Exam (elaborations) Mark Klimek Yellow Book At Columbus State Community College Study Blue

Mark Klimek Yellow Book At Columbus State Community College Study Blue Mark Klimek- Yellow Book Ohio | Columbus State Community College | Rule of the B's: If the ____ and the _____ are ______ in the same direction then it is meta_____ pH, Bicarb, Both, Bolic pH 7.30_______ HCO3 20_______ ↓= acidosis; ↓= metabolic pH 7.58_______ HCO3 32_______ ↑= alkalosis; ↑= metabolic pH 7.22_______ HCO3 30_______ ↓= acidosis; ↑= respiratory MacKussmaul The only acid base to cause Kussmaul respirations is Metabolic ACidosis Compensation only _______ the pH Changes pH 7.42 _______ HCO3 19 _______ ↑= compensated alkalosis ↓= respiratory pH 7.43 _______ HCO3 34 _______ ↑= compensated alkalosis ↑= metabolic pH 7.39 _______ HCO3 25 _______ CO2 61 _______ Norm., norm., ↑ = CO2 problem not acid-base problem As the _______ goes, so goes _______ except for _______ _______ pH, my patient, Potassium pH is Up Alkalosis, Hypokalemia, HTN, Tachycardia, Tachypnea, Seizures, Irritability, Spastic, Diarrhea, Borborygme, Hyperreflexia, etc Tachy, hyper, elevated, irritable, peaking, increase, spastic, rise pH is Down Acidosis, Hyperkalemia, htn, Bradycardia, Constipation, Absent bowel sounds, Flacid, Bradypnea Brady, hypo, lethargic, decrease, few, scant, suppressed 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, underventilating, overventilating, alkalosis, underventilating, acidosis Causes of acid-base imbalances: If it's not lung, then it's _______. If the patient has _______ _______ vomiting or suctioning, pick _______. For everything else that isn't lung, pick _______ _______. When you don't know what to pick, choose _______ metabolic, prolonged(days) gastric, alkalosis, metabolic acidosis, metabolic acidosis High pressure alarms are triggered by _______ resistance to air flow. increased High pressure alarms are triggered by increased resistance to airflow and can be caused by obstructions of three types: _______-> action: _____, _______-> action: _____, _______-> action: _____ (Least invasive to most) kinked tube-> action: unkink water in tube-> action:empty mucus in airway-> action: cough and deep breathe When the question asks for an action use least to most invasive Low pressure alarms are triggered by _______ resistance to airflow. decreased Low pressure alarms are triggered by decreased resistance to airflow and can be caused by disconnections of the _______ tubing (reconnect it UNLESS tube is on the floor in which case bag them and call RT) Respiratory alkalosis means ventilator settings may be too _______ high Respiratory acidosis means ventilator settings may be too _______ low What does "wean" mean? gradually decrease with the goal of getting off altogether What is Maslow's hierarchy of needs from highest priority to lowest priority? 1. Physiological 2. Safety 3. Comfort 4. Psychological (problems within the person) 5. Social (problems with other people) 6. Spiritual Used to prioritize needs Arrange from highest to lowest priority using Maslow's: Denial Spiritual Distress Pain in Wrist Fall Risk Family Dysfunction Electrolyte Imbalance Electrolyte Imbalance (Physiological) Fall Risk (Safety) Pain in Wrist (Comfort) Denial (Psychological) Family Dysfunction (Social) Spiritual Distress (Spiritual) What are the 5 stages of grief? DABDA Denial Anger Bargain Depression Acceptance The #1 problem in abuse is _______ denial Denial is the _______ to accept the _______ of their problem refusal, reality Treating denial: _______ it by pointing out to the person the difference between what they _______ and what they _______. In contrast, _______ the denial of loss and grief confront, say, do, support Dependency: When the _______ gets the Significant Other to do things for them or make decisions for them abuser (They want someone else to do life for them so they can abuse) Codependency: When the _______ _______ derives positive _______ from doing things for or making decisions for the _______ Significant Other, self-esteem, abuser When treating dependency/codependency: Set _______ and _______ them. Agree in advance on what requests are allowed, then enforce the agreement Work on the _______ of the codependent person limits, enforce self-esteem Manipulation: when the _______ gets the _______ _______ gets the _______ _______ to do things for him/her that are not in the _______ _______ of the _______ _______. The nature of the act is _______ or _______ to the _______ _______ abuser, significant other, interest, significant other, dangerous, harmful, significant other Treating manipulation: Set _______ and _______ them. Its easier to treat than dependency/codependency because likes being manipulated limits, enforce them Wernicke's (Korsakoff's) Syndrome: _______ induced by Vitamin _______(thiamine) deficiency Psychosis, B1 (Can't metabolize alcohol without sufficent B1) Cause of phychosis in Cause of phychosis in Wernike's (Korsakoff's) is...