MARK KLIMEK STUDY GUIDE
Acid Base
As the ph goes the patient goes and except for potassium
pH goes up potassium goes down
pH goes down potassium goes up
pH up(alkalosis)… Hyper, tachy, increased, elevated, exaggerated, increasing, excessive.
Irritability, diarrhea, borborygmi= increased bowel sounds.
pH down(acidosis)… hypo, decreased, scant, absent, a-, brady, depressed, suppressed, oligo,
Pt has acidosis what heart rhythm would you see- second degree heart block
Tetany- muscle spasms, hyper muscles, hyper hyper contractility
Cardiac arrest- slow down
MAC-Kussmal
Kussmal only occurs in Metabolic ACidosis
Causes of acid base imbalances:
Ask yourself is it Lung? If it does= respiratory
Is the client overventilating or under??
If they are over---Alkalosis…
If under—acidosis.
Too much PCA pump what acid base can result… depress respirations, underventilation…
respiratory ACIDOSIS.
Near drowning—Respiratory acidosis
Acute panic anxiety- Respiratory alkalosis
If it isn’t lung its metabolic.
If client has PROLONGED gastric vomiting or suctioning—METABOLIC ALKALOSIS
For everything else that isn’t lung pic metabolic acidosis that doesn’t have to do with suctioning
or vomiting
Metabolic Acidosis if we don’t know what to pick!
,Respiratory rate is highly unreliable use your gases, lung sounds and saturation!!!
Ventilator-
High pressure alarm= increased resistance to airflow. High pressure to push through so look for
OBSTRUCTION!!! 3 obstructions, DO IN THIS ORDER!! Least invasive to most!
1. Kink. - UNKINK
2. Water condensing in tubing. GET WATER OUT
3. Mucous. Suction is not best answer… TURN COUGH AND DEEP BREATHE. If that doesn’t
work SUCTION!
Low pressure alarm!
Due to DISCONNECTIONS!
1. Main tube disconnected-
2. Oxygen Sensor line! Plug back in.
If tubing hits the floor call respiratory and start bagging!! If it falls on them then on the bed
then clean off with alcohol and reconnect
Respiratory Alkalosis- Over Ventilating
Respiratory Acidosis- Under Ventilating
DON’T ASK ANOTHER PEOPLE. DON’T USE CHICKEN QUESTIONS. TAKE CARE OF IT YOURSELF
ETOH,Abuse,Overdose vs. Withdrawal, & Mycin
In abuse**
“Maslow” Ranking
1. Physiologic needs
2. Safety needs
3. Comfort needs
4. Psychological needs
5. Sociological needs
6. Spiritual needs
Alcoholic with fractured foot which would be priority?
His denials?
His pain?
His break***
Adequate pain control is number one for palliative care
Psychodynamic- what’s their major malfunction?
Abusers- greatest psychological priority is denial! Refusal to accept reality with problem.
Confront denial in abusers!
,“You say you aren’t an alcoholic but it’s 10 am and you’ve drank a fifth of whiskey and a 6
pack.”
Denial during loss and grief:
Don’t confront. You support and allow them to continue because it serves a purpose
and function.
Dependency=abuser gets significant other to make decisions for them or do things for them
because they can spend their time drinking.
Codependency=significant other derives positive self esteem from doing things for or making
decisions for the abuser. So abuser says will you do this for me and the codependent does it
and then says to themselves “I’m a wonderful person because I do this for them and no one
else would”
Set limits for the abuser and enforce them. No you call your boss, etc.
Work on self esteem of the codependent person.
Abusers manipulate people to do stuff that is harmful to significant other.
Dependency vs manipulate
Dependency- not harmful husband buys wife alcohol
Manipulative- harmful 17-year-old buys alcohol for mom
Wernickes-Korsakoff
- Psychosis induced by vitamin b1 deficiency –thiamine
- Lose touch with reality because you lack the B vitamin
- Amnesia with confabulation- memory loss with making up stories because you can’t
remember. They don’t know they made it up that’s what makes them psychotic. The
believe their stories.
