Mark Klimek Lecture Outline
If the pH and the BiCarb are both in the same direction then it is? - ANS-Metabolic
If the pH is up it is? - ANS-Alkalosis
As the pH goes so goes my patient except for? - ANS-Potassium
If the pH is down it is? - ANS-Acidosis
If the pH is up my patient with show signs and symptoms of? - ANS-Increase... like
tachycardia,diarrhea and borborygmi
If the pH is down my patient will show signs and symtoms of? - ANS-Decrease... like
decreased output, bradycardia and constipation
If my pH is up my potassium (K+) is ? - ANS-Down
If my pH is down my potassium (K+) is? - ANS-Up
If my patient is overventilating I should choose? - ANS-Respiratory Alkalosis
If my patient is underventilating I should choose? - ANS-Respiratory Acidosis
If my patient has prolonged gastric vomiting or suction I choose? - ANS-Metabolic
Alkalosis
If it is not lung or prolonged vomiting or suctioning I choose? - ANS-Metabolic Acidosis
Kussmal Respirations - ANS-Metabolic Acidosis ( Remember MacKussmal
Before measuing ABGs you should check what? - ANS-Allen's test. Should be positive.
Pt makes a fist and pressure is applied to the ulnar and the radial arteries Ulnar
pressure is released and color should return in 7 seconds (means it's positive and OK to
take ABG's).
Definition of Compensation - ANS-PH is normal! It is never compensated if it is
abnormal.
,If PH normal - ANS-look in the direction it is going. Closer to Acidic? (7.35) acidosis.
Then look at Bicarb & figure out which is abnormal. If Bicarb is out of range, it's
metabolic acidosis.
If C02 is abnormal, it's Respiratory Acidosis :)
If your pt is acidotic and you need to pick a symptom - ANS-Pick the symptom where
everything is DOWN. ( And vice Versa)
Ex: 2 degree Morbitz Type 2 BLOCK. <---- Down direction
If you don't know what causes an acid base balance, pick - ANS-Metabolic Acidosis
If in doubt in ABGs, always pick - ANS-Headache, nausea, weakness & numbness+
tingling. It can be either up or down.
High pressure alarms are triggered when? - ANS-They cannot push air in
High pressure alarms are caused by what three types of obstructions? - ANS-Kinking,
Water in dependant loops and mucus in the airway.
If kinking in the tube is present you? - ANS-Unkink
If water is present in the dependant loops you? - ANS-Open system and empty water.
If mucus is present you? - ANS-Turn them, cough and have them deep breath first. If
ineffective you then suction.
Don't suction unless - ANS-Coughing & deep breathing is deemed inappropriate.
In order to suction, you must be able to hear - ANS-Mucus in the lung
Low pressure alarms are triggered when? - ANS-It is to easy to push air in.
Low pressure alarms are normally caused by? - ANS-Disconnection
If the tubing is disconnected you? - ANS-Reconnect
If O2 sensor line is disconnected you? - ANS-Reconnect
,In a vented client respiratory alkalosis means the vent setting may be too? - ANS-High
In a vented client respiratory acidosis means the vent may be too? - ANS-Low
What do you do if the patients disconnected tube is on the floor? - ANS-Bag them, (call
for help) get new tube and then reconnect.
First question to ask if the low pressure alarm sounds - ANS-Where is the tubing?!
HOLD - ANS-H- High Pressure
O- Obstruction
L- Low
D- Disconnections
Never put anything in YOUR scope of practice - ANS-On anyone else
Make sure your answer is - ANS-PATIENT FOCUSED.
TAKE CARE OF YOUR PATIENT!
Don't answer based on staff, building, machine, etc.
PATIENT FIRST.
What does wean mean? - ANS-Decrease Gradually
What do you do if the patients disconnected tube is on the chest? - ANS-Reconnect ... if
its above the waist its ok.
Remember is PSYCH if you are asked to Prioritize, Don't forget - ANS-MASLOW!
1. Physiological
2. Safety
3. Comfort - Includes pain
4. Psychological
5. Social
6. Spiritual
When prioritizing, always use Maslow + ABCs - ANS-For one patient. Don't if you have
more than one patient.
What is the biggest problem in abuse? - ANS-Denial
, To treat denial you need to? - ANS-Confront them.
Definition of Denial - ANS-Refusal to accept reality of their problem
How do you confront? - ANS-Point out the difference between what they say and what
they do.
What is the one circumstance that you as a nurse would support denial? - ANS-Loss
and Grief
Always go - ANS-Med surg first. Then Psych
What is dependency? - ANS-When the abuser gets a significant other so make
decisions for them or do thing for them.
What is codependency? - ANS-When the significant other gets positive self esteem
from doing things or making decisions for an abuser.
To treat dependency/codependency you ? - ANS-Set limits and enforce them.
Say NO and follow through.
Agree in advance on what requests are allowed, then enforce the agreement.
You also need to work or the self esteem of the codependent.
What is manipulation? - ANS-When the abuser gets the significant other fo do things for
them that is not in the best interest of the significant other. This can be dangerous and
harmful to the significant other.
How do you treat manipulation? - ANS-Set limits and enforce.
Why is manipulation easier to treat then dependency/codependency? - ANS-Because
no one likes being manipulated.
