Recording 1:
1. Knowledge
2. Confidence
3. Skill- exam proficiency
“You can apply what you don’t know, you have to apply what you do
... [Show More] know.”
Have to achieve a little less than average on this test to pass.
Boards does not test your knowledge of lists, it tests your knowledge of principles.
Acid/Base Balance:
Lab values convert to words
ROME
If the pH and the bicarb are both in the same direction = metabolic
If they are in different directions = respiratory
pH= acidoic and alkalosis (7.35-7.45)
Bicarb (HCO3)= 22-26 (2+2+2=6)
Up and normal is not the same direction so it would still be respiratory
Principle: As the pH goes, so does my patient (when pH goes up, patient goes
up & when pH goes down, patient gowns down) EXCEPT for potassium
o Alkalosis- irritability, hyper-reflexes (3,4), tachypnea, tachycardia,
borborygmi ileus (increased bowel sounds)
o Acidosis- hyporeflexia, bradycardia, lethargy, obtunded, paralytic ileus, coma
What acid base imbalance patient needs an ambu bag at the bedside? Acidosisrespiratory distress
What acid base imbalance patient needs suction at the bedside? Alkalosis- bc they
could seize and aspirate
Kussmual respirations- Mac Kussmual = metabolic acidosis
Adynamic= without movement
Causes of acid/base imbalance:
What causes something is the opposite of what the signs and symptoms are.
Is it Lung? – Respiratory problem
Is the patient over ventilating (alkalosis) or under ventilating (acidosis)?
o Vent= respiratory
o Over= alkalosis
o Under= acidosis
Ventilation= gas exchange (SaO2) NOT respiratory rate.
If it is NOT LUNG= metabolic
Metabolic alkalosis= prolonged gastric vomiting or suctioning (only things that
are metabolic alkalosis) b/c you are loosing acid
For everything else, that isn’t lung or vomiting/suctioning pick metabolic
acidosis.
IF YOU DON’T KNOW WHAT IT IS METABOLC ACIDOSIS
VENTILATORS:
Alarms
o High pressure- triggered by increased resistance to airflow (machine is
having to push to hard to get hair into the lungs).
Obstructions: (click & drag)
Kinks in tubing unkink the tubing
Water condensation empty the water
Mucous secretions in airway turn/cough/deep breath, then
suction (ONLY SUCTION AS NEEDED)
o Low pressure- triggered by decreased resistance to airflow (machine is
saying “that was too easy”
Disconnections:
Disconnection of main tubing reconnect
Oxygen sensor tubing plug sensor back in
HOLD
Respiratory Alkalosis- over ventilating ventilator setting may be too high
Respiratory Acidosis- under ventilating ventilator settings are too low
Recording 2:
ALCOHOLISM
Psychodynamics:
Number one problem in abuse is DENIAL
o You can use the alcohol rule in any abuse
o Number one bc you cant treat someone that denies they have a problem
o Denial- refusal to accept reality of a problem
o You treat denial by CONFRONTING it- difference between what they say and
what they do (“you say you aren’t an alcoholic but you already drank a 6
pack and its 10 o clock in the morning”)
o Aggression attacks the person, confrontation attacks the problem
ON BOARDS NEVER ATTACK PERSON
o When confronting an issue with staff:
Good answer = “I”
Bad answer= “you”
Ex: NOT-“you wrote the order incorrectly” instead, “I am having a
difficult time interpreting what you want”
DABDA- denial, anger, bargaining, depression, acceptance (stages of grief
o Denial is healthy and normal in loss and grief
o You don’t confront in this situation you support it
When you get a question about denial you have to determine if it is loss or abuse
o Abuse- CONFRONT
o Loss- SUPPORT
Number two problem in abuse:
o Dependency- when abuser makes significant other do things for them or
make decisions for them
Ex: “would you call my boss”
Abuser= dependent
o Codependency- when significant other derives positive self esteem from
making decisions for the abuser
Ex: “Aren’t I such a good spouse because I did that, cause I don’t know
anyone else that would do it for that jerk”
o How to treat it?
SET LIMITS AND ENFORCE THEM say “NO” to those things that you
are feeding into
Work on the self esteem for the codependent person “I’m saying no,
and I’m a good person because I’m saying NO”
MANIPULATION: when abuser gets significant other to do things for him/her when it
is not in the best interest of the significant other
o Nature of the act is dangerous or harmful
o Different from dependency:
If what significant other is asked to do is neutral =
dependency/codependency
Ex: 49 year old alcoholic asks 50 year old husband to go buy
alcohol (not harmful for 50 year old man to go buy alcohol)
If what significant other is asked to do is harmful = manipulation
Ex: 49 year old alcoholic gets 17 year old daughter to go buy
alcohol (dangerous b/c its illegal for 17 year old to buy alcohol)
o How to treat?
SET LIMITS AND ENFORCE THEM
Its easier to treat b/c no one likes to be manipulated and there is no
self esteem issue
Alcoholism Terms:
Wernicke’s- encephalopathy
Korsakoffs- psychosis
Wernicke-Korsakoff- number one psychosis induced by vitamin B1 or thiamine
deficiency (loose touch with reality, go insane, b/c you have a deficiency in B1)
o Symptoms- amnesia (memory loss) with confabulation (making up stories)
o REDIRECT- takes what he can’t do and rechannel to something he can do.
Ex: If he says he wants to go to Obama’s cabinet meeting you
redirect by saying “why don’t you take a shower and we will watch
CNN to see what’s going on at the white house today.”
DON’T PRESENT REALITY- they cant learn reality
o Characteristics:
Preventable- take vitamin B1
Stop it from getting worse by taking B1
Irreversible
Drugs used to treat alcoholism:
Antabuse (Disulfiram)
o Aversion therapy- develop a hatred for alcohol
o Creates an unpleasant reaction to alcohol
o Onset & duration- 2 weeks
o Patient teaching- avoid all forms of alcohol including mouthwash, aftershave,
perfume & cologne, insect repellents, any OC that ends in –elixir, alcohol
based hand sanitizers, uncooked icings (vanilla extract), red wine vinaigrette
Overdose/Withdrawal:
Every ABUSED drug is either an upper or a downer
o First question- upper or a downer?
Uppers- caffeine, cocaine, PCP/LSD (hallucinogens),
methamphetamines (crystal meth), Adderall
Signs and symptoms- things go “up” euphoria, tachycardia,
restlessness, irritability, diarrhea, borborygmi bowels, 3-4
reflexes, seizure (suction @ bedside)
Downers- everything that isn’t upper is a downer
Signs and symptoms- things go “down” lethargic, respiratory
arrest (ambu bag @ bedside)
o Second Question- overdose or withdrawal?
Overdose/intoxication- too much
Withdrawal- not enough
If you don’t have enough upper makes everything go down
If you don’t have enough downer makes everything go up
UPPER OVERDOSE LOOKS LIKE DOWNER WITHDRAWL
DOWNER OVERDOSE LOOKS LIKE UPPER WITHDRAWL
Respiratory arrest/depression- downer overdose & upper withdrawal
Seizure- upper overdose, downer withdrawal
Number one most abused class of drug that is not an upper or downer LAXATIVES
in elderly
Drug Addiction in Newborn:
ALWAYS assume intoxication NOT withdrawal at birth
After 24 hours assume withdrawal [Show Less]