Common Laboratory Procedures:: Medical Surgical Nursing :: Review For Nursing Licensure Examination Slide Transcript Slide 1: Common

Laboratory procedures: Nursing Responsibilities and Implications Slide 2: 3 Phases of Diagnostic testing Pretest Client preparation Intra-test specimen collection and VS monitoring Post-test Monitoring and follow-up nursing care Slide 3: Related Nursing Diagnoses Anxiety Fear Impaired physical mobility Deficient knowledge Slide 5: BLOOD TESTS CBC Hemoglobin, Hematocrit, WBC, RBC and platelet Serum Electrolytes Arterial blood gases Blood Chemistry Drug and Hormone Assay Slide 6: Complete Blood Count Specimen: Venous blood Pretest: obtain syringe, tourniquet, vial with appropriate anticoagulant Intratest: Cubital vein commonly used for venipuncture Post-test: direct pressure and observe for bleeding, label vial Slide 7: Normal values for CBC RBC (M) 4.7-6.1/ (F) 4.2-5.4 Hgb (M) 14-18/ (F) 12-16 mg/dL Hct (M) 42-52/ (F) 33-47 % WBC 5-10,000 cells/cubic cm Differential count Neutrophils- 55- 70% Lymphocytes- 20-40% Monocytes- 2-5% Eosinophils- 1-4% Platelets 150,000-400,000 Slide 9: Table. 11.2 Slide 11: CBC Normal WBC count 5-10,000 cell/cm3 Increased WBC More than 10, 000 (Leukocytosis) Increased Neutrophils ACUTE bacterial infection Increased Lymphocytes CHRONIC bacterial infection VIRAL infection Increased Eosinophils PARASITIC infection Slide 12: Serum Electrolytes Specimen: venous blood Pretest/Intratest/Post-test- same Commonly ordered: Sodium- 135-145 mEq/L Potassium- 3.5-5.0 mEq/L Chloride- 95-105 mEq/L Magnesium1.3 to 2.1 mEq/L Calcium- 8 to 10 mg/dL Slide 13: Serum Electrolytes Problems can be Hyper if increased Hypo if decreased Slide 14: Blood Chemistry Specimen: Venous blood, serum Pretest/Intratrest/Post-test-same Examined are enzymes, hormones, lipid profile BUN , Creatinine, etc Place patient on NPO for 8 h *Creatinine is produced relatively constant by muscles, excreted by the kidneys and is the RELIABLE Reflection of Renal Status Slide 15: Blood Chemistry Normal values for : Creatinine: 0.7 to 1.4 mg/dL BUN: 10-20 mg/dL Creatinine clearance: 1.67 to 2.5 mL/s Serum uric acid: 2.5 to 8 mg/dL Blood osmolality= 250 to 290 mOsm/L Slide 16: Blood Chemistry Enzymes/acids Purpose Uric acid Gout detection SGOT/SGPT Liver function

test Rheumatoid factor For Rheumatoid arthritis Anti-DNA antibody SLE diagnosis CK-MB, LDH and Identifies Cardiac Troponin damage or muscle damage Slide 17: Blood Chemistry Coagulation studies Purpose PT Measures the effectiveness of Warfarin 12-16 seconds PTT The BEST single screening test for coagulation disorders 60-70 seconds aPTT Same as PTT, measures effectiveness of HEPARIN 30-40 seconds (more specific than PTT) Bleeding time Measures Platelet function 1-9 minutes Slide 18: Blood Chemistry Others Purpose ESR (erythrocyte Measures the rate at which sedimentation rate) the RBCs settle out of the anti-coagulated blood 10-20 mm/hour Elevates in inflammation auto immune diseases Blood lipids To detect hyperlipidemia Cholesterol= 150-200 mg/dL Triglycerides= 140200 mg/dL Slide 19: Diabetes Mellitus DIAGNOSTIC CRITERIA FBS equal to or greater than 126 mg/dL (7.0mmol/L) (Normal 8 hour FBS- 80-109 mg/dL) Slide 20: Diabetes Mellitus DIAGNOSTIC CRITERIA OGTT value 1 and 2 hours post- prandial equal to or greater than 200 mg/dL Normal OGTT 1 and 2 hours post-prandial- is 140 mg/dL Slide 21: Diabetes Mellitus DIAGNOSTIC CRITERIA RBS of equal to or greater than 200 mg/dL PLUS the 3 Ps Slide 22: Diabetes Mellitus DIAGNOSTIC CRITERIA Glycosylated hemoglobin (HbA1c) is a monitoring test to assess the adherence to diabetic medication Slide 23: Arterial Blood Gases Specimen: arterial blood Pretest: obtain syringe with heparin, rubber stopper, container with ice Intratest: usual site-radial artery, perform Allens test Post-test: Apply direct pressure on site for 5-10 minutes, send specimen with occluded needle on ice Slide 24: Normal ABG values pH 7.35-7.45 pCO2 35-45 mmHg paO2 80-100 mmHg HCO3 22-26 mEq/L Base excess -2 to +2 O2 sat 95-98% Slide 25: ABG interpretation Value Normal Acidosis Alkalosis pH 7.35-7.45 Below 7.35 Above 7.45 paO2 95-100 mmHg SaO2 95-98% Respiratory Respiratory paCO2 35-45 mmHg >45 <35 Metabolic Metabolic HCO3 22-26 mEq/L <22 >26 Slide 27: Urine Analysis Specimens Clean-voided urine for routine urinalysis Clean-catch or midstream urine for urine culture Suprapubic and catheterized urine for urine culture Slide 28: Routine Urinalysis Specimen: Clean voided Pretest: give clean vial and instruct to void directly into the specimen bottle Intratest: Allow a 10 ml collection Post-test: prompt delivery to

laboratory *First voided urine in a.m. is highly concentrated, more uniform concentration and with more acidic pH Slide 29: Urine Culture: Normal is <100,000 Specimen: clean catch, midstream or catheterized urine Pretest: Instruct to wash and dry genitalia/perineum with soap and water. (M)- circular motion, (F)front to back direction Intratest: Midstream urine, 30-60 ml Post-test: Cap and label, prompt delivery and documentation Slide 30: Special Urine Collection Infants Special urine bag Or cut a hole of the diaper (front for the boy, middle for the girl) pulling out through the hole the special bag Children May use potty chair or bedpan Give another vial to play with, allow parent to assist Elderly Assistance may be required Slide 31: Timed-urine collection Collection of ALL urine voided over a specified time Refrigerated or with preservative Pretest: Specimen container with preservative, receptacle for collection, a post sign Intratest: At the start of collection, have patient void and discard the urine At the end of collection period, instruct to completely void and save the urine Post test: Documentation Slide 32: Catheter specimen Sterile urine Insert needle of the syringe through a drainage port Only done with the rubber catheter not the plastic, silastic or silicone catheter. Intratest: Clamp catheter x 30 mins if no urine Wipe area where needle will be inserted 30-45 angle, 3 ml for culture Post-test : Unclamp catheter after collection Slide 34: Stool Analysis Occult Blood GUAIAC test Steatorrhea Ova/Parasites Bacteria Viruses Slide 35: General Nursing consideration for stool collection Pretest: Determine purpose/s, obtain gloves, container and tongue blade Intratest: Instruct to defecate in clean bed pan Void before collection Do not discard tissue in bedpan Obtain 2.5 (1 inch) formed stool 15-30 ml of liquid stool Post-test: prompt delivery Slide 36: Occult Blood: Guaiac Test Detect the presence of enzyme: Peroxidase (+) blue color positive guaiac Restrict intake of red meats, some medications and Vitamin C for 3-7 days FALSE (+): red meat, raw fruits and vegetables especially radish, turnip, melon and horseradish; meds like aspirin, NSAIDS, iron and anticoagulants FALSE (-): Vitamin C, ingested 250 mg per day from any source Slide 38: Sputum Analysis For Culture and sensitivity For sputum cytology For sputum AFB For monitoring of the effectiveness of therapy Slide 39: Sputum examination Pretest: Morning specimen is collected Intratest: Mouthwash with plain water Deeply inhale x 2 then cough Wear gloves in collecting specimen Expectorate needed1-2 Tbsp or 15-30 ml Post-test: oral care and prompt delivery to lab

