oh god hif i learn all this can i pass

What skill should you learn for acid-base questions?

learn how to convert lab values to words

What is the Rule of the B’s for identifying a metabolic acid-base disorder?

if the pH and the BiCarb are both in the same direction -> metabolic Hint: draw arrows beside each to see directions

What does a downward direction indicate in acid-base interpretation?

acidosis

What does an upward direction indicate in acid-base interpretation?

alkalosis

How is a respiratory acid-base disorder identified using the Rule of the B’s?

has no b in it; if in other directions (or if bicarb is normal value)

Which normal acid-base lab values must be known?

KNOW NORMAL pH, BiCarb, CO2

What should you focus on instead of memorizing lists for NCLEX select-all questions?

Hint: DON’T MEMORIZE LISTS…know principles (they test knowledge of principles by having you generate lists..) - for “select all” questions

In general, what do opioids/pain medications do?

sedate you, CNS depressors * ex. what does dilaudid do? don’t memorize specifics or a list of dilaudid, know principles of opioids (such as sedation, CNS depression -> lethargy, flaccidity, reflex +1, hypo-reflexia, obtunded)

Why should you avoid relying on memorized lists for boards questions?

boards don’t test by lists because all books/ classes have different lists

What is the main signs-and-symptoms principle for acid-base disorders?

principles of S&S acid bases: as the pH goes so goes my patient (except K+)

What happens to the patient when pH goes up?

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

What signs and symptoms should you expect with alkalosis?

alkalosis - think of a body system and go high: hyper-reflexive (+3, +4 [2 is normal]), tachypnea, tachycardia, borborygmi, seizure - pH down

What signs and symptoms should you expect with acidosis?

acidosis - think of a system and go low: 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)

What is the Kussmaul respiratory compensation clue for acid-base disorders?

Mac Kussmaul - Kussmaul’s (compensatory respiratory mechanism) is only present in only 1 of the 4 metabolic (acid-base) disorders

What does “M AC” stand for in the Kussmaul mnemonic?

metabolic AC

What is the most common mistake on select-all-that-apply questions?

selecting one more than you should (stop when you select the ones you know! don’t get caught up on the “could be’s”)

What selection rule is given for select-all-that-apply questions?

Hint: don’t select none or all on select all that apply questions (never only one and never all)

What are acid-base causation scenarios asking you to determine?

scenarios and what acid-base disorder would result (what would cause an imbalance)

Why must you distinguish signs/symptoms from causation in acid-base questions?

DON’T MIX UP S&S and CAUSATION - often what causes something is the opposite of the S&S - ex. diarrhea will cause a metabolic acidosis but once you are acidotic your bowel shuts down and you get a paralytic illeus

If an acid-base scenario involves the lungs, what category of disorder should you think of?

respiratory

How do you distinguish respiratory alkalosis from respiratory acidosis in a lung scenario?

then check if the client is over-ventilating (alkalosis) or under-ventilating (acidosis) - remember to look at the words (ex. over, under, ventilating) -> “as the pH goes so goes my PT” -> VENTILATING DOESN’T MEAN RESPIRATORY RATE; resp. rate is irrelevant w/ acid-base, ventilation has to do with gas exchange not resp. rate (look at the SaO2 -> if your resp. rate is fast but SaO2 is low you are underventilating) -> ex. PCA pump - What acid-base disorder indicates they need to come off of it? respiratory acidosis (resp. depression -> resp. arrest) —> if it’s not lung, it’s metabolic

What is the main scenario that causes metabolic alkalosis?

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

What are examples of prolonged gastric loss that can cause metabolic alkalosis?

