysfunction weakness emotional disturbance
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| clinical manifestations of obesity | increase in mortality and morbidity associated with CV disease, cancer and DM
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| clinical manifestations of domestic violence | injuries: contusions, fxs, lacerations subdural hematomas GI disturbances
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| How are symptoms detected? | Patient’s subjective information What they “complain” (c/o) about
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| What is the best way to get a history? | Listen Ask directed and clarifying questions
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| Keys to developing good interview skills | 1. Accurate clinical hypothesis 2. Good Examination and intervention approach t 3. Recognizing signs and symptoms 4. Particip. in the clinical decision-making process appropriate diagnostic testing
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| A good examination approach has what considerations? | o meet the individual’s culture, communication, anatomical , and physiological needs and abilities
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| Why are recognizing signs and symptoms important? | In order to know if their problem is within your scope of practice or if they need to be referred to another health care provider
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| What skills are necessary for patient interview | communication Active listening nonverbal communication patient centered
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| Keys to a patient centered interview | Start with open ended questions Funnel to closed ended questions Avoid biased questions Ask one question at a time Speak slowly Ask brief questions Periodically restate and summarize Use the patient’s own words when appropriate Do not use jargon
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| Radiology | Rays found on electromagnetic spectrum (x-rays) pass through object, leaving signal on plate of sensors behind it that is then converted to images
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| Why is radiology the first study ordered? | due to low cost, ease of imaging and speed of results
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| Nuclear radiology | Patient administered radionucleotide agent with radioactive tracer that has affinity for body tissues CT scan
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| What is good about nuclear radiology? bad? | good measure of function, poor detail (cardiac imaging, bone scans, etc)
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| MRI | Uses strong magnetic field to disturb atomic nuclei and then records their response to radio signals as they emit specific radio frequencies collected and images created
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| Scopes | Non-invasive flexible tube with small camera
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| Types of scopes done | Athroscopy: joints Bronchoscopy: lung Colonoscopy: colon Cystoscopy: bladder Endoscopy: esophagus Gastroscopy: stomach
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| Catheterization | Arterial (cardiac, renal, carotid, UE or LE) or urinary procedure Deploy stents to open up arteries or other obstructions
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| What is important to know about PTs treatment implications with someone with a catheter or recent catheterization? | 4-8 hours after on bed rest
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| Ultrasound | Uses high-frequency sound waves to visualize soft tissue structures
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| EKG?ECG | Records electrical activity of the cardiac tissue
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| EKGs are valuable to assess what? | Cardiac rhythms Conduction abnormalities Detecting myocardial ischemia Specific pathologies: (COPD), cardiomyopathy, pericarditis, among others
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| Electroencephalogram | Multiple electrodes attached to patient’s head and then to computer to monitor electrical activity of the brain
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| EEGs are helpful in diagnosing what? | Seizures (epilepsy) Brain function and activity after head injury, degenerative disease, stroke, etc
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| What is a biopsy? | Removal of small piece of tissue anywhere throughout the body for further examination
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| Open vs needle biopsy? | Needle biopsy: needle passes through syringe to extract tissue Open biopsy: surgical procedure under anesthesia or conscious sedation
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| Abbreviations BP: PA: CVP: A-line: | BP: blood pressure PA: pulmonary artery CVP: central venous pressure A-line: arterial line
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| Other Abbreviations PWP PCOP PCWP CO CI SVR PVR | PWP (pulmonary wedge pressure), PCOP (pulmonary capillary occlusive pressure) or PCWP (pulmonary capillary wedge pressure) CO (cardiac output) CI (cardiac index) SVR (systemic vascular resistance) PVR (pulmonary vascular resistance
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| PT implications of Telemetry | no contraindications
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| peripheral IV | Used to deliver medications or fluids through venous system
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| What is the purpose of an air filter on the IV? | Air filter on IV tubing for patent forarem ovale (PFO) to decrease risk of air bubbles, which can cause air embolus and stroke
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| PICC line | Peripherally Inserted Central Catheter (PICC) LINE
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| What is the reason for a PICC line? | Used for extended antibiotics or medications, chemotherapy or total parenteral nutrition (TPN
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| Where is the PICC Line placed? why? | Usually placed in cephalic, basilic or brachial vein tip advanced through larger veins until tip rests in superior vena cava or cavo-atrial junction
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| What happens if the tip of the catheter is advanced to far into the atrium? | If tip of catheter is advanced too far into right atrium, can cause arrhythmias due to irritation location confirmed by chest film
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| foley catheter | Tube placed in bladder to drain urine Drains by gravity
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| surgical drains | Tube placed in surgical or infection site to drain fluid Many operate via a suction mechanism
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| chest tube? function? | Includes any tube placed into the chest Drains blood, fluid or air to re-expand the lung
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| What does bubbling indicate in a chest tube? | Bubbling in the water of the CT can indicate an airleak or a pneumothorax in some systems. It is important to know this prior to treating the patient and to note any changes during or after the treatment.