- These people have dementia-break from reality due to brain damage
- DON’T ARGUE WITH THEM, PLAY ALONG!!
Characteristics!!!
- Preventable by taking vitamin b1. Don’t have to stop drinking.
- Megadose on B1 your blood alcohol will be lower.
- Arrestable- you can keep it from getting worse by starting to take your b1
- Its irreversible because its brain damage.
GOAL:
For wernickes client memory- client will maintain current memory.
DEMENTIA- NEVER IMPROVEMENT!! MAINTAIN!
Antabuse/Disulfiram
- Form of aversion therapy
- If you take this and you drink alcohol, it makes you sick.
, - Onset and duration is 2 weeks. If you start taking it today it takes 2 weeks. If you stop
today it takes 2 weeks to be able to drink again.
- It’s any alcohol. Avoid all forms of alcohol like insect repellents, aftershave, perfumes,
colognes, mouthwash, any OTC elixir (Dayquil, Nyquil, etc), vinaigrettes, vanilla extracts
(uncooked vanilla icing), alcohol based hand sanitizer.
Overdose/Withdrawal
Principles:
- Every abused is an upper or downer
- Is it upper or downer??
Uppers:
- Caffeine
- Cocaine
- PCP/LSD (psychedelic hallucinogens)
- Amphetamines (METH) “speed”
- Bath salts
- ADHD drugs Adderall and Ritalin
These are all stimulants. Make things go up because they are uppers.
You will see hyper, tachy, irritable, diarrhea, tremors, seizures.
Downers:
Everything else.
Qualudes- downers
Fentanyl
Things go down
WORST THING= respiratory distress
You go opposite way drug does during withdrawal!!!
You withdrawal from upper you go down.
You withdrawal from downer you go up.
Overdose on upper- tachycardia
Overdose on lower- bradycardia
Withdrawal from an upper- bradycardia
Withdrawal from a downer- tachycardia
Clonus- very jumpy reflexes
ALWAYS ASSUME BABY IS INTOXICATED AND NOT WITHDRAWING at birth or in first 24 hours
unless they tell you differently.
Acid Base
As the ph goes the patient goes and except for potassium
pH goes up potassium goes down
pH goes down potassium goes up
pH up(alkalosis)… Hyper, tachy, increased, elevated, exaggerated, increasing, excessive.
Irritability, diarrhea, borborygmi= increased bowel sounds.
pH down(acidosis)… hypo, decreased, scant, absent, a-, brady, depressed, suppressed, oligo,
Pt has acidosis what heart rhythm would you see- second degree heart block
Tetany- muscle spasms, hyper muscles, hyper hyper contractility
Cardiac arrest- slow down
MAC-Kussmal
Kussmal only occurs in Metabolic ACidosis
Causes of acid base imbalances:
Ask yourself is it Lung? If it does= respiratory
Is the client overventilating or under??
If they are over---Alkalosis…
If under—acidosis.
Too much PCA pump what acid base can result… depress respirations, underventilation…
respiratory ACIDOSIS.
Near drowning—Respiratory acidosis
Acute panic anxiety- Respiratory alkalosis
If it isn’t lung its metabolic.
If client has PROLONGED gastric vomiting or suctioning—METABOLIC ALKALOSIS
For everything else that isn’t lung pic metabolic acidosis that doesn’t have to do with suctioning
or vomiting
Metabolic Acidosis if we don’t know what to pick!
,Respiratory rate is highly unreliable use your gases, lung sounds and saturation!!!
Ventilator-
High pressure alarm= increased resistance to airflow. High pressure to push through so look for
OBSTRUCTION!!! 3 obstructions, DO IN THIS ORDER!! Least invasive to most!
1. Kink. - UNKINK
2. Water condensing in tubing. GET WATER OUT
3. Mucous. Suction is not best answer… TURN COUGH AND DEEP BREATHE. If that doesn’t
work SUCTION!
Low pressure alarm!
Due to DISCONNECTIONS!