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

If a scenario is not lung-related and not prolonged gastric vomiting/suctioning, what is the default acid-base disorder?

otherwise everything else that isn’t lung you pick metabolic acidosis (DEFAULT)

What are examples that point toward metabolic acidosis?

ex. hyperemesis graviderum w/ dehydration acute renal failure, infantile diarrhea

What are the four acid-base disorders you choose from?

remember, you only have 4 to pick from: - respiratory alkalosis - respiratory acidosis - metabolic alkalosis - metabolic acidosis

What examples show why modifying phrases matter more than the original noun?

ex. person w/ OCD who is now psychotic (psychotic trumps OCD); hyperemesis with dehydration (pay attention to dehydration)

What should you know about ventilator alarm systems?

know alarm systems (you set it up so that the machine doesn’t use less than or more than specific amounts of pressure)

What does a high-pressure ventilator alarm indicate?

increased resistance to airflow (the machine has to push too hard to get air into lungs)

What causes a high-pressure ventilator alarm?

from obstructions:

What should you do for a kink in ventilator tubing?

i. kinks in tubing (unkink it)

What should you do for water condensation or mucus causing a high-pressure ventilator alarm?

ii. water condensation in tube (empty it!) iii. mucous secretions in the airway (change positions/turn, C&DB, and THEN suction) *** suction is only PRN!!!

What is the priority when troubleshooting a high-pressure ventilator alarm?

you would check kinks first, suction is not first

What does a low-pressure ventilator alarm indicate?

decreased resistance to airflow (the machine had to work too little to push air into lungs)

What causes a low-pressure ventilator alarm?

from disconnections:

What should you do if the main ventilator tubing is disconnected?

i. main tubing (reconnect it duh!)

What should you do if the ventilator O2 sensor tubing is disconnected?

ii. O2 sensor tubing (which senses FiO2 at the airway/trach area; black coated wire coming from machine right along the tubing - reconnect!)

What should you know about ventilators and blood gases?

know blood gases

What ventilator setting problem can cause respiratory alkalosis?

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

What ventilator setting problem can cause respiratory acidosis?

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

What blood-gas finding suggests a patient may be ready to wean from the ventilator?

ex. weaning a PT off ventilator -> should not be under-ventilated, they need the ventilator; if they are over-ventilating then they can be weaned

What type of answer should you avoid on NCLEX when you can take action yourself?

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

What is the #1 psychological problem in any abusive situation?

DENIAL

Why is denial so prominent in abusive situations?

abusers have an infinite capacity for denial so that they can continue the behavior w/o answering for it

Can the alcoholism rules be applied to other forms of abuse?

can use the alcoholism rules for any abuse - ex. # 1 psych problem in child abuse, gambling or cocaine abuse is denial

Why is denial a problem in treatment?

HOW CAN YOU TREAT SOMEONE WHO DENIES/DOESN’T RECOGNIZE THEY HAVE A PROBLEM

What is denial?

refusal to accept the reality of a problem

How is denial in abuse treated?

treat denial by CONFRONTING the problem (it’s not the same as aggression which attacks the person, not the problem)

How should therapeutic communication avoid attacking the person?

Hint: never pick answers that attack the person -> ex. bad answers have bad pronouns - “you” -> ex. good answers have good pronouns - “I”, “we” -> ex. “you wrote the order wrong” vs. “I’m having difficulty interpreting what you want”

How should denial related to loss and grief be handled?

for this denial you must SUPPORT it

What does DABDA stand for?

denial, anger, bargaining, depression, acceptance

What distinction must you make when answering questions about denial?

Hint: for questions about denial, you must look to see if it is LOSS or ABUSE

How should denial in loss/grief be handled?

support

How should denial in abuse be handled?

confront

What is the #2 psychological problem in abuse?

DEPENDENCY, CO-DEPENDENCY

What is dependency in an abusive relationship?

when the abuser gets significant other to do things for them or make decisions for them -> the dependent

What is co-dependency in an abusive relationship?

when the significant other derives positive self-esteem from making decisions for or doing things for the abuser

Why can a co-dependent significant other have difficulty leaving the relationship?

the abuser gets a life w/o responsibilities -> the sig. other gets positive self-esteem (which is why they can’t get out of the relationship)

How are dependency and co-dependency treated?

set limits and enforce them

What should the significant other be taught to say when treating dependency/co-dependency?

start teaching sig. other to say NO (and they have to keep doing it)

What else must be addressed when treating co-dependency?

must also work on the self-esteem of the co-dependent (ex. I’m a good person because I’m saying “no”)

What is manipulation in an abusive relationship?

when the abuser gets the sig. other to do things for them that are not in the best interest of the sig. other

What makes manipulation different from dependency?

the nature of the act is dangerous/harmful

How are manipulation and dependency similar?

in both the abuser is getting the other person to do something for them

How do you tell the difference between manipulation and dependency?

