NR 507 Week 8 Final Exam / NR507 Week 8 Final Exam (V2)(NEW)(2022/2023): Advanced Pathophy, Exams of Nursing

Download NR 507 Week 8 Final Exam / NR507 Week 8 Final Exam (V2)(NEW)(2022/2023): Advanced Pathophy and more Exams Nursing in PDF only on Docsity! Week I8 IFinal IExam IStudy IGuide Reproductive: endometrial Icycle Iand Ithe Ioccurrence Iof Iovulation IOvulation Iis Ithe Irelease Iof Ian Iovum Ifrom Ia Imature Ifollicle Iand Imarks Ithe Ibeginning Iof Ithe Iluteal/secretory Iphase Iof Ithe menstrual Icycle. IHCG Ican Ibe Idetected Iin Imaternal Iblood Iand Iurine I8 Ito I10 Idays Iafter Iovulation. IOvulatory Icycles Iappear Ito Ihave Ia Iminimum Ilength Iof I24 Ito I26.5 Idays. IOnce Iovulation Ioccurs Iand Iserum Iprogesterone Ilevels Iincrease, Ithe Iendometrial Itissue Idevelops Isecretory Icharacteristics I(secretory Iphase). IIf Iimplantation Iof Ia Ifertilized Iovum Idoes Inot Itake Iplace, Iendometrial Itissue Ibegins Ito Ibreak Idown Iapproximately I11 Idays Iafter Iovulation I(ischemic Iphase Iof Imenstruation) IDetermines Iwhether Iovulation Ihas Ioccurred Iby Iobtaining Iendometrial Itissue Ion Iday I26 Iof I28-day Imenstrual Icycle I(or Ipostovulatory Iday I12). INormal Imenstrual Icycle I27-30 Idays. IOvulatory Iphase: Iestrogen Ilevels Idip; Iprogesterone Ilevels Ibegin Ito Irise, ICorpus Iluteum Ibegins Ito Idevelop; Iendometrium Ienters Isecretory Iphase. IShift Iin Itemperature Iis Irelated Ito Iovulation. uterine Iprolapse Iis Idescent Iof Ithe Icervix Ior Ientire Iuterus Iinto Ithe Ivaginal Icanal. ILoss Iof Isupport Iby Ipelvic Imuscles. IUterine Iprolapse Idescent Ior Iherniation Iof Ithe Iuterus Iinto Ior Ibeyond Ithe Ivagina Ibecause Iof Iweakness Iof Ithe Ipelvic Imusculature, Iligaments, Iand Ifascia Ior Iobstetric Itrauma Iand Ilacerations Isustained Iduring Ilabor Iand Idelivery. polycystic Iovarian Isyndrome I(PCOS) IStrong Igenetic Ifactor I-A Ihyperandrogenic Istate Iis Ia Icardinal Ifeature Iin Ithe Ipathogenesis Iof IPCOS. IGlucose Iintolerance/insulin Iresistance I(IR) Iand Ihyperinsulinemia Ioften Irun Iparallel Ito Iand Imarkedly Iaggravate Ithe Ihyperandrogenic Istate. ISigns Iand Isymptoms Iof Iwomen Iwith IPCOS Imay Ichange Iover Itime, Iwith Imetabolic Isyndrome Ibecoming Imore Iprominent Iwith Iage. IIn Iaddition, Ipolycystic Iovaries Imay Ibe Iassociated Iwith ICushing Isyndrome, Iacromegaly, Ipremature Iovarian Ifailure, Isimple Iobesity, Icongenital Iadrenal Ihyperplasia, Ithyroid Idisease, Iandrogen-producing Iadrenal Itumors Ior Iovarian Itumors. IAnovulation Iresults Ifrom Imetabolic Iabnormalities Icontributing Ito Iobesity Iinclude ICushing Isyndrome, ICushing Idisease, Ipolycystic Iovary Isyndrome. testicular Icancer Iand Iconditions Ithat Iincrease Irisk: IPainless Itesticular Ienlargement Iis Ithe Ifirst Isign Iof Itesticular Icancer. ISigns Iof Itesticular Icancer Iinclude Iabnormal Iconsistency, Iinduration, Inodularity, Ior Iirregularity Iof Ithe Itestis IA Ifirm, Inontender Itesticular Imass Ior Idiffuse Ienlargement Iis Ifound Iin Ithe Imajority Iof Icases. IRisk Ifactor Ifor Imen Iwith Iundescended Itesticles, Ia Ifactor Iin Isome Istudies Icorrelated Iwith IDES Iexposure. IThe Irisk Iof Itesticular Icancer Iis I35 Ito I50 Itimes Igreater Ifor Imen Iwith Icryptorchidism. IIn Imen Ibetween Ithe Iages Iof I15-35 Iy/o. IGerm Icell Itumors Iconstitute I90% Iof Itesticular Icancer. IRisk Ifactors Iinclude Ihistory Iof Icryptorchidism, Iabnormal Itesticular Idevelopment, IHIV, Iand IAIDS, IKlinefelter Isyndrome, Iand Ihx Iof Itesticular Icancer. IScrotal Iincisions Imay Iincrease Irisk Ior Irecurrence. ISome Iaffected Imen Ihave Ipersistent Iparesthesia, IRaynaud Iphenomenon, Ior Iinfertility. ICryptorchidism I(one Iof Ithe Itestes Ifails Ito Idescend Iinto Ithe Iscrotum) Isignificantly Iincreases Ithe Irisk Iof Itesticular Icancer symptoms Ithat Irequire Ievaluation Ifor Ibreast Icancer Iwoman Iwho Icarries Ia Imutation Iin Ithe IBRCA1 Ior IBRCA2 Igenes. IFirst Isign Iof Ibreast Icancer Iis Ia Ipainless Ilump. IOther Ipresenting Isigns Iinclude Ipalpable Inodes Iin Ithe Iaxilla, Iretraction Iof Itissue I(dimpling) I(Fig. I25.49), Ior Ibone Ipain Icaused Iby Imetastasis Ito Ithe Ivertebrae. IBenign Ibreast Idisease I(BBD) Imost Icommon Isymptoms Ireported Iare Ipain, Ipalpable Imass, Inipple Idischarge. IStrong Ilink Ibetween Istress Iand Ibreast Icancer progression. Ishift-work Iand Iits Idisruptive Ieffects Ion Icircadian Irhythms Iand Isleep Ideprivation Iat Inight Ihave Ibeen Isuggested Ias Ia Irisk Ifactor Ifor Ibreast