Mark Klimek Lecture Outline NCLEX

If the pH and the BiCarb are both in the same direction then it is?

Metabolic

If the pH is up it is?

Alkalosis

If the pH is down it is?

Acidosis

As the pH goes so goes my patient except for?

Potassium

If the pH is up my patient with show signs and symptoms of?

Increase... like tachycardia,diarrhea and borborygmi

If the pH is down my patient will show signs and symtoms of?

Decrease... like decreased output, bradycardia and constipation

If my pH is up my potassium (K+) is ?

Down

If my pH is down my potassium (K+) is?

Up

If my patient is overventilating I should choose?

Respiratory Alkalosis

If my patient is underventilating I should choose?

Respiratory Acidosis

If my patient has prolonged gastric vomiting or suction I choose?

Metabolic Alkalosis

If it is not lung or prolonged vomiting or suctioning I choose?

Metabolic Acidosis

High pressure alarms are triggered when?

They cannot push air in

High pressure alarms are caused by what three types of obstructions?

Kinking, Water in dependant loops and mucus in the airway.

If kinking in the tube is present you?

Unkink

If water is present in the dependant loops you?

Open system and empty water.

If mucus is present you?

Turn them, cough and have them deeo breath first. If ineffective you then suction.

Low pressure alarms are triggered when?

It is to easy to push air in.

Low pressure alarms are normally caused by?

Disconnection

If the tubing is disconnected you?

Reconnect

If O2 sensor line is disconnected you?

Reconnect

In a vented client respiratory alkalosis means the vent setting may be too?

High

In a vented client respiratory acidosis means the vent may be too?

Low

What do you do if the patients disconnected tube is on the floor?

Bag them, (call for help) get new tube and then reconnect.

What do you do if the patients disconnected tube is on the chest?

Reconnect ... if its above the waist its ok.

What is the biggest problem in abuse?

Denial

To treat denial you need to?

Confront

How do you confront?

Point out the difference between what they say and what they do.

What is the one circumstance that you as a nurse would support denial?

Loss and Grief

What is dependency?

When the abuser gets a significant other so make decisions for them or do thing for them.

What is codependency?

When the significant other gets positive self esteem from doing things or making decisions for an abuser.

To treat dependency/codependency you ?

Set limits and enforce them. You also need to work or the self estreem of the codependent.

What is manipulation?

When the abuser gets the significant other fo do things for them that is not in the best interest of the significant other. This can be dangerous and harmful to the significant other.

How do you treat manipulation?

Set limits and enforce.

Why is manipulation easier to treat then dependency/codependency?

Because no one likes being manipulated.

What is Wernickes (Korsakoffs) Syndrome?

Psychosis induced by vitamin B1 (Thiamine) deficiency.

Vitamin B1 helps breakdown?

Alcohol

Primary symptom of Wernickes?

Amnesia with confabulation (making up stories).

Is Wernickes preventable?

Yes

Is Wernickes arrestable?

Yes

Is Wernickes reversible?

No

What is aversion therapy?

When you try and make the patient hate something.

Antabuse onset and duration is?

2 weeks

Teach a patient taking Antabuse to avoid what?

Alochol

On top of alcohol a patient taking Antabuse should also avoid what other 7 things?

Elixirs, Vanilla Extract, Aftershave/Perfumes, Alcohol based hand sanitizer, Insect repellant, Mouthwash and Vinagerette.

What are the five uppers?

Caffeine, Cocaine, Methamphetamines, PCP/LSD and ADHD Meds

Downers are?

Everything other then the five uppers.

S/S of upper use?

Everything goes up...Tachycardia, increased BP etc.

S/S of downer use?

Everything goes down...Bradycardia, decreased BP etc.

Overdose of a downer causes everything to go?

Down

Overdose of an upper causes everything to go?

Up

Withdrawal of an upper causes everything to go?

Down

Withdrawal of a downer causes everything to go?

Up

At birth if the mother was addicted to a substance always assume the newborn is in?

Intoxication

If 24 hours after birth assume the baby is in?

Withdrawal

Every alcoholic goes through what withing 24 hours after cessation?

Withdrawal syndrome

After 72 hours of alochol withdrawal a small minority may get?

Delirium Tremens

Can Delirium Tremens kill you?

Yes

Can Alcohol Withdrawal Syndrome kill you?

No

Are patients with Alcohol Withdrawal Syndrome a danger to themselves or others?

No

Are patients with Delirium Tremens a danger to themselves or others?

Yes

N/I for Delirium Tremens?

Private room near nurses station, NPO/Clear liquids, Restricted bed rest, restraints, tranquilizer, multivitamin (B1 vit.) and antihypertensive.

N/I for Alcohol Withdrawal Syndrome?

Semi-private room anywhere, regular diet, up and ad-lib, no restraint, tranquilizer, multivitamin (B1) and antihypertensive.

A two point restraint is?

One arm and the opposite leg.

N/I for restraints?

Check Q15min. and rotate sites Q2H

All aminoglycosides end in?

"mycin" Vancomycin

If it has "thro" in it you?

Throw it out...Zithromycin

Toxic effects of aminoglycosides?

Ototoxicity, nephrotoxicity and cranial nerve 8 (vestibulocochlear nerve) which senses sound.

In aminoglycoside use monitor?

Hearing, balance, tinnitus & creatinine (best indicator of renal function)

Frequency of administration for aminoglycosides?

Q8H

Aminoglycoside route of administration?

Im or IV

Aminoglycosides are given PO for what two reasons?

Hepatic Encephalopathy and Pre-op bowel surgery.

Neomycin and Kanmycin are used for what?

Bowel sterilzation?

Who can sterilize my bowel?

"Neo" "Kan"

Hepatic Encephalopathy is caused by?

High ammonia levels

What raises ammonia levels the most?

Ecoli in the gut

When do you draw a trough level?

30 minutes before the next scheduled dose.

When do you draw a sublingual peak level?

5-10 minutes after it is dissolved.

When do you draw a IV peak level?

15-30 minutes after dose is finished.

When do you draw a IM peak level?

30-60 minutes after given

Drugs DON't determine peak and trough times, the ROUTE does.

...

Calcium Channel Blockers are like what for the heart?

Valium

Calcium Channel Blockers treat what? (the 6 A's)

Antihypertensive, Anti-Anginal, Anti Atrial Arrythmia and SVTS

Calcium Channel Blocker side effects? (the 2 H's)

Headache and Hypotension

What causes angina?

Chest pain due to O2 supply and demand issues.

90% of Calcium Channel Blockers end in?

"dipine" and "zem"

When giving a Calcium Channel Blocker you hold and notify if?

Systolic is 100 or lower.

"QRS" refers to?

Ventricular

"P" refers to?

Atrail

Asystole is?

A lack of QRS repolarizations

Atrail Flutter is?

Rapid P-wave repolarizations in a saw tooth pattern.

A-Fib is?

Chaotic QRS depolarizations

V-fib is?

Chaotic QRS depolarizations

V-tach is?

Wide bizarre QRS's

PVC is?

Periodic wide, bizarre QRS's

Be concerned about PVC's if? ( the 6, 6 T's of PVC's)

More then 6 per minute, 6 in a row

What are the 2 lethal arrythmias?

A-systole and V-Fib

What are the 4 potentially life threatening arrythmias?

V-tach, A-fib, A-flutter and PVC

What are the 6 arrythmias you are tested over on the NCLEX?

V-fib, A-fib, A-flutter, PVC, A-systole and V-tach

What are the 6 arrythmias for NCLEX in order for prioritization?

A-systole, V-fib, V-tach, A-fib, A-flutter and PVC