KEEP CALM
and
PASS NCLEX
with
MARK KLIMEK
Review
1.
Acid-base balance/ventilators
Rule of the B’s.. If the pH & the bicarb are both in the same direction = metabolic
If they are in different directions = respiratory
pH = 7.35-7.45 acidosis/alkalosis
HCO3 (bicarb) = 22-26 (2+2+2 = 6)
CO2 = 45-35
ex:
pH: 7.30 = ↓
bicarb: 20 = ↓ = metabolic acidosis
ex:
pH: 7.58 =↑
bicarb: 32 = ↑ = metabolic alkalosis
ex:
pH: 7.22 =↓
bicarb: 30 =↑ = respiratory acidosis
ex:
You are providing care to a client with the following blood gas results: pH 7.32, CO2 49, HCO3
29, PO2 80 & SaO2 90%. Based on the results, the client is experiencing:
↓ = acidosis, ↑ = respiratory
-opioid: CNS depressant.. know the symptoms (sedation, respiratory depression, etc)..
*principle: acid base signs/symptoms..
,as the pH goes… so goes my patient!!!
-when pH goes up; patient goes up.. (everything gets irritable!)
-when pH goes down; patient goes down! (systems in your body shut down)
…except with potassium: when pH goes up; potassium goes down… when pH goes down;
potassium goes up!
(up) alkalosis: irritibility, hyper-reflexia (3 & 4), tachypnea, tachycardia, borborygmi
(increased bowel sounds), seizure, aspirate..
(down) acidosis: hypo-reflexia, bradycardia, lethergy (obtunded), paralytic ileus (decreased
bowel sounds), coma, respiratory arrest (ambu-bag!!)
Kussmaul breathing is a deep and labored breathing pattern often associated with severe
metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure… MAC
Kussmaul!!
M: metabolic
AC: acidosis
ex:
pT has respiratory acidosis… (select all that apply)..
+1 reflexes
diarhhea
adynamic ileus
spasm
urinary retention
tachycardia
2nd degree mobits type 2 heart block
hypokalemia
SATA questions: *never only 1… never all of them*
diarhhea will cause a metabolic acidosis.. but once you get acidodic, it will shut your bowels
down = paralytic ileus
…with scenarios.. always ask first “is it lung?” = respiratory
…then ask if the pt is over-ventilating or under-ventilating?
over-ventilating = alkalosis
under-ventilating = acidosis
…it’s about the SaO2!!! (pay attention!!)
if it isn’t lung = metabolic..
if pt has prolonged gastric vomiting or suctioning… it’s always metabolic alkalosis…
why? losing acid = becomes basic..
for everything else that is not lung - choose metabolic acidosis..
-if you don’t know the answer… always answer metabolic acidosis..
,ventilators
alarms.. high pressure alarm… triggered by increasure resistance to air flow.. (machine is
pushing too hard to get air into the lungs).. respiratory alkalosis
3 obstructions: kink in tubing (get kink out), water condensing within the tube (empty
tube), mucus secretions in the airway (turn, cough, deep breathe… then suction).. suction
as needed!! *in that order*…
low pressure alarm.. decreased resistance (too easy for the machine..)
respiratory acidosis
Low pressure alarms are triggered by decreased resistance to airflow & can be
caused by disconnections of the main tubing or oxygen sensor tubing… Tubing
(reconnect it!) - oxygen sensor tube (reconnect it UNLESS tube is on t
the floor - bag them & call Respiratory therapist if this happens)
Respiratory alkalosis = ventilator setting may be too high.
Respiratory acidosis = ventilator setting may be too low.
What does “wean” mean? gradually decrease with the goal of getting off altogether
ex:
Doc says wean off vent in AM… 6am ABG’s show resp. acidosis…
a) follow order
b) call respiratory
c) hold order.. call doc
d) begin to decrease the settings
MASLOW’s Priorities (HIGHest - LOWest)
physiological
safety
comfort
psychological (problems within the person)
social (problems with other people)
spiritual
ex:
Arrange from HIGHest - LOWest…
denial, spiritual distress, pain in elbow, fall risk, pathological family dynamics & electrolyte
imbalance…
= electrolyte imbalance (psyiological), fall risk (safety), pain in elbow (comfort), denial
(psychological), pathological family dynamics (social) & spiritual distress (spiritual)
2.
