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Signs Things you can see or measure symptoms Subjective information (The patient must tell you) Pack years Packs per day multiplied by the number of years. Advanced directives are? documents that provide instructions incase the patient is unable to. These instructions should be notarized and copies given to the family and physician. If a patient has a DNI order you can still? Provide non invasive ventilation ( BiPAP) A durable power of attorney allows? A person to make decisions for the patient. What is normal urine output? 40mL per hour or 1 Liter per day. Where does sensible water loss occur? Through the urine or vomiting, Diarrhea. Where does insensible water loss occur? Through the skin or exhalation. What is normal Central venous pressure? 2 to 6 mmHg What should you recommend for patients with an elevated CVP? Diuretics What should you recommend for a patient with a low CVP? Fluids. The abbreviation ADL stands for? Activities of daily living. What is Orthopnea? Difficulty breathing while laying flat. Often seen in CHF patients. What is general malaise? A generalized run down feeling, nauseas, weak, fatigued, headache. Think electrolyte imbalance. What does Dysphagia mean? Difficulty swallowing. Why does peripheral edema most commonly occur? edema is most likely caused by CHF or renal failure. What is Acites? Acites is fluid in the abdomen. Typically caused by liver failure. What causes clubbing of the fingers? Chronic hypoxemia. How fast should color return to a finger during a capillary refill test? Blood should return in less than 3 seconds. What is Diaphoresis? A state of profuse sweating. What is Jaundice? A yellowish appearance of the skin caused by increased bilirubin in the blood and tissue. What is Erythema? Redness of the skin due from capillary congestion, inflammation, or infection.