Icancer. Clinical Imanifestation Iof Ibreast ICa: Chest Ipain nipple Idischarge IDilated Iblood Ivessel nipple Iretraction IDimpling Iof Iskin pitting Iof Ithe Iskin Edema reddened Iskin, Ilocal Itenderness, Iwarmth IHemorrhage skin Iretraction Local Ipain ulceration INipple/areolar Ieczema signs Iof Ipremenstrual Idysphoric Idisorder ICyclic Irecurrence I(in Ithe Iluteal Iphase Iof Ithe Imenstrual Icycle) Iof Idistressing Iphysical, Ipsychologic, Ior Ibehavioral Ichanges Ithat Iimpair Iinterpersonal Irelationships Ior Iinterfere Iwith Iusual Iactivities Iand Iresolve Iafter Imenstruation. I t Iis Ilinked Ito Ihormonal Ichanges Iemotional Isymptoms Iof Idepression, Ianger, Iirritability, Iaggression, Ifatigue, Iand Iimpulse Icontrol. IPhysical Isymptoms Is/s Ibreast Itenderness, Iabdominal Ibloating, Iheadache, Iand Iswelling Iof Iextremities, Iwater Iretention, Ibloating, Iweight Igain. Box I25.5 Diagnostic I Criteria I for I Premenstrual I Dysphoric I Disorder • A. I≥5 Isymptoms Ibelow: Ioccur Iin Imost Icycles Iduring Ithe Iweek Ibefore Imenses Ionset, Iimprove Iwithin Ia Ifew Idays Iafter Imenses Ionset, Iand Idiminish Iin Ithe Iweek Ipostmenses • B. IOne I(or Imore) Iof Ithe Ifollowing Isymptoms Imust Ibe Ipresent: o a. IMarked Iaffective Ilability o b. IMarked Iirritability Ior Ianger Ior Iincreased Iinterpersonal Iconflicts o c. IMarked Ianxiety, Itension • C. IOne I(or Imore) Iof Ithe Ifollowing Isymptoms Imust Ialso Ibe Ipresent: o a. IDecreased Iinterest o b. IDifficulty Iconcentrating o c. IEasy Ifatigability, Ilow Ienergy o d. IIncrease Ior Idecrease Iin Isleep o e. IFeelings Iof Ibeing Ioverwhelmed o f. IPhysical Isymptoms Isuch Ias Ibreast Itenderness, Imuscle Ior Ijoint Iaches, I“bloating” Ior Iweight Igain NOTE: ICriteria IA–C Imust Ibe Ipresent Ifor Imost Imenstrual Icycles Iin Ithe Ipreceding Iyear • D. ISymptoms Iare Iassociated Iwith Isignificant Idistress Ior Iinterferences Iwith Iwork, Ischool, Irelationships • E. IThe Idisturbance Iis Inot Imerely Ian Iexacerbation Iof Ianother Idisorder Isuch Ias Imajor Idepression, Ipanic Idisorder, Ipersistent Idepressive Idisorder, Ior Ia Ipersonality Idisorder • F. ICriterion IA Ishould Ibe Iconfirmed Iby Iprospective Idaily Iratings Iin Iat Ileast Itwo Isymptomatic Icycles • G. IThe Isymptoms Iare Inot Idue Ito Iphysiological Ieffects Iof Ia Isubstance Ior Ianother Imedical Icondition Neurological: Dermatomes ISpecific Iareas Iof Icutaneous I(skin) Iinnervation Iat Ithese Ispinal Icord Isegments Iare Icalled Idermatomes. IThe Isensation Iof Ipain Icorresponds Ito Iskin Idermatomes IT6 Iand IL1. ISensory Inerve Idistribution Iof Iskin Idermatomes. IReferred Ipain Iis Iusually Iwell Ilocalized Iand Iis Ifelt Iin Ithe Iskin Idermatomes Ior Ideeper Itissues Ibecause Ivisceral Iafferent Ineurons Iand Iregional Isomatic Ineurons Iconverge Ion Isecond-order Ineurons Iat Ithe Isame Ilevel Iof Ithe Ispinal Icord. IReferred Ipain substance Irelease Iat Ithe Isynapse IChemical Imessengers Icalled Ineurotransmitters Iare Ireleased Spondylolysis IIs Ia Istructural Idefect I(Degeneration, Ifracture, Ior Idevelopmental Idefect) Iin Ithe Ipars Iinterarticularis Iof Ithe Ivertebral Iarch I(the Ijoining Iof Ithe Ivertebral Ibody Ito Ithe Iposterior Istructures). IThe Ilumbar Ispine Iat IL5 Iis Iaffected Imost Ioften. IHeredity Iplays Ia Isignificant Irole Iand Ispondylolysis Iis Iassociated Iwith Ian Iincreased Iincidence Iof Iother Icongenital Ispinal Idefects. ISymptoms Iinclude Ilower Iback Ipain Iand Ilower Ilimb Ipain. location Iof Ithe Imotor Iand Isensory Iareas Iof Ithe Ibrain ICerebral ICortex IThe Iperipheral Inervous Isystem Iis Idivided Iint Isomatic Inervous Isystem Iand Iautonomic Inervous Isystem. IThe Isomatic Inervous Isystem Iconsist Iof Imotor Iand Isensory Ipathways Iregulating Ivoluntary Imotor Icontrol Iof Iskeletal Isystem. IThe Iautonomic Inervous Isystem Iconsists Iof Imotor Iand Isensory Icomponents Iinvolved Iin Iregulating Ithe Ibody’s Iinternal Ienvironment I(viscera) Ithrough Iinvoluntary Icontrol Iof organ Isystems. IPrimary Imotor Icortex I(M1) Ilies Ialong Ithe Iprecentral Igyrus Iin Ifrontal Ilobe, ISensory Iis Ipostcentral Igyrus Iin Ithe Icortex. pathophysiology Iof Icerebral Iinfarction Iand Iexcitotoxins IPathophysiology- ICerebral Iinfarction Iresults Iwhen Ian Iarea Iof Ithe Ibrain Iloses Iits Iblood Isupply Ibecause Iof Ivascular Iocclusion. IIV ItPA Iis Iused Ito Itreat Iacute Istrokes Idue Ito Iits Ithrombolytic Iactivity Ibut Ican Ialso Icause Ineurotoxic Ioutcomes Iduring Istroke. IIntracerebral