MK letures

Acid Base

As the ph goes, so goes my patient, except for potassium
Ph up, alkalosis, everything up
Ph down, acidosis, everything down
MAC Kussmauls

Acidosis heart rhythm

second degree heart block

Causes of Acid Base balances

IS IT LUNG? Yes - respiratory
OVERventilating - alkalosis
UNDERventilating - acidosis
prolonged suctioning or vomiting...metabolic alkalosis
everything that isn't lung or met alk, pic met acid

Ventilator

high pressure alarm: OBSTRUCTION. kink, water, secretions. turn cough deep breathe THEN suction

low pressure alarm: DISCONNECTION or LEAK
if tube hits floor..call resp and start bagging. if tube hits pt and bed, clean with alcohol and reconnect

Denial

in abusers: confront them
in grief: support them

Dependency and Codependency

Dependency: abuser gets sig other to make decisions for them or do stuff for them so they can keep drinking
Codependecy: sig other derives positive self esteem from doing things for the abuser

Set limits for the abuser and enforce them. NO!!!!!
Work on self esteem of the codependent person

Dependency vs Manipulating

dep: not harmful
man: harmful

Wernickes-Korsakoff

- psychosis induces by VITAMIN B1 DEFICIENCY/THIAMINE
- lose touch with reality
- amnesia with confabulation: making up stories bc they don't remember what happened
- this is DEMENTIA: break from reality due to BRAIN DAMAGE
- do not argue, play along
- PREVENTABLE by taking B1.
- IRREVERSIBLE brain damage

Antabuse

disulfiram
aversion therapy, forms hatred for alcohol. makes you sick if you drink any alcohol while on it
ONSET AND DURATION IS TWO WEEKS
all forms of alcohol: mouthwash, aftershave, perfume, dayquil, vanilla extract (icing)

overdose and withdrawal rules

overdose SAME
withdrawal OPPOSITE
uppers go up
downers go down

Uppers

Caffeine
Cocaine
PCP/LSD (stankadelics)
amphetamines: meth/speed
bath salts
ADHD adderall and ritalin

Downers

everything else
qualudes
fentanyl
RESPIRATORY DISTRESS

drug baby

always assume newborn baby is INTOXICATED in first 24 hours unless told otherwise. withdrawal after 24 hours

AWS and DT

every alcoholic goes through alcohol withdrawals 24 hours from last drink.
delirium tremens occurs after 72 hours from last drink. NOT EVERYONE GOES THROUGH THIS.
both get antihypertensive and B1 vitamin

alcohol withdrawal syndrome

guaranteed to happen
stable
not a danger to self or others
regular diet
no restraints

delirium tremens

not guaranteed to happen
unstable; this can kill you
danger to self and others
private near nurse station
NPO/clear liquid diet - seizure risk
restraints, bed rest (bed pan)

AMINOGLYCOSIDES

A MEAN OLD MYCIN
hard to treat infections: TB, septic peritonitis, serious intense infections
all end in mycin, but not every drug that ends in mycin is an aminoglycoside. if it has thro in it, throw it out
ototoxic, nephrotoxic, 8th CN, every 8 hr
mickey and minnie \= mice \= ears
creatinine!!!!
only give IM and IV
not give po bc not absorbed, only for sterile bowel (NEO CAN)

trough levels

for everything: 30 min before next dose

peak levels

sublingual: 5-10 min
IV: 15-30 min AFTER FINISHED
IM: 30 min
PO: none

Calcium Channel Blockers

like valium for your heart
treats A, AA, AAA
A: antihypertensive
AA: anti angina
AAA: anti atrial arrhythmia
-DIPINE, dipping in CCB
AE headache and hypotension
hold CCB if systolic

arrhythmias

QRS: VENTRICULAR
P: ATRIAL

PVC and Vtach

amiodarone
lidocaine

atrial arrhythmias

ABCD
adenosine, slam it
beta blockers
calcium channel blockers
digitalis, lanoxin, digoxin

asystole

EPINEPHRINE
atropine

Chest Tubes

reestablishes negative pressure in the pleural space. neg pressure good, pos pressure bad.
placed for: pneumothorax, hemothorax, pneumohemothorax
PNEUMO: removing air. should bubble
HEMO: removing blood. shouldn't bubble
PNEUMOHEMO: bubble and blood

apical vs basilar chest tubes

apical: implanted high, removing air, for pneumo.no drainage good. drainage bad
basilar: at base, removing blood, for hemo. drainage good, no drainage bad.
basilar and apical for pneumohemothorax

chest tube chambers

patient-\> CWS
collection, water, suction

Knock chest tube over

sit pt up, take deep breaths

Break tube/crack water seal

clamp tube, cut tube, submerge in sterile water, then unclamp
best answer: submerge
**do not clamp chest tube for longer than 15 seconds unless doctor order says to**

