Mark Klimek Yellow Book (KV)

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

Metabolic

If the pH is up it is?

Alkalosis

As the pH goes so goes my patient except for?

Potassium

If the pH is down it is?

Acidosis

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

Kussmal Respirations

Metabolic Acidosis ( Remember MacKussmal

Before measuing ABGs you should check what?

Allen's test. Should be positive. Pt makes a fist and pressure is applied to the ulnar and the radial arteries Ulnar pressure is released and color should return in 7 seconds (means it's positive and OK to take ABG's).

Definition of Compensation

PH is normal! It is never compensated if it is abnormal.

If PH normal

look in the direction it is going. Closer to Acidic? (7.35) acidosis.

Then look at Bicarb & figure out which is abnormal. If Bicarb is out of range, it's metabolic acidosis.

If C02 is abnormal, it's Respiratory Acidosis :)

If your pt is acidotic and you need to pick a symptom

Pick the symptom where everything is DOWN. ( And vice Versa)

Ex: 2 degree Morbitz Type 2 BLOCK. <---- Down direction

If you don't know what causes an acid base balance, pick

Metabolic Acidosis

If in doubt in ABGs, always pick

Headache, nausea, weakness & numbness+ tingling. It can be either up or down.

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.

Don't suction unless

Coughing & deep breathing is deemed inappropriate.

In order to suction, you must be able to hear

Mucus in the lung

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.

First question to ask if the low pressure alarm sounds

Where is the tubing?!

HOLD

H- High Pressure

O- Obstruction

L- Low

D- Disconnections

Never put anything in YOUR scope of practice

On anyone else

Make sure your answer is

PATIENT FOCUSED.

TAKE CARE OF YOUR PATIENT!

Don't answer based on staff, building, machine, etc.

PATIENT FIRST.

What does wean mean?

Decrease Gradually

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

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

Remember in a PSYCH question if you are asked to Prioritize, Don't forget

MASLOW!

1. Physiological

2. Safety

3. Comfort - Includes pain

4. Psychological

5. Social

6. Spiritual

When prioritizing, always use Maslow + ABCs

For one patient. Don't if you have more than one patient.

What is the biggest problem in abuse?

Denial

To treat denial you need to?

Confront them.

Definition of Denial

Refusal to accept reality of their problem

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

Always go

Med surg first. Then Psych

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.

Say NO and follow through.

Agree in advance on what requests are allowed, then enforce the agreement.

Work on self esteem 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.

DABDA

D- Denial

A- Anger

B- Bargaining

D- Depression

A- Acceptance

Psych Needs, In order

Denial

Depend

Manipulation

To address a patient's psychological needs, they must be:

STABLE, safe, comfortable.

Pain

Never killed anyone. NOT the top priority, especially if there are physiological needs in the question that make the patient unstable.

What is Wernickes (Korsakoffs) Syndrome?

Psychosis induced by vitamin B1 (Thiamine) deficiency.

Symptom of Wernickes Korsakoffs syndrome?

Amnesia with confabulation.

= Loss of memory with making up stories to fill in the gaps.

Vitamin B1 helps breakdown?

Alcohol

So without B1 what happens?

Alcohol isn't metabolized correctly goes to the brain and causes Wernickes

Primary symptom of Wernickes?

Amnesia with confabulation (making up stories).

Is Wernickes preventable?

Yes- Take Vitamin B1

Is Wernickes arrestable?

Yes- Take Vitamin B1

Is Wernickes reversible?

No

What is the goal of patients dementia/organic brain syndrome?

Maintain function, Never Improve.

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?

Alcohol

Aftershave, Cologne, Perfumes

Insect Repellent

Elixirs

Vanilla Extract

Vinaigrettes

Handsanitizer

Alcohol Prep Pads

Vanilla Icing

How long does it take for Antabuse to get out of the system so they can drink Alcohol again?

2 weeks

What are Elixirs?

95% of liquids. If it is not an antibiotic, assume it is an elixir, so the patient can't have it if on antabuse.

This rule applies for diabetics too (elixers also have sugar).

What happens if a person on Antabuse ingests alcohol?

Nausea, Vomiting, & Possibly Death

In Overdose VS Withdrawal, Ask yourself?

Is this drug an upper or a downer?

What are the five uppers?

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

Downers are?

Everything other then the five uppers.

Heroin

Ativan

Valiumn

Fetanyl

S/S of upper use?

Everything goes up

Tachycardia

Increased BP

Irritability

Fever

Diarrhea

+4 Reflexes

Pupil Dilation

Excitability

Seizures

Borborygmi

ETC.

S/S of downer use?

Everything goes down

Bradycardia

Lethargy

Constricted Pupils

Hyporeflexia

Flaccidity

Respiratory Depression

Then ask yourself:

Are they talking about Overdose or Withdrawal?

Overdose/Intoxication:

I have too much....

Withdrawal:

I don't have enough...

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

Upper withdrawal looks like

Downer Overdose

Downer Withdrawal looks like

Upper overdose

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

Overdosed

If 24 hours after birth assume the baby is in?

Withdrawal

Every alcoholic goes through what withing 24 hours after cessation?

Alcohol Withdrawal syndrome

What is Alcohol Withdrawal Syndrome?

Hyper irritability state less than 24 hours after the first drink

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 Vitamin/Thiamine)

Antihypertensive.

N/I for Alcohol Withdrawal Syndrome?

Semi-private room anywhere

Regular diet

Up and ad-lib, no restraint

Tranquilizer

Multivitamin (B1/Thiamine)

Antihypertensive.

A two point restraint is?

One arm and the opposite leg.

N/I for restraints?

Check Q15min

Rotate sites Q2H