alcoholism.. (or any abuse)
#1 problem = denial *refusal to accept the reality of a problem*
You treat denial by confronting it…
, pronouns ~
good: i…
bad: you…
positions ~
good: i’m having a difficult time reading this…
bad: you wrote it wrong..
loss & grief: Denial Anger Bargining Depression Acceptance
don’t confront it; support it..
ex:
You have a pt that just hand a hand amputated & they say, “I can’t wait to get back to playing the
piano”… You say “Oh, how long have you played, etc? - you NEVER say “You can’t because you
only have 1 hand”
abuse = confront
loss = support
#2 problem = dependency *when the abuser get the significant other to do something.. “Call
my boss, i’m sick”* (abuser gets to keep abusing..)
= co-dependency *calls the boss*… (positive self esteem)
How to treat this?!? Set limits and enforce them… Learn to say NO!
manipulation = when the abuser gets the significant other to do things for him or her… the
nature of the act is dangerous or harmful
how is it like dependency? the abuser is getting the other person to do something
no harm = dependent / co-dependent (wife buying alcohol for husband)
dangerous/harmful = manipulated (kid buying alcohol for father)
…depends on legal/illegal………….
Wernicke-Korsakoff Syndrome (WKS) is a neurological disorder. Wernicke's
Encephalopathy and Korsakoff's Psychosis are the acute and chronic phases, respectively,
of the same disease. WKS is caused by a deficiency in the B1 vitamin thiamine. Thiamine (B1)
plays a role in metabolizing glucose to produce energy for the brain.
primary symptom of WKS = amnesia with confabulation (making up stories) *they believe
the lie..*
ex:
You have a pt who believes he is Ronald Regan’s Natioal Security Officer… And they want to go
to a cabinet meeting… :/ WHAT DO YOU DO?!? Redirect!! (“well, why don’t you get a shower
and then we’ll go watch CNN and see what the news is in Washington D.C.”)
WKS is…
-It’s preventable & arrestable (stop it from getting worse) - Take vitamin B1
-Irreversible… *About 70%*
and
PASS NCLEX
with
MARK KLIMEK
Review
1.
Acid-base balance/ventilators
Rule of the B’s.. If the pH & the bicarb are both in the same direction = metabolic
If they are in different directions = respiratory
pH = 7.35-7.45 acidosis/alkalosis
HCO3 (bicarb) = 22-26 (2+2+2 = 6)
CO2 = 45-35
ex:
pH: 7.30 = ↓
bicarb: 20 = ↓ = metabolic acidosis
ex:
pH: 7.58 =↑
bicarb: 32 = ↑ = metabolic alkalosis
ex:
pH: 7.22 =↓
bicarb: 30 =↑ = respiratory acidosis
ex:
You are providing care to a client with the following blood gas results: pH 7.32, CO2 49, HCO3
29, PO2 80 & SaO2 90%. Based on the results, the client is experiencing:
↓ = acidosis, ↑ = respiratory
-opioid: CNS depressant.. know the symptoms (sedation, respiratory depression, etc)..
*principle: acid base signs/symptoms..
,as the pH goes… so goes my patient!!!
-when pH goes up; patient goes up.. (everything gets irritable!)
-when pH goes down; patient goes down! (systems in your body shut down)
…except with potassium: when pH goes up; potassium goes down… when pH goes down;
potassium goes up!
(up) alkalosis: irritibility, hyper-reflexia (3 & 4), tachypnea, tachycardia, borborygmi
(increased bowel sounds), seizure, aspirate..
(down) acidosis: hypo-reflexia, bradycardia, lethergy (obtunded), paralytic ileus (decreased
bowel sounds), coma, respiratory arrest (ambu-bag!!)
Kussmaul breathing is a deep and labored breathing pattern often associated with severe
metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure… MAC
Kussmaul!!
M: metabolic
AC: acidosis
ex:
pT has respiratory acidosis… (select all that apply)..
