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Mark Klimek Blue Book 2 (Question and Answers, 100% Verified) Primary dietary prescription for calcium nephrolithiasis (kidney stones) ? PG. 85 Low calc... [Show More] ium diet For client with nephrolithiasis the diet should be ___ ash Acid If kidney stone is calcium phosphate the diet must be low in ___ too Phosphorus Primary diet tx for uric acid nephrolithiasis is __ ____ Low purine Client with uric acid nephrolithiasis should have a diet low in ____ Methionine What is methionine? Precursor of the amino acid cystine 2 foods high in methionine? Eggs, milk Clients with cystine nephrolithiasis should have an ____ ash diet Alkaline Inc. fluids over 3000 cc /day is more effective in treating renal calculi than ANY dietary modification, T/F? True. Want to flush tract than worry about diet What is the common name for Laryngotracheobronchitis - LTB Croup What is the typical temp elevation in croup? Low grade, usually below 102, but can go up to 104. Are ATBs helpful for croup? For epiglottits? For croup, no. Epiglottitis, yes Is croup viral or bacterial? Viral With which condition is croup most often confused? Epiglottitis Can croup be managed at home? Can epiglottitis be managed at home? Yes. No, epiglottitis is a 911 emergency Are sedatives used for kids with croup? No, bc this would mask the signs of respiratory distress What causes epiglottitis? A virus or bacteria? H. influenza BACTERIA What is the best tx for croup? Cool moist air What should never be done to a child with epiglottitis? Never put anything in the child's mouth, ie, a tongue blade can lead to obstruction What are the typical signs and symptoms of croup? Barking cough, inspiratory stridor, labored resp. pattern What 3 signs tell you that the child has epiglottitis instead of croup? Muffled voice, drooling, increased fever When is croup bad enough to be evaluated by a doc? When retractions, and high pitched stridor are present What lead level needs intervention? 50-60 micrograms/ dl With which class of drugs will a child with lead poisoning be treated? Chelating agents What do chelating drugs do? They increase the excretion of heavy metals The most freq. cause of lead poisoning is... Ingestion of lead-based paint chips Name 3 common chelating agents for lead poisoning EDTA, desferal, BAL in oil S&S of lead poisoning Drowsiness, clumsiness, ataxia, seizures, coma, resp. arrest Sx of lead poisoning show up in the ____ system Neuro Leukemia is cancer of the ___ forming tissues Blood The type of cell that is most common and problematic in leukemia is ____ Immature WBC In leukemia the RBC count is ... Low, bc the bone marrow is going "wild" producing all those immature WBC - no energy or nutrients to make platelets In leukemia, the platelet count is ... Low, bc the bone marrow is going "wild" producing all those immature WBC - no energy or nutrients to make platelets Bc the RBCs are low, the pt will exhibit ___ and ___ Pallor and fatigue Bc of the immature WBCs, the pt is at risk for ___ Infection Bc of low platelets, the pt is at risk for ___, ___, and ___ Bruising, ecchymosis, bleeding, petechiae What causes lymph gland enlargement in leukemia? All those small immature WBC clog the lymph system Should you take a rectal temp on a child with leukemia? No Should you take an oral temp on a child with leukemia? Yes, as long as they are over 4 years old, in remission, and have no sores in their mouth Should the child with active leukemia use straws, forks, cups? NO straws, NO forks, YES cups RN's priority in tx a child with newly diagnosed leukemia is... Dec. risk of infection When the leukemia child's platelets and WBC's are low, his activities should be ... Limited When the platelet and WBCs are low the nurse should not insert a.. Suppository Are IM injections and IV sticks permitted on a child with leukemia? When labs are low IMs avoided and IVs limited; only done when absolutely necessary (to give chemo or measure blood counts) Why are kids on chemo also on allopurinol To prevent uric acid kidney stones (remember when chemo kills cancer cells, purines and uric acid build up and could cause kidney stones Why do some kids with leukemia have joint pain? The immature WBCs infiltrate the joint and cause inflammation Why is a child with leukemia at risk for neuro sx due to ICP The immature WBCs infiltrate the brain and cause inflammation What is alopecia? Hair loss If the platelet count is low what drug should the child not take? Aspirin Is the alopecia from chemo permanent? No. It will grow back. (Alopecia of radiation therapy is permanent bc the follicle is destroyed) [Show Less]