Slide 41: VISUALIZATION PROCEDURES Invasive procedures are direct methods and need CONSENT Non-invasive procedures are indirect methods and may need written consent in some instances Slide 42: Visualization procedures They can be: Radiographic procedures Scopic procedures Slide 44: GIT Visualization Barium Swallow- UGIS Pretest: written consent, NPO the night Intratest: administer barium orally, then followed by X-ray Post-test: Laxative for constipation, increased fluids, assess for intestinal obstruction , warn that stool is light colored! Slide 47: GIT Visualization Barium Enema- LGIS Pretest: Informed consent, NPO the night, Enema the morning Intratest: Position on LEFT side, administer enema, then X-ray follow Post-test: Cleansing enema , Laxative for constipation, assess for intestinal obstruction Slide 49: GIT Visualization Esophagogastroscopy Pretest: Informed consent, NPO for 8 hours, warn that gag reflex is abolished Intratest: Position on LEFT side during scope insertion Post-test: NPO until gag returns. Monitor for complications Slide 51: GIT Visualization Anoscopy, proctoscopy, proctosigmoidoscopy, colonoscopy Pretest: Consent, NPO, and enema administration the morning Intratest: Position on the LEFT side during scope insertion Post-test: Monitor for complications Slide 54: Gallbladder Oral cholescystogram PTC ERCP Ultrasound Slide 55: IV Cholecystogram X-ray visualization of the gallbladder after administration of contrast media intravenously Pre-test: Allergy to iodine and sea- foods Intra-test: ensure patent IV line Posttest: increase fluid intake to flush out the dye, Assess for delayed hypersensitivity reaction to the dye like chills and N/V Slide 57: Oral Cholecystogram X-ray visualization of the gallbladder after administration of contrast media Done 10 hours after ingestion of contrast tablets Done to determine the patency of biliary duct Slide 60: Endoscopic retrograde cholangiopancreatography Examination where a flexible endoscope is inserted into the mouth and via the common bile duct and pancreatic duct to visualize the structures Iodinated dye can also be injected after for the x-ray procedure Slide 61: Endoscopic retrograde cholangiopancreatography Pre-test: consent, NPO for 12 hours, Allergy to sea-foods, Atropine sulfate Intra-test: Gag reflex is abolished, Position on LEFT side Posttest: NPO until gag reflex returns, Position side lying and monitor for perforation and hemorrhage Slide 65: Percutaneous Transhepatic Cholangiogram Under fluoroscopy, the bile duct is entered

percutaneously and injected with a dye to observe filling of hepatic and biliary ducts Slide 67: Ultrasound of the liver, gallbladder and pancreas Consent MAY be needed Place patient on NPO!!! Laxative may be given to decrease the bowel gas Slide 69: Urinary Visualization Non-invasive: KUB, IVP, Ultrasound Pretest: Elicit allergy to iodine and seafood, NPO after midnight Intra-test: IV iodinated Dye is administered then X-ray is taken Posttest: Increase fluids to flush the dye. Documentation, VS monitoring Slide 72: Urinary Visualization Invasive: retrograde cystourethrogram Pretest: Elicit allergy to iodine and seafood Intra-test: catheter is inserted with dye is administered then X-ray is taken as patient voids Post-test: Increase fluids to flush the dye. Documentation, VS monitoring Slide 75: Pulmonary visualization Invasive: Bronchoscopy, laryngoscopy Non-invasive: CXR and Scan Slide 76: Bronchoscopy Purpose: Diagnostic and therapeutic Pretest: Consent, NPO, client teaching, anti-anxiety drugs Intratest: gag reflex is abolished, instruct to remain still during procedure, FOWLER or SUPINE Post-test: NPO until gag reflex returns, monitor patient for complication like perforation/bleed Slide 79: Pulmonary function test Test to determine lung volumes and capacities Slide 82: LUNG VOLUMES 1. Tidal volume TV 2. Inspiratory Reserve Volume- IRV 3. Expiratory Reserve Volume- ERV 4. Residual volume- RV Slide 83: LUNG CAPACITIES Lung volume + another lung volume 1. Inspiratory Capacity- IC 2. Functional Residual Capacity- FRC 3. Vital capacity- VC 4. Total Lung capacity- TLC Slide 84: Pulmonary \"Volumes 1. Tidal Volume: -volume of air inspired or expired with each normal breath, about 500ml 2. Inspiratory Reserve Volume -extra volume of air than can be inspired over & beyond the normal tidal volume, about 3000ml Slide 85: Pulmonary \"Volumes 3. Expiratory Reserve Volume -amount of air that can still be expired by forceful expiration after the end of a normal tidal expiration -about 1100ml 4. Residual Volume volume of air still remaining in the lungs after the most forceful expiration, averages about 1200ml Slide 86: Pulmonary \"Capacities:\" 1. Inspiratory Capacity -equals TV + IRV, about 3500ml -amount of air that a person can breathe beginning at the normal expiratory level & distending his lungs to maximum amount 2. Functional Residual Capacity -equals ERV + RV -about amount of air remaining in the lungs at the end of normal expiration, about 2300ml

Slide 87: Pulmonary \"Capacities:\" 3. Vital Capacity -equals IRV + TV + ERV or 1C + ERV, about 4600ml -maximum amount of air that a person can expel from the lungs after filling the lungs to their maximum extent & expiring to the maximum extent 4. Total Lung Capacity -maximum volume to which the lungs can be expanded with the greatest possible effort -volume of air in the lungs at this level is equal to FRC (2300ml) in young adult Slide 89: Cardiac Visualization Invasive:angiography. Cardiac catheterization Non-invasive: ECG, Echocardiography, Stress ECG Slide 90: The Cardiovascular System LABORATORY PROCEDURES ECHOCARDIOGRAM Non-invasive test that studies the structural and functional changes of the heart with the use of ultrasound No special preparation is needed Slide 91: 2 D-echocardiogram Slide 92: Angiography Pretest: informed consent, allergy to dyes, seafood and iodine Intratest: Monitor VS Post-test: maintain pressure dressing over puncture site Immobilize for 6 hours Slide 95: Cardiac Catheterization Introduction of catheter into heart chambers Pretest: informed consent, allergy to dyes, seafood and iodine, NPO 8-12 hours Intra-test: Empty bladder, Monitor VS, explain palpitations Post-test: maintain pressure dressing over puncture site Immobilize for 6-8 hours with extremity straight Slide 97: Myelography Radiographic examination of the spinal column and sub- arachnoid space to help diagnose back pain causes Pre-test: Consent, NPO, allergy to seafoods Intra-test: like LT Posttest: supine for 12 hours Slide 99: Arthroscopy Insertion of fiber optic scope into the joint to visualize it, perform biopsy Performed under OR condition After care: Dressing over the puncture site for 24 hours to prevent bleeding Limit activity for several days (7 usually) Slide 101: Arthrogram X-ray visualization of the joint after introduction of contrast medium Pre-test: consent, allergy to seafoods Post-test: Dressing over puncture site and limit joint activity Slide 103: Electromyelography Records the electrical activity in muscles at rest and during involuntary and electrical stimulation Detects disorders such as MG, MS and Parkinsons Explain the use of electrode inserted into the muscles Mild discomfort may be experienced About 45 minutes for one muscle Slide 106: CT scan Painless, non-invasive, x- ray procedure Mechanism: distinguish density of tissues

Slide 108: MRI Painless, non-invasive, no radiation Creates a magnetic field Contraindications: (+) pacemaker (+) metal prosthesis Client teaching: Lie still during the procedure for 60-90 minutes Earplugs to reduce noise discomfort Claustrophobia No radiation Slide 113: ASPIRATION AND BIOSPY Aspiration: withdrawal of fluid Biopsy: removal and exam of tissue Invasive procedure needs INFORMED CONSENT Slide 114: Lumbar Puncture Withdrawal of CSF from the arachnoid space Purpose: diagnostic and therapeutic To obtain specimen, relieve pressure and inject medication Pretest: consent, empty bladder Slide 115: Lumbar Puncture Intra-test: Site used-between L4/L5 Position- flexion of the trunk Posttest: Flat on bed (8-12 hours) Offer fluids to 3 Liters Oral analgesic for headache Monitor bleeding, swelling and changes in neurologic status Slide 118: Abdominal Paracentesis Withdrawal of fluid from the peritoneal space Purpose: diagnostic and therapeutic Pretest: consent, empty bladder Position: sitting Site: midway between the umbilicus and symphysis Slide 119: Abdominal Paracentesis Intratest: 1,500 ml maximum amount collected at one time, Monitor VS Post-test: monitor VS, bleeding complication Measure abdominal girth and weight Slide 121: Thoracentesis Removal of fluid from the pleural space Purpose: Diagnostic and therapeutic Pretest: Consent, teach to avoid coughing Position: sitting with arms above head Slide 122: Thoracentesis Intra-test: Support and observation Post-test: Assess VS Position Postprocedure: lie on the UNAFFECTED SIDE with head elevated 30 x 30 minutes to facilitate expansion of the affected lungs Slide 125: Bone marrow Biopsy Removal of specimen of bone marrow Purpose: diagnostic Pretest: consent, teach that procedure is painful Site: POSTERIOR SUPERIOR ILIAC CREST (adult); PROXIMAL TIBIA (pedia) Position: prone or lateral Slide 126: Bone marrow Biopsy Intratest: Monitor, maintain pressure dressing over punctured site X 10 mins Post-test: Asses for discomfort, administer prescribed pain meds Slide 127: Liver Biopsy Liver tissue obtained for diagnostic purpose Pretest: consent, administer Vitamin K, monitor bleeding parameters, NPO 2 hours before procedure Position: Supine or semifowlers with upper right quadrant of abdomen exposed Slide 128: Liver Biopsy Intra-test: Monitor VS Take few deep inhalation and exhalation and hold final

breath in exhalation x 10 seconds as needle is injected Post-test: monitor VS, bleeding Position postprocedure: RIGHT side-lying with folded towel/pillow under biopsy site for 4-6 hours Slide 129: Papanicolau Smear Done as screening test for cervical cancer, for culture Pre-test: no coitus for 2-3 days, no menstrual bleeding Intra-test: Lithotomy, speculum with water for lubrication, specimen obtained for cervix and vagina Post-test: monitor for bleeding Slide 131: The Cardiovascular System LABORATORY PROCEDURES ELECTROCARDIOGRAM (ECG) A noninvasive procedure that evaluates the electrical activity of the heart Electrodes and wires are attached to the patient Slide 135: What the waves represent? P wave= Atrial Depolarization QRS= Ventricular Depolarization T wave= Ventricular REPOLARIZATION Slide 137: LABORATORY PROCEDURES CVP The CVP is the pressure within the SVC Reflects the pressure under which blood is returned to the SVC and right atrium Slide 138: LABORATORY PROCEDURES CVP Normal CVP is 0 to 8 mmHg/ 4-10 cm H2O Slide 139: LABORATORY PROCEDURES Measuring CVP 1. Position the client supine with bed elevated at 45 degrees (CBQ) 2. Position the zero point of the CVP line at the level of the right atrium. Usually this is at the MAL, 4th ICS 3. Instruct the client to be relaxed and avoid coughing and straining. Slide 142: Tubes Levine Salem Sump tube Gastrostomy tube Jejunostomy tube Slide 146: Drainage Penrose Drain Hemovac Pleuravac Jackson-Pratt Slide 150: Asked in the local boards DRE Snellens chart Webers test Rinnes test Slide 151: DRE Position: Left Lateral or Sims position with upper leg acutely flexed. Females can also be examined in lithotomy Ask client to BEAR DOWN To accentuate rectal fissure, prolapse ,polyps To relax the anal sphincter Slide 152: Snellens Chart: test for visual acuity 20 ft or 6 m distance 3 readings: L, R and Both eyes Report: 20/ xxx Numerator: denotes the distance from the chart Slide 154: Snellens Chart: test for visual acuity Denominator denotes the distance from which the normal eye can read the chart 20/60: the person can see at 20 feet, what a normal person can see at 60 feet. Slide 155: Webers test Test for lateralization and bone conduction Tuning fork is placed on top of