+1 reflexes
diarhhea
adynamic ileus
spasm
urinary retention
tachycardia
2nd degree mobits type 2 heart block
hypokalemia
SATA questions: *never only 1… never all of them*
diarhhea will cause a metabolic acidosis.. but once you get acidodic, it will shut your bowels
down = paralytic ileus
…with scenarios.. always ask first “is it lung?” = respiratory
…then ask if the pt is over-ventilating or under-ventilating?
over-ventilating = alkalosis
under-ventilating = acidosis
…it’s about the SaO2!!! (pay attention!!)
if it isn’t lung = metabolic..
if pt has prolonged gastric vomiting or suctioning… it’s always metabolic alkalosis…
why? losing acid = becomes basic..
for everything else that is not lung - choose metabolic acidosis..
-if you don’t know the answer… always answer metabolic acidosis..
,ventilators
alarms.. high pressure alarm… triggered by increasure resistance to air flow.. (machine is
pushing too hard to get air into the lungs).. respiratory alkalosis
3 obstructions: kink in tubing (get kink out), water condensing within the tube (empty
tube), mucus secretions in the airway (turn, cough, deep breathe… then suction).. suction
as needed!! *in that order*…
low pressure alarm.. decreased resistance (too easy for the machine..)
respiratory acidosis
Low pressure alarms are triggered by decreased resistance to airflow & can be
caused by disconnections of the main tubing or oxygen sensor tubing… Tubing
(reconnect it!) - oxygen sensor tube (reconnect it UNLESS tube is on t
the floor - bag them & call Respiratory therapist if this happens)
Respiratory alkalosis = ventilator setting may be too high.
Respiratory acidosis = ventilator setting may be too low.
What does “wean” mean? gradually decrease with the goal of getting off altogether
ex:
Doc says wean off vent in AM… 6am ABG’s show resp. acidosis…
a) follow order
b) call respiratory
c) hold order.. call doc
d) begin to decrease the settings
MASLOW’s Priorities (HIGHest - LOWest)
physiological
safety
comfort
psychological (problems within the person)
social (problems with other people)
spiritual
ex:
Arrange from HIGHest - LOWest…
denial, spiritual distress, pain in elbow, fall risk, pathological family dynamics & electrolyte
imbalance…
= electrolyte imbalance (psyiological), fall risk (safety), pain in elbow (comfort), denial
(psychological), pathological family dynamics (social) & spiritual distress (spiritual)
2.
alcoholism.. (or any abuse)
#1 problem = denial *refusal to accept the reality of a problem*
You treat denial by confronting it…
, pronouns ~
good: i…
bad: you…
positions ~
good: i’m having a difficult time reading this…
bad: you wrote it wrong..
loss & grief: Denial Anger Bargining Depression Acceptance
don’t confront it; support it..
ex:
You have a pt that just hand a hand amputated & they say, “I can’t wait to get back to playing the
piano”… You say “Oh, how long have you played, etc? - you NEVER say “You can’t because you
only have 1 hand”
abuse = confront
loss = support
#2 problem = dependency *when the abuser get the significant other to do something.. “Call
my boss, i’m sick”* (abuser gets to keep abusing..)
= co-dependency *calls the boss*… (positive self esteem)
How to treat this?!? Set limits and enforce them… Learn to say NO!
manipulation = when the abuser gets the significant other to do things for him or her… the
nature of the act is dangerous or harmful
how is it like dependency? the abuser is getting the other person to do something
no harm = dependent / co-dependent (wife buying alcohol for husband)
dangerous/harmful = manipulated (kid buying alcohol for father)
…depends on legal/illegal………….
Wernicke-Korsakoff Syndrome (WKS) is a neurological disorder. Wernicke's
Encephalopathy and Korsakoff's Psychosis are the acute and chronic phases, respectively,
of the same disease. WKS is caused by a deficiency in the B1 vitamin thiamine. Thiamine (B1)
plays a role in metabolizing glucose to produce energy for the brain.
primary symptom of WKS = amnesia with confabulation (making up stories) *they believe
the lie..*
ex:
You have a pt who believes he is Ronald Regan’s Natioal Security Officer… And they want to go
to a cabinet meeting… :/ WHAT DO YOU DO?!? Redirect!! (“well, why don’t you get a shower
and then we’ll go watch CNN and see what the news is in Washington D.C.”)
WKS is…
-It’s preventable & arrestable (stop it from getting worse) - Take vitamin B1
-Irreversible… *About 70%*