Iinjection Iof Iexcitotoxins Isuch Ias Iglutamate Icauses Ineuronal Idamage. INeuronal Iinjury Ifollowing Ifocal Icerebral Iischemia Iis Iattributed Ito Iexcitotoxic Ieffects Iof Iglutamate Iinjury Icausing Ihypoxia Ifrom Idepolarization. Agnosia IA Idefect Iof Ipattern Irecognition—a Ifailure Ito Irecognize Ithe Iform Iand Inature Iof Iobjects. IAgnosia Ican Ibe Itactile, Ivisual, Ior Iauditory, Ibut Ionly Ione Isense Iis Igenerally Iaffected. IFor Iexample, Ian Iindividual Imay Ibe Iunable Ito Iidentify Ia Isafety Ipin Iby Itouching Iit Iwith Ia Ihand Ibut Iable Ito Iname Iit Iwhen Ilooking Iat Iit. IAgnosia Imay Ibe Ias Iminimal Ias Ia Ifinger Iagnosia I(failure Ito Iidentify Iby Iname Ithe Ifingers Iof Ione's Ihand) Ior Imore Iextensive, Isuch Ias Ia Icolor Iagnosia. IAgnosia Imost Icommonly Iis Iassociated Iwith Icerebrovascular Iaccidents I(CVA), Iit Imay Iarise Ifrom Iany Ipathologic Iprocess Ithat Iinjures Ithese Ispecific Iareas Iof Ithe Ibrain. IEx. ISpatial, Iobject, Ivisual, Icolor, Iauditory, Ifinger, Itactile accumulation Iof Iblood Iin Ia Isubarachnoid Ihemorrhage ISubarachnoid Ihemorrhage Iis Iwhen Ia Ivessel Iis Ileaking, Iblood Ioozes Iinto Ithe Isubarachnoid Ispace. IWhen Ia Ivessel Itears, Iblood Iunder Ipressure Iis Ipumped Iinto Ithe I Isubarachnoid I Ispace. ISubarachnoid I Ihemorrhage I(SAH) Iis Ithe Iescape Iof Iblood Ifrom Ia Idefective Ior Iinjured Ivasculature Iinto Ithe Isubarachnoid Ispace. IThe Iblood Iincreases Ithe Iintracranial Ivolume, I(Increased IICP, Iheadache). IChronic Isubdural Ihematomas Idevelop Iover Iweeks Ito Imonths. IThe Iexisting Isubdural Ispace Icontains Ithe Iliquefied Iclot Ifrom Ithe Iacute Ibleed Iand/or Iaccumulation Iof Iblood Ifrom Ia Ileaking Ivein. I80% Ihave Ichronic Iheadaches Iand Itenderness Iover Ithe Ihematoma Ion Ipalpation. IThey Imay Ihave Iconfusion, Imemory Iloss, Ior Icoma, Idifficulty Ispeaking Ior Iswallowing, Iand Iweakness Iwith Idifficulty Iwalking, Iloss Iof Isensation, Ior Iseizures. IChronic Isubdural Ihematomas Irequire Ia Icraniotomy Ito Ievacuate Ithe Igelatinous Iblood Iand Ito Iprevent Ibrain Iherniation. IPercutaneous Idrainage Ifor Ichronic Isubdural Ihematomas Ihas Iproven Isuccessful most Icommon Icause Iof Imeningitis IInfectious Imeningitis Imay Ibe Icaused Iby Ibacteria, Iviruses, Ifungi, Iparasites, Ior Itoxins. IViral Imeningitis Iis Ithe Imost Icommon Icause. Streptococcus Ipneumoniae Ibacteria Iis Ithe Imost Icommon Icause Iof Ibacterial Imeningitis. IBacterial: IMeningococcus I(Neisseria Imeningitidis) Iand Ipneumococcus I(Streptococcus Ipneumoniae) Iare Ithe Imost Icommon Ipathogens. Genitourinary: diet Iand Ithe Iprevention Iof Iprostate Icancer INongenetic Irisk Ifactors Ifor Iprostate Icancer Imay Iinclude Ia Ihigh-fat Idiet. IChange Iin Idiet Ifrom Ihigh Iintake Iof Ianimal Iproducts Ito Imore Ifruits Iand Ivegetables Iis Ibeneficial. IMediterranean IDiet Ireduces Imortality Irate Iof IProstate ICa I(increase Ifruit Iand Ivegetable, Ifish Ioil, Iwhole Igrain, Iolive Ioil, Iand Itomatoes, Igreen Itea, I& Icurcumin, Ialcohol Iand Ired Iwine Iin Imoderation, Ireduce Isaturated Ifats, Ired I& Iprocessed Imeats Iand Idairy Iproduct), Iincrease IVitamins ID I& IE I& Iselenium. IThe IAlpha-Tocopherol, IBeta-Carotene ICancer IPrevention I(ATBC) IStudy Ishowed Isupplementation Iwith Ivitamin IE Icould Ireduce Ithe Iincidence Iof Iprostate Icancer, IVitamin I D Imay Iplay I an I important I role I in I prostate I cancer I prevention. containing Ithree Icopies Iof Ione Ichromosome aneuploid I cell Impact Iof IBenign IProstatic IHypertrophy I(BPH) Ion Ithe Iurinary Isystem IBenign Iprostatic Ihyperplasia I(BPH) Iis Ienlargement Iof Ithe Iprostate Igland. IPostrenal-caused Iby IUT Iobstruction, IBPH Iis Iproblematic Ias Iprostatic Itissue Icompresses Ithe Iurethra Iresulting Iin Ifrequent Ilower Iurinary Itract Isymptoms Isuch Ias Iurge Ito Iurinate Ioften, Ia Idelay Iin Istarting Iurination, Idecreased Iforce Iof Ithe Iurinary Istream, Ilong-term Iurinary Iretention. IObstruction Ito Iurine Iflow Iin Ithe Ilower Iurinary Itract Iincludes Ienlargement Iof Iprostate Iin Imen. Genetics: the Irole Iof IDNA Iin Igenetics IGenes Iare Icomposed Iof IDNA, Iand Ithe Imost Iimportant Iconstituent Iof IDNA Iis Ifour Itypes Iof Initrogenous Ibases I(Fig. I4.1). IThe Ifour Ibases, Iadenine, Icytosine, Iguanine, Iand Ithymine, Iare Icommonly Irepresented Iby Itheir Ifirst Iletters: IA, IC, IG, Iand IT, Irespectively. IDNA Ito Iserve Ias Ithe Ibasis Iof Igenetic Iinheritance, IDNA Imust Ibe Iable Ito Iprovide