head NORMAL: sound is heard in BOTH ears, localized at the center of the head: WEBER NEGATIVE Slide 156: Webers test Sound is heard BETTER in the affected ear: Bone conductive hearing loss Sound is heard only or better on the NORMAL ear: Sensorineural heating loss ABNORMAL: WEBER POSITIVE Slide 157: Rinnes Test Test for AIR and BONE conduction Tuning fork is initially placed on the mastoid process until no vibration is heard Tuning fork is now placed in front of the ear until sound disappears Slide 158: Rinnes Test Air conduction is LONGER than bone conduction Normal is POSITIVE Rinnes Slide 159: Rinnes Test CONDUCTIVE HEARING LOSS: Bone conduction is GREATER than or equal to the AIR conduction Abnormal is NEGATIVE RINNEs Slide 160: Rinnes Test SENSORINEURAL HEARING LOSS: No bone conduction and air conduction vibration can be assessed NEGATIVE RINNEs Slide 161: Weber Slide 162: Rinnes Slide 163: Rinnes

HERBAL MEDS St. John's wort - antidepressant, photosensitive (C/I in SULFA drugs) Garlic - antihypertensive (avoid aspirin) Ginseng - Anti stress (C/I in coumadin) Green tea - antioxidant (check if risk for calculi-oxalates) Echinacea - immune stimulant (6-8 weeks only)(C/I in SANDIMMUNE-Immunosuppressant) Licorice - cough and cold

Ginger root - antinausea (C/I in Coumadin) Ginkgo - improves circulation (C/I in anticoagulant, headache side effect - check PT) Ma huang - bronchodilator, stimulant (Ephedra)

Digitalis Toxicity includes.. N - nausea A - anorexia V - vomiting D - diarrhea A - abdominal pain

Drugs which can cause URINE DISCOLORATION Adriamycyn------ Reddish Rifabutin--------- Red orange Rifampicin------- Red orange Bactrim---------- Red orange Robaxin--------- Brown, Black or Greenish Azulfidine------ Orange yellow Flagyl------------ Brownish Dilantin---------- Pink tinged Anti Psychotic-- Pinkish to Red brown Early signs of hypoxia: R-restlessness A-anxiety T-Tachycardia Late signs of hypoxia: B-bradycardia E-extreme restlessness D-dyspnea In pediaF-feeding difficulty I-inspiratory stridor N-nares flare E-expiratory grunting S-sternal retractions Respiratory Patterns

Kussmaul- fruity acetone breath odor Cheyne-stokes- near death breathing pattern

Seasonal Affective Disorder (SAD) may affect over 10 million Americans. The typical symptoms of SAD include depression, lack of energy, increased need for sleep, a craving for sweets and weight gain. Symptoms begin in the fall, peak in the winter and usually resolve in the spring. Some individuals experience great bursts of energy and creativity in the spring or early summer. Susceptible individuals who work in buildings without windows may experience SAD-type symptoms at any time of year. Some people with SAD have mild or occasionally severe periods of mania during the spring or summer. If the symptoms are mild, no treatment may be necessary. If they are problematic, then a mood stabilizer such as Lithium might be considered. There is a smaller group of individuals who suffer from summer depression. SAD is recognized in the DSM-IV (The American Psychiatric Association's diagnostic manual) as a subtype of major depressive episode. Some individuals who work long hours inside office buildings with few windows may experience symptoms all year round. Some very sensitive individuals may note changes in mood during long stretches of cloudy weather. A sign of improvement from dehydration would be a decreased urine specific gravity and a decreased/decreasing hematocrit. So the SG of 1.015 and a Hct of 46% would be the answer. It is the best answer of the two you had in you question. The normal urine SG is 1.003-1.035 (Usually between 1.010-1.025 with normal hydration and volume) (different texts give a slightly different range). SG 1.025-1.030+ (concentrated urine) SG 1.001-1.010 (dilute urine) SG 1.001-1.018 in infants under 2 years of age Specific gravity is a measurement of the kidney's ability to concentrate urine. The range of urine's SG depends on the state of hydration and varies with urine volume and the load of solids to be excreted under standardized conditions; when fluid intake is restricted or increased, SG measures the concentrating and diluting functions of the kidney. Loss of these functions is an indication of renal dysfunction. SG values usually vary inversely with amounts of urine excreated (decrease in urine volume = increase in specific gravity). However in some conditions this is not the case. EYE ABBREVIATIONS OU- both eyes OR- right eye OS- left eye

CUSHINGS (Hypersecretion of Adrenal Cortex Hormones) C = Check VS, particularly BP U = Urinary output & weight monitoring S = Stress Management H = High CHON diet I = Infection precaution N = Na+ restriction G = Glucose & Electrolytes Monitoring S = Spousal support ADDISON'S (Hyposecretion of Adrenal Cortex Hormones) Always Remember the 6 A's of Addison's disease 1.) Avoid Stress 2.) Avoid Strenuous 3.) Avoid Individuals with Infection 4.) Avoid OTC meds 5.) A lifelong Glucocorticoids Therapy 6.) Always wear medic alert bracelet

Hirschsprungs diagnosed with rectal biopsy looking for absence of ganglionic cells. Cardinal sign in infants is failure to pass meconium, and later the classic ribbon-like and foul smelling stools. Intussusception common in kids with CF. Obstruction may cause fecal emesis, currant jelly-like stools (blood and mucus). A barium enema may be used to hydrostatically reduce the telescoping. Resolution is obvious, with onset of bowel movements. With omphalocele and gastroschisis (herniation of abdominal contents) dress with loose saline dressing covered with plastic wrap, and keep eye on temp. Kid can lose heat quickly. After a hydrocele repair provide ice bags and scrotal support. No phenylalanine with a kid positive for PKU (no meat, no dairy, no aspartame). Second voided urine most accurate when testing for ketones and glucose. Never give potassium if the patient is oliguric or anuric.

Nephrotic syndrome is characterized by massive proteinuria (looks dark and frothy) caused by glomerular damage. Corticosteroids are the mainstay. Generalized edema common. A positive Western blot in a child <18 months (presence of HIV antibodies) indicates only that the mother is infected. Two or more positive p24 antigen tests will confirm HIV in kids <18 months. The p24 can be used at any age. For HIV kids avoid OPV and Varicella vaccinations (live), but give Pneumococcal and influenza. MMR is avoided only if the kid is severely immunocompromised. Parents should wear gloves for care, not kiss kids on the mouth, and not share eating utensils. Hypotension and vasoconstricting meds may alter the accuracy of o2 sats. An antacid should be given to a mechanically ventilated patient w/ an ng tube if the ph of the aspirate is <5.0. Aspirate should be checked at least every 12 hrs. Ambient air (room air) contains 21% oxygen. The first sign of ARDS is increased respirations. Later comes dyspnea, retractions, air hunger, cyanosis. Normal PCWP is 8-13. Readings of 18-20 are considered high. First sign of PE (pulmonary embolism) is sudden chest pain, followed by dyspnea and tachypnea. High potassium is expected with carbon dioxide narcosis (hydrogen floods the cell forcing potassium out). Carbon dioxide narcosis causes increased intracranial pressure. Pulmonary sarcoidosis leads to right sided heart failure. An NG tube can be irrigated with cola, and should be taught to family when a client is going home with an NG tube.

Q&As found in the NCLEX FORUM Question # 1 (Multiple Choice) History and exam indicates your 77 year old female patient has digitalis toxicity. Which drugs are contraindicated in this case? Plz provide your rationale. A) lidocaine and atropine

B) adenosine and amiodarone C) magnesium sulfate and sodium bicarbonate D) bretylium and verapamil Answer:: A) lidocaine and atropine-Don't affect dig level/dig toxicity. B) adenosine and amiodarone-Amiodarone, increases serum dig levels, possibly causing dig toxicity. Adenosine doesn't affect dig toxicity. Only one of these meds is contraindicated in dig levels/toxitiy. C) magnesium sulfate and sodium bicarbonate. Neither drug affects dig levels D) bretylium and verapamil-BEST ANSWER: Verapamil, increases serum dig levels, possibly causing dig toxicity. Bretylium aggravates dig toxicity and digoxin toxic arrhytmias are exacerbated by bretylium. This answer has two meds that are should not be given to dig toxic patients.

Question # 2(Multiple Choice) Regarding abruptio placentae A) Blood loss is confined within the amniotic sac B) Internal bleeding is generally minimal. C) Blood loss may be concealed between the uterine wall and the placenta D) There is always excessive external vagina bleeding what's the correct one? I just don't agree with c.