Chest tube gets pulled out

cover hole with gloved hand, then vaseline gauze, then dry sterile dressing and then tape it on 3 sides

Bubble bubble where? chest tubes

water seal: intermittent good, continuous bad
suction control: intermittent bad, continuous good

Crutches

mismeasured crutches can cause nerve damage. Measure length of crutch: 2-3 fingers below axilla to point slightly in front of the foot, never on the foot
handgrip: elbow flexion should be at least 30 degrees, a little less than 45

Crutch Gait

2 point, 3 point, 4 point, swing through
EVEN FOR EVEN ODD FOR ODD
bilateral: even
unilateral: odd
2 point for mild, 4 for severe
STAIRS: up with the good, down with the bad

Canes and Walkers

COAL: cane opposite affected leg
Walkers: pick up, set down, walk to

Congenital Heart Defects

TRouBLe
trouble or no trouble?
trouble: starts with T, shunts right to left, blue cyanotic, low life expectancy
all CHD will have heart murmur and echo

Tetralogy of Fallot

VarieD PictureS Of A RancH
VD: ventricular defect
PS: pulmonic stenosis
OA: overriding aorta
RH: right hypertrophy

Psych Questions

is the patient PSYCHOTIC or not?

Delusions

false fixed. they don't see it, they think it.
- paranoid: out to get me
- grandiose: superiority, i am jesus
- somatic: body parts. my arm is bionic

Hallucinations

false fixed sensory component
hearing, feeling, seeing something that isn't there
most common: command auditory. can also be visual, tactile, olfactory, or gustatory

Illusions

misinterpretation of reality
there is a referent in reality

Nonpsychotic patients

has INSIGHT. reality based, knows they have a problem.
use good therapeutic communication

Functional Psychotic

can have normal life if on meds
acknowledge feelings, present reality, set and enforce limits
SCHIZO SCHIZO MAJOR MANIA

Psychosis of Dementia

Due to BRAIN DAMAGE
acknowledge feeling and redirect
CAN orient to reality..person place and time

Psychotic Delirium

temporary, episodic, sudden onset loss of reality due to chemical imbalance
acknowledge, reassure them of their safety and that it is temporary

psychotics shortcut

functional: reality
dementia: redirect
delirium: reassure

Different characteristics of psych stuff

flight of ideas: loosely associated
word salad: cant make phrases just say words
neolochism: makeup words
narrowed self concept: refuses to change clothes or leave room bc scared of what will happen if they do... don't make them
ideas of references: think people are talking about you

diabetes insipidus

low ADH: polyuria, polydipsia, dehydration. low urine specific gravity

SIADH

oliguria, not thirsty, fluid overload. high specific gravity

type 1 diabetes

DIE: diet, insulin, exercise
insulin is most important

type 2 diabetes

DOA: diet, oral hypoglycemic, activity. diet most important

R insulin

rapid, run IV

N insulin

not so fast, no IV

insulin chart

1 6
2 8-10
4 12

Lispro or Humalog

RAPID, give WITH meals. 15,30,3

Lantus or Glargine

long acting
peakless
bedtime insulin

Hypoglycemia

DRUNK IN SHOCK
too much insulin
always top priority
SUGAR AND PROTEIN
skim milk is good answer
glucagon or D50 if unconscious

DKA

TYPE 1
acute viral URI is most common cause of DKA
D: dehydration
K: ketones, kussmaul's, high K
A: acetone breath, acidosis, anorexia
tx fluids and insulin IV

HNNK

TYPE 2
dehydration symptoms
rehydrate them

Diabetes complications

peripheral neuropathy
poor tissue perfusion
best indicator of sugar control: A1C

lithium

antimania
0.6-1.2
2

digoxin

afib and chf
1-2
2

aminophylline

relieves airway spasms
10-20
20

dilantin

seizures
10-20
20

bilirubin

10-20
20

hiatal hernia

regurg of acid into esophagus
upper portion of stomach herniated up into diaphragm
looks like GERD
high fowlers, high fluids, high carbs
HIatal HIgh

