Basic knowledge Flashcards
1
Q
3 systemic factor that impaired wound healing
A
- Increasing age
- Malnutrition
- Diabetes
2
Q
Describe serosanguineous fluid
A
- Discharge that contain both blood and a blood serum
- Due to damaged capillary
- Old dressing might damaged the capillary close to skin when pulling off
3
Q
Normal urine output
A
- 800 to 2000ml per day if intake around 2 liter per day
4
Q
How long did it take for Vit K to correct INR
A
- IV route: onset within 2 hours
5
Q
Nutritional status assessment
A
- Unintentional weight loss
- Body mass index (BMI)
- Bitemporal wasting
- Mid-arm circumference
- Triceps skinfold thickness
- Serum albumin (half-life: 18-20 days), transferrin (half-life: 8-9 days; indicator of protein status only in setting of normal serum iron)
- Electrolyte, glucose, and BUN/Cr to assess fluid volume status before parenteral nutrition given
6
Q
Definition of refeeding syndrome
A
- The clinical complications that can occur as a result of fluid and electrolyte shifts during aggressive nutritional rehabilitation of malnourished patient
- Potentially fatal when not detected/ treated early
7
Q
Pathogenesis of refeeding syndrome
A
- Hypophosphatemia: stores of phosphate depleted during starvation; when nutritional replenishment, glucose cause insulin release, which trigger cellular uptake of phosphate -> tissue hypoxia, myocardial dysfunction, inability for diaphragm to contract, rhabdomyolysis, hemolysis, seizure
- Hypokalemia: c/b insulin same as above
8
Q
Which access to choose for nutritional replenish
A
- Typically do not start feeding parenterally before 1-2 weeks due to increase risk of infection in malnutrition patient (no added benefit as well comparatively) unless contraindicated for enteral nutrition (eg: bowel obstruction/ both hemodynamically unstable and have not had their IV volume fully resuscitated -> predisposed to bowel ischemia)
- Central venous catheter if TPN given for more than few days because its high osmotic load is not tolerated by peripheral veins
- Peripheral venous catheter rarely indicated due to lack of benefit from short term TPN and ease of obtaining central access
9
Q
Type of NG tube feeding content
A
- Standard
- Concentrated: if required fluid restriction (eg: respiratory failure, volume overload)
- Predigested: protein hydrolyzed to short-chain peptide, carbohydrate are in less complex form (eg: malabsorptive syndromes)
- Critical illness: (eg: renal formula for patient with fluid and electrolyte restriction; glycemic control formula for patient receiving bolus feeding)
10
Q
A-delta vs C nerve fiber
A
A-delta:
- Pain (mechanical and thermal)
- Myelinated, conduction speed fast
C:
- Pain (mechanical, thermal and chemical)
- Non-myelinated, conduction slow
11
Q
Levels of sympathetic and parasympathetic outflow
A
> Sympathetic
- T1-L1
> Parasympathetic
- CN 3, 7, 9, 10
- S2-4
- Cervical don’t have autonomic outflow
12
Q
Sympathetic cardiac innervation at which level
A
- T6
- So injury above might cause neurogenic shock
13
Q
Triad of neurogenic shock
A
- Bradycardia
- Hypotension
- Autonomic dysfunction (eg: hypothermia)
14
Q
Location of baroreceptor
A
- Carotid sinus
- Aortic arch
15
Q
Total blood volume
A
5L
