Mark Klimek NCLEX Review WITH VERIFIED SOLUTIONS

Concept: • ABGs (identifying & cause) ••••••••••••••••••••••••••••••••••••••••••••••••••••• Rule of the B's: If the ____ and the _____ are ______ in the same direction then it is meta_____ pH, Bicarb, Both, Bolic Compensated v.s. Partially Compensated COMPENSATED: pH will be within the normal range (body has corrected the problem) PARTIALLY COMPENSATED: pH is not normal. Look at the system that is supposed to fix the problem (if you have a respiratory problem, the metabolic system will try to compensate and vice versa) and see if it is abnormal, which means it is trying to compensate • If YES, then you have PARTIAL compensation • If NO, then you have UNCOMPENSATION As the _______ goes, so goes _______ except for _______ pH, my patient, potassium Up (alkalosis) Hyperkalemia, Hypertension, Tachycardia, Tachypnea, Diarrhea, Seizures, Irritability, Spastic, Tentany, Borborygme, Hyperreflexia, etc. Down (acid) Hyperkalemia, Hypotension, Bradycardia, Bradypnea, Constipation, Coma, - Arrest, Lethargic, Absent bowel sounds, Flacid, etc. MAC Kussmaul The only acid base to cause Kussmaul respirations is Metabolic ACidosis (Note: does not follow rule as it is not a symptom but a compensation mechanism.) 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 or underventilating overventilating = alkalosis underventilating = acidosis (Note: generally respiration rate does not correlate to ventilation but SaO2 DOES.) Causes of acid-base imbalances: If it's not lung, then it's _______. If the patient has _______ _______ vomiting or suction, pick _______. For everything else that isn't lung, pick _______ _______. When you don't know what to pick, choose ______ ______. not lungs = metabolic prolonged gastric vomiting or suction = alkalosis metabolic acidosis metabolic acidosis Ventilator Alarms - HIGH pressure: Triggered by _______ resistance to air flow. Caused obstructions of three types: 1. _______ [action] 2. _______ [action] 3. _______ [action] increased 1. kinked tube [unkink] 2. water in tube [empty] 3. mucus in airway [cough + deep breathe] Ventilator Alarms - LOW pressure: Triggered by _______ resistance to air flow. Caused by disconnections: 1. _______ [action] 2. _______ [action] decreased 1. tubing [reconnect it] 2. oxygen sensor tube [reconnect, UNLESS tube is on the floor or below bed then bag them & call RT] Respiratory alkalosis means ventilator settings may be too _______. Respiratory acidosis means ventilator settings may be too _______. high low (Remember!!! respiratory alkalosis = overventilation; respiratory acidosis = underventilation.)