Mark Klimek Blue Book Mark Klimek Blue Book Name the five/six essential nutrients - carbs, fats, proteins, vitamins, minerals, water The major source of... [Show More] energy for the body is - carbs carbs provide ____________ Kcalories per 1 gram - 4 Sucrose is a sugar found in ____________ and _____________. - fruits, veggies Lactose is a sugar found in ? - milk What is glycogen? - It is a stored formed of glucose/energy manufactured by the liver Is glycogen eaten in foods? - NO! It is a stored form of glucose MANUFACTURED by the liver. When the body does not receive enough carbs it burns ___________ and _____________. - protein, fat The most concentrated source of energy for the body is ___________. - fats Fats provide ___________ Kcalories per 1 gram. - 9 Fats carry vitamins - A,D,E,K (Remember FADE K!) The nutrient needed most for growth and repair of tissues is _____________. - protein (second best is Vit C) Proteins provide __________ Kcalories per 1 gram. - 4 Vitamins and minerals provide energy for the body. (T/F) - False- they are necessary for a body's chemical reactions. Water is present in ALL body tissues. (T/F) - True (even bone) Water accounts for ________ to ___________% of an adult's total weight? - 50 to 60% Name the four basic food groups - Milk & Cheese, Meat & Legumes, Veggies & Fruits, Bread & Cereal Water acounts for __________ to _________% of an infant's total weight? - 70 to 75% An individual is overweight if they are ________% above the ideal weight. - 10 An individual is obese if they weigh ________% above the ideal weight. - 20 What solution and material are used to cleanse the eyes of an infant? - Plain water, cotton balls, washcloths Can you use cotton swabs to clean the eyes, nares or ears of an infant? - No, this is dangerous Can you use the same cotton ball/washcloth edge for both eyes? - No, it would cross contaminate Should you cover an unhealed umbilical site with the diaper? - No, fold the diaper down. What temperature is appropriate for the water used to bathe an infant? - 100 to 105 What is the #1 purpose of a tepid sponge bath? - Lower body temperature during fever. How should the temperature of the water be tested if no thermometer is available? - Dropping water on inside surface of your forearm. With which body part do you begin when bathing an infant? - Eyes always When cleansing an infant's eye, cleanse from outer to inner canthus? - No, inner to outer Should you retract the foreskin of a 5 week old male, uncircumcised infant to cleanse the area? - No, not until foreskin retracts naturally and without resistance- then it should be retracted, cleansed and replaced. When sponge-bathing with tepid water the correct temp is _____________. - 98.6 F How long does it take for the umbilical stump to fall off? - 7 to 14 days The primary reason why an infant is draped during the bath is to provide privacy. (T/F) - False, the primary purpose of draping is to prevent chilling. You may use friction to remove vernix caseosa from an infant's skin. (T/F) - False, it causes damage/bruising What solution is commonly used for care of umbilical cord? - 70% alcohol to promote drying (trend is toward soap and water) What cranial nerve is affected in Bell's Palsy? - #7, facial nerve What is the #1 symptom of Bell's Palsy? - One sided (unilateral) facial paralysis Complete recovery from the paralysis of Bell's Palsy should occur in _______ to ______ months. - 4 to 6 In addition to the facial paralysis, the sense of ______ is also affected. - taste Will the patient be able to close their eye on the affected side? - no Give three eye interventions for the client with Bell's Palsy. - Dark glasses, artificial tears, cover eye at night As the prostate enlarges it compresses the ___________ and causes urinary ________. - Urethra, rentention At what age does BPH occur? - men over 50 years of age What does BPH stand for? - Benign Prostatic Hypertrophy IN BPH the man has (increased/decreased) frequency of urination - increased In BPH the force of the urinary stream is (increased/decreased). - decreased The man with BPH has a _________-stream of urine - forked The man with BPH has hesitancey. What does this mean? - Difficulty starting to void Will the man with BPH have enuresis, nocturia or hematuria? - Enuresis-No, Nocturia-Yes, and Hematuria-Maybe Enuresis - inability to control the flow of urine and involuntary urination What is the best way to screen men for BPH? - Digital rectal exam Should fluids be forced or restricted in BPH? - forced What