Ia Icode Ifor Iall Ithe Ibody's Iproteins. IIn Iaddition Ito Ihaving Ithe Iability Ito Ispecify Iamino Iacid Isequences, IDNA Imust Ibe Iable Ito Ireplicate Iitself Iaccurately Iduring Icell Idivision Iso Ithat Ithe Igenetic Icode Ican Ibe Ipreserved Iin Isubsequent Icell Igenerations transcription Itranscription Iof Ithe Iinformation Istored Iin IDNA. ITranscription Iis Ithe Iprocess Iby Iwhich IRNA Iis Isynthesized Ifrom Ia IDNA Itemplate. IThe Iresult Iis Ithe Iformation Iof Imessenger IRNA I(mRNA) Ifrom Ithe Ibase Isequence Ispecified Iby Ithe IDNA Imolecule. Transcription Iof Ia Igene Ibegins Iwhen Ian Ienzyme Icalled IRNA Ipolymerase Ibinds Ito Ia Ipromoter Isite Ion Ithe IDNA. IThe Iflow Iof Igenetic Iinformation Ifrom IDNA Ito ImRNA Iso Ithe Iproteins Iare Ispecified Iby IDNA, Iex. ISpecifies Ia Isequence Iof ImRNA. effects Iof Igenetic Imutations IA Imutation Iis Ian Iinherited Ialteration Iof Igenetic Imaterial I(ex. IDNA) Icaused Iby Imutagens. IThey Icause Imany Iof Ithe Iserious Igenetic Idiseases, Idisease Icausing Imutations. IMutation Igenerally Imeans Ian Ialteration Iin Ithe IDNA Isequence Iaffecting Iexpression Ior Ifunction Iof Ia Igene, Iaffecting Iexpression Ior Ifunction Iof Ia Igene I( Ithe Iactivity Iof Ithe Iprotein) Iex. ICancer I& IHemophilia Trisomy IAn is Isaid Ito Ibe trisomic I(a Icondition Itermed Itrisomy. IChromosome Idisorders, Isuch Ias Itrisomy I21, Iare Iroutinely Idetected Iusing Ikaryotypes. IChromosomes I13, I18, Ior I21. IThe Imost Iwell-known Iexample Iof Ianeuploidy Iin Ian Iautosome Iis Itrisomy Iof Ithe Itwenty-first Ichromosome, Iwhich Icauses IDown Isyndrome. Ifemales, Iis Itrisomy IX. IInstead Iof Itwo IX Ichromosomes, Ithese Ifemales Ihave Ithree IX Ichromosomes Iin Ieach Icell. ITrisomy I13- Icleft Ilip Ipalate Trisomy I13 Isyndrome I(Patau ISyndrome) IVSD I((ventricular Iseptal Idefect)), IPDA I(patent Iductus Iarteriosus), Idextrocardia Trisomy I18 Isyndrome I(Turners ISyndrome) IVSD, IPDA, IPS I(pulmonary Istenosis) ITrisomy I21 I(Down Isyndrome) IAVSD I(atrioventricular Iseptal Idefect), IVSD Down ISyndrome ITrisomy I21 Ichromosome, I47 Ichromosomes Iwith Ian Iextra Ion I#21. IThe Ifacial Iappearance Iis Idistinctive I(Fig. I4.14), Iwith Ia Ilow Inasal Ibridge, Iepicanthal Ifolds, Iprotruding Itongue, Iand Iflat, Ilow-set Iears. IPoor Imuscle Itone I(hypotonia) Iand Ishort Istature Iare Iboth Icharacteristic. IApproximately I97% Iof IDown Isyndrome Icases Iare Icaused Iby Inondisjunction Iduring Ithe Iformation Iof Ione Iof Ithe Iparent's Igametes Ior Iduring Iearly Iembryonic Idevelopment. IRisk Iincreases Iwith Imaternal Iage I>35. I. IIt Iaffects I1 Iin I800 Ilive Ibirths Iand Iis Imuch Imore Ilikely Ito Ioccur Iin Ithe Ioffspring Iof Iwomen Iolder Ithan I35 Iyears Iof Iage. IAssociated Iwith Iacute Ileukemia or Ib. ITwo Iof Ithe Ifollowing: I1. INeurofibroma I2. IMeningioma I3. IGlioma I4. ISchwannoma I5. IJuvenile Iposterior Isubcapsular Ilenticular Iopacity Musculoskeletal: ions Ithat Iinitiate Imuscle Icontraction ICa++ Iions Iactive Itransport Isystem Ithat Iregulates Ithe ICa++ Ilevels Iin Ithe Icell's Icytoplasm, Iwhich Iin Iturn Iregulates Imuscle Icontraction growth Iof Ilong Ibones Iin Ichildren Ilong Ibones Iof Ithe Iextremities I(tibia, Ifemur, Iradius, Iulna). Igrowth Iin Ithe Ilength Iof Ilong Ibones Ioccurs Iat Ithe Iphyseal Iplate I(growth Iplate) Ithrough Iendochondral Iossification. IWith Igrowth Ithe Ifemur Iassumes Iits Inormal Ialignment I(by I12 Iyears Iof Iage) Iand Itibial Irotation Ineutralizes Iat I8 Iyears Iof Iage.5. ILong Ibones Ihave Ia Ibroad Iend I(epiphysis), Ibroad Ineck I(metaphysis), Iand Inarrow Imidportion I(diaphysis) Ithat Icontains Ithe Imedullary Icavity. IRickets Ioccurs Iin Ithe Igrowing Ibones Iof Ichildren, Ideficient IVit. ID Ior Icalcium. bones Ibelonging Ito Ithe Iappendicular Iskeleton IThe Iappendicular Iskeleton Iconsists Iof I126 Ibones Ithat Imake Iup Ithe Iupper Iand Ilower Iextremities, Ithe Ishoulder Igirdle I(pectoral Igirdle), Iand Ithe Ipelvic Igirdle I(os Icoxae) Immunity/Inflammation: how Ivaccines Iare Iformed Iprophylactic Ior Itherapeutic Iprocedures Ihave Ibeen Ideveloped Ito Iprevent Ipathogens Ifrom Iinitiating Idisease I(vaccines). IContracting Iand Isurviving Ian Iinfectious Idisease Iis Ithe Imost Ieffective Imeans Iof Ideveloping Ilifelong Iimmunity Iagainst Iparticular Ipathogens. IThe Ipurpose Iof Ivaccination Iis Ito Iinduce Iactive Iimmunologic Iprotection Ibefore Iexposure Ito Ithe Irisks Iof Idebilitating Ior Ifatal Iinfection. IFor Ieach Ivaccine