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NCLEX Quick Review: MARK KLIMEK STUDY GUIDE. MARK KLIMEK STUDY GUIDE Acid Base As the ph goes the patient goes and except for potassium pH goes up potassium goes down pH goes down potassium ... goes up pH up(alkalosis)… Hyper, tachy, increased, elevated, exaggerated, increasing, excessive. Irritability, diarrhea, borborygmi= increased bowel sounds. pH down(acidosis)… hypo, decreased, scant, absent, a-, brady, depressed, suppressed, oligo, Pt has acidosis what heart rhythm would you see- second degreeheart block Tetany- muscle spasms, hyper muscles, hyper hyper contractility Cardiac arrest- slow down MAC-Kussmal Kussmal only occurs in Metabolic ACidosis Causes of acid base imbalances: Ask yourself is it Lung? If it does= respiratory Is the client overventilating or under?? If they are over---Alkalosis… If under—acidosis. Too much PCA pump what acid base can result… depress respirations, underventilation… respiratory ACIDOSIS. Near drowning—Respiratory acidosis Acute panic anxiety- Respiratory alkalosis If it isn’t lung its metabolic.If client has PROLONGED gastric vomiting or suctioning—METABOLIC ALKALOSIS For everything else that isn’t lung pic metabolic acidosis that doesn’t have to do with suctioning or vomiting Metabolic Acidosis if we don’t know what to pick! Respiratory rate is highly unreliable use your gases, lung sounds and saturation!!! VentilatorHigh pressure alarm= increased resistance to airflow. High pressure to push through so look for OBSTRUCTION!!! 3 obstructions, DO IN THIS ORDER!! Least invasive to most! 1- Kink. - UNKINK 2- Water condensing in tubing. GET WATER OUT 3- Mucous. Suction is not best answer… TURN COUGH AND DEEP BREATHE. If that doesn’t work SUCTION! Low pressure alarm! Due to DISCONNECTIONS! 1. Main tube disconnected- 2. Oxygen Sensor line! Plug back in. If tubing hits the floor call respiratory and start bagging!! If it falls on them then on the bed then clean off with alcohol and reconnect Respiratory Alkalosis- Over Ventilating Respiratory Acidosis- Under Ventilating DON’T ASK ANOTHER PEOPLE. DON’T USE CHICKEN QUESTIONS. TAKE CARE OF IT YOURSELF ETOH,Abuse,Overdose vs. Withdrawal, & Mycin In abuse** ―Maslow‖ Ranking 1. Physiologic needs 2. Safety needs 3. Comfort needs4. Psychological needs 5. Sociological needs 6. Spiritual needs Alcoholic with fractured foot which would be priority? His denials? His pain? His break*** Adequate pain control is number one for palliative care Psychodynamic- what’s their major malfunction? Abusers- greatest psychological priority is denial! Refusal to accept reality with problem. Confront denial in abusers! ―You say you aren’t an alcoholic but it’s 10 am and you’ve drank a fifth of whiskey and a 6 pack.‖ Denial during loss and grief: Don’t confront. You support and allow them to continue because it serves a purpose and function. Dependency=abuser gets significant other to make decisions for them or do things for them because they can spend their time drinking. Codependency=significant other derives positive self esteemfrom doing things for or making decisions for the abuser. So abuser says will you do this for me and the codependent does it and then says to themselves ―I’m a wonderful person because I do this for them and no one else would‖ Set limits for the abuser and enforce them. No you call your boss, etc. Work on self esteem of the codependent person. Abusers manipulate people to do stuff that is harmful to significant other. Dependency vs manipulate Dependency- not harmful husband buys wife alcohol Manipulative- harmful 17-year-old buys alcohol for momWernickes-Korsakoff - Psychosis induced by vitamin b1 deficiency –thiamine - Lose touch with reality because you lack the B vitamin - Amnesia with confabulation- memory loss with making up stories because you can’t remember. They don’t know they made it up that’s what makes them psychotic. The believetheir stories. - These people have dementia-break from reality due to brain damage - DON’T ARGUE WITH THEM, PLAY ALONG!! Characteristics!!! - Preventable by taking vitamin b1. Don’t have to stop drinking. - Megadose on B1 your blood alcohol will be lower. - Arrestable- you can keep it from getting worse by starting to take your b1 - Its irreversible because its brain damage. GOAL: For wernickes client memory- client will maintain current memory. DEMENTIA- NEVER IMPROVEMENT!! MAINTAIN! Antabuse/Disulfiram - Form of aversion therapy - If you take this and you drink alcohol, it makes you sick. - Onset and duration is 2 weeks. If you start taking it today it takes 2 weeks. If you stop today it takes 2 weeks to be able to drink again. - It’s any alcohol. Avoid all forms of alcohol like insect repellents, aftershave, perfumes, colognes, mouthwash, any OTC elixir (Dayquil, Nyquil, etc), vinaigrettes, vanilla extracts (uncooked vanilla icing), alcohol based hand sanitizer. Overdose/Withdrawal Principles: - Every abused is an upper or downer - Is it upper or downer?? Uppers: - Caffeine - Cocaine - PCP/LSD (psychedelic hallucinogens)- Amphetamines (METH) ―speed‖ - Bath salts - ADHD drugs Adderall and Ritalin These are all stimulants. Make things go up because they are uppers. You will see hyper, tachy, irritable, diarrhea, tremors, seizures. Downers: Everything else. Qualudes- downers Fentanyl Things go down WORST THING= respiratory distress You go opposite way drug does during withdrawal!!! You withdrawal from upper you go down. You withdrawal from downer you go up. Overdose on upper- tachycardia Overdose on lower- bradycardia Withdrawal from an upper- bradycardia Withdrawal from a downer- tachycardia Clonus- very jumpy reflexes ALWAYS ASSUME BABY IS INTOXICATED AND NOT WITHDRAWING at birth or in first 24 hours unless they tell you differently. Newborn after 24 hours they are in withdrawal. An infant at 10 min APGAR- intoxicated 3 days after birth- withdrawal Child born to alcohol addicted mom 48 hours after delivery- everything is up bc of withdrawal to downer. Every alcoholic goes through alcohol withdrawals 24 hours from last drink Delirium Tremens ―DT’s‖ 72 hours after last drink…. Not everyone goes through this. AWS is not life threateningDT’s can kill you. AWS is stable DT’s is not stable AWS is not danger to themselves and others DT’s are danger to self and others AWS: Up at lib Regular Diet Semi private room No restraints Antihypertensive B1vitamin Tranquilizer b/c of withdrawal stage – minor DT’s: Private, near nurse’s station NPO or Clear liquid Restricted Bedrest- no getting up to go to the bathroom urinal and bedpan Restrained, vest or leather restraints, two point leather restraints. Antihypertensive B1 vitamin Tranquilizer b/c withdrawal stage –major Aminoglycosides- powerful antibiotics ―A mean old mycin‖ Hard to treat infections: mRSA, TB, Septic Doesn’t treat UTI, bladder infection, sinusitis, pharyngitis Only antibiotic used to treat cancers ALL IN MYCIN!!!!!!! Not all drugs that end with -mycin are aminoglycosides. NOT AMINOGLYCOCIDES: EryTHROmycin AziTHROmycin ClariTHROmycin MEAN OLD MYCIN END IN MYCIN IF THEY HAVE THRO THROW THEM OFF THE LISTS. First toxicity with aminoglycosides- ototoxicity Monitor hearing Balance [Show More]

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