does TURP stand for? - Transurethral resection of the prostate The most radical prostate surgery is the ____________ prostatectomy. - Perineal What type of diet is used in BPH? - Acid Ash Acid Ash diet - Decrease pH (makes urine acid) Chz, eggs, Meat, fish, oysters, poultry, Bread, Cereal, Whole Grains, Pastries, Cranberries, Prunes, Plums, Tomatoes, Peas, Corn, Legumes. What is the primary purpose of a 3 way continuous bladder irrigation (CBI) after TURP? - To keep the catheter clear of clots and to drain urine What solution is used for CBI? - Normal saline (0.9 NaCl) How fast do you run the CBI? - At whatever rate it takes to keep the urine flowing and free of clots What drug is use to treat bladder spasm? - B&O suppositories (Belladonna & Opiates) Should you take a rectal temp after prostatectomy? Give stool softeners? - No rectal temperatures, yes stool softeners You should call the MD after TURP when you see _________ thick ________, _____________ clots, and ____________ urine drainage on the dressing. - Bright thick blood, persistent clots, persistent urine on dressing (don't call MD for transitory clots and urine on dressing.) If you see an increase in blood content of urine coming out of the catheter, you would first ___________. - Pull carefully on the catheter to apply local pressure on the prostate with the Foley balloon. If you see clots in the tubing you would first ____________. - Increase the flow-rate [Show Less]
NCLEX Mark Klimek Blue Book Mark Klimek Blue Book 1. In Abruptio Placenta, the placenta ____________ from the uterine wall ____________. - Separates; pr... [Show More] ematurely 2. Abruptio Placenta usually occurs in (prima/multi) gravida over the age of ____________. - Multigravida, 35 (HTN, trauma, cocaine) 3. How is the bleeding of Abruptio Placenta different from that in Placenta Previa? - Usually painful; bleeding is more voluminous in placenta previa 4. If you are the nurse starting the IV on the client with Abruptia Placenta, what gauge needle should you use? - 18 (in preparation to give blood if necessary) 5. How often should you measure the VS, vaginal bleeding, fetal HR during Abruptio Placenta? - Q5-15 minutes for bleeding, - maternal VS and continuous fetal Monitoring Deliver baby at earliest sign of fetal distress 6. How is an infant delivered when Abruptio Placenta is present? - Usually C-section 7. Is there a higher or lower incidence of fetal death with Abruptio Placenta compared to Placenta Previa? - Higher 8. In what trimester does Abruptio Placenta most commonly occur? - Third 9. At what age are accidental poisonings most common? - 2 years old 10. If a child swallows a potentially poisonous substance, what should be done first? - Call for medical help 11. Should vomiting be induced after ingestion of gasoline? - No- not for gas or any other petroleum products 12. When taking a child to the ER after accidental poisoning has occurred what must accompany the child to the ER? - the suspected poison 1 13. An elderly client is a (high/low) risk for accidental poisoning? What about a school age child? - high - due to poor eyesight - high 14. What types of chemicals cause burns to oral mucosa when ingested? - Lye, caustic cleaners 15. Children at highest risk for seizure activity after ingestion are those who have swallowed _____________ and ______________. - drugs; insecticides 16. Can impaired skin integrity ever be an appropriate nursing diagnosis when poisoning has occurred? - Yes, when Lye or caustic agents have been ingested 17. What is the causative organism of acne? - P. acnes (propionibacterium acnes) 18. What structures are involved in acne vulgaris? - The sebaceous glands 19. Name 3 drugs given for acne? 1. Vitamin A 2. Antibiotics 3. Retinoids 20. Dietary indiscretions and uncleanliness are causes of acne? - False 21. What are the 3 causative factors in acne vulgaris? 1. Hereditary 2. Bacterial 3. Hormonal 22. Uncleanliness is a cause of acne? - False 23. What is the most common retinoid given to people with acne? - Accutane 24. Accutane is an analog of which vitamin? - Vitamin A 2 25. What is the most common side effect of accutane? And what is the most important in health teaching in administration? - Inflammation of the lips; - Causes birth defects 26. What is the antibiotic most commonly given to clients with acne? - Tetracycline 27. How long will it take for the person to see results when acne is being treated? - 4 to 6 weeks 28. Does stress make acne worse? - Yes 29. How often should the client with acne wash his face each day? - Twice a day 30. What instructions do you give to a client taking Tetracycline? - Take it on an empty stomach and avoid the sunlight (photosensitivity) 31. What are comedones? - Blackheads and white heads 32. What virus causes AIDS? - HIV (Human immunodeficiency virus) 33. The AIDS virus invades the helper ____________. - T-lymphocytes (or CD4 cells) 34. AIDS is transmissible through what four routes? 