Ian Iinitial Iimmunization. IFor Ieach Ivaccine Ian Iinitial Iimmunization Iprotocol Iis Ideveloped Ito Iproduce Ilarge Inumbers Iof Imemory Icells Iand Ia Isustained Iprotective Isecondary Iimmune Iresponse Iin Ithe Igreatest Inumber Iof Iindividuals. IDevelopment Iof Ia Isuccessful Ivaccine Idepends Ion Imany Ifactors. IThese Iinclude Icharacterizing Ithe Idesired Iprotective Iimmune Iresponse I(e.g., Iantibody, IT Icell), Iidentifying Ithe Iappropriate Iantigen Ito Iinduce Ithat Iresponse I(i.e., Iimmune Iresponses Iagainst Isome Iantigens Ion Ian Iinfectious Iagent Iare Iineffective Ior Ieven Iincrease Ithe Irisk Ifor Iinfection), Idetermining Ithe Imost Ieffective Iroute Iof Iadministration I(e.g., Iinjected, Ioral, Iinhaled), Ioptimizing Ithe Inumber Iand Itiming Iof Ivaccine Idoses Ito Iinduce Iprotective Iimmunity Iin Ia Ilarge Iproportion Iof Ithe Iat-risk Ipopulation, Iand Ideciding Ithe Imost Ieffective, Iyet Isafe, Iform Iin Iwhich Ito Iadminister Ithe Ivaccine. IFor Iinstance, Imost Ivaccines Iagainst Iviral Iinfections I(e.g., Imeasles, Imumps, Irubella, IVaricella Izoster I[chickenpox], Iyellow Ifever) Icontain Ilive Iviruses Ithat Iare Iweakened I(attenuated) Ito Icontinue Iexpressing Ithe Iappropriate Iantigens Ibut Iare Iunable Ito Iestablish Imore Ithan Ia Ilimited Iand Ieasily Icontrolled Iinfection. ISome Icommon Ibacterial Ivaccines Iare Ikilled Imicroorganisms Ior Iextracts Iof Ibacterial Iantigens. Ihe Iexistence Iof Ia Iprolonged Iand Iprotective Isecondary Iimmune Iresponse I Iexplains I Ihow I Ivaccinations Iprovide Iprotection Iagainst Icertain Ipathogenic Imicroorganisms. IEdward IJenner, Ian IEnglish Iphysician Iof Ithe Ilate Ieighteenth Icentury, Iperformed Ithe Ifirst Iwell-documented Ivaccine Itrial Iwith Ismallpox. I“vacca”=cow I(cowpox) IEdward IJenner- Ismallpox. IActive Iimmune Iresponse- I3rd Iline Iof Idefense Iused Iwhen Iimmunizing Iagainst Idisease. IThe Iimmunization Icontains IAg Iin Ismall Iamounts. IThe Ibody’s Ilymph Isystem Isees Iit Ias Ia Iforeign Imaterial. IThe Ilymph Isystem Itells IT Icell Ispecific Ito IAg. IClones Iit Ito IB Icells Iforming Iantibodies Ito Ifight Ithe Iantigen Ifor Iwhen Iyou Iget Iexposed. INow Ibody Ican Ifight Ithe Iantigen. populations Iat Irisk Ifor Igetting Isystemic Ifungal Iinfections Iand Iparasitic Iinfections Ipeople Iwith Iweakened Iimmune Isystems, Igenetic Idefects, Iinfections Isuch Ias IHIV, Icancer, Iand Idrugs Iused Ito Iprevent Itransplant Irejection. Ippl Ion Ibroad Ispectrum Iantibiotics. IPoor Ihygiene I& Isanitation, Ideveloping I countries, I children. I Immune I deficiencies I may I allow I invasive I systemic Iinfections I(e.g., Isystemic Ifungal Iinfections) systemic Imanifestations Iof Iinfection Ifever, Ileukocytosis, Iplasma Iprotein Isynthesis. ISystemic manifestations Iof Icellular Iinjury Iinclude Ifever, Ileukocytosis, Iincreased Iheart Irate, Ipain, Iand Iserum Ielevations Iof Ienzymes Iin Ithe Iplasma mechanisms Iresponsible Ifor Ithe Iincrease Iin Iantimicrobial Iresistance Iworldwide Ioveruse Ior Imisuse Iof Iantimicrobials I(antibiotics). IAntimicrobial Iresistance Ioccurs Inaturally Ithrough Igenetic Ichanges. functions Iof Inormal Iflora Iin Ithe Ibody I1st Iline Iof Idefense Iused Ito Isweep Iflush, Ior Iperistaltic Iaction Isuch Ias Imucous, Iurine, Itears, Iand Ibile. IOur Imost Iimportant Iimmune Idefense Iis Iintact Iskin Iand Imucous Imembrane Iused Ias Iimpermeable Ibarriers Ito Ianything Ithat Itries Ito Iinvade Iour Ibody Ifrom Ithe Ioutside. IPhysical Iand Imechanical Ibarriers Iare Ithe Ifirst Ilines Iof Idefense Ithat Iprevent I damage I to I the I individual I and I prevent I invasion I by I pathogens; I these I include I the Iskin Iand Imucous Imembranes. IAntibacterial Ipeptides Iin Imucous Isecretions, Iperspiration, Isaliva, Itears, Iand Iother Isecretions Iprovide Ia Ibiochemical Ibarrier Iagainst Ipathogenic Imicroorganisms. IThe Inormal Ibacterial Iflora I Iprovides I Iprotection I Iby I Ireleasing I Ichemicals Ithat Iprevent Icolonization Iby Ipathogens. desensitization Itherapy IClinical Idesensitization Ito Iallergens Ican Ibe Iachieved Iin Isome Iindividuals. IMinute Iquantities Iof Ithe Iallergen Iare Iinjected Iin Iincreasing Idoses Iover Ia Iprolonged Iperiod. IThe Iprocedure Imay Ireduce Ithe Iseverity Iof Ithe Iallergic Ireaction Iin Ithe Itreated Iindividual. Imechanisms Iby Iwhich Idesensitization Ioccurs Imay Ibe Iseveral, Ione Iof Iwhich Iis Ithe Iproduction Iof Ilarge Iamounts Iof Iso-called Iblocking Iantibodies, Iusually Icirculating