Answer:: C. is the best answer because it does describe placenta previa, most correctly. Placenta previa is premature separation of the placenta, and the blood loss can be either apparent or concealed. If the edges of the placenta remain attached to the uterus then there will be no apparent loss of blood. However the woman is still have significant internal bleeding. A. is incorect because it does not describe A.P.

B. is incorrect because blood loss is usually significant, not minimal. D. is incorrect because blood loss can be hidden.

Question # 3 (Multiple Choice) The geriatric patient suffering from organic brain syndrome or dementia may not be able to make a rational decisions regarding emergency care. In these situations, you may use ____to permit you to legally render care A) Good Samaritan Laws B) Standards of Care C) Implied Consent D) Informed Consent c is given as correct. why? Answer:: Implied consent means that the patient most likely has been found in distress and it is assumed that person wants to live. Therefore, you are within the law to treat a person who is unable to make a decision about his/her care who is in an emergency situation.

Above answer to your question explains why C is the best answer. Let me point out a test taking tip to further support how you would choose this answer on an exam, like NCLEX. First look at your question and identify, the key words, i.e. what the question is asking. This question is asking which law will permit you to deliver care in an emergency situation, when the patient is unable to give consent. Now define each of the possible reponses. A) Good Samaritan Laws-This law is to protect the individual that intervene to provide care in an emergency from litigation. In other words, if a nurse stops at an accident scene and provides care, the nurse will not be held liable for their actions, if the care was provided in good faith according to practice standards. Therefore this is not the answer. B) Standards of Care-These are established guidelines for the nurse/health care provider that outline safe and effective nursing care/interventions for given diagnoses, etc. So, again this is not the answer to the question.

C) Implied Consent-Best answer, the patient can't verbalize consent, due to their OBS/dementia, but they need emergency care. Because care is required then consent to provide life saving care is implied. The same principle applies when giving emergency care to unconscious patients. You can't wait for them to tell you it is OK, to save their life, the law allows you to intervene. This is implied consent. D) Informed Consent-This is when the physician describes the procedure that is to be preformed. Included in this explanation is the benefits and risks associated with the procedure. The patient is INFORMED about the procedure and then they give their consent. Again, this is not the best answer. Try this technique when answering NCLEX-like questions, and you will find that you will get more correct. HCO 3 22 27 mEq/ml PO2 80 100 mm Hg SaO2 93 100% RBC Male 4.5 - 6.2 million/ cubic mm Female 4.0 - 5.5 million/cubic mm WBC 4,300 - 10,800/ cubic mm Platelets 150,000 - 350,000/ cubic mm Hgb Male 14 - 16.5 g/dL Female 12 - 15 g/ dL Hct Male 42 - 52% Female 35 - 47% PT (Warfarin/ Coumadin) Male 9.6-11.8 secs Female 9.5-11.3 secs Should be 1.5 to 2 times the Normal

PTT/ APTT (Heparin) 20-36 secs / 30-45 secs Should be 1.5 to 2.5 times the Normal INR 2 3 Standard Warfarin therapy 3 4.5 High dose Warfarin therapy 2-3 Atrial fibrillation, DVT and Pulmonary embolism 2.5-3.5 Prosthetic heart valves Bleeding Time 3 - 7 mins. 8 - 15mins (Saunders) Electrolytes K 3.5 - 5.1 mEq/ L Mg 1.6 - 2.6 mEq/ L Ph 2.7 - 4.5 mEq/ L Na 135 - 145 mEq/ L Cl 98-107 mEq/ L Ca 8.6 - 10 mg/dL Potassium Chloride With a dilution of not more than 1mEq/ 10ml Maximum infusion rate of 5-10 mEq/ hr NEVER to exceed 20 mEq/ hr at any circumstance Blood Sugar 70 110 mg/dL Glycosylated Hgb (glycohemoglobin) less than 7.5% Good 7.6 - 8.9% Fair greater than 9% Poor Vanillylmandelic Acid (VMA) 0.7 - 6.8 mg/24 hrs GFR 125 ml/min

Creatinine 0.8 - 1 mg/dL 0.6-1.3 mg/dL (Saunders) BUN 10 20 mg/dL 8-25 mg/dL (Saunders) UO Adult: 30 cc/hr and 720 cc/24 hours Pedia: 2cc/ kg/ hr AST/ ALT 5-40 IU/L Ammonia 9-33 mol/L 35-65 mcg/ dl Albumin 3 - 5 g/dL Amylase 25-151 units/ L Lipase 10-140 units/ L Bilirubin (Total) less than 1.5 mg/ dL Pulmonary capillary mean wedge pressure 4-12 mmHg Central Venous Pressure 2-6 mmHg Plasma Osmolality 280-300 mOsm/kg Serum Alcohol LEGAL .08 - .10

TOXIC! grater than 0.15 (50mg/100cc of blood) greater than 8%

__________]

Review For Nursing Licensure Examination: Anatomy & Physiology Slides Transcript Slide 1: Nursing Review of Anatomy and Physiology Review for Philippine Nursing Licensure Examination Slide 3: Outline of Selected Topics in Anatomy and Physiology The Cell Integumentary Musculoskeletal Nervous Endocrine Cardiovascular and Hematologic Gastrointestinal Urinary/Fluids and Electrolytes Reproductive Slide 4: The Cell BasicStructural and Functional Unit of the body Slide 5: Functions of the Cell Basic unit of life 1. Protection and support 2. Movement 3. Communication 4. Cell metabolism and energy release 5. Inheritance 6. Slide 6: The Cell Composed of the Cytoplasm, Cell Membrane, the organelles, the nucleus and the inclusions Slide 8: The Cell The cytoplasm is the viscous, translucent, watery material where the organelles are located Slide 9: The Cell The Cell membrane is a semi- permeable membrane that serves as the boundary separating the cellular structures from the external environment Slide 11: The cell membrane Selectively permeable Bi-lipid layers Functions to regulate passage of substances Slide 12: The cell membrane Phagocytosis- cell eating Pinocytosis- cell drinking Endocytosis- cell engulfment Exocytosis- cell excretion Slide 15: Cell connections Tight junction= binds adjacent cell together and form permeability barrier, which regulates what material crosses Desmosome= mechanical link that functions to bind cell to one another Hemidesmosomes= anchor the cell to the basement membrane Gap junction= small channel that allows molecules and ions to pass from one another Slide 17: The cellular organelles These are the cellular metabolic units with specific functions to maintain the life of the cell These include the mitochondrion, endoplasmic reticulum, ribosome, golgi

apparatus, lysosomes, peroxisomes, cytoskeleton and centrosomes Slide 18: The mitochondrion The POWERHOUSE of the cell Contains enzymes and the complexes responsible for the production of the ATP Also contains mitochondrial DNA Metabolic processes occurring in this organelle include Krebs cycle, beta- oxidation of fats, urea cycle, heme synthesis This organelle is maternally inherited Slide 20: The endoplasmic reticulum An extensive network of membrane- enclosed tubules There are two types- Rough and Smooth endoplasmic reticulum Rough endoplasmic reticulum is covered with ribosomes site of protein synthesis Smooth endoplasmic reticulum has no ribosome site of lipid synthesis Slide 22: Ribosome Together with the endoplasmic reticulum is the site of protein synthesis Maybe found in the cytoplasm and in the mitochondria They may be free or attached to the endoplasmic reticulum Slide 23: Golgi Apparatus This organelle modifies, concentrates and packages proteins This also packages enzymes into lysozomes Proteins and enzymes usually are transported from the rough endoplasmic reticulum to the golgi apparatus Slide 25: The lysosomes These are membrane-limited digestive bodies that contain enzymes that break down foreign or damaged materials The enzymes digest all materials brought in by phagocytosis Slide 27: The peroxisomes Similar to lysosomes, these are membrane-bound sacs containing oxidases (not found in the lysosomes) Oxidases are enzymes capable of reducing oxygen to hydrogen peroxide Slide 28: The cytoskeleton A series of tubules and rods that runs through the cytoplasm supporting the cellular structures This is also responsible for cellular movements Slide 30: The centrosomes Thiscontains the centrioles short cylinders adjacent to the nucleus responsible for cellular division Slide 31: The cellular inclusions These are non-functional units made up of chemical substances These may or may not be present in all cells Examples are pigments, granules, and fat globules Slide 32: Cilia and Flagella Cilia are short, hair-like extensions that occur in large numbers on the outer surface of the cell Flagella are long projections formed by centrioles that propel the cell Slide 34: The Nucleus The central control of the cell Controls cell growth, metabolisms and reproduction Contains DNA Contains chromosomes DNA + proteins appearing as granules in the non-dividing cell Genes segments of chromosomes

