NURSE-GN 1301 Mark-klimek-lectures-1-to-12 GUIDE • Mark Klimek’s Lecture

NURSE-GN 1301 Lecture 5— Diabetes
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Mark-klimek-lectures- Diabetes Insipidus
SIADH
1-to-12 Insulin
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GUIDE • Mark Klimek’s Lecture HHNK


Lecture 1— Acid-Base
Balance Lecture 6— Drug Toxicities (Lithium,
Ventilators Lanoxin, Dilantin,
Bilirubin,
Lecture 2— Alcohol Aminophylline)
Wernicke Kernicterus
Overdose and Withdrawal
S/Sx
Aminoglycosides
Peak and Trough
Dumping/HH
Lecture 3— Drug Toxicities (Lithium, Electrolytes: K+, CA, MG,
Lanoxin, Dilantin, and NA
Bilirubin, TX for HyperKalemia
Aminophylline)
Kernicterus Lecture 7— Thyroid (Hyper-, Hypo-)
Dumping/HH Adrenal Cortex (Addison
Electrolytes: K+, CA, MG, Disease, Cushing)
and NA Toys
TX for HyperKalemia Laminectomy

Lecture 4— Crutches Lecture 8— Lab Values
Canes Five Deadly Ds
Walkers Neutropenic Precaution
Delusions
Hallucinations Lecture 9— Psych Drugs
Psychosis Tri
Psychotic and Non- Benzo
Psychotic MAOI
Hallucination Lithium
Illusion Prozac
Delusion Haldol
Clozaril
Zoloft

,Lecture 10— Maternity and Medication Hints
Neonatology Psych Tips
Operational Stages
Lecture 11— Fetal Complications
Stages of Labor Lecture 12— Prioritization
Assessments Delegation
Variations for NB Staff Management
Maternity Meds Guessing Strategies
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Lecture 1 • Mark Klimek • 92:21


Acid/Base Balance (Start times:
30:00)

In order to solve acid-base disorders,
it is
important to know the normal values
for
pH, CO2 and HCO3 (bicarbonate),
which
are shown below
• pH 7.35 to 7.45

• CO2 35 to 45

• HCO3 22 to 26

The first value to look at in an acid-base disorder is the pH
• If pH is <7.35, the acid-base imbalance is acidotic

• If pH is <7.45, the acid-base imbalance is alkalotic

Now, to determine if the imbalance is metabolic or respiratory , determine whether
HCO3 goes in the same or opposite direction with pH

• Rule of the Bs: If pH and Bicarb move both in the same direction, then
the acid-base imbalance is metabolic … Otherwise, it is respiratory

Example #1
• pH 7.3 Acidotic

, • HCO3 20 Metabolic

• This is an example of metabolic acidosis

Example #2
• pH 7.58 Alkalotic

• HCO3 32 Metabolic

• This is an example of metabolic alkalosis

Example #3
• pH 7.22 Acidosis

• HCO3 35 Respiratory

• This is an example of respiratory acidosis

As the pH goes, so goes my patient, except for Potassium …
That means • If pH is low, everything is low, except
potassium

• If pH is high, everything is high, except potassium
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If pH goes over 7.45, this is alkalosis
• Therefore everything is up: tachycardia, tachypnea, HTN, seizures, irritability,
spastic, diarrhea, borborygmi (increase bowel sounds), hyperreflexia (3+, 4+) •

However, potassium is opposite. Therefore, hypokalemia • What is the nursing
intervention?
o Pt need suctioning because of seizures

If pH goes below 7.35, this is acidosis

• Therefore, everything is down: bradycardia, constipation, absent bowel sounds,
flaccid, obtunded, lethargy, coma hyporeflexia (0, 1+), bradypnea, low BP •

However, potassium is high (hyperkalemia) • What is the nursing
intervention?
o Pt needs to be ventilated with an Ambu bag—respiratory arrest

, So, remember that “MAC Kussmaul” is the only acid-base imbalance
to cause M etabolic AC idosis with Kussmaul respirations

Causes of Acid/Base imbalance

First ask yourself, “Is it LUNG? … If yes, then it is respiratory

• Then ask yourself, “Are they overventilating or underventilating ? o If
UNDERventilating, then pick acidosis—pH is under 7.35
o If OVERventilating, then it is alkalosis, pH is over 7.45

What type of acid-base derangement is present in the
following condition? • In labor? o Respiratory
alkalosis … Overventilating —pH increases …
Alkalosis) • Drowning?
o Respiratory acidosis … Underventilating —pH decreases …
Acidosis • Pt is on PCA (patient-controlled anesthesia)
pump? o Ventilation is down … Respiratory acidosis

If it is not LUNG, then it is metabolic . If the patient has
prolonged
gastric vomiting or suction (sucking out acid), pick alkalosis

• For everything else that isn’t lung, pick metabolic acidosis

• So, when you don’t know what to pick, pick metabolic
acidosis

Tip
• Set your default setting to Metabolic Acidosis

• Always pay attention to modifying phrase rather than
original noun

Figure 1. Patient controlled anesthesia (PCA) pump.
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Ventilator

A ventilator is a machine designed to move breathable air into and out of the
lungs, aids patients who are physically unable to breathe, or breathing