DABDA - ANS-D- Denial
A- Anger
B- Bargaining
D- Depression
If the pH and the BiCarb are both in the same direction then it is? - ANS-Metabolic
If the pH is up it is? - ANS-Alkalosis
As the pH goes so goes my patient except for? - ANS-Potassium
If the pH is down it is? - ANS-Acidosis
If the pH is up my patient with show signs and symptoms of? - ANS-Increase... like
tachycardia,diarrhea and borborygmi
If the pH is down my patient will show signs and symtoms of? - ANS-Decrease... like
decreased output, bradycardia and constipation
If my pH is up my potassium (K+) is ? - ANS-Down
If my pH is down my potassium (K+) is? - ANS-Up
If my patient is overventilating I should choose? - ANS-Respiratory Alkalosis
If my patient is underventilating I should choose? - ANS-Respiratory Acidosis
If my patient has prolonged gastric vomiting or suction I choose? - ANS-Metabolic
Alkalosis
If it is not lung or prolonged vomiting or suctioning I choose? - ANS-Metabolic Acidosis
Kussmal Respirations - ANS-Metabolic Acidosis ( Remember MacKussmal
Before measuing ABGs you should check what? - ANS-Allen's test. Should be positive.
Pt makes a fist and pressure is applied to the ulnar and the radial arteries Ulnar
pressure is released and color should return in 7 seconds (means it's positive and OK to
take ABG's).
Definition of Compensation - ANS-PH is normal! It is never compensated if it is
abnormal.
,If PH normal - ANS-look in the direction it is going. Closer to Acidic? (7.35) acidosis.
Then look at Bicarb & figure out which is abnormal. If Bicarb is out of range, it's
metabolic acidosis.
If C02 is abnormal, it's Respiratory Acidosis :)
If your pt is acidotic and you need to pick a symptom - ANS-Pick the symptom where
everything is DOWN. ( And vice Versa)
Ex: 2 degree Morbitz Type 2 BLOCK. <---- Down direction
If you don't know what causes an acid base balance, pick - ANS-Metabolic Acidosis
If in doubt in ABGs, always pick - ANS-Headache, nausea, weakness & numbness+
tingling. It can be either up or down.
High pressure alarms are triggered when? - ANS-They cannot push air in
High pressure alarms are caused by what three types of obstructions? - ANS-Kinking,
Water in dependant loops and mucus in the airway.
If kinking in the tube is present you? - ANS-Unkink
If water is present in the dependant loops you? - ANS-Open system and empty water.
If mucus is present you? - ANS-Turn them, cough and have them deep breath first. If
ineffective you then suction.
Don't suction unless - ANS-Coughing & deep breathing is deemed inappropriate.
In order to suction, you must be able to hear - ANS-Mucus in the lung
Low pressure alarms are triggered when? - ANS-It is to easy to push air in.
Low pressure alarms are normally caused by? - ANS-Disconnection
If the tubing is disconnected you? - ANS-Reconnect
If O2 sensor line is disconnected you? - ANS-Reconnect
,In a vented client respiratory alkalosis means the vent setting may be too? - ANS-High
In a vented client respiratory acidosis means the vent may be too? - ANS-Low
What do you do if the patients disconnected tube is on the floor? - ANS-Bag them, (call
for help) get new tube and then reconnect.
First question to ask if the low pressure alarm sounds - ANS-Where is the tubing?!
HOLD - ANS-H- High Pressure
O- Obstruction
L- Low
D- Disconnections
Never put anything in YOUR scope of practice - ANS-On anyone else
Make sure your answer is - ANS-PATIENT FOCUSED.
TAKE CARE OF YOUR PATIENT!
Don't answer based on staff, building, machine, etc.
PATIENT FIRST.
What does wean mean? - ANS-Decrease Gradually
What do you do if the patients disconnected tube is on the chest? - ANS-Reconnect ... if
its above the waist its ok.
Remember is PSYCH if you are asked to Prioritize, Don't forget - ANS-MASLOW!
1. Physiological
2. Safety
3. Comfort - Includes pain
4. Psychological
5. Social
6. Spiritual
When prioritizing, always use Maslow + ABCs - ANS-For one patient. Don't if you have
more than one patient.
What is the biggest problem in abuse? - ANS-Denial
, To treat denial you need to? - ANS-Confront them.
Definition of Denial - ANS-Refusal to accept reality of their problem
How do you confront? - ANS-Point out the difference between what they say and what
they do.
What is the one circumstance that you as a nurse would support denial? - ANS-Loss
and Grief
Always go - ANS-Med surg first. Then Psych
What is dependency? - ANS-When the abuser gets a significant other so make
decisions for them or do thing for them.
What is codependency? - ANS-When the significant other gets positive self esteem
from doing things or making decisions for an abuser.
To treat dependency/codependency you ? - ANS-Set limits and enforce them.
Say NO and follow through.
Agree in advance on what requests are allowed, then enforce the agreement.
You also need to work or the self esteem of the codependent.
What is manipulation? - ANS-When the abuser gets the significant other fo do things for
them that is not in the best interest of the significant other. This can be dangerous and
harmful to the significant other.
How do you treat manipulation? - ANS-Set limits and enforce.
Why is manipulation easier to treat then dependency/codependency? - ANS-Because
no one likes being manipulated.
DABDA - ANS-D- Denial
A- Anger
B- Bargaining
D- Depression
