SUR 126 - fluids/chemo agents
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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
most abundant anion in extracellular fluid and helps regulate osmotic pressure between intra- and extracellular spaces
most abundant mineral in the body and necessary for formation and function of bones and teeth
normal calcium levels
4.5 to 5.5 mEq/L
electrolyte associated with cardiac arrhythmias
normal potassium levels
3.5 to 5 mEq/L
IV fluid that contains 0.9% sodium chloride
most commonly used IV fluids in surgical setting
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
IV fluid used when transfusing blood products
why is dextrose in water used in surgical patient?
- hydrate patient
- spare body protein
- enhance liver function
physiologic salt solution used to replenish patient's electrolytes and for rehydration to stimulate renal activity
lactated Ringer solution
primary IV tubing
contains drip chamber, injection port, and roller clamp
secondary IV tubing
- contains drip chamber and roller clamp
- hung higher than primary IV tubing so secondary med infuses first (antibiotics)
functions of blood
- transports oxygen, nutrients, wastes, hormones, enzymes throughout body
- maintains acid-base balance, temp and water content
amount of circulating blood volume in average adult
approx. 70 mL/kg of body mass
normal hemoglobin level
- adult females - 12-16 g/100 mL of blood
- adult males - 14-18 g/100 mL of blood
volume of erythrocytes in a given volume of blood
normal hematocrit levels
35% to 52%
average blood volume to body mass ratio
3 formed elements of blood
- erythrocytes (RBCs)
- leukocytes (WBCs)
mediate clotting process
what does below-normal hemoglobin level indicate?
reduced oxygen-carrying capacity
test performed to determine compatibility between donor and recipient
what happens if unmatched blood is given?
most common indication for blood replacement in surgery
hypovolemia (low circulating blood volume)
other indications for blood replacement
- maintain clotting properties (hemophilia)
use of donor blood
patient donating own blood prior to surgery
patient's own blood collected and used during or after surgery
risk associated with transfusion of donor blood
transmission of blood-borne pathogens (hep B, C and HIV)
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
most blood transfusions
packed RBCs with synthetic volume expander (proven to be as effective as whole blood)
how are packed cells obtained?
removing approximately 200 mL of plasma and most of the platelets from 1 unit of whole blood
when is plasma administered?
when clotting factors are needed in addition to circulating volume
how long after thawing does fresh frozen plasma need to be used?
within 6 hours of thawing
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)
what must be done to platelets at room temp?
must be continually gently agitated to prevent clumping
plasma component used in the treatment of bleeding caused by hemophilia A, von Willebrand disease, DIC, and lack of factor XIII
when is cryoprecipitate given in surgery?
when coagulation has been compromised
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
what type of blood cannot be used for autotransfusion?
blood exposed to collagen hemostatic agents and some medications - clotting in the machine may occur
why are volume expanders used?
to increase total volume of body fluid when hypovolemia occurs
volume expander categories
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)
what does Dextran do?
expands plasma volume by drawing fluid from interstitial space to intravascular fluid space
what is Dextran 40 used for?
used prophylactically for thrombosis and embolism
what is Dextran 70 or 75 used for?
to expand plasma volume in impending hypovolemic shock
what is Hetastarch used for?
- needed to circulate RBCs, which carry oxygen to tissues
- acts as albumin in management of shock
names of oxygen therapeutics
irrigation solution that can be used for TURB but not for TURP
balanced electrolyte solution used as sterile irrigant for wounds, washing and rinsing purposes, and as irrigant for body joints
used as irrigating fluid for urinary bladder because it provides a high degree of visibility without conducting heat and current
what is Sorbitol sometimes used in combination with?
Purisole for transurethral procedures and hysteroscopy
sterile, nonconducting fluid used to irrigate body cavities
32% solution of dextran 70 suspended in glucose
Hyskon - used to distend uterus during hysteroscopy and to irrigate blood and tissue debris
irrigant for joints during arthroscopic surgeries and synovial fluid substitute
most commonly used irrigator in open procedures
agents that fight cancer
for what are antineoplastic agents used?
remission, palliative effects, and/or to prolong life
this means to harm normal cells as well as malignant cells
abatement of symptoms and possible cure
relief of symptoms without a cure
antineoplastic agent categories
- alkylating agents
- mitotic inhibitors
- antineoplastic antibiotics
- hormone antagonists
largest group of anticancer agents that are toxic to tissues that grow rapidly
first antineoplastic drug
how do alkylating agents work?
kills by directly damaging DNA strands and keeping cancer cells from reproducing
examples of alkylating agents
how do antimetabolites work?
disrupt cells' metabolic processes by interfering with DNA and RNA growth
examples of antimetabolites
how do mitotic inhibitors work?
block cell division by preventing chromosomes from dividing and migrating to the ends of the cells
examples of mitotic inhibitors
anti-tumor antibiotic used to prevent recurrence of pterygium
corticosteroids primarily used for treatment of cancers of breast, endometrium and prostate
main functions of biologic response modifiers
- enhance body's immunologic function
- destroys or interferes with tumor activities
- inhibit protein and RNA synthesis
2 BRM agents used to treat chemo side effects by stimulating RBC production
- erythropoietin (Epogen)
- filgrastim (Neupogen)
science that studies factors that determine and influence frequency, distribution, and cause of disease, and seeking to find a cure
leading sites of fatal cancers in women
lung, breast, colon, and rectum
cause of disease
most important known carcinogen in the US
area of science and technology that focuses on atomic- and molecular-scale structures
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
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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