help me god

What is the rule of the B’s?

if the pH and the Bicarb are both in the same direction -> metabolic

If pH and Bicarb are in the same direction, what disorder is it?

metabolic

What indicates respiratory (in the rule)?

respiratory -> has no b in it

If bicarb is normal value, what type do you look for?

respiratory

What does “as the pH goes so goes my patient” mean (except K+)?

as the pH goes so goes my patient (except K+)

If pH is up, what does the patient become (EXCEPT K+)?

body system gets more irritable, hyper-excitable (EXCEPT K+)

If pH up, what type is it?

-> alkalosis

With alkalosis, think of a body system and go high: what reflex and other S&S?

hyper-reflexive (+3, +4 [2 is normal]), tachypnea, tachycardia, borborygmi, seizure

If pH is down, what does the patient become (EXCEPT K+)?

body systems shut down (EXCEPT K+)

If pH down, what type is it?

-> acidosis

With acidosis, think of a system and go low: what reflex and other S&S?

hypo-reflexive (+1, 0), bradycardia, lethargy, obtunded, paralytic illeus, respiratory arrest

Which acid-base disorders need an ambu-bag at the bedside?

acidosis (resp. arrest)

Which acid-base disorders need suction at the bedside?

alkalosis (seize and aspirate)

Kussmaul’s (compensatory respiratory mechanism) is only present in how many of the 4 metabolic (acid-base) disorders?

only present in only 1 of the 4 metabolic (acid-base) disorders

What mnemonic says M

?

What does AC

?

What is the most common mistake with select all questions?

selecting one more than you should

What should you do when selecting in select all that apply questions?

stop when you select the ones you know! don’t get caught up on the “could be’s”

What should you not do on select all that apply questions?

don’t select none or all (never only one and never all)

What is diarrhea an example of for S&S vs causation?

diarrhea will cause a metabolic acidosis but once you are acidotic your bowel shuts down and you get a paralytic illeus

If it’s a lung scenario, what type do you use?

if it’s a lung scenario

If the client is over-ventilating, what does that indicate?

alkalosis

If the client is under-ventilating, what does that indicate?

acidosis

What does “ventilating” not mean with acid-base?

VENTILATING DOESN’T MEAN RESPIRATORY RATE

What does ventilation have to do with?

ventilation has to do with gas exchange not resp. rate (look at the SaO2)

If resp. rate is fast but SaO2 is low, you are?

under-ventilating

If it’s not lung, what type do you pick?

if it’s not lung, it’s metabolic

What acid-base disorder indicates they need to come off of a PCA pump?

respiratory acidosis (resp. depression -> resp. arrest)

Metabolic alkalosis: what is the really only scenario?

if the PT has prolonged gastric vomiting/suctioning - because you are losing ACID

What are examples of metabolic alkalosis scenarios?

GI surgery w/ NG tube with suctioning for 3 days; hyperemesis graviderum

If it isn’t lung, what is the default metabolic disorder?

metabolic acidosis (DEFAULT)

What are examples of “not lung” scenarios leading to metabolic acidosis?

hyperemesis graviderum w/ dehydration acute renal failure, infantile diarrhea

How many acid-base disorders do you only have 4 to pick from?

respiratory alkalosis - respiratory acidosis - metabolic alkalosis - metabolic acidosis

Pay more attention to what than the original noun?

modifying phrases than the original noun

In acid-base scenarios, how do you decide based on modifying phrases?

OCD who is now psychotic (psychotic trumps OCD); hyperemesis with dehydration (pay attention to dehydration)

What is a high pressure alarm on ventilators?

high pressure alarm

High pressure alarm: what are obstruction causes?

kinks in tubing (unkink it) / water condensation in tube (empty it!) / mucous secretions in the airway (change positions/turn, C&DB, and THEN suction)

Suction with high pressure alarm: what is it?

suction is only PRN!!!

High pressure alarm priority: what would you check first?

you would check kinks first, suction is not first

What is a low pressure alarm on ventilators?

low pressure alarm

From disconnections, what causes a low/high pressure problem you must check?

main tubing (reconnect it duh!) / O2 sensor tubing (reconnect!)

What does the O2 sensor tubing do?

which senses FiO2 at the airway/trach area

Respiratory alkalosis on ventilators: what may happen to ventilation settings?

ventilation settings might be set too high (OVER-VENTILATING)

Respiratory acidosis on ventilators: what may happen to ventilation settings?

ventilation settings might be set too low (UNDER-VENTILATING)

Weaning a PT off ventilator: what should you not do?

should not be under-ventilated, they need the ventilator

Weaning a PT off ventilator: if they are over-ventilating, what can you do?

if they are over-ventilating then they can be weaned

Never pick an answer where you don’t do something and someone else has to do something

never pick an answer where you don’t do something and someone else has to do something

What is the purpose of PPE?

