MARK K review

ABG

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

Metabolic (rule of the Bs)

ABG

Do you ever choose "Compensated" if the pH is abnormal?

NEVER

ABG

If all three (pH, Bicarb, Co2) are abnormal then what is it?

Partially compensated

ABG

If the pH is up it is?

Alkalosis

ABG

If the pH is down it is?

Acidosis

ABG

As the pH goes so goes my patient except for?

Potassium

ABG

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

Increase... like tachycardia,diarrhea and borborygmi

ABG

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

Decrease... like decreased output, bradycardia and constipation

ABG

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

Down

ABG

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

Up

ABG

If my patient is experiencing Kussmaul Respirations what do they have?

Metabolic Acidosis

think! MAC KUSSMAUL

ABG

Is it a lung problem?, if yes then what is it

Respiratory

ABG

If my patient is overventilating I should choose?

Respiratory Alkalosis

ABG

If my patient is underventilating I should choose?

Respiratory Acidosis

ABG

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

Metabolic Alkalosis

ABG

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

Metabolic Acidosis

ABG

What is the go to answer when you dont know what it is?

Metabolic Acidosis

Ventilator Alarms

High pressure alarms are triggered when?

there is increased resistance to air flow, caused by obstructions

Ventilator Alarms

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

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

Ventilator Alarms

If kinking in the tube is present you...?

Unkink the tubing, DUH

Ventilator Alarms

If water is present in the dependant loops you...?

Open system and empty water.

Ventilator Alarms

If mucus is present you...?

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

Ventilator Alarms

Low pressure alarms are triggered when?

there is decreased resistance to air flow, caused by disocnnections

Ventilator Alarm

Low pressure alarms are normally caused by?

Disconnection

• main tubings or

• oxygen sensor tubing

Ventilator Alarms

If the tubing is disconnected you?

Reconnect

Ventilator Alarms

If O2 sensor line is disconnected you?

Reconnect

Ventilator Alarms

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

High

Ventilator Alarms

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

Low

Ventilator Alarms

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

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

Ventilator Alarms

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

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

Alcoholism

What is the biggest problem in abuse?

Denial

Alcoholism

How do you prioritize?

use Maslows hierarchy

1. physiological

2. safety

3. comfort

4. psychological

5. social

6. spiritual

Alcoholism

To treat denial you need to?

Confront

Alcoholism

How do you confront?

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

Alcoholism

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

Loss and Grief

Alcoholism

What is dependency?

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

Alcoholism

What is codependency?

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

Alcholism

To treat dependency/codependency you ?

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

Alcoholism

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.

Alcoholism

How do you treat manipulation?

Set limits and enforce.

Alcoholism

Why is manipulation easier to treat then dependency/codependency?

Because no one likes being manipulated.

Alcholism

What is Wernickes (Korsakoffs) Syndrome?

Psychosis induced by vitamin B1 (Thiamine) deficiency.

Alcoholism

What is the primary symtpom for Wernickes

amnesia with comfabulation

• make stuff up and truly believe it

Alcoholism

Vitamin B1 helps breakdown?

Alcohol

Alcoholism

Primary symptom of Wernickes?

Amnesia with confabulation (making up stories).

Alcoholism

is Wernickes preventable?

Yes take b1

Alcoholism

Is Wernickes arrestable?

Yes you can stop it from geting worse

Alcoholism

Is Wernickes reversible?

No

Alcoholism

What is aversion therapy?

When you try and make the patient hate something.

Alcoholism

What drugs are used in aversion therapy

Antabuse (disulfiram) and revia (naltrexone)

Alcoholism

Antabuse onset and duration is?

2 weeks

Alcoholism

Teach a patient taking Antabuse to avoid what?

Alochol

Alcoholism

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

RED WINE vinegrette is OKAY

Overdose vs. Withdrawal

Every abused drug is either... or ....?

upper or downer

Overdose vs. Withdrawal

What are the five uppers?

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

Overdose vs. Withdrawal

Downers are?

Everything other then the five uppers.

Overdose vs. Withdrawal

S/S of upper use?