IIgG. ISuppressing Ithe Iallergic Iresponse cells Iinvolved Iin I“left Ishift” Iin Ithe IWBC Icount Idifferential IDuring Imany Iinfections, Ileukocytosis Imay Ibe Iaccompanied Iby Ia Ileft Ishift Iin Ithe Iratio Iof Iimmature Ito Imature Ineutrophils, Iso Ithat Ithe Imore Iimmature Iforms Iof Ineutrophils, Isuch Ias Iband Icells, Imetamyelocytes, Iand Ioccasionally Imyelocytes, Iare Ipresent Iin Irelatively Igreater Ithan Inormal Iproportions. IPremature Irelease Iof Ithe Iimmature Iwhite Icells I(leukocytes) Iis Iresponsible Ifor Ithe Iphenomenon Iknown Ias Ia Ishift-to-the-left Ior Ileukemoid Ireaction. Increased Inumber Iof Iimmature Ineutrophils forms Iof Iimmunity IInnate- I1st-line Iof Idefense Iagainst Ia Ipathogen Iskin Ibarrier. IInnate-2nd Iline Iof Idefense- Iinflammatory I(WBC). I3rd Iline Iof Idefense-Adaptive Iimmunity-acquired I(active Iand Ipassive) ILymphocytes- IB I& IT Icells, INK Icells. IPassive Iimmunity Ioccurs Iwhen Iantibiotics Iare Ipassed Ifrom Ione Iperson Ito Ianother Iex. ITransfusion). IActive Iimmunity Iinvolves IT I& IB Icells Ilymphocytes I& IWBCs. IAutoimmunity- Iimmune Isystem Iresponds Ito Iself-antigens, Iresponds Ito Iantigens Iwithin Iyour Iown Ibody. IIgM Iappears Ifirst Ibut Irapidly Idisintegrates, Ifollowed Iby IIgG Ipersists Ilonger. IAdaptive Iimmunity I– Iprimary Iresponse Iwithin I5 Idays Iof IAg Iexposure, Iincreased I gM, Isecondary Iresponse- Iafter Ire-exposure Ito Isame IAg, IIgG Irises Ifaster Iand Ihigher Idue Ito Imemory Icells IB I& IT Icells. major Ihistocompatibility Iclass II Iantigens IOn IChromosome I#6. IIntracellular IProteins Iare Iexpressed Ion Ithe Isurface Iof Iall Icells Iexcept IRBCs. IReferred Ito Ias Ihuman Ileukocyte Iantigens (HLA), Ieach Iperson Iinherits I2 Isets Iof IMHC Igenes, Iit Iacts Ias Ithe Iunique Ibarcode Ion Ithe Isurface Iof Ieach Iof Iour Icells. IIt Ialso Idisplays Ipresent Iforeign Imaterial Ito Ithe Iimmune Isystem Ifor IB I& IT Icell Iactivation. IClass I1 IMHC I(HLA IA, IB, IC) Iexpressed Ion Iall Inucleated Icells Iand Iplatelets, Ipresents IENDOGENOUS Iantigens, Irecruits ICD8+ I & ITc-Cells. I MHC I class I I I molecules I are Iheterodimers Icomposed Iof Ia Ilarge Ialpha I(α) Ichain Iand I a I smaller I chain I called I β2- Imicroglobulin. IEndogenous Iantigens Iare I“non-self” I(foreign) Iintracellular Iproteins inflammatory Ichemicals Iblocked Iby Ianti-inflammatory Idrug IProstaglandin Iblocked Iby Ianti- Iinflammatory Idrugs characteristics Iof Iacute Iphase Ireactant IC-reactive Iprotein Imarkers Iof Iinflammation Ithat Ihave Ibeen Ilinked Ito Ian Iincrease Iin ICAD Irisk, Ihighly Isensitive IC-reactive Iprotein I(hs-CRP) Ihas Ibeen Iexplored Iin Ithe Igreatest Idepth. Ihs-CRP Iis Ian Iacute Iphase Ireactant Ior Iprotein Imostly Isynthesized Iin Ithe Iliver Iand Iis Ian Iindirect Imeasure Iof Iatherosclerotic Iplaque- Irelated Iinflammation Iand Iplaque Iprogression. IC-reactive Iprotein I(CRP) Iis Ian Iacute Iphase Ireactant Iprotein Iproduced Iby Ithe Iliver, Imainly Iin Iresponse Ito Iinterleukin-6 Iproduced Iby Iinflammation Iof Iany Itype. ICRP Iis Imost Isensitive Ito Iacute Iphase Ireactants; Iconsequently, Iits Ilevel Irises Irapidly Iduring Iinflammation Dermatology: process Iby Iwhich Ia Ideep Ipressure Iulcer Iheals INegative Ipressure Iwound Itherapy. IRequires Iadequate Irelief Iof Ipressure, Idebridement Iof Idead Itissue, Iopening Iof Ideep Ipockets Ifor Idrainage, Iand Irepair Iof Idamage Itissue Iby Iconstruction Iof Iskin Iflaps Ifor Ilarge, Ideep Iulcers. complications Iof Ithe Idevelopment Iof Icontractures Iduring Iwound Ihealing IScar Iformation Iwith Icontractures Iis Ioften Ia Iconsequence Iof Ihealing Iin Iburns. Idevelopment Iof Iportal Ihypertension Iand Iesophageal Ivarices Iand Iesophageal Istrictures Acid/Base: causes Iof Irespiratory Ialkalosis Ihigh Iblood IpH Iand Ilow IPaCO2. ICauses: IHyperventilation, Iextreme Ianxiety/panic, Ipain, Ialtitude Ichanges, Ihypermetabolic Istates I(fever, Isepsis, Ihyperthyroidism). IIn Igeneral, Ialkalosis Iincreases ICNS Iresponsiveness I=> Idizziness, Icramping, Iagitation, Iseizure molecules Ithat Iact Ias Ibuffers Iin Ithe Iblood Icarbonic Iacid-bicarbonate Ibuffer Isystem I(H2CO3) Iremoves Iexcess Ibody Iacids I(H+) Ior Ibases I(OH-). Cardiovascular: congestion. IThis Icauses Ithe Iright Iventricle Ito Ihypertrophy. IRight Iheart Ifailure Isecondary Ito Ileft Iheart Ifailure Iis Icalled ICor IPulmonale. differences Ibetween Ileft Iand Iright Isided Iheart Ifailure Left Isided Iheart Ifailure- ICHF. IInability