1. Blood 2. Sexual contact 3. Breast feeding 4. Across placenta in utero 35. HIV is present in all body fluids? - No; only through blood, semen and breast milk 36. Name the 5 risk groups for AIDS 1. Homosexual/bisexual men 2. IV drug users 3. Hemophiliacs 4. Heterosexual partners of infected people 5. Newborn children of infected women 3 37. What is the first test for HIV antibodies? - ELISA 38. What test confirms the ELISA? - Western Blot 39. Which test is the best indicator of the PROGRESS of HIV disease? - CD4 count 40. A CD4 count of under __________ is associated with the onset of AIDS-related symptoms [Show Less]
Mark Klimek Blue Book (Q& A, All Answers correct) If the pH and the BiCarb are both in the same direction then it is? Metabolic If the pH is up it is? ... [Show More] Alkalosis If the pH is down it is? Acidosis As the pH goes so goes my patient except for? Potassium If the pH is UP my patient will 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 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. Low pressure alarms are triggered when? It is too 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. What do you do if the patients disconnected tube is on the chest? Reconnect ... if its above the waist its ok. What is the biggest problem in abuse? Denial applicable to all forms of abuse To treat denial you need to? Confront 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 What is dependency? When the abuser gets a significant other to make decisions for them or do thing for them. the abuser is dependent 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. You also need to work or the self estreem 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. What is Wernickes (Korsakoffs) Syndrome? Psychosis induced by vitamin B1 (Thiamine) deficiency. Vitamin B1 helps breakdown? Alcohol Primary symptom of Wernickes? Amnesia with confabulation (making up stories). Is Wernickes preventable? Yes Is Wernickes arrestable? Yes Is Wernickes reversible? No 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? Elixirs, Vanilla Extract, Aftershave/Perfumes, Alcohol based hand sanitizer, Insect repellant, Mouthwash and Vinagerette. What are the five uppers? Caffeine, Cocaine, Methamphetamines, PCP/LSD and ADHD Meds Downers are? Everything other then the five uppers. S/S of upper use? Everything goes up...Tachycardia, increased BP etc. S/S of downer use? Everything goes down...Bradycardia, decreased BP etc. 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 At birth if the mother was addicted to a substance always assume the newborn is in? Intoxication If 24 hours after birth assume the baby is in? [Show Less]
Mark Klimek - Acid/Base & Electrolytes Mark Klimek - Acid/Base & Electrolytes Normal pH 7.35-7.45 Normal Bicarb 22-26 Normal CO2 35-45 Metabolic Ac... [Show More] idosis - causes DKA, diarrhea, renal failure, shock Metabolic Alkalosis - causes Vomiting, GI suction, antacids Metabolic Acidosis S/Sx bradycardia, constipation, dyspnea, lethargy, obtundant, respiratory arrest Patient is going down Metabolic Alkalosis S/Sx Tachycardia, tachypnea, borborygmus, increased BP, seizures Patient goes up If the patient is over-ventilated then? [Show Less]
NUR NURS 123 Mark Klimek- Yellow Book At Columbus State Community College - StudyBlue Rule of the B's: If the ____ and the _____ are ______ in the same ... [Show More] direction then it is meta_____ pH, Bicarb, Both, Bolic pH 7.30_______ HCO3 20_______ ↓= acidosis; ↓= metabolic pH 7.58_______ HCO3 32_______ ↑= alkalosis; ↑= metabolic pH 7.22_______ HCO3 30_______ ↓= acidosis; ↑= respiratory MacKussmaul The only acid base to cause Kussmaul respirations is Metabolic ACidosis Compensation only _______ the pH Changes pH 7.42 _______ HCO3 19 _______ ↑= compensated alkalosis ↓= respiratory pH 7.43 _______ HCO3 34 _______ ↑= compensated alkalosis ↑= metabolic pH 7.39 _______ HCO3 25 _______ CO2 61 _______ Norm., norm., ↑ = CO2 problem not acid-base problem As the _______ goes, so goes _______ except for _______ _______ pH, my patient, Potassium pH is Up Alkalosis, Hypokalemia, HTN, Tachycardia, Tachypnea, Seizures, Irritability, Spastic, Diarrhea, Borborygme, Hyperreflexia, etc Tachy, hyper, elevated, irritable, peaking, increase, spastic, rise pH is Down Acidosis, Hyperkalemia, htn, Bradycardia, Constipation, Absent bowel sounds, Flacid, Bradypnea Brady, hypo, lethargic, decrease, few, scant, suppressed Causes of acid-base imbalances: First ask yourself, "Is it _______?" If yes, then it's _______. Then ask yourself: "Are they _______ or ______?" If _______, pick _______. If _______, pick _______ lung, respiratory, overventilating, underventilating, overventilating, alkalosis, underventilating, acidosis [Show Less]