Slide 36: Cell Division Formation of two daughter cell from a single parent cell. Mitosis formation of new cell d. necessary for growth and tissue repair. Meosis formation of sex cell e. necessary for the reproduction. Slide 37: Cellular division Two types- Mitosis and Meiosis Mitosis- equal division of materials which yields two exact duplicates of the original cell The diploid number (46) of chromosomes is maintained All of the body cells undergo mitosis except the gametes or sex cells Slide 38: Mitosis All body cell undergo mitosis except sex cell. There are two step in mitosis: Genetic material within the cell is e. replicated. Cell divided to form two daughter with f. same amount and type of DNA. Slide 39: The cellular division Five steps of cellular division I-P- M-A-T Interphase- inactive or resting state Prophase-Chromatin coils to form chromosomes, centrioles begin to assemble Metaphasechromosomes line the equator, and they split lengthwise Anaphase-Chromatids separate and move to the opposite poles Telophase-chromosomes uncoil and nucleoli reappear Slide 40: INTERPHASE time between cell division during which DNA replicate. DNA strand separate where old strand joined with new strand of DNA to form two new DNA molecule. Slide 41: Four stage of Mitosis Prophase chromatin condensed into chromosome. 2. Chromosome consist of two chromatin join by centromere. Centriole move to opposite pole. Nucleus and nuclear envelope disappear. 2. Metaphase chromosome aligned at the center, w/ spindle fiber. 3. Anaphase chromatin separate to form two sets of identified chromosome. Chromosome assisted by spindle fiber. Slide 42: 4. Telophase chromosome disperse. Nuclear membrane and nucleolus formed. Cytoplasm divided into two cell. Slide 43: Differentiation process by which cell develop with specialized function. Egg and sperm cell formed single cell during fertilization divided by mitosis to form two cell then become four cell and so forth which differentiate, give rise to different cell. E.g. bone cell, muscle cell Slide 45: The cellular division Meiosis is a reduction division occurring in the sex cells Sex cells have only one pair of chromosomes (23)haploid number Slide 46: Cell Physiology Slide 48: DIFFUSION The movement of SOLUTES or particles in a solution from a higher concentration to a lower concentration This is a passive process, no energy is required

Slide 50: OSMOSIS The movement of solvent or water from a diluted solution into a more concentrated solution through a semi-permeable membrane The pressure that draws water inside the vessel which is more concentrated is called Osmotic pressure Slide 52: Filtration If a sugar is placed in plain water, the glucose molecules will dissolve and distribute in the solution Factors that affect diffusion- concentration gradient, particle size, solubility and temperature Slide 53: Special osmosis A special type of osmotic pressure is exerted by the proteins in the plasma. It is called ONCOTIC PRESSURE Slide 54: FILTRATION The movement of both solute and solvent by hydrostatic pressure, i.e., from an area of a higher pressure to an area of a lower pressure An example of this process is urine formation Slide 55: Hydrostatic pressure Hydrostatic pressure is the pressure exerted by the fluid against the container Increased hydrostatic pressure is one mechanism producing edema Slide 56: Active transport This is the movement of solutes across a membrane from a lower concentration to a higher concentration with utilization of energy Example is the Sodium-Potassium pump, Endocytosis and Exocytosis Slide 59: Tissue Group of cells with similar structure and function There are four (4) Basic types 4. Epithelial 5. Connective 6. Muscle 7. Nervous Slide 60: BODY TISSUES Epithelium Lining, covering and glandular tissues of the body The functions are to protect, absorb, filtrate and secrete substances Slide 61: Epithelial tissues Simple epithelium Lined by ONE Layer of cell Stratified epithelium Lined by many layers of cells Slide 62: Epithelial tissues Simple epithelia 1. Simple squamos- alveoli, BV 2. Simple cuboidalglands 3. Simple columnar- GI tract 4. Pseudo stratified epithelium- bronchial lining Slide 63: Epithelial tissues Stratified epithelium 1. Stratified Squamos- skin 2. Stratified cuboidalreproductive duct 3. Transitional epithelium- bladder and ureter Slide 67: Connective tissues Bone Cartilage Muscle Blood Blood vessels Adipose tissue Slide 72: The Integumentary System The largest body system Includes the skin and accessory structures like the hair, nails, and glands Function: Protection of body structures and regulation of

body temperature Slide 74: The Skin as first line protection The skin seals off the body from the immediate environment There are three layers of the skin: Epidermis, dermis, and hypodermis. Slide 75: Skin cells There are many other cells aside from the keratinized squamos cells of the skin. Melanocytes produce pigment melanin. Langerhans cells participates in the immune system. Histiocytes are specialized macrophages Slide 77: Skin as temperature regulator Abundant nerves, blood vessels and glands are within the skins deeper layer They aid in temperature regulation Blood vessels constrict or dilate depending on the temperature Slide 78: Skin functions Sweat glands produce sweat to control temperature by evaporation The piloerector (arrector pili) muscles will contract to raise the hairs to trap the heat Slide 79: Other skin functions Vitamin D synthesis 7-dehydrocholesterolCholecalciferol (D3) Route of excretion Insensible fluid loss of about 500 ml/day Sweat contains water, electrolytes, urea and lactic acid Slide 80: Other skin functions Skin and mucus membrane are the first line defense of the body in immunity Skin has receptors for pain, cold, pressure and heat. Slide 81: The Skin layers: EPIDERMIS The outermost layer with stratified squamos epithelium Varies in thickness depending on the body part Thinnest in the eyelids and thickest in the soles and palms Slide 82: EPIDERMIS The layers are- C-L-G-S-B The outermost layer is the stratum corneum with keratin The stratum basale is the layer which regenerates/replaces new skin cells Melanocytes in the skin produce melanin Slide 83: The Skin layers: DERMIS The second layer- cutis vera Is flexible and elastic Two layerspapillary and reticular Contains blood vessels, lymphatic vessels, nerves and appendages Slide 84: The Skin layers: DERMIS The connective tissues in the dermis contain collagen (gives its strength) elastin (gives its flexibility) and reticular fibers (connect collagen and elastin) Slide 85: The Skin layers: Hypodermis This is the subcutaneous tissue Not strictly a part of the skin Functions to insulate the body to conserve heat Slide 86: Hypodermis Serves as the energy storage and mechanical shock absorber With little vascular supply and scant nerve supply

Slide 87: The Skin appendages Hairs- long shafts composed of keratin. Expanded lower end is called hair bulb or root. There are extensive nerve and blood supply in the hair bulbs Nails-flattened structure of specialized type of keratinized surface. The visible part is the nail body. Slide 88: Fig. 5.5 Slide 89: Appendages Sebaceous glands-glands which produces an oily material called sebum, found in all body parts except the palms and soles. Sweat glands or sudoriferous glands- glands which secrete sweat, found in all body parts except in the nipples. Two types exist- Eccrine and Apocrine Slide 90: Fig. 5.6 Slide 91: The Musculoskeletal System This system consists of the muscles, tendons, ligaments, bones, cartilage, joints, and bursae Slide 92: The Musculoskeletal System Functions: Locomotion and protection blood production in the bone marrow heat generation, maintenance of posture and storage of minerals Slide 93: The Muscles Three types of muscles exist in our body Voluntary skeletal muscle Involuntary cardiac muscle Involuntary visceral smooth muscle Slide 94: The Muscles Muscles are composed of muscle fibers having numerous nuclei and striations Slide 98: Properties of Muscles Electrical excitability Ability to contract to certain stimuli Contractility Ability to contract forcefully when stimulated Extensibility Ability to stretch without being damaged Elasticity Ability to return to its original length and shape Slide 99: Muscle Physiology Muscle fibers are enclosed sheaths- perimysium, epimysium and endomysium Each muscle cell has actin and myosin filaments arranged in a sarcomere This sarcomere is the basic structural unit of the muscle Slide 100: Muscle Physiology Muscle contraction occurs as actin and myosin slide past one another causing the sarcomeres to shorten Calcium ion is released by the muscle endoplasmic reticulum to initiate contraction ATP is used both for muscle contraction and muscle relaxation Slide 103: Fig. 7.5a Slide 104: Fig. 7.6 Slide 105: Fig. 7.7a

Slide 106: Fig. 7.7b Slide 107: Muscle Physiology Muscle contraction can be of two types 1. ISOMETRIC- iso= same, metric=distance: The length of the muscle does not change, but the tension increases 2. ISOTONICiso=same, tonus=tone: The amount of muscle tension is constant but the length of the muscle varies Slide 108: Muscle Physiology Muscle tone= refers to the constant tension produced by muscles of the body for long periods of time FAST-twitch muscles= contract quickly and fatigue quickly SLOW-twitch muscles=contract slowly and are more resistant to fatigue Slide 109: Muscle Physiology Smooth Muscle= is not striated, contracts more slowly, is autorhythmic and under involuntary control Cardiac muscle- is striated, is autorhythmic, and under involuntary control Slide 110: MUSCLE and JOINT MOVEMENTS Flexion- decreasing the angle between two joints Extension- increasing the angle between two joints Abduction- movement of the limb away from the midline Adduction- movement of the limb towards the midline Slide 111: MUSCLE and JOINT MOVEMENTS Internal rotation- moving the body part inward towards the midline External rotation- moving the body part outward away from the midline Supinationturning a body part upward Pronation- turning a body part downward Slide 112: MUSCLE and JOINT MOVEMENTS Inversion- turning the foot inward Eversion- turning the foot outward Retraction- moving a body part backward Protraction- moving a body aprt forward Slide 113: Muscles of the face 1. Frontalis 2. Orbicularis oculi 3. orbicularis oris 4. Buccinator 5. Zygomaticus Facial Nerve innervation Slide 114: Muscles of Mastication 1. Masseter 2. Temporalis 3. Pterygoid muscles Innervated by TRIGEMINAL NERVE Slide 115: Muscles of the neck 1. Platysma 2. Sternocleidomastoid Slide 116: Muscle of the upper limb 1. Biceps 2. triceps 3. deltoid Slide 117: Muscles of the lower limb 1. Hamstring muscles 2. Quadriceps 3. Gluteal muscles 4. calf muscles Slide 118: TENDONS These are bands of fibrous connective tissue that attach muscles to bones