NEUTRAL vs. NEGATIVE (look at what they’re being asked to do)

How do neutral versus harmful requests distinguish dependency from manipulation?

if the sig. other is being asked to do something neutral (no harm) its dependency/co-dependency -> if the sig. other is being asked to do something that will harm them or is dangerous to them they are manipulated

How do you treat manipulation?

set limits and enforce them -> “NO”

Why is manipulation easier to treat than dependency/co-dependency?

easier to treat than dependency/co-dependency because no one likes to be manipulated (no positive self-esteem issue going on)

How many patients are involved in denial, dependency/co-dependency, and manipulation?

denial

What is Wernicke’s in alcoholism?

encephalopathy

What is Korsakoff’s in alcoholism?

psychosis (lose touch with reality) -> tend to go together, find them in the same PT

What is Wernicke-Korsakoff syndrome in alcoholism?

psychosis induced by Vit. B1 (Thiamine) deficiency - lose touch w/ reality, go insane because of no B1

What is the primary symptom of Wernicke-Korsakoff syndrome?

amnesia w/ confabulation - significant memory loss w/ making up stories - they believe their stories

Why is confrontation a bad approach for patients with Wernicke-Korsakoff syndrome?

bad way

What is the preferred approach for patients with Wernicke-Korsakoff syndrome?

redirection (take what the PT can’t do and channel it into something they can do)

How is Wernicke-Korsakoff syndrome preventable?

take Vit. B1 (co-enzyme needed for the metabolism of alcohol which keeps alcohol from accumulating and destroying brain cells) * PT doesn’t have to stop drinking

How is Wernicke-Korsakoff syndrome arrestable?

can stop it from getting worse by taking Vit. B1

Must a patient stop drinking for vitamin B1 to arrest Wernicke-Korsakoff syndrome?

also not necessary to stop drinking

Is Wernicke-Korsakoff syndrome reversible?

it’s irreversible (70% of cases) -> Hint: On boards, answer w/ the majority (ex. if something is majority of the time fatal, you say it’s fatal even if 5% of the time it’s not)

What type of therapy is disulfiram (Antabuse)?

aversion therapy -> want PT’s to develop a gut hatred for alcohol

What happens when disulfiram (Antabuse) interacts with alcohol?

interacts w/ alcohol in the blood to make you very ill

What is the onset/duration teaching point for disulfiram (Antabuse)?

onset & duration: 2 weeks (so if you want to drink again, wait 2 weeks)

What is the key patient teaching for disulfiram (Antabuse)?

avoid ALL forms of alcohol to avoid nausea, vomiting & possibly death

Which hidden or non-beverage alcohol sources must a patient taking disulfiram avoid?

including mouthwash, aftershaves/colognes/perfumes (topical stuff will make them nauseous), insect repellants, any OTC that ends with “-elixir”, alcohol- based hand sanitizers, uncooked (no-bake) icings which have vanilla extract, red wine vinaigrette

How are abused drugs broadly classified for overdose and withdrawal questions?

every abused drug is either an UPPER or DOWNER

What are the five uppers listed for overdose and withdrawal questions?

caffeine, cocaine, PCP/LSD (psychedelic hallucinogens), methamphetamines, adderall (ADD drug)

What signs and symptoms occur with uppers?

S&S - make you go up; euphoria, tachycardia, restlessness, irritability, diarrhea, borborygmi, hyperreflexia, spastic, seize (need suction)

How should you classify a drug that is not one of the listed uppers?

downers

What signs and symptoms occur with downers?

make you go down; lethargy, respiratory depression (& arrest)

If a patient is high on cocaine, what is critical to assess?

NOT resps below 12 because they will be high -> maybe check reflexes

What does overdose/intoxication mean in upper/downer questions?

too much

What does withdrawal mean in upper/downer questions?

not enough

What should you expect with an upper overdose?

pick the S&S of too much upper

What should you expect with a downer overdose?

pick the S&S of too much downer

What should you expect with upper withdrawal?

not enough upper makes everything go down

What should you expect with downer withdrawal?

not enough downer makes everything go up

What does an upper overdose look like?

downer withdrawal

What does a downer overdose look like?

upper withdrawal