Dumping Syndrome

post op gastric surgery complication
stomach contents dump too quickly into duodenum
ADS
Acute abdominal distress, drunk, shock
low head of bed, low fluids (only between meals), low carb

Kalemias

same as prefix EXCEPT for heart rate and urine output
hyper: everything up, hr and uo down
hypo: everything down, hr and uo up

Calcemias

opposite of prefix
hyper: everything down
hypo: everything up, chvosteks and trousseaus

Magnesemias

opposite of prefix
hyper: down
hypo: up

electrolyte imbalances

in a tie: don't pick magnesiums. if symptom involves nerves or skeletals pick calcium for any other symptom pick potassium
early sign numbness and tingling
universal sign muscle weakness

Natremias

hypEr dEhydration
hypO Overload

Potassium Imbalance Tx

NEVER PUSH K IV
not more than 40 in IV bag
first way: D5W and insulin IV
KAYEXALATE: k exits late

Hyperthyroidism

Hypermetabolism
weight loss, heat intolerance, tachycardia, exopthalmus
Grave's disease
RADIOACTIVE IODINE: alone for 24 hours, flush 2-3 times after urine. foley leaks, call hazmat
PTU: puts thyroid under. immunosuppression, INFECTIONS

Thyroidectomy

total: lifelong hormone replacement, risk of hypocalc
subtotal: risk of thyroid storm...high temp/VS, delirium. self limiting. Ice packs and cooling blankets

post op risks: first 12 hours...AIRWAY AND HEMORRHAGE
after 12 but before 48, Tetany Total, Storm Sub

Hypothyroid

weight gain, cold intolerance, resp depression

myxedema: supplemental thyroid (synth) DO NOT SEDATE THESE PEOPLE, DO NOT HOLD PILL BEFORE SURGERY
surgical risks bc of anesthetics

Addison's Disease

undersecretion
hyperpigmented, DO NOT RESPOND TO STRESS, will go into shock
supplement with steroids
addisons you ADD A SONE

Cushing's

oversecretion
moon face, hairy, buffalo hump, striae, truncal obesity, gynecomastia, skinny arms and legs, retains fluid
HIGH GLUCOSE. bruise easily.
Im mad i have an infection
tx adrenalectomy, lifelong replacement

kids toys

safe, age appropriate, feasible
no small toys under 4
no metal (diecast) toys if O2 is in use
fomites: germs grow, plush toys. best is plastic cause can be cleaned easily

toys 0-6 m

musical mobile

toys 6-9 m

cover then uncover toys

toys 9-12 m

verbal toys

under 9 months? dont pick

build, stack, make, sort, construct

toddler toys

push pull toys
gross motor
parallel play

preschool 3-6

fine motor
balance
play with each other

school age 7-11

creative, collective, competitive
blank paper

adolescents

group associations, want to hang out with friends
only stop them if one has had surgery in last 12 hours, or one is immunosuppressed

creatinine

best indicator of kidney function
0.6-1.2
elevated A

INR

warfarin/coumadin therapy
2s and 3s is therapeutic range
greater than equal to 4 \= C!
hold, assess bleeding, prepare vit K, CALL

Potassium

3.5-5.3
less than 3.5 is C .. assess heart, prepare potass, notify
high BUT still in 5s is C ... hold, assess, prepare d5w and reg insulin, call
6 OR HIGHER IS A D! hold, assess heart, d5w reg insulin or kayexalate, DO ALL STAT

pH

7.35-7.45
any pH in the 6 is a D
assess vital signs, call doctor

BUN

8-30 ; (10-20)
elevated BUN is a B
watch for dehydration

Hgb

12-18
8-11 is B, assess bleeding
under 8 is C, assess bleeding, prepare blood, call

CO2

35-45
in 50s that's a C. assess resp status, pursed lipped breathing
60s IS A D! resp distress, prepare to intubate and ventilate, call resp first, then Dr

paO2

78-100
if low but still in 70s is a C,,, assess resp status, give o2, call doctor
60s and lower is D, resp failure, prepare to intubate, call resp and doctor

sa02

93-100
anything under 93 is C
assess resp status
give o2

BNP

indicator of congestive heart failure
want under 100

Sodium

change in LOC is a C

WBC Count

5,000-11,000
below is a C
absolute neutrophil, want above 500, below is a C
CD4... below 200 is aids, C

Platelets

below 90 is a C, bleeding precautions
below 40 is a D, admin platelets call doctor

5 D's

potassium
pH
pO2
pCO2
platelets