Slide 119: LIGAMENTS These are dense, strong, flexible bands of fibrous connective tissue that bind bones to other bones Slide 120: BONES Bone is a living growing tissue made of porous mineralized structure. The human skeleton contains 206 bones Axial bones are bones on the midline like the vertebrae, skull, facial bones, ribs and sternum Appendicular bones include the scapulae, bones of the arms and legs Slide 122: Classification of Bones Long bones- - These bones have a shaft and ends. Ex: tibia, humerus, femur Short bones- Small and cubical shaped- Ex: carpals and tarsals Irregular bones- vertebrae, mandible Sesamoid bones- bones embedded in the tendons. Ex:patella Flat bones- with spongy bones inside. Ex: scapulae, ribs, clavicle Slide 123: Structure of the bone Long bones have a diaphysis ( shaft) and epiphysis (ends) Bones consist of layers of calcified matrix occupied by bone cells. The outer layer of bone is composed of dense compact bone (cortical bone) The inner layer is composed of spongy cancellous bones Slide 125: Bone Structure Blood supply of bones reaches by way of arterioles in the haversian canal, through the vessels in the Volkmann's canal Bone formation can be from the cartilage and from the membrane Slide 126: Bone Structure OSTEOBLAST- bone cell responsible for bone formation and calcification OSTEOCLAST- bone cell responsible for bone resorption and destruction Slide 127: Bone Ossification Ossification is the formation of bone by the osteoblasts. This involves the mineralization of bones from a cartilage (endochondral) and from a membrane (membranous). Slide 128: Fig. 6.5a Slide 129: Fig. 6.6 Slide 130: Bone Remodeling Bone remodeling involves the removal of old bones by cells called osteoclasts and deposition of new bones by the osteoblasts. Bone is the major storage of calcium If calcium levels in the blood falls, it is removed from the bone Slide 131: Bone repair When a bone is broken, blood vessels are also damaged clot 2-3 days after injury, blood vessels and cells invade the blood clot callus formation Osteoblasts enter the callus and begin to form a spongy bone Immobilization of the bone is required because the delicate new matrix of bone is easily damaged by excessive movement Slide 132: Fig. 6.8

Slide 133: The Skull Skeleton of the head Made of 21 bones Cranial bones Frontal Parietal Temporal occipital Slide 134: The Skull Facial bones Maxilla Mandible Zygoma Nasal Vomer Palatine Slide 135: The paranasal sinuses These are air-filled cavities in the facial bones surrounding the nose and open into the nasal cavity They decrease the weight of the skull and act as resonator of sounds Frontal, maxillary, ethmoid and sphenoid Slide 137: The Vertebrae Composed of 32-33 bones 7 cervical 12 thoracic 5 lumbar 5 sacral 3-4 coccygeal Slide 138: Functions of the vertebrae 1. Supports the weight of the head and trunk 2. Protects the spinal cord 3. Allows spinal nerves to exit the spinal cord 4. Provides a site for muscle attachment 5. Permits the movement of the head and trunk Slide 139: The Cervical Vertebrae 7 in number C1- atlas C2- axis C7- cervical prominence Atlas and occipital bone= yes motion Atlas and Axis= no motion Slide 140: The Thorax Made up of the sternum and ribs The sternum has 3 parts Manubrium Body Xiphoid process The slight elevation in the sternum is called the Sternal Angle of Louis. It identifies the location of the second rib Slide 141: The Ribs The ribs are 12 pairs True ribs= 1-7 False ribs= 8-10 Floating ribs=11-12 Slide 143: The shoulder The clavicle and scapulae constitute the shoulder The clavicle Articulates with the sternum Most commonly fracture bone The Scapulae Attached to the ribs and vertebrae by muscles only Has an acromion process, where the clavicle attaches Slide 145: The Upper extremity Composed of the following bones Humerus Ulna Radius Carpals (wrist bones) Metacarpals Phalanges Slide 147: The pelvic girdle Composed of the 3 fused bones- pubis, ilium and ischium Constitute the hip bone Slide 148: The pelvic girdle Female pelvis has the following structure: The pelvic inlet is large/oval, symphysis is shallow. obturator foramen is oval or triangular, sacrum is broader The male pelvis has the following: The pelvic inlet is small/round to heart-shape, symphysis is deep. Obturator foramen is round Slide 149: Fig. 6.32

Slide 152: The Lower extremity bones Composed of the Thigh bones- femur The leg bones- Tibia and Fibula The ankle- tarsal bones The foot- metatarsal bones Slide 154: CARTILAGE A dense connective tissue that consists of fibers embedded in a strong, gel-like substance. Cartilage supports and shapes various structures such as the ear pinna, intervertebral disks, ear canal, larynx, etc. It serves as cushion and shock absorber Slide 156: Types of Cartilage Fibrous cartilage Found in the intervertebral disks Hyaline cartilage Found in the symphisis, the thyroid cartilage Elastic cartilage Found in the ears, the epiglottis Slide 158: Fig. 6.39a Slide 159: Fig. 6.39b Slide 160: Fig. 6.40a Slide 161: Fig. 6.40b Slide 162: Fig. 6.40c Slide 163: Joints These are point of attachment or contact between two bones Variously classified according to its movement and flexibility Fibrous joints- with fibrous tissue with little or no movement Cartilaginous joints- with cartilage Synovial joints- with capsule; freely movable joints Slide 165: Synovial joints Freely movable joints With joint cavity/capsule Articular surface Synovial membrane Synovial fluid Slide 166: Synovial joints Plane joint- intercarpal joint of wrist Hinge joint- elbow and ankle Pivotatlas and axis Condyloid- egg-shape metacarpophalengeal joint Slide 167: Synovial joints Saddle joint- joint of the thumb Ball and socket- hip joint Slide 168: Bursae Small synovial fluid sacs located at friction points around joints, between tendons, ligaments and bones Act as cushions, decrease stress on adjacent structure Slide 171: The Nervous System The nervous system coordinates all body functions, enabling a person to adapt to changes in internal and external environment The nervous system is composed mainly of the nerve cells (neurons) and supporting cells (neuroglia) Slide 172: The neuron This is the basic conducting cell of the nervous system Highly specialized but

cannot reproduce itself Main parts are the cell body (soma), the fibers: axon and dendrites. Slide 173: The neuron The axon is a long process with myelin sheath. This conducts impulses away from the cell body The dendrites are short, thick, diffuse branching processes that receive impulses and conduct them towards the cell body Slide 175: The neuroglia The supporting cells They supply nutrients to the neurons and help maintain the electrical potential They also form part of the blood- brain barrier Slide 176: The neuroglia Oligodendrocytes produce myelin sheath in the CN Schwann cells produce myelin sheath in the peripheral NS Slide 180: The Organization of the Nervous System The nervous system is divided functionally and structurally into 2 parts 1. Central Nervous System- the Brain and the spinal cord 2. Peripheral Nervous System- the cranial nerves and spinal nerves Slide 183: The Organization of the nervous System The Peripheral Nervous System is further classified into THREE Functional Divisions 1. The Somatic Nervous System- controls the skeletal muscles 2. The Autonomic Nervous System- controls the visceral organs 3. The Enteric Nervous System- controls the functions of the GIT Slide 184: The Central Nervous System Composed of the brain The brain consists of the gross structures: cerebrum, cerebellum, brainstem and the diencephalon. Diencephalon- Thalamus. Hypothalamus and pineal body Brainstem- Pons, medulla and Midbrain Slide 186: Fig. 8.23 Slide 187: The Cerebrum This is the largest part of the brain Consists of right and left hemisphere connected by the corpus callosum Each cerebral hemisphere is composed of different lobes- frontal, temporal, parietal and occipital Embedded in the cerebrum is the BASAL ganglia Slide 189: The Frontal Lobe of the cerebrum Influences the personality of the person Also responsible for judgment, abstract reasoning, social behavior, language expression and motor movement. Slide 190: The Temporal lobe of the Cerebrum This part of the cerebrum controls the hearing, language comprehension, storage and recall of memories The LIMBIC system is deeply located in the temporal lobe. This controls the basic drives such as hunger, anger, emotion and sexual drive. Slide 191: The Parietal lobe of the cerebrum This is the principal center for the reception and interpretation of Sensation This part interprets and integrates the sensory inputs like touch, temperature and pain It interprets size, shape, distance and texture

Slide 192: The occipital lobe of the cerebrum This functions mainly to interpret visual stimuli Slide 193: Speech areas in the cerebrum 1. Wernickes area- responsible for the sensory reception of speech. 2.Brocas Area- responsible for the motor speech Slide 195: Fig. 8.28 Slide 196: The Cerebellum The second largest brain region Has also two hemispheres Functions to maintain muscle tone, coordinate muscle movement, posture and control balance/equilibrium If this is damaged, muscle tone decreases and fine motor movements become very clumsy Slide 198: The Brainstem Lies inferior to the cerebrum Continuous with the cerebrum and the spinal cord It is composed of the midbrain, the pons and the medulla oblongata Functions: houses the center for respiration and cardiovascular system Slide 199: The Midbrain This connects with the cerebrum Contains numerous ascending and descending tracts and fibers Slide 200: The Pons Connects the cerebellum with the cerebrum Houses the respiratory center and cardiovascular center Exit points for cranial nerves 5, 6 and 7 Slide 201: The Medulla oblongata The most inferior portion of the brainstem Serves as the center for autonomic reflexes to maintain homeostasis, regulating respiratory vasomotor and cardiac functions Serves as exit of cranial nerves 9,10,11 and 12 Slide 202: The Diencephalon The thalamus and the hypothalamus The thalamus is the relay station of all sensory stimuli towards the brain The hypothalamus controls body temperature, appetite, water balance, pituitary secretions and sleep-wake cycle Slide 203: The Basal ganglia Slide 204: Brain circulation: The circle of Willis Slide 205: The spinal cord A long cylindrical structure extending from the foramen magnum to the L1 in adult, L3/L4 in pedia Slide 206: The spinal cord In the cross section of the spinal cord, we find the GRAY matter- contains neurons; and WHITE matter-consists of nerve fibers There are 31 pairs of spinal nerves that exit the spinal cord Slide 209: The spinal cord Each spinal nerve is formed by the dorsal root (sensory) and the ventral root