1. Main tube disconnected-
2. Oxygen Sensor line! Plug back in.
If tubing hits the floor call respiratory and start bagging!! If it falls on them then on the bed
then clean off with alcohol and reconnect
Respiratory Alkalosis- Over Ventilating
Respiratory Acidosis- Under Ventilating
DON’T ASK ANOTHER PEOPLE. DON’T USE CHICKEN QUESTIONS. TAKE CARE OF IT YOURSELF
ETOH,Abuse,Overdose vs. Withdrawal, & Mycin
In abuse**
“Maslow” Ranking
1. Physiologic needs
2. Safety needs
3. Comfort needs
4. Psychological needs
5. Sociological needs
6. Spiritual needs
Alcoholic with fractured foot which would be priority?
His denials?
His pain?
His break***
Adequate pain control is number one for palliative care
Psychodynamic- what’s their major malfunction?
Abusers- greatest psychological priority is denial! Refusal to accept reality with problem.
Confront denial in abusers!
,“You say you aren’t an alcoholic but it’s 10 am and you’ve drank a fifth of whiskey and a 6
pack.”
Denial during loss and grief:
Don’t confront. You support and allow them to continue because it serves a purpose
and function.
Dependency=abuser gets significant other to make decisions for them or do things for them
because they can spend their time drinking.
Codependency=significant other derives positive self esteem from doing things for or making
decisions for the abuser. So abuser says will you do this for me and the codependent does it
and then says to themselves “I’m a wonderful person because I do this for them and no one
else would”
Set limits for the abuser and enforce them. No you call your boss, etc.
Work on self esteem of the codependent person.
Abusers manipulate people to do stuff that is harmful to significant other.
Dependency vs manipulate
Dependency- not harmful husband buys wife alcohol
Manipulative- harmful 17-year-old buys alcohol for mom
Wernickes-Korsakoff
- Psychosis induced by vitamin b1 deficiency –thiamine
- Lose touch with reality because you lack the B vitamin
- Amnesia with confabulation- memory loss with making up stories because you can’t
remember. They don’t know they made it up that’s what makes them psychotic. The
believe their stories.
- These people have dementia-break from reality due to brain damage
- DON’T ARGUE WITH THEM, PLAY ALONG!!
Characteristics!!!
- Preventable by taking vitamin b1. Don’t have to stop drinking.
- Megadose on B1 your blood alcohol will be lower.
- Arrestable- you can keep it from getting worse by starting to take your b1
- Its irreversible because its brain damage.
GOAL:
For wernickes client memory- client will maintain current memory.
DEMENTIA- NEVER IMPROVEMENT!! MAINTAIN!
Antabuse/Disulfiram
- Form of aversion therapy
- If you take this and you drink alcohol, it makes you sick.
, - Onset and duration is 2 weeks. If you start taking it today it takes 2 weeks. If you stop
today it takes 2 weeks to be able to drink again.
- It’s any alcohol. Avoid all forms of alcohol like insect repellents, aftershave, perfumes,
colognes, mouthwash, any OTC elixir (Dayquil, Nyquil, etc), vinaigrettes, vanilla extracts
(uncooked vanilla icing), alcohol based hand sanitizer.
Overdose/Withdrawal
Principles:
- Every abused is an upper or downer
- Is it upper or downer??
Uppers:
- Caffeine
- Cocaine
- PCP/LSD (psychedelic hallucinogens)
- Amphetamines (METH) “speed”
- Bath salts
- ADHD drugs Adderall and Ritalin
These are all stimulants. Make things go up because they are uppers.
You will see hyper, tachy, irritable, diarrhea, tremors, seizures.
Downers:
Everything else.
Qualudes- downers
Fentanyl
Things go down
WORST THING= respiratory distress
You go opposite way drug does during withdrawal!!!
You withdrawal from upper you go down.
You withdrawal from downer you go up.
Overdose on upper- tachycardia
Overdose on lower- bradycardia
Withdrawal from an upper- bradycardia
Withdrawal from a downer- tachycardia
Clonus- very jumpy reflexes
ALWAYS ASSUME BABY IS INTOXICATED AND NOT WITHDRAWING at birth or in first 24 hours
unless they tell you differently.