Iof ILV Ito Iprovide Iadequate Iblood Iflow Iinto Isystemic Icirculation. ICauses: ISystemic Ihypertension I(most Icommon), ILV IMI, ILV Ihypertrophy, Iaortic ISLV Ior Ibicuspid Ivalve Idamage Isecondary Ito Iright Iheart Ifailure. IMost Icommon Icause Iof ILHF Iis Ihigh Isystemic Ivascular Ipressure. IProcess Iof ISystemic Ivascular Ipressure: IIncrease ILV Iafterload, IIncrease ILV Ipreload, IIncrease ILA Ipreload, IIncrease Iblood Ivolume Iand Ipressure Iin Ipulmonary Iveins, Ifluid Iforced Iout Iinto Ipulmonary Itissues. IResults Iin IPulmonary Iedema, Idyspnea, Iand Isecondary Iright Iheart Ifailure I(Cor IPulmonale) I= IBiventricular Iheart Ifailure I(R I& IL Iheart) Right Isided Iheart Ifailure- ICor IPulmonale. IInability Iof IRV Ito Iprovide Iadequate Iblood Iflow Iinto Ipulmonary Icirculation. ICauses: IPulmonary Idisease Isuch Ias IPulmonary IHTN Imost Icommon Iright Iheart Ifailure, IRV IMI, IRV Ihypertrophy, Ipulmonary ISLV Ior Itricuspid Ivalve Idamage Isecondary Ito Ileft Iheart Ifailure. IProcess Iof Ipulmonary Ivascular Ipressure: Iincreased IRV Iafterload, IIncreased IRV Ipreload, Iincreased IRA Ipreload, IIncreased Ivena Icava, Ifluid Iforced Iout Iinto Iperipheral Itissues. Results Iin Ijugular Ivein Idistension I(JVD), Ihepatosplenomegaly, Iperipheral Iedema, Ileft Iheart Ifailure I= Ibiventricular Iheart Ifailure. infective Iendocarditis IInfective Iendocarditis I(IE) Iis Ia Igeneral Iterm Iused Ito Idescribe Iinfection Iand Iinflammation Iof Ithe Iendocardium, Iespecially Ithe Icardiac Ivalves. IMost Icommon Icause Iof Iaortic Iregurgitations I(mitral Ivalve Iregurgitations) Idue Ito Iimplantation Iof Iprosthetic Ivalves. IPathogen Ienters Ithe Inervous Isystem Iby Ihematogenous Ispread. ITrauma, Icongenital Iheart Idisease, Ivalvular Iheart Idisease, Iand Ithe Ipresence Iof Iprosthetic Ivalves Iare Ithe Imost Icommon Irisk Ifactors Ifor Iendocardial Idamage Ithat Ileads Ito IIE. IBlood-borne Imicroorganism Iadherence Ito Ithe Idamaged Iendocardial Isurface. IBacteria Imay Ienter Ithe Ibloodstream Iduring Iinjection Idrug Iuse, Itrauma, Idental Iprocedures. IFormation Iof Iinfective Iendocardial Ivegetations I(Fig. I33.36). IBacteria Iinfiltrate Ithe Isterile Ithrombi Iand Iaccelerate Ifibrin Iformation Iby Iactivating Ithe Iclotting Icascade. IThe I“classic” Ifindings Iare Ifever, Inew Ior Ichanged Icardiac Imurmur, Iand Ipetechial Ilesions Iof Ithe Iskin, Iconjunctiva, Iand Ioral Imucosa. ICharacteristic Iphysical Ifindings Iinclude IOsler Inodes I(painful Ierythematous Inodules Ion Ithe Ipads Iof Ithe Ifingers Iand Itoes) Iand IJaneway Ilesions. IOther Imanifestations Iinclude Iweight Iloss, Iback Ipain, Inight Isweats, Iand Iheart Ifailure. ICNS, Isplenic, Irenal, Ipulmonary Iperipheral Iarterial, Icoronary, Iand Iocular Iemboli Imay Ilead Ito Ia Iwide Ivariety Iof Isigns Iand Isymptoms. IThe Iwidely Iaccepted IDuke Icriteria Ifor Ithe Idiagnosis Iof IIE Iinclude Ithe Itwo Imajor Icriteria Iof Ipositive Iblood Icultures I(at Ileast I2 Ipositive Icultures Idrawn I>12 Ihours Iapart) Iand Ievidence Ifor Iendocardial Iinvolvement I(echocardiographic Ifindings Iof Ivegetations Iand Ivalvular Idysfunction Ior Idamage), Iplus Iminor Icriteria Iincluding Ipredisposing Iconditions, Ifever, Ievidence Iof Iemboli I(e.g., IJaneway Ilesions), Iand Iimmunologic Iphenomena I(e.g., IOsler Inodes). Box I33.3 IRisk IFactors Ifor IInfective IEndocarditis I• IImplantation Iof Iprosthetic Iheart Ivalves • Congenital Ilesions Iassociated Iwith Ihighly Iturbulent Iflow I(e.g., Iventricular Iseptal Idefect) I• IAcquired Ivalvular Iheart Idisease I(especially Imitral Ivalve Iprolapse) I• IPrevious Iattack Iof Iinfective Iendocarditis I• IIntravenous Idrug Iuse I• ILong-term Iindwelling Iintravenous Icatheterization I(e.g., Ifor Ipressure Imonitoring, Ifeeding, Ihemodialysis) I• IImplantable Icardiac Ipacemakers I• IHeart Itransplant Iwith Idefective Ivalve. Pathology Iof Iunstable Iangina: 1. Unstable Iangina Iresults Iform Irupture Iof Ian Iatherosclerotic Iplaque Iwith Isubsequent Ithrombosis Ior Iobstruction Iof Iflow Ithrough Ia Icoronary Iartery. 2. Atherosclerosis Ibegins Iwith Iendothelial Iinjury. IMacrophages Ithat Iare Ifilled Iwith Ilipoproteins Iare Icalled Ifoam Icells. IThese Imigrate Iinto Ithe Ivessel Iwall Iand Iaccumulate, Iforming Ifatty Istreaks. 3. Smooth Imuscle Icells Imigrate Iover Ithe Ifatty Istreak I& Ifibrous Itissue Iis Isynthesized. IThis Iforms Ia Iplaque Iwhich Ican Ipartially Iobstruct Ithe Ilumen Iof Ithe Ivessel. 