Mark Klimek Audio Lecture 6 Electrolytes 100% complete RULE: POTASSIUM IMBALANCES DO THE SAME AS THE PREFIX, EXCEPT FOR HEART RATE & URINE OUTPUT!! br... [Show More] ain:irritability, restlessness, agitation lungs: tachypnea heart: low heart rate – bradycardia urine: oliguria bowel: diarhhea, borborygmi muscles: spasticity; increased tone reflexes: 3+ or 4+ - hyperreflexia *K rarely affects CNS and seizures doesn’t occur. K greatly affects Cardiovascular and NeuroMuscular systems [Show Less]
Mark Klimek Audio Lectures: Lecture 3 Cardiac Medications, Cardiac rhythms, Chest tubes, Newborn Heart Defects, Isolation Precautions: - It takes 3 things ... [Show More] to pass the NCLEX exam - Knowledge - Confidence - Exam Proficiency 100% [Show Less]
Mark Klimek Lectures 1 to 12: The Guide.Latest (100% Best,Graded A) Mark Klimek Lectures 1 to 12: The Guide.Latest (Best,Graded A) Guide.Lecture 1— Acid... [Show More] -Base Balance Ventilators Lecture 2— Alcohol Wernicke Overdose and Withdrawa l S/Sx Aminoglycosides Peak and Trough Lecture 3— Drug Toxicities (Lithium, Lanoxin, Dilantin, Bilirubin, Aminophylline) Kernicterus Dumping/HH Electrolytes: K+, CA, MG, and NA TX for HyperKalemia Lecture 4— Crutches Canes Walkers Delusions Hallucinations Psychosis Psychotic and Non-Psychotic Hallucination Illusion Delusion Lecture 5— Diabetes Mellitus Diabetes Insipidus SIADH Insulin DKA HHNK Lecture 6— Drug Toxicities (Lithium, Lanoxin, Dilantin, Bilirubin, Aminophylline) Kernicterus Dumping/HH Electrolytes: K+, CA, MG, and NA TX for HyperKalemia Lecture 7— Thyroid (Hyper-, Hypo-) Adrenal Cortex (Addison Disease, Cushing) Toys Laminectomy Lecture 8— Lab Values Five Deadly Ds Neutropenic Precaution Lecture 9— Psych Drugs Tri Benzo MAOI Lithium Prozac Haldol Clozaril Zoloft Lecture 10— Maternity and Neonatology Lecture 11— Fetal Complications Stages of Labor Assessments Variations for NB Maternity Meds Medication Hints Psych Tips Operational Stages Lecture 12— Prioritization Delegation Staff Management Guessing Strategies [Show Less]
Mark Klimek revised notes Version 1 ACID BASE BALANCE RULE OF THE B’S 1. If the pH and the Bicarb are in the same direction METABOLIC 2. If the p... [Show More] H and the Bicarb are in different directions RESPIRATORY Examples: pH 7.25 (v) HCO3 20 (v) Metabolic Acidosis pH 7.21 (v) HCO3 38 (^) Respiratory Acidosis pH 7.50 (^) HCO3 30 (^) Metabolic Alkalosis pH 7.50 (^) HCO3 25 (normal) Respiratory Alkalosis (NORMAL) SIGNS & SYMPTOMS Know the principles, not the lists. PRINCIPLE: “As the pH goes, so does my patient, except for potassium” ALKALOSIS (^) ACIDOSIS (v) Hyperreflexia Headache Irritability Hyporeflexia Tachypnea Bradycardia Tachycardia Bradypnea Borborygmi Paralytic/adynamic ileus Seizures *need suction Coma Hypokalemia Respiratory arrest *need ambu bag HYPOkalemia MACkussmau’s (ONLY METABOLIC ACIDOSIS “MAC”) Heart block HYPERkalmia CAUSES OF IMBALANCES OVER-VENTILATING UNDER-VENTILATING RESPIRATORY ALKALOSIS RESPIRATORY ACIDOSIS Examples: - Pregnant woman hyperventilating. - Ventilator setting is TOO HIGH. Examples: - Emphysema - Drowning - Pneumonia - PCA pump (toxicity) - Ventilator setting is TOO LOW. PROLONGED SUCTIONING OR VOMITING ANYTHING ELSE! METABOLIC Alkalosis METABOLIC Acidosis Examples: - Surgery with NG tube suction for 3 days - Hyperemesis gravidum Examples: - Acute RF - Infantile diarrhea - 3 rd degree burns over 60% of body - Hyperemesis gravidum with dehydration NOTE: Always pay attention to MODIFYING PHRASE rather than original statement. . 1. Is it a LUNG SCENARIO? YES. It is RESPIRATORY. 2. What if it is NOT A LUNG SCENARIO? It is METABOLIC VENTILATORS AND ALARMS HIGH PRESSURE ALARM Ventilator is working too hard to get air into lungs. There is INCREASED RESISTANCE due to OBSTRUCTIONS. 1. Kinks unkink 2. Water condensing into dependent loops empty 3. Mucus in airway turn, cough and deep breathe, suction PRN. LOW PRESSURE ALARM Ventilator finds that it is working too easy to get air into lungs. There is DECREASED RESISTANCE due to DISCONNECTIONS. 