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| types of enteric feeding tubes | Ng tube Gastric feeding tube I-tube
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| NG tube? how long? | Tube placed through nares esophagus stomach Usually short-term nutrition or placed to suction to remove all stomach contents (i.e. ileus or bowel obstruction)
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| Gastric Feeding Tube (G-Tube) or Percutaneous Endoscopic Gastrostomy Tube (PEG) | Tube placed through abdomen directly into stomach Long-term nutrition in patients with normal gastric emptying
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| J-tube | Through abdomen into 1st part of jejunum Long-term nutrition
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| Partial Parentral Nutrition | Peripheral vein Subsidizes regular diet Usually combination of lipids, amino acids and/or dextrose solutions
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| Total Parentral Nutrition | Central vein Long-term, intensive nutritional support Usually combination of proteins and dextrose Electrolytes, minerals, insulin are added as needed for each patient Useful in non-functioning bowel tracts
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| Hemodialysis | Method for removing waste products from blood stream for patients in renal failure
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| Pain Controlled Analgesia | Self administered pain medication
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| Vac Dressing? function? | System provides negative pressure to wound to approximate wound edges Decreases edema Increases perfusion Promotes granulation tissue formation
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| Venodyne boots | Promotes LE circulation via air pumping through boots Reduces risk for DVT in immobile patients
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| VITAL SIGNS | Blood pressure (BP) Heart Rate (HR) Respiratory Rate (RR) Oxyhemoglobin saturation (SpO2)
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| implication of Na levels | 1 Usually Na+ retention H2O retention & loss of Na+ loss of H2O (unless rapid shift as in profuse sweating)
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| Implications of K levels | Excitable cells especially cardiac muscle (hyper- or hypokalemia leads to sudden cardiac death)
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| Implications of Cl levels | Follows Na+ and H2O
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| Implications of BUN levels | Rises with decreased kidney function due to decreased renal flow (reflects balance of nitrogen added to blood & excreted by kidney)
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| Implications of Cr levels | Normal waste product of (muscle) cell metabolism that is excreted at stable rate. Rises due to decreased glomerular filtration rate.
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| Implications of HCO3 levels | Critical to acid-base relationship buffer that maintains homeostasis with direct effects on metabolic and/or respiratory status
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| Implcations of Mg levels | Regulation of excitable cells, especially when low patients can have arrhythmias, weakness, muscle spasms and numbness
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| Exercise and hypoglycemia | Activity requires glucose If increased activity with low levels, will continue to decrease
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| Exercise and hyperglycemia | If blood sugar is high no available insulin to assist with metabolism If exercise, will INCREASE these levels, progressing toward ketoacidosis due to metabolism that occurs with activity
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| Hepatic function tests | Ammonia Albumin Bilirubin Alanine amino transferase (ALT) Alkaline phosphatase (ALP) Aspartrate aminotransferase (AST)
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| Implicaitons of ammonia result | great variability in normal values, intermediate byproduct, with severe liver injury there is inability to convert ammonia into urea (excreted by the kidney) hepatic encephalopahty (confusion, lethargy, tremors, deteioration of fine motor skills)
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| Implications of albumin levels | looks at the ability of the liver to synthesize proteins (good indication of nutrition)
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| Implications of bilirubin levels | total (liver disease, bile duct occlusion, hemolytic anemia) and indirect
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| Implications of ALT levels | enzyme in liver, primary test for detecting hepatitis
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| Implications of ALP levels | bile ducts
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| Implications of AST levels | in liver, heart and skeletal muscles and has been used to assist with diagnosis chest pain
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| creatine kinase | Enzyme found in heart, brain skeletal muscle that assists with muscle contraction
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| CK-MB | is cardiace muscle specific form of CK
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| Troponin | Cardiac specific proteins that regulate muscle contractions
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| Creatine kinase and myocardial infarction | Begins to rise 4-6 hrs after injury, peak at 18-24 hrs and normalizes in 2-3 days
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| CK-MB and myocardial infarction | ratio of total muscle damage to cardiac muscle Rise at 3-4 hrs, peaks 18-24 hrs and normal within 24 hrs
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| Troponin and myocardial infarction | Elevate within 3-4 hours and can stay elevated for 10-14 days
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| Cholesterol identifies a risk of what? | cardiac disease
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| Brain nateuretic peptide (BNP or NT-proBNP) | Assists with regulating blood volume, increases as left ventricle stretches and increased demand
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| D-dimer test? diagnoses what? | Detects fibrin as degradation products diag: PE and DVY
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| Erythrocyte sedimentation rate (ESR), measures what? | Non-specific test for inflammatory disorders Measures how quickly RBCs sink to bottom of test solution
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| An increase ESR indicates? | Increased rate faster sinking more clumping of cells inflammation
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| Urine analysis | Analysis of: protein, sugar, sodium, volume, culture and sensitivity (C&S)
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| cultures | Assists with identifying infection source so correct medication can be prescribed to treat it
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| What fluids are sued for cultures | Body Fluids: urine, feces, sputum Cereborspinal fluid Wound drainage
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