4. Unstable Iplaque Iare Ithose Iwith Ia Ithin Ifibrous Icap Iand Ia Irich Ilipid Icore. IWhen Ithose Iplaque Irupture, Iplatelets Ibegin Isticking Ito Ithe Iexposed Iunderlying Itissue Iand Iform Ia Iclot Ithat Ican Icompletely Iocclude Ithe Ivessels. 5. If Ithe Iclot Idissolves Iwithin I10-20 Iminutes, Itissue Iperfusion Iis Irestored Ibefore Iinfarction Ican Ioccur. IThis Iresults Iin Iacute Icoronary Isyndrome Iknown Ias Iunstable Iangina I& Iindicates Ia Ihigher Irisk Ifor Isubsequent IMI. Peripheral Ivascular Idisease: pathophysiology Iof Ideep Ivein Ithrombosis IVichow’s Itriad Hematology: physiological Iresponse Ito Ihypoxia Iin Ianemia IThe Igrowth Ifactor IERYTHROPOIETIN I(EPO) Iis Imade Iby Ithe Ikidney Iand Iliver Iin Iresponse Ito Itissue Ihypoxia. populations Iat Ithe Ihighest Irisk Ifor Ideveloping Ifolate Ideficiency Ianemia IAlcoholics, Imalnutrition I(poor Idiet), Itaking Ianticonvulsant Iprescription I(seizure), Ipregnant Iwomen, Ithose Iwho Ican’t Iproduce Ifolate Iin Itheir Ibodies I(some Ibabies), Ipoor, Ielderly causes Iof Iiron Ideficiency Ianemia IInadequate Idietary Iintake, Ichronic Iand Ior Ioccult Iblood, I(hemorrhage, Icolitis, Icirrhosis, IGI Iulcers, Iesophageal Ilesions, Ior Imenorrhagia) Idecreased Iability Ito Iutilize IFe Ifor Iheme Isynthesis I(transferrin Ideficiencies, Imitochondrial Idefects) expected Ilab Itest Iresults Ifound Iin Ilong Istanding Iiron Ideficiency Ianemia IMicrocytic- Ihypochromic Ianemia- Ismall Icells Iand Ilow IHb Ilevel, Ipaler Icells Sickle ICell IAnemia IInherited IDisorder Iof IErythrocytes: IHemoglobinopathies. IAutosomal Irecessive Igenetic Idisorder. IInheritance Iof I2 Iabnormal Igenes I(one Ifrom Ieach Iparent). IInheritance Iof Ione Inormal IHb Igene I+ Ione Iabnormal IHb Igene I= Isickle Icell Itrait I(carrier). IPathophysiology: ISingle Iamino Iacid Ichange Ion Ibeta-chain Iforms Ielongated IHb Imolecules I(HbS). IOxidative Istress I(hypoxia), Ianxiety, Ifever, Icold, Idehydration, Idecreased Ioxygen Ibinding Ito IHb Iand Iincreases Isickling Itendencies. I(Normochromic, Inormocytic) IHemolytic Ianemia, Iabnormal Ishape Iof Ihemoglobin. IOcclude Iblood Ivessels Iand Ispleen I=> Ihigh Irisk Ifor ICVA Iand Isplenic Idamaged causes Iof Iaplastic Ianemia IChemical Ior Iradiation Iexposure I(SE Ior Icancer Itx), Iviral-induced I(Hepatitis, IEpstein-Barr, ICMV), Itumors I(Multiple IMyeloma), Iantibiotics Iand Iother Iprescriptions I(PCN, Ichloramphenicol, Iphenytoin, Idiuretics, Iantidiabetic I& ISulfa IRx), Icongenital Idefects I(Fanconi’s Ianemia) underlying Ipathophysiologic Imechanisms Ileading Ito Iautoimmune Ihemolytic Ianemia IPremature Idestruction Iof IRBC Idue Ito Ienzymes/toxins Iproduced Iby Iinfectious Iagent, Imediated Iby Iown Iimmune Isystem, Ior Ithe Ieffects Iof Icertain Ichemicals/drugs. IAutoimmune Ireaction- Icongenital Ior Iidiopathic secondary Ipolycythemia IIncreased Ierythropoietin I(RBCs) Isecretion Iin Iresponse Ito Ichronic Ihypoxia. anemia Iof Ichronic Irenal Ifailure IDue Ito Ierythropoietin Ideficiency Itherefore, IRecombinant Ihuman Ierythropoietin I(r-HuEPO) Iis Iused Iin Iindividuals Iwith Ianemia Isecondary Ito Idecreased Ierythropoietin Iproduction Ifrom Ichronic Irenal Ifailure. IAn Iimmediate Ieffect Iof Iincreased Iendogenous Ior Iexogenous Ierythropoietin Iis Ian Iincrease Iin Ithe Iblood Ireticulocyte Icount, Ifollowed Iby Iincreasing Ilevels Iof Ierythrocytes. Fluid Iand IElectrolytes: conditions Ithat Iresult Iin Ipure Iwater Ideficit I(hypertonic Ivolume Idepletion) IHypertonic- IECF Iis Iincreased Imore Ithan IICF. ITherefore, Iwater Idraws Iout Iof Icell Iresulting Iin Icell Ishrinkage Iand Iincreased Iplasma Ivolume I= Ihypervolemia osmoreceptors Ithat Istimulate Ithirst Iand Ithe Irelease Iof IADH Icauses Iof Ihypernatremia effects Iof Iincreased Ialdosterone Idependent Iedema definition Iof Iisotonic ISame I+ Iand I– Icharges Iin IECF Iand IICF I(equal Iosmolality) principle Iof Icapillary Ioncotic Ipressure IChemical Iforce Isuch Ias Iprotein I(albumin) Ito Ipull Ifluid Iin = IReabsorption types Iof Ifluid Icompartments Iin Ithe Ibody IIntracellular Ifluid, Iextracellular Ifluid, Iother I CF- IK+, IHPO4 ECF- I1. IIntravascular Ifluid I(IV)- Iblood Ipressure 2. Interstitial Ifluid I(IF)- Ibetween Icells I- IEDEMA 3. Other Ifluids- I3rd Ispaces- Ilymph, Isynovial Ifluid, ICSF, Iintestinal Ifluid, Isweat, Iurine, Iintraocular, Iand Ibody Icavity Ifluid Pulmonary: most Ieffective Imeasure Ito Iprevent Ipulmonary Iembolus Ifrom Ideveloping Iin Ipatients Iwhen Ithe Ipractitioner Iwill Inote Itactile Ifremitus