Rule of B's for ABGs
if the pH and the Bicarb are Both in the same direction it is metaBolic
normal pH
normal Bicarb
pH: 7.35-7.45
Bicarb:
... [Show More] 22-26
Kussmul respirations
MACkussmul= metabolic acidosis
S&S of acid-base imbalance
as the pH goes, so goes my patient except for potassium
UP: (alkolosis):decreased K+, highest risk for seizures
DOWN: (acidosis): increased K+, highest risk for respiratory arrest
causes of respiratory acid-base imbalance
lung=respiratory
overvent or undervent
overvent= alkolosis
undervent=acidosis
causes of metabolic acid-base imbalance
not lung=metabolic
prolonged gastric vomiting or suction=metabolic alkolosis (losing acid)
everything else=metabolic acidosis
high pressured ventilator alarms
triggered by increase resistance to air flow and can be caused by obstruction of three types:
kinked tube: unkink it
water in tube: empty it
mucus in airway: turn, cough, deep breathe
low pressured ventilator alarams
triggered by decreased resistance to air flow and can be caused by disconnections:
tubing: reconnect if not contaminate
if contaminated (below bed level): call first, then bag, reconnect
respiratory alkalosis vs acidosis
alkalosis: ventilator setting may be too high (overvent)
acidosis: ventilator setting may too low (undervent)
HOLD
high pressured alarms
obstruction
low pressured alarms
disconnection
Maslow
1. physiological
2. safety
3. comfort
4. psychological
5. social
6. spiritual
#1 problem in substance abuse
denial: refusal to accept the reality of their problem
treatment: confront it by pointing out to the person the difference between what they say and what they do.
however, in grief and loss support denial
dependency/codependency
dependency: when abuser gets SO to do things for them or make decisions for them
codependency: when the SO derives positive self-esteem from doing things for or making decisions for the abuser
treating dependency/codenpendency
set limits and enforce them. agree in advance what requests are allowed then enforce the agreement
work on the self-esteem of the codependent person
manipulation
when abuser gets the SO to do things for him/her that are no in the best interest of the SO. nature of the act is dangerous or harmful to SO
treatment of manipulation
set limits and enforce them
easier to treat than dependency/codependency because no body likes being manipulated
wenicke's korsakoff syndrome
psychosis caused by a lack of B1 (thiamine) deficiency
primary symptom: amnesia with confabulation
-preventable
-arrestable
-irreversible
antabuse/revia (disulfiram)
aversion therapy
onset/duration of effectiveness: 2 weeks
pt teaching: avoid all forms of alcohol to avoid nausea, vomiting, death
uppers
cocaine, caffeine, PCP/LSD, methamphedimines, ADHD meds (amphetimines), bath salts
S&S: increase everything, pupils dilate (mydriasis), seizures
downers
codeine, heroin, alcohol, marijuana
S&S: decrease everything, pupils constrict (miosis), respiratory arrest [Show Less]