PPE

What is the most important PPE rule for taking it off?

always take it off in alphabetical order

What is an example of PPE sequence “take it off” ?

gloves, goggles, gown, mask

What is the PPE sequence for putting it on (reverse alphabetically for the ‘g’s’ & mask comes 2nd)?

gown, mask, goggles, gloves

What are the categories of infectious disease transmission based precautions listed?

Standard; Universal; Contact; Droplet; Airborne

What is Contact precautions for enteric?

for anything enteric

What are enteric bugs listed for Contact precautions?

C-Diff, Hep. A, Cholera, Dysentery

Staph infections are used with which precautions?

Contact

RSV (respiratory syncytial virus in 1-2 yr olds) goes with which precautions?

Contact precautions

How is RSV transmitted (per notes) but still put on Contact precautions?

transmitted by droplet BUT still put them on contact precautions because little kids catch it from touching things that other sick kids touched

What does Contact precautions involve: room?

private room is preferred (but not required) / or 2 RSV kids in the same room (cohort)

For RSV, what should you do with suspected RSV?

keep RSV kid & suspected RSV separate because you need positive cultures (not based on symptoms)

What does Contact precautions NOT include (NO)?

mask, eye/face shield (unless for universal), special filter mask, PT mask, neg. air flow

What does Contact precautions include (YES)?

gloves, gown, hand-washing, special supplies & dedicated equipment (includes toys)

Example of “disposable supply vs. dedicated equipment”?

thermometer cover - BP cuff that stays in room

What is Droplet precautions for?

for bugs that travel 3 feet on large particles due to sneezing/coughing

What are examples under Droplet precautions?

all meningitis / H Flu (haemophilus influenza B)

How is meningitis cultured (per notes)?

cultured through lumbar puncture

H Flu (haemophilus influenza B): what instruction is given?

never stick something down throat because it will cause obstruction

Droplet precautions: what does it include (YES)?

mask, gloves, hand-washing, PT worn mask (when leaving room), disposable supplies & dedicated equipment

Droplet precautions: what does it NOT include (NO)?

gown, eye/face shield, special filter mask, neg. air flow

Airborne precautions listed for which pathogens?

M-M-R; TB; varicella (chicken pox)

Airborne precautions: what is required?

private room is required

Airborne precautions: what does it NOT include (NO)?

gown (mostly for contact), eye/face shields

Airborne precautions: what does it include (YES)?

mask, gloves, hand-washing, special-filter mask ONLY for TB, PT mask for leaving room (but really shouldn’t be leaving), neg. air flow

Airborne: is disposable/dedicated equipment essential like other 2?

disposable supplies & dedicated equipment is a good thing but not really as essential as in the other 2

How is TB handled according to the notes?

TB: technically transmitted via droplet BUT put on airborne

Crutches: what is the correct crutch length measurement location?

2-3 finger-widths below anterior axillary fold to a point lateral to & slightly in front of the foot

Crutches: what is the correct crutch hand grip placement angle?

apx. 30 degrees elbow flexion

What is the 2-point crutch gait?

move a crutch and opposite foot together followed by other crutch & opposite foot

What is the defining idea of the 2-point gait?

moving 2 things together

What is the 3-point crutch gait?

moving 2 crutches & the bad leg together

What is the defining idea of the 3-point gait?

moving 3 things together

What is the 4-point crutch gait?

move any crutch, then opposite foot, followed by next crutch then other foot

What is the defining idea of the 4-point gait?

move everything separately

What is the 4-point gait description?

very slow but very stable

What is the swing-through crutch gait for?

for non-weight bearing injuries (ex. amputations)

What happens in swing-through gait?

plant crutches and swing the injured limb through (never touches down)

When asking which crutch gait to use, what question should you ask yourself?

“how many legs are affected?”

What does a 2-point gait indicate?

mild problems (bilateral)

What does a 4-point gait indicate?

severe problems (severe, bilateral weaknesses)

What does a 3-point gait indicate?

only odd one, when only 1 leg is affected

Early stages of rheumatoid arthritis gait choice?

2-point

Left, above the knee amputation gait choice?

swing-through

First day post-op right knee replacement, partial weight-bearing allowed gait choice?

3-point

Advanced stages of ALS gait choice?

4-point

Left hip replacement, 2nd day post-op, non weight-bearing gait choice?

swing-through

Bilateral total knee replacement, 1st day post-op, weight-bearing allowed gait choice?

4-point

Bilateral total knee replacement, 3 weeks post-op gait choice?

2 point

Stairs with crutches: going up with what?

up with the good

Stairs with crutches: going down with what?

down with bad

Stairs with crutches: crutches move with what leg?

crutches move with the bad leg

Cane: where do you hold it?

hold the cane on the strong side