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

Overdose vs. Withdrawal

S/S of downer use?

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

Overdose vs. Withdrawal

Overdose of a downer causes everything to go?

Down

Overdose vs. Withdrawal

Overdose of an upper causes everything to go?

Up

Overdose vs. Withdrawal

Withdrawal of an upper causes everything to go?

Down

Overdose vs. Withdrawal

Withdrawal of a downer causes everything to go?

Up

Overdose vs. Withdrawal

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

Intoxication

Overdose vs. Withdrawal

If 24 hours after birth assume the baby is in?

Withdrawal

Overdose vs. Withdrawal

Every alcoholic goes through what within 24 hours after cessation?

Withdrawal syndrome

Overdose vs. Withdrawal

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

Delirium Tremens

Overdose vs. Withdrawal

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

Yes

Overdose vs. Withdrawal

Can Alcohol Withdrawal Syndrome kill you?

No

Overdose vs. Withdrawal

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

No

Overdose vs. Withdrawal

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

Yes

Overdose vs. Withdrawal

N/I for Delirium Tremens?

Private room near nurses station, NPO/Clear liquids, Restricted bed rest, restraints(2 point locked leahthers, or vest), tranquilizer, multivitamin (B1 vit.) and antihypertensive.

Overdose vs. Withdrawal

N/I for Alcohol Withdrawal Syndrome?

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

Overdose vs. Withdrawal

What do you do for both AWS and Dt's

give anti hypertensives, tranquilizers, and multivitamin (containing B1)

Overdose vs. Withdrawal

A two point restraint is?

One arm and the opposite leg.

Overdose vs. Withdrawal

N/I for restraints?

Check Q15min. and rotate sites Q2H

Aminoglycosides

All aminoglycosides end in?

"mycin" Vancomycin

Aminoglycosides

What do you think of

A mean old mycin, for mean old infections

Aminoglycosides

If it has "thro" in it you?

Throw it out...Zithromycin

Aminoglycosides

Toxic effects of aminoglycosides?

Ototoxicity

• think MICE --> ears nephrotoxicity

• ears are shaped like kidneys Cranial nerve 8 (vestibulocochlear nerve) which senses sound.

• 8 can be drawn in the ear

Aminoglycosides

In aminoglycoside use monitor?

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

Aminoglycosides

Frequency of administration for aminoglycosides?

Q8H

Aminoglycosides

Aminoglycoside route of administration?

Im or IV

Aminoglycosides

Aminoglycosides are given PO for what two reasons?

Hepatic Encephalopathy and Pre-op bowel surgery.

Aminoglycosides

Neomycin and Kanmycin are used for what?

Bowel sterilzation?

Aminoglycosides

Who can sterilize my bowel?

"Neo" "Kan"

Aminoglycosides

Hepatic Encephalopathy is caused by?

High ammonia levels

Aminoglycosides

What raises ammonia levels the most?

Ecoli in the gut

Aminoglycosides

When do you draw a trough level?

30 minutes before the next scheduled dose.

Aminoglycosides

When do you draw a sublingual peak level?

5-10 minutes after it is dissolved.

Aminoglycosides

When do you draw a IV peak level?

15-30 minutes after dose is finished.

Aminoglycosides

When do you draw a IM peak level?

30-60 minutes after given

Aminoglycosides

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

...

Calcium Channel Blockers

Calcium Channel Blockers are like what for the heart?

Valium

Calcium Channel Blockers

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

Antihypertensive, Anti-Anginal, Anti Atrial Arrythmia and SVTS

Calcium Channel Blockers

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

Headache and Hypotension and bradycardia

Calcium Channel Blockers

What do inotropic drugs control?

Strength of heartbeat

Calcium Channel Blockers

What dromotropic drugs control?

conductivity

Calcium Channel Blockers

What type of ino/chrono/dromo is calcium channel blockers

NEGATIVE ALL, weakens trength slows rate blocks/slows conduction

Calcium Channel Blockers

What do chronotropic drugs control?

Rate of heartbeat

Calcium Channel Blockers

What causes angina?

Chest pain due to O2 supply and demand issues.