(motor) Cervical segments= 8 pairs Thoracic segments=12 pairs Lumbar= 5 pairs Sacral=5 pairs Coccygeal=1 pair Slide 210: The Meninges These are 3 connective tissue layers surrounding the brain and spinal cord. 1. DURA MATER- the superficial, thickest layer. The area above the dura mater is called epidural space 2. ARACHNOID- second layer, thin and wispy. 3. PIA MATER- the deepest layer, adhered to the brain and spinal cord substance Slide 212: The Meninges The space in between the arachnoid and pia mater is called the arachnoid space This arachnoid space contains the cerebro-spinal fluid (CSF) In this space, blood vessels are also found Slide 213: The Ventricles These are CSF filled cavities in the brain The lateral ventricle- found in the cerebrum The third ventricle- in the center of the thalamus and hypothalamus The fourth ventriclelocated at the base of the cerebellum Slide 214: The CSF This is the fluid found inside the ventricles that bathe the brain and spinal cord Function: provides protective cushion around the CNS Produced by the choroid plexus in the ventricles Absorbed by the arachnoid granulations Slide 215: Tracing the CSF pathway Lateral ventricle Interventricular foramen of Monro Third ventricle Cerebral aqueduct of Sylvius Fourth ventricle Exits trough the median foramen of Magendie or the lateral foramen of Luscka Subarachnoid spaces in the cisterna magna, spinal cord subarachnoid space of the brain superior sagittal sinus Slide 217: The cranial nerves Are 12 pairs of nerves that exit the brain Can be classified as Sensory Motor Mixed (sensory and motor) Slide 221: The Autonomic Nervous System The part of the peripheral nervous system that innervates cardiac muscles, smooth muscles and glands Functionally divided into Sympathetic Nervous System Parasympathetic Nervous System Slide 222: The SYMPATHETIC system Originates from the T1-L2/L3 segments of the spinal cord (thoracolumbar) Utilized by the body for FLIGHT and FIGHT response Neurotransmitter agents are Epinephrine and Norepinephrine (coming from the adrenal gland) ADRENERGIC system Slide 223: Sympathetic responses Increased: HR RR BP Visual Acuity (Pupillary Dilation) Smooth Muscle tone sphincters are contracted Vasoconstriction Metabolism glucose, fatty acids Slide 224: Sympathetic responses Decreased Peristalsis Salivary secretions Ejaculation

Slide 225: Parasympathetic system CHOLINERGIC system The vegetative system Feed and Breed responses Cranio-sacral location Cranial nerves- 3, 7, 9, 10 and S2-S4 Neurotransmitter is Acetylcholine Slide 226: Parasympathetic responses Increased Gastric secretions Salivary secretions peristalsis Pupillary constriction Decreased Smooth muscle tone sphincters are relaxed erection Slide 228: Nerve Physiology The nerve cells are excitable cells Any stimulus will change the membrane potential and cause an action potential to generate impulse transmission The myelin sheath of the nerve cell is responsible for the SALTATORY conduction increases the nerve transmission Slide 230: Fig. 8.11 Slide 231: Fig. 8.12 Slide 232: The SYNAPSE This is the region where communication occurs between 2 neurons or between a neuron and a target cell A neurotransmitter is released from the nerve cell towards the other cell with receptor Slide 233: Fig. 8.13 Slide 236: The eye and the visual pathway Vision is made possible by the stimulation of the photoreceptor cells in the retina Receptor cells are the RODS and CONES The eye is made up of three layers Fibrous layer- sclerae and cornea Uvea- choroid and iris and ciliary bodies Nervous coatretina Slide 239: Fig. 9.13 Slide 240: The optic nerve This is the collection of fibers from the cells in the retina It passes through the brainstem as the optic chiasm it will reach the occipital lobe for visual interpretation Slide 242: The Vestibular apparatus This is the part of the ear that helps in equilibrium Located in the inner ear The saccule and utricle control LINEAR motion The semicircular ducts control the Angular movement/ acceleration Slide 244: The Hearing Apparatus Slide 245: The Olfactory apparatus Consists of the nose and the olfactory nerve Stimulation form the olfactory nerves will reach the limbic system of the brain Slide 246: The Gustatory apparatus The receptor for taste are cells in the tongue group together called

the taste buds They are numerous in the vallate and fungiform papillae Slide 247: The Gustatory apparatus Basic taste modalities Sweet- tip of the tongue Salty- over the dorsum of the tongue Sour- sides of the tongue Bitter- back of the tongue Slide 250: The Endocrine System This system is made up of widely distributed organs whose secretions (called HORMONES) are poured into the blood to reach the target cells Slide 252: Hormones These are chemical substances released by the glands into the blood Each hormone will go to the target organ and binds its receptor Two types exists: 1. Peptides or protein hormones 2. Lipid or steroid hormones Slide 255: The hormonal regulation There exists an inter- related regulation between the HYPOTHALAMUS, Pituitary and the endocrine gland. Slide 258: The hormonal regulation We call it the Hypothalamic- pituitary-endocrine axis The exception are the pancreas and the parathyroid gland Slide 259: The endocrine glands The pituitary- anterior and posterior The pineal gland The thyroid gland The parathyroid gland The adrenal gland The pancreas The gonads- testes and ovary Slide 261: The pituitary gland : anterior lobe Also called Adenohypophysis Hormones produced Growth hormone The stimulating hormones- ACTH, TSH, FSH and LH Prolactin Slide 262: The pituitary gland: posterior lobe Also called the neurohypophysis This lobe does not secrete hormones but only stores hormones Antidiuretic hormone (vasopressin) Oxytocin Slide 263: The pineal gland Also called epiphysis cerebri Secretes melatonin Slide 264: The thyroid gland Located in the lower part of the anterior neck With two lobes connected by the isthmus Slide 265: The thyroid gland Secretes thyroxine (T4) and tri- iodothyronine (T3) The T3 is the most active hormone Function of T3/T4: Increase metabolic rate, essential for normal growth and maturation Slide 268: The thyroid gland It also secretes CALCITONIN This is released in response to an INCREASED calcium level in the blood Function: decreases bone resorption and increases calcium excretion in the kidney to decrease the calcium levels Slide 270: The parathyroid glands 2 pairs (4) of yellowish glands closely related to the posterior surface

of the thyroid gland Secretes parathyroid hormone (PTH) Slide 271: The parathyroid glands Functions of the hormone: Increases bone breakdown by osteoclasts Increases Vitamin D synthesis Increases Calcium level in the blood Causes retention of calcium in the kidney Slide 273: The Adrenal glands a pair of gland resting on top of each kidney with 2 layers ADRENAL CORTEX Secretes mineralocorticoids Secretes glucocorticoids Secretes androgens- sex hormones ADRENAL MEDULLA Secretes the cathecolamines- Epinephrine, and norepinephrine Slide 275: Fig. 10.17 Slide 276: Fig. 10.18 Slide 277: The Adrenal Cortex Mineralocorticoid- Aldosterone Increases sodium retention, water retention secondarily Causes excretion of potassium Slide 278: The Adrenal Cortex Glucocorticoids- cortisol Increases fat and protein breakdown Increases glucose synthesis Inhibit inflammation and immune response Slide 279: The Adrenal Cortex Adrenal androgens Estrogens, androgens and progestins Insignificant in males Increase female sexual drives, pubic hair and axillary hair growth Slide 280: The pancreas The endocrine portion of the pancreas is the ISLETS of LANGERHANS This islet is composed of three types of cells- alpha, beta and delta Slide 281: Fig. 10.19 Slide 282: The pancreas The Alpha cells secrete GLUCAGON The Beta cells secrete INSULIN The delta cells secrete SOMATOSTATIN Slide 284: Pancreatic insulin Causes Hypoglycemia by two mechanisms: Glucose breakdownglycolysis Glycogen production- glycogenesis Slide 285: Pancreatic insulin Needed by most body cells to allow Glucose to enter the cell membrane The brain cells, intestinal cells, the red blood cells and the islet cells do not need insulin for glucose entry Slide 286: Pancreatic glucagon Causes increased level of Glucose by: Glycogen breakdownglycogenolysis Glucose production- glucogenesis Slide 287: The Gonads : Male- Testes The testes houses the Interstitial cells of Leydig which secrete