1. Main tubing is disconnected reconnect 2. Oxygen sensor tubing, which senses FiO2, is disconnected. This is the black coated wire reconnect Question MD orders to disconnect ventilator in AM @ 0900hr. At 0600hr, ABC reveals respiratory acidosis. What do you do? a. Follow order b. Call MD and hold order c. Call RT d. Begin to decrease settings. B is the answer because the patient is not able to breathe without the ventilator. The settings are TOO low. Patient should be in respiratory ALKALOSIS. ALCOHOLISM #1 PROBLEM: DENIAL Psychological problem in abuse is denial, which is refusal to accept the reality of a problem. Denial is the #1 problem in all abuse situations. It is #1 because how can you treat someone who can’t admit that they have a problem? You treat denial by confronting it by pointing out the difference between what they say and what they do. Confrontation attacks the problem. Aggression attacks the person. You say you’re not an alcohol, but it’s 10AM and you already drank a 6-pack. You say you’re not a spouse abuser, but she has a restraining order against you. They deny, you confront. Denial of loss + grief is different. Stages of Grief: DABDA: Denial, anger, bargaining, depression, and acceptance You want to support this type of denial. Guy lost one hand and wants to play piano. You do not tell him he can’t. You ask him more about piano. Pay attention to the question, is it loss or abuse? With loss you support. With abuse you confront. #2 PROBLEM: DEPENDENCY VERSUS CODEPENDENCY Dependency: Abuser gets significant other to do things for them. The abuser is dependent on others. Call in sick for me. Go buy me this. Drop me off here. Codependency: Significant other derives positive self-esteem from making decisions for or doing things for the abuser. Aren’t I such a great wife for calling in sick for you? Abuser: Life without responsibility Significant Other: Positive self esteem Treatment: Set limits and enforce them. Teach significant other to say NO. Work on self-esteem of the codependent person to solve the issue. o I’m saying no and I’m a good person because I’m saying no. May solve the problem but may lose relationship. #3 PROBLEM: MANIPULATION [Show Less]
Mark Klimek Lecture Notes LECTURE 1: Acid Base Balance & Ventilator Interpreting blood gases (remember the rules of the B’s) • If the pH and the b... [Show More] icarb are both in the same direction then it’s metaBolic (Bicarb Both Bolic), if they are in different directions then it is respiratory • If bicarb is normal and the pH is low or high then its respiratory • You will be given 8 values for arterial blood gas, always first look at the pH and the bicarb first • You get acidosis and alkalosis from the pH LABS: ABG’s The normal pH is 7.35-7.45 The normal bicarb is 22-26 (the bicarb years where you make all the decisions [22-26 years old], or 2+2+2=6) The normal CO2 is 35-45 (same as pH) Signs and Symptoms with ABG’s • As the pH goes up so does my patient o If the pH goes up, every system in your body gets more irritable/hyperexcitable • As the pH goes down so does my patient o If the pH goes down, systems in your body shut down • Except for potassium- When pH goes down, potassium goes up • If the pH goes up (alkalosis): you will find irritability, hyperreflexia (3&4), tachypnea, tachycardia, borborygmi (increased bowel sounds), seizure (need suctioning at the bed side because they can seize and aspirate) • If pH goes down (acidosis): hyporeflexia, bradycardia, lethargy, obtunded, paralytic ileus, coma, respiratory arrest (need bag-mask ventilation bag at bedside for respiratory arrest), +1 reflexes • MACkussmal- compensatory and respiratory pattern for only acid base disorder: MAC- Metabolic ACidosis Respiratory Acidosis multiple choice example: What would you see with a patient who is in respiratory acidosis? a. +1 reflex, b. diarrhea, c. adynamic ileus (no movement), d. spasm, e. urinary retention, f. paraxysmol atrial tachycardia, g. second degree lovitz, type 2 heart block (impulse is being slowed), h. hypokalemia LAB: REFLEXES 0&1-hyporeflexia 2-normal 3&4- hyperreflexia EXAMPLE: (In general what do pain meds do? ANSWER: They sedate you, they are CNS depressants: lethargy, lucidity, reflexes at +1, hyporeflexia, obtundent Causes of Acid Base Imbalance • Don’t get signs and symptoms mixed up with causation!!! • What causes something is the opposite of what the signs and symptoms are o EXAMPLE: diarrhea will cause a metabolic acidosis but once you get acidotic, it will shut your bowels down and you will get a paralytic ileus. • The first question you should ask yourself if the scenario involves