Mark Klimek Notes for Audio Lectures

Mz.ANTICHOLINERGIC vs. CHOLINERGIC EFFECTS ANTICHOLINERGIC CHOLINERGIC • ↓ Mucus • Bronchodilation • Dry mouth • Dry eyes • Urinary retention • Dry skin • Constipation • Shut down GI • Prevents V when trying to intubate • Bronchorrhea (large amounts of mucus in airway) • Bronchoconstriction • Salivation • Lacrimating • Urination • Diaphoresis/Diarrhea • GI Upset • Emesis ACID BASE GASES A. ABG Interpretation a. Rule of the B’s i. If the pH and the BICARB (HCO3) ii. Are BOTH in the same direction, iii. Then it is METABOLIC b. ↓ pH = acidosis c. ↑ pH= alkaline B. Values a. Normal pH = 7.35 – 7.45 b. Normal Bicarb= 22-26 c. PaO2= 80-100 mmHg d. PaCO2= 35-45 mmHg e. SaO2= 95-100% C. Signs & Symptoms of Acid-Base Imbalance a. As the pH goes, so goes the patient except for Potassium (bc it will try to compensate) pH UP ↑ K↓ [ALKALOSIS] pH DOWN ↓ K↑ [ACIDOSIS] • Tachycardia • Tachypnea • Diarrhea • Tremors • Seizure • Hyperreflexia • Agitated • Bradycardia • Bradypnea • Hypotension • ↓ lucidity • anorexia • coma • lethargy • Borborygmi (↑ bowel sounds) • Hypertension • Palpitations • Tetany • Anxiety/Panic • Poly • cardia arrest • suppressed, decreased, falling D. Causes of Acid-Base Imbalance a. First ask, “Is it Lung?” i. If YES-! then it is Respiratory b. Then ask yourself: i. Are they Overventilating or Underventilating? 1. If Overventilating ! pick Alkalosis 2. If Underventilating ! pick Acidosis c. If not lung, then it’s Metabolic i. If the patient has prolonged gastric vomiting or suction, pick Metabolic Alkalosis ii. For everything else that isn’t lung, pick Metabolic Acidosis 1. Also, if you don’t know what to pick choose Metabolic Acidosis VENTILATOR ALARMS 1. High Pressure Alarms are triggered by ↑ resistance to air flow and can be caused by obstructions of three types: a. Kinked Tube i. NRS ACTION: Unkink it b. Water in tubing (caused by condensation) i. NRS ACTION: Empty it/Remove H2O c. Mucus in airway i. NRS ACTION: Turn, C&DB; only use suction if C&DB fails, as a last resort 2. Low Pressure Alarms are triggered by ↓ resistance to air flow and can be caused by disconnections of the: a. Tubing i. NRS ACTION: Pay attention to where tubing is…(contamination) ii. If on floor, change out iii. If on chest, clean with alcohol then put back on 3. Respiratory Alkalosis (Overventilation) means ventilator settings may be too HIGH. 4. Respiratory Acidosis (Underventilation) means ventilator settings may be too LOW. 5. To “Wean” ! To gradually and incrementally decrease with the goal of ridding all together ALCOHOLISM Note: Remember in a psych question if you are asked to prioritize DO NOT forget Maslow! Use the following priorities: 1. Physiological 2. Safety 3. Comfort 4. Psychological 5. Social 6. Spiritual Also, ALL PSYCH PATIENTS START AS MED SURG PATIENTS…RULE OUT ALL FEASIBLE MED ANSWERS BEFORE PICKING PSYCH ANSWERS 1. Psychodynamics of Alcoholism a. The #1 psychological problem in abuse is DENIAL. i. Definition: 1. Refusal to accept the reality of their problem. ii. Treatment: 1. Confront it by pointing out to the person the difference between what they say and what they do. 2. In contrast, support the denial of loss and grief (BC the use of denial is serving a functioning person) b. DEPENDENCY/CODEPENDENCY i. Dependency: When the abuser gets the significant other to do things for them or make decisions for them. ii. Codependency: When the significant other derives positive self-esteem from doing other things for or making decisions for the abuser. iii. Treatment: 1. Set boundary (limits) and enforce them. Agree in advance on what requests are allowed then enforce the agreement 2. Work on the self-esteem of the codependent person. c. MANIPULATION i. Definition: When the abuser gets the significant other to do things for him/her that are not in the best interest of the Significant Other. The nature of the act is dangerous or harmful to the significant other ii. Treatment: 1. Set limits and enforce 2. Its easier to treat than dependency/codependency because nobody likes to be manipulated 2. Wernicke’s (Korsakoff’s) Syndrome a. Psychosis induced by Vitamin B1 (Thiamine) deficiency. b. Primary symptom: amnesia with confabulation (making up stories to fill in memory loss—believe as true) c. Characteristics: i. Preventable 1. By giving B1 vitamins ii. Arrestable 1. Can stop from getting worse- not imply better iii. Irreversible 1. Dementia symptoms don’t get better—only worse 3. Antabuse/Revia a. Disulfiram (drugs used for alcoholism b. Aversion Therapy c. Onset and duration of effectiveness: 2 weeks i. Take drugs 2 weeks and builds up in blood to a level that when drinking alch will become horribly sick; if off for two weeks, will be able to drink without sickness again d. Patient teaching: Avoid ALL forms of alcohol to avoid nausea, vomiting, and possibly death, including: i. Mouthwash, aftershave, perfumes/cologne, insect repellant, vinigarettes (salad dressings), vanilla extract, elixirs (contains alch-OTC med), alcohol prep pad, alch sanitizers OVERDOSE VS. WITHDRAWAL First ask yourself, is the drug an upper or a downer? UPPERS↓ DOWNERS↓ Names: • Caffeine • Cocaine • PCP/LSD (Psychedelic hallucinogens) • Methamphetamines-speed • ADHD- adderrall/Ritalin • Bath Salts (Cath-Kath) Names: • Everything else Signs/Symptoms: • Tachycardia • Hypertension • Diarrhea • Agitation • Tremors • Clonus • Belligerence • Seizures • Exaggerated, shrill, high pitched cry • Difficult to console