ANDROGENS Testosterone Dehydrotestosterone Androsterone Slide 288: The Androgens Aid in spermatogenesis Maintain functional reproductive organs Responsible for secondary sex characteristics Responsible for male sexual drives Slide 289: The Gonads: Female- Ovary The Follicular cells of the ovarian follicle secrete ESTROGEN and the corpus luteum secretes PROGESTERONE Slide 290: The estrogen Aids in uterine and mammary gland development Maintains the structure of the external genitalia Produces the secondary sexual characteristics in female Maintains normal menstrual cycle Slide 291: The progesterone Together with estrogen, maintains normal menstruation Increases body temperature Decreases muscle tone and peristalsis Maintains pregnancy Slide 292: The CARDIOVASCULAR SYSTEM Slide 294: The CARDIOVASCULAR SYSTEM This system is composed of the heart and the blood vessels The main functions of this system are: to transport oxygen, hormones and nutrients to the tissues and to transport waste products to the lungs and kidneys for excretion Slide 295: The Gross Anatomy of the Heart The heart is located within the thorax behind the sternum in the compartment called MEDIASTINUM The heart is commonly described as the size of a clenched fist Slide 296: The Gross Anatomy of the Heart The shape is conical, with a base and an apex The base is directed upward The apex is directed downward to the left at the level of the 5th ICS LMCL Slide 297: Heart Surface ANTERIOR SURFACE Right ventricle POSTERIOR SURFACE Left ventricle Slide 299: The Heart : Anatomy The heart has three layers The epicardium The myocardium The endocardium The heart is covered by the pericardium with a parietal and visceral layers The pericardial sac is a potential space in between the two pericardial layers with a minimal (15 cc) fluid Slide 300: Fig. 12.4 Slide 301: The Heart: Anatomy The heart has four chambers The right atrium The right ventricle The left atrium The left ventricle Slide 302: The Heart: Anatomy The heart also has four valves that guard the openings in the chambers The tricuspid valve between the right atrium and right ventricle The mitral or bicuspid valve-

between the left atrium and left ventricle The pulmonic valve- between the right ventricle and the pulmonary trunk The aortic valve- between the left ventricle and the aorta Slide 304: The Heart: Anatomy The blood supply of the heart: The coronary arteries are the blood supply There are two main coronary arteries- the right coronary artery and the left coronary artery The venous drainage of the heart is the coronary sinus; the anterior cardiac vein and the smallest cardiac vein Slide 305: Blood Supply Slide 307: Venous Drainage Coronary sinus will collect all the venous blood from the heart into the RIGHT atrium The anterior cardiac vein drains NOT into the coronary sinus but DIRECTLY into the right atrium Slide 308: Circulation Slide 309: Fig. 12.11 Slide 310: The Heart : Physiology This consists of The conducting system The cardiac cycle The cardiac output and Blood pressure The preload and afterload The Starlings law of the heart Slide 311: The Heart: Physiology The conducting system of the heart is a group of specialized heart cells that functions to conduct electrical impulses independent of any nerve supply Slide 312: The Heart: Physiology The parts of the conducting system of the heart are: The SA (sinoatrial) node The AV (atrio-ventricualr) node The Bundle of His with its right and left bundle The Purkinje fibers Slide 314: The Heart: Physiology The intrinsic conduction system causes the heart muscle to depolarize in one direction The rate of depolarization is around 75 beats per minute The SA node sets the pace of the conduction This electrical activity is recorded by the Electrocardiogram (ECG) Slide 318: The Heart: Physiology The cardiac cycle consists of the contraction phase and the relaxation phase in each heartbeat The SYSTOLE is the contraction phase The DIASTOLE is the relaxation phase Slide 321: The Heart: Physiology Heart sounds can be auscultated S1, S2, S3, and S4 S1 is due to the closure of the AV valves S2 is due to the closure of the semilunar valves S3 is due to the rushing of blood through the AV opening S4 is due to contraction of the atrium Slide 322: The Heart: Physiology The amount of blood the heart pumps out in each beat is called the STROKE VOLUME When this volume is multiplied by the number of heart beat in a minute (heart rate),

it becomes the CARDIAC OUTPUT When the Cardiac Output is multiplied by the Total Peripheral Resistance, it becomes the BLOOD PRESSURE Slide 323: The Heart: Physiology The PRELOAD is the degree of stretching of the heart muscle when it is filled-up with blood The AFTERLOAD is the resistance to which the heart must pump to eject the blood Slide 324: The Heart: Physiology StarlingsLaw of the Heart states that the force of contraction is proportional to the degree of stretching of the cardiac muscle fibers As the length of the muscle fiber is stretched, the contractile force increases But when the maximum length has been reach, any further stretching will impair the contraction Slide 326: The Blood vessel: Anatomy This consists of the artery, vein and capillary together with the lymphatic vessels The ARTERY has thicker wall, deeply located, pulsating, reddish, with abundant smooth muscles and elastic tissues that carries oxygenated blood away from the heart towards the body tissues Slide 328: The Blood vessel: Anatomy The VEIN is thin-walled, superficially located, non-pulsating, bluish vessel that carries unoxygenated/deoxygenated blood towards the heart Arterioles are small arteries Venules are small veins CAPILLARIES are diffuse network of thin- walled tubules that connect arterioles and venules together Slide 329: The Blood vessel: Physiology The diameter of the arterioles is the main contributor of the peripheral resistance In the presence of epinephrine, cold temperature and irritation, the smooth muscles of the blood vessels will contract making the lumen smaller resistance In the presence of histamine, warm temperature, the vessels will dilate resistance Slide 330: Terminology Anatomy & Physiology Chronotropic Refers to a change in heart rate effect A positive chronotropic effect refers to an increase in heart rate A negative chronotropic effect refers to a decrease in heart rate Dromotropic Refers to a change in the speed of conduction effect through the AV junction A positive dromotropic effect results in an increase in AV conduction velocity A negative dromotropic effect results in a decrease in AV conduction velocity Inotropic Refers to a change in myocardial contractility effect A postive inotropic effect results in an increase in myocardial contractility A negative inotropic effect results in a decrease in myocardial contractility Slide 331: Basic Electrophysiology Myocardial Cell Types Kinds of Where Primary Primary Cardiac Cells Found Function Property Myocardial cells Myocardium Contraction and Contractility Relaxation Specialized cells Electrical Generation and Automaticity of the electrical conduction conduction of Conductivity conduction system electrical system impulses Slide 332: Systemic circulation The aorta- leaves the left ventricle to form the ascending aorta, aortic

arch, descending aorta, thoracic aorta and abdominal aorta The Vena cava ( superior and inferior) drains the whole body and returns the blood to the right atrium Slide 334: Physiology of circulation Blood pressure is the measure of force exerted by blood against the blood vessel wall Measured by sphygmomanometer Normally BP is measured as systolic pressure and diastolic pressure PULSE PRESSURE = SP-DP Slide 335: Physiology of circulation Capillary exchange Most exchange of gas and substances occur across the wall of the capillary Usually, the exchange is due to the filtration difference and diffusion Slide 337: BP regulation Central Pons and medulla Sympathetic nervous system Increases heart rate Parasympathetic nervous system (vagus) decreases heart rate Slide 338: BP regulation Baroreceptors Receptors sensitive to stretch located in the carotid sinuses and aortic arch stretch reflex increase in heart rate BP stretch reflex decrease in heart rate BP Slide 339: BP regulation Hormonal Epinephrine vasoconstriction increased resistance increased BP lung Angiotensinogen A1 blood Angiotensin 2 ADH water reabsorption Blood volume increased BP ANF increase sodium excretion increased urine decreased blood volume decreased BP Slide 341: Fig. 13.22 Slide 342: Fetal circulation Slide 344: Cardiac assessment Inspection Palpation of the apical pulse and PMI at the 5th ICS LMCL Auscultation for the heart sounds S1 and S2 Auscultation for the heart valves TV MV PV AV Slide 346: Fig. 13.23 Slide 347: Blood Blood is a special connective tissue Total blood volume is about 5 liters Blood is composed of two portions: 1. Formed elements- RBC, WBC, Platelets 2. Plasma- the liquid portion Hematocrit is the percentage of RBC per unit volume of blood Slide 350: Fig. 11.2 Slide 352: The RED Blood Cell Non-nucleated cellular element in the blood Biconcave Transports Oxygen loosely bound to Hemoglobin Red pigment is due to hemoglobin Lifespan is 120 days Reticulocytes are immature RBC

Slide 353: Fig. 11.4 Slide 355: The Leukocytes or WBC Nucleated, larger than the RBC Divided into Granulocytes and Agranulocytes Slide 356: The Leukocytes or WBC GRANULOCYTES 2. Neutrophils- most abundant WBC, 60-70%. This is the first cell to arrive in injury/inflammation. Increased in bacterial infection In females, there is the presence of the Barr bodies, the condensed X chromosome Slide 357: The WBC 2. Eosinophils- cell type that is capable of limited phagocytosis, with granules containing peroxidase. This is increased during parasitic and allergic reactions Slide 358: The WBC 3.Basophils- a WBC that is capable of releasing Histamine, heparin and serotonin during anaphylaxis . The rarest type of WBC. Slide 359: The WBC Agranulocytes: 1. Lymphocyte- second most abundant (next to neutrophils) Found increased in Viral infection and chronic infection. This can be: T-lymphocyte B-lymphocyte Slide 360: The WBC Agranulocytes: T-lymphocyte- mediator of Cellular Immunity B-lymphocytemediator of Humoral immunity because this cell secretes ANTIBODIES when transformed into plasma cells. Slide 361: The WBC 2.Monocyte- has kidney-shaped nucleus, a very large WBC that stays only for 2-3 days in the circulation. This becomes the MACROPHAGE in the tissues. Slide 362: The Platelets Also called thrombocytes Smallest formed element, lifespan is 8-10 days Involves in clot formation Forms the platelet plug in an injured vessel Releases chemicals that can cause activation of the clotting mechanism Slide 363: Table. 11.2 Slide 364: The Blood groups Blood types are grouped into A, B, AB and O based on the presence of the antigen on the surface of the RBC If antigen A is present, then the blood is type A If antigen B is present, then the blood is type B If antigen A and antigen B is present, then the type is AB If no antigen is present, then blood type is O Slide 366: Fig. 11.11 Slide 367: The Blood groups Blood group A has Antibody B, that can react to blood type B and AB Blood group B has antibody A, that can react to blood type A and AB Blood group AB has no antibody Blood group O has no antigen, but has Both antibody A and B

Slide 369: Rh group Along with the ABO group, there is an Rh system in the blood The D antigen is the most prevalent A person with D antigen is Rh (+) A person with no D antigen is Rh (-) Most Filipinos are Rh (+)