__________________________________________ Psychosis is a form of _______. Death of brain cells due to alcohol toxicity due to Vitamin B1 deficiency, Dementia Primary symptoms of Wernicke's (Korsakoff's) Syndrome: _______ with _______. amnesia (memory loss), confabulation (making up stories to explain things because they don't remember) Characteristics of Wernicke's (Korsakoff's) Syndrome: 1. _______ 2. _______ 3. _______ preventable (supplement with B1) arrestable (can stop it from progressing) irreversible (can't go back) Antabuse (disulfiram)/Revia is _______ Therapy Aversion Onset and duration of effectiveness of Antabuse/Revia: _______ 2 weeks Patient teaching with Antabuse/Revia: Avoid _______ forms of _______ to avoid _______, _______, _______ ALL, alcohol, nausea, vomiting, possible death What are examples of products that contain alcohol? mouth wash cologne/perfume aftershave elixirs/most OTC liquid medicines that are not antibiotics insect repellant real vanilla extract vinagerettes alcohol-based hand sanitizers alcohol prep pads Overdose vs. Withdrawal: First ask yourself: "Is this First ask yourself: "Is this drug an _______ or a _______?" upper, downer Every abused drug is either an _______ or a _______. upper, downer Names of Uppers: (6 you should know) Caffeine Cocaine PCP/LSD Methamphetamines () Adderall/ Ritalin Bath Salts Signs and symptoms of Uppers: Make everything go up Names of Downers: All the not Uppers Signs and symptoms of Signs and symptoms of Downers: Make everything go down Overdose vs. Withdrawal: Then ask yourself: "Are they talking about _______or _______?" overdose, withdrawal Overdose/ Intoxication: "I have too much..." Upper: Everything is _______. Downer: Everything is _______. up, down Withdrawal: "I don't have enough..." Upper: Everything is _______. Downer: Everything is _______. down, up Drug addiction in the Newborn: Always assume_______ (not assume_______ (not _______) at birth and ____ ____ ______ ______. intoxication, withdrawal, for the first 24hrs Every alcoholic goes through _______. Only a minority get _______ Alcohol Withdrawal Syndrome, Delirium Tremens (72hrs out) _______ is not lifethreatening. _______ can kill you. Alcohol Withdrawal Syndrome, Delirium Tremens Patients with _______ are not ____________ to themselves or others. Patients with ________ are ____________ to self and others. Alcohol Withdrawal Syndrome, dangerous, Delirium Tremens, dangerous AWS or DT: semiprivate room, any location room, any location AWS AWS or DT: private room near the nurse's station DT AWS or DT: Regular diet AWS AWS or DT: Clear liquid or NPO diet (risk for aspiration) DT AWS or DT: Up ad lib AWS AWS or DT: Restricted to bedrest with no bathroom privileges DT AWS or DT: No restraints AWS AWS or DT: Usually restrained with either vest or 2 point (1 arm and 1 leg) (Check every _______, rotate every _______) DT 15 minutes, 2 hours AWS or DT: Give anti-HTN medication Both AWS or DT: Give tranquilizer Both AWS or DT: Give multivitamin to prevent Wernicke's Both For Aminoglycosides, think " __ ____ ___ _____" a mean old mycin When are aminoglycoside antibiotics used? to treat mean old infections (serious, life-threatening infections) (ex. TB, septic shock, etc.) All aminoglycosides end in _______, but not all drugs that end in _______ are aminoglycosides. mycin, mycin What are some examples of wannabe mycins? Azithromycin, Clarithromycin, Erythromycin What are some examples of aminoglycosides? Streptomycin, Cleomycin, Tobramycin, Gentamycin, Vancomycin, Clindamycin When remembering toxic effects of mycin's think, the most famous feature of the worlds most famous mouse: _______ ears What is the toxic effect, and what must you monitor? ototoxicity; monitor hearing, balance, and tinnitus The human ear is shaped like a _______ so another toxic effect of aminoglycosides is _______ so monitor _______ kidney, nephrotoxicity, creatinine The number "___" drawn The number "___" drawn inside the ear reminds you of cranial nerve ___ and frequency of administration ___ 8, 8, Q8H Do not give aminoglycosides PO except in these 2 cases: 1. _______ _______ (due to high _______ level) 2. Pre-op _______ surgery hepatic encephalopathy (liver coma, ammonia-induces encephalopathy), ammonia (E.coli is the #1 producer of ammonia in your gut) bowel (will start you on it 2days before surgery) Who can sterilize my bowel!? NEOmycin KANomycin! What is the reason for drawing Trough and Peak (TAP) levels? To narrow therapeutic window To narrow therapeutic window When do you ALWAYS draw the trough? 30 minutes before next dose When do you draw the peak level of sublingual medications? 5-10 minutes after drug dissolves When do you draw the peak level of IV medications? 15-30 minutes after medication is finished When do you draw the peak level of IM medications? 30-60 minutes