a lung problem. o Is it a respiratory problem? BUT remember it can still be respiratory acidosis/alkalosis… • Next question you ask yourself… o is the client overventilating or underventilating? o If the patient is overventilating pick alkalosis o If they are underventilating pick acidosis • If the client is overventilating.. it has an attachment to the word- alkalosis (because they are both OVER)… ventilating OVER becomes respiratory ALKALOSIS • If the client is undeventilating.. it has an attachment to the word- acidosis (because they are both UNDER)- ventilating UNDER becomes respiratory ACIDOSIS Examples: 1) A woman is overzealously using her breathing techniques during labor, what acid base disorder will she exhibit? Overventilation o Respiratory Alkalosis 2) A child is near drowning, what acid base disorder would it be? Underventilating o Respiratory Acidosis 3) Your patient has emphysema, what acid base disorder would it be? Underventilating [Show Less]
KEEP CALM and PASS NCLEX with MARK KLIMEK Review. Comprehensive Information and content for revisions and last minute EXAM READING Acid-base balance/venti... [Show More] lators Rule of the B’s.. If the pH & the bicarb are both in the same direction = metabolic If they are in different directions = respiratory pH = 7.35-7.45 acidosis/alkalosis HCO3 (bicarb) = 22-26 (2+2+2 = 6) CO2 = 45-35 ex: pH: 7.30 = ↓ bicarb: 20 = ↓ = metabolic acidosis ex: pH: 7.58 =↑ bicarb: 32 = ↑ = metabolic alkalosis ex: pH: 7.22 =↓ bicarb: 30 =↑ = respiratory acidosis ex: You are providing care to a client with the following blood gas results: pH 7.32, CO2 49, HCO3 29, PO2 80 & SaO2 90%. Based on the results, the client is experiencing: ↓ = acidosis, ↑ = respiratory -opioid: CNS depressant.. know the symptoms (sedation, respiratory depression, etc).. *principle: acid base signs/symptoms.. as the pH goes… so goes my patient!!! -when pH goes up; patient goes up.. (everything gets irritable!) -when pH goes down; patient goes down! (systems in your body shut down) …except with potassium: when pH goes up; potassium goes down… when pH goes down; potassium goes up! (up) alkalosis: irritibility, hyper-reflexia (3 & 4), tachypnea, tachycardia, borborygmi (increased bowel sounds), seizure, aspirate.. (down) acidosis: hypo-reflexia, bradycardia, lethergy (obtunded), paralytic ileus (decreased bowel sounds), coma, respiratory arrest (ambu-bag!!) Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure… MAC Kussmaul!! M: metabolic AC: acidosis ex: pT has respiratory acidosis… (select all that apply).. +1 reflexes diarhhea adynamic ileus spasm urinary retention tachycardia 2nd degree mobits type 2 heart block hypokalemia SATA questions: *never only 1… never all of them* diarhhea will cause a metabolic acidosis.. but once you get acidodic, it will shut your bowels down = paralytic ileus …with scenarios.. always ask first “is it lung?” = respiratory …then ask if the pt is over-ventilating or under-ventilating? over-ventilating = alkalosis under-ventilating = acidosis …it’s about the SaO2!!! (pay attention!!) if it isn’t lung = metabolic.. if pt has prolonged gastric vomiting or suctioning… it’s always metabolic alkalosis… why? losing acid = becomes basic.. for everything else that is not lung - choose metabolic acidosis.. -if you don’t know the answer… always answer metabolic acidosis.. ventilators alarms.. high pressure alarm… triggered by increasure resistance to air flow.. (machine is pushing too hard to get air into the lungs).. respiratory alkalosis 3 obstructions: kink in tubing (get kink out), water condensing within the tube (empty tube), mucus secretions in the airway (turn, cough, deep breathe… then suction).. suction as needed!! *in that order*… low pressure alarm.. decreased resistance (too easy for the machine..) respiratory acidosis Low pressure alarms are triggered by decreased resistance to airflow & can be caused by disconnections of the main tubing or oxygen sensor tubing… Tubing (reconnect it!) - oxygen sensor tube (reconnect it UNLESS tube is on t the floor - bag them & call Respiratory therapist if this happens) Respiratory alkalosis = ventilator setting may be too high. Respiratory acidosis = ventilator setting may be too low. What does “wean” mean? gradually decrease with the goal of getting off altogether ex: Doc says wean off vent in AM… 6am ABG’s show resp. acidosis… a) follow order b) call respiratory c) hold order.. call doc d) begin to decrease the settings MASLOW’s Priorities (HIGHest - LOWest) physiological safety comfort psychological (problems within the person) social (problems with other people) spiritual ex: Arrange from HIGHest - LOWest… denial, spiritual distress, pain in elbow, fall risk, pathological family dynamics & electrolyte imbalance… = electrolyte imbalance (psyiological), fall risk (safety), pain in elbow (comfort), denial (psychological), pathological family dynamics (social) & spiritual distress (spiritual) 2. alcoholism.. (or any abuse) #1 problem = denial *refusal to accept the reality of a problem* You treat denial by confronting it… pronouns ~ good: i… bad: you… positions ~ good: i’m having a difficult time reading this… bad: you wrote it wrong.. loss & grief: Denial Anger Bargining Depression Acceptance don’t confront it; support it.. ex: You have a pt that just hand a hand amputated & they say, “I can’t wait to get back to playing the piano”… You say “Oh, how long have you played, etc? - you NEVER say “You can’t because you only have 1 hand” abuse = confront loss = support #2 problem = dependency *when the abuser get the significant other to do something.. “Call my boss, i’m sick”* (abuser gets to keep abusing..) = co-dependency *calls the boss*… (positive self esteem) How to treat this?!? Set limits and enforce them… Learn to say NO! manipulation = when the abuser gets the significant other to do things for him or her… the nature of the act is dangerous or harmful how is it like dependency? the abuser is getting the other person to do something no harm = dependent / co-dependent (wife buying alcohol for husband) dangerous/harmful = manipulated (kid buying alcohol for father) …depends on legal/illegal…………. Wernicke-Korsakoff Syndrome (WKS) is a neurological disorder. Wernicke's Encephalopathy and Korsakoff's Psychosis are the acute and chronic phases, respectively, of the same disease. WKS is caused by a deficiency in the B1 vitamin thiamine. Thiamine (B1) plays a role in metabolizing glucose to produce energy for the brain. primary symptom of WKS = amnesia with confabulation (making up stories) *they believe the lie..* ex: You have a pt who believes he is Ronald Regan’s Natioal Security Officer… And they want to go to a cabinet meeting… :/ WHAT DO YOU DO?!? Redirect!! (“well, why don’t you get a shower and then we’ll go watch CNN and see what the news is in Washington D.C.”) WKS is… -It’s preventable & arrestable (stop it from getting worse) - Take vitamin B1 -Irreversible… *About 70%* [Show Less]
Mark Klimek Audio Tapes 1-12 ACID BASE BALANCE 1. Rule of B’s a. If the pH and the Bicarb are Both in the same direction, then it is metabolic 2. S... [Show More] igns and Symptoms a. As the pH goes, so goes my patient, except for potassium i. as pH goes up, systems gets irritable ii. as pH goes down, systems shut down 1. UP pH (Alkalosis) a. HTN b. Tachycardia c. Tachypnea d. Seizures e. Irritability f. Spastic g. Diarrhea h. Borborygme i. Hyperreflexia, (3,4) j. Hypokalemia 2. DOWN pH (Acidosis) a. Hypotension b. Bradycardia c. Constipation d. Absent bowel sounds e. Flaccid f. Bradypnea g. Hyperkalemia h. Lethargy i. Obtunded (one step down from lethargy) j. Paralytic ileus k. Coma l. Respiratory arrest b. MacKussmaul i. The only acid base to cause Kussmaul respirations is Metabolic Acidosis 3. Causes a. First ask yourself, “Is it lung?” If yes, then it’s respiratory. Then ask yourself: “Are they overventilating or underventilating. If overventilating, pick alkalosis. If underventilating, pick acidosis. b. If it is not lung, then it is metabolic. If the patient has prolonged gastric vomiting or suction, pick alkalosis. For everything else that isn’t lung, pick metabolic acidosis. When you don’t know what to pick, choose metabolic acidosis. VENTILATORS 1. High pressure alarms are triggered by increased resistance to air flow. 2. High pressure alarms are triggered by resistance to airflow and can be caused by obstructions of 3 types: kinked tube, (unkink) action, water in tube (empty) action, mucus in airway (turn, cough and deep breathe) action. Lastly suction 3. Low pressure alarms are triggered by decrease resistance to airflow and can be caused by disconnections of the tubing (reconnect it) or oxygen sensor tube (reconnect it UNLESS tube is on the floor- bag them and call RT if this happens) (black coated wirey tubing that piggy backs the tubing, measure FiO2) 4. Respiratory alkalosis means the ventilator settings may be too high. 5. Respiratory acidosis means the ventilator settings may be too low. 6. What does “wean” mean? Gradually decrease with the goal of getting off altogether Mark Klimek Audio Tape 2 [Show Less]
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