Mark Klimek Lecture Notes
how to remember s/s for pH imbalances - ANS-"as the pH goes, so goes my patient....
except potassium"
#1 priority for alkalosis & why - ANS-pt needs suctioning because of seizures
#1 priority for acidosis & why - ANS-pt needs to be ventilated with ambu bag bc of
respiratory arrest
what acid-base imbalance does kussmaul respirations cause - ANS-metabolic acidosis
acid-base imbalance for over/under ventilating - ANS-over ventilating: respiratory
alkalosis
under ventilating: respiratory acidosis
acid-base imbalance for prolonged gastric vomiting or suction - ANS-metabolic alkalosis
reasons for high pressure alarms on vent & what to do for them - ANS-1. kinks... unkink
it
2. condensed water... empty it
3. mucus plugs... turn, cough, deep breathe, or suction PRN
reasons for low pressure alarms on vent & what to do for them - ANS-1. main tubing
disconnection... reconnect it
2. O2 sensor tube disconnection... reconnect it
*if tubing is on the floor... bag pt and call respiratory therapist*
what acid-base imbalance would the pt be considered ready to be weaned off the vent
& why - ANS-respiratory alkalosis b/c over ventilating
#1 psychological problem for any abuse situation - ANS-DENIAL
when is denial ok - ANS-with loss & grief
stages of grief: (DABDA) denial, anger, bargaining, depression, acceptance
,dependency, co-dependency, & manipulation (what to do for each of them) -
ANS--dependency: abuser gets the significant other to do things or make decisions for
them ... CONFRONT THEM
-co-dependency: when the significant other derives self-esteem for doing things or
making decisions for the abuser, however NOT harmful ... SET LIMITS & ENFORCE
THEM, say no, work on the self-esteem of co-dependent person
-manipulation: abuser gets significant other to do things or make decisions that are NOT
IN THE BEST INTEREST of the significant other, harmful & dangerous ... SET LIMITS
& ENFORCE THEM
wernicke (korsakoff) syndrome .. what it is, s/s, what to do, how to prevent -
ANS-psychosis-induced encephalopathy by vitamin B1 (thiamine) deficiency from
alcoholism
s/s: amnesia & confabulation
what to do: REDIRECT them when confabulating about something that is not true
how to prevent: take vitamin B1
antabuse and revia (disulfiram) - ANS-aversion therapy (development of hatred for
alcohol)
onset AND duration of effectiveness: 2 weeks
pt teaching: avoid all forms of alcohol to avoid nausea, vomiting, and death (includes
mouthwash, cologne, perfume, aftershave, elixir OTC meds, hand sanitizer, insect
repellant, vanilla extract... CAN have red wine vinigarettes)
what are the upper & downer drugs with s/s - ANS-uppers:
-caffeine
-cocaine
-LSD/PCP
-methamphetamines
-adderall
s/s: euphoria, seizures, restlessness, irritability, hyperreflexia (3+, 4+), tachycardia,
borborygmi, diarrhea
,downers:
-over 135 others; if it's not an upper, it's a downer
s/s: lethargic, respiratory depression/arrest, constipated
highest priority in an upper vs downer - ANS-upper: suctioning due to seizures
downer: intubation/ventilation due to respiratory arrest
overdose vs withdrawal in an upper and a downer - ANS-overdose on an upper: too
much
overdose on a downer: too little
withdrawal on a upper: too little
withdrawal on a downer: too much
drug abuse in a newborn: intoxication vs withdrawal - ANS-intoxication in a newborn is
less than 24 hours after birth
withdrawal is 24 hours or more after birth
alcohol withdrawal vs delirium tremens - ANS-alcohol withdrawal:
-occurs after 24 hours after drinking
-non life threatening to self or others
-regular diet
-semiprivate room, anywhere on unit
-pt is up and able to move around
-no restraints
delirium tremens:
-occurs after 72 hours after drinking
-life threatening to self or others
-NPO or clear liquid diet
-private room, near nursing station
-restricted bed rest
-restraints (vest or 2-point lock letters)
, what to give to both a pt in alcohol withdrawal & delirium tremens - ANS-anti-HTN
medication, tranquilizer, & multivitamin containing B1
aminoglycosides - ANS-"mean old mycins"
-big guns of ABX
-end in mycin (gentamycin, vancomycin, clindamycin, streptomycin) but NOT the drugs
ending in -thromycin
-what they treat: TB, septic peritonitis, fulminating pyelonephritis, septic shock, infection
from 3rd degree burn wound covering >80% of the body
-what they don't treat: sinusitis, otitis media, bladder infection, viral pharyngitis, & strep
throat
-toxic effects: CN8 toxicity (monitor hearing- #1, balance, tinnitus) & nephrotoxicity
(monitor creatinine)
-given IM or IV because PO is not absorbed. PO only given for hepatic encephalopathy
(when ammonia levels get too high) or pre-op bowel surgery (to sterilize the bowel)
-which aminoglycosides sterilize the bowel: neomycin & kanamycin
-draw TAP (trough, administer, peak) on mycins
when are trough and peak levels drawn of each route - ANS-*trough is always drawn 30
min before no matter the route*
peaks:
SubL - 5 to 10 minutes after the drug is dissolved
IV - 15 to 30 minutes after the drug is finished (NOT when its hung)
IM - 30 to 60 minutes
SubQ - depends on insulin
PO - not necessary
calcium channel blockers - ANS--they relax and slow down the heart
-ends in -dipine + verapimil and cardizem (diltiazem)-- continuous IV drip so titrate to
make systolic >100 .... "dipping in the calcium channel"
how to remember s/s for pH imbalances - ANS-"as the pH goes, so goes my patient....
except potassium"
#1 priority for alkalosis & why - ANS-pt needs suctioning because of seizures
#1 priority for acidosis & why - ANS-pt needs to be ventilated with ambu bag bc of
respiratory arrest
what acid-base imbalance does kussmaul respirations cause - ANS-metabolic acidosis
acid-base imbalance for over/under ventilating - ANS-over ventilating: respiratory
alkalosis
under ventilating: respiratory acidosis
acid-base imbalance for prolonged gastric vomiting or suction - ANS-metabolic alkalosis
reasons for high pressure alarms on vent & what to do for them - ANS-1. kinks... unkink
it
2. condensed water... empty it
3. mucus plugs... turn, cough, deep breathe, or suction PRN
reasons for low pressure alarms on vent & what to do for them - ANS-1. main tubing
disconnection... reconnect it
2. O2 sensor tube disconnection... reconnect it
*if tubing is on the floor... bag pt and call respiratory therapist*
what acid-base imbalance would the pt be considered ready to be weaned off the vent
& why - ANS-respiratory alkalosis b/c over ventilating
#1 psychological problem for any abuse situation - ANS-DENIAL
when is denial ok - ANS-with loss & grief
stages of grief: (DABDA) denial, anger, bargaining, depression, acceptance
,dependency, co-dependency, & manipulation (what to do for each of them) -
ANS--dependency: abuser gets the significant other to do things or make decisions for
them ... CONFRONT THEM
-co-dependency: when the significant other derives self-esteem for doing things or
making decisions for the abuser, however NOT harmful ... SET LIMITS & ENFORCE
THEM, say no, work on the self-esteem of co-dependent person
-manipulation: abuser gets significant other to do things or make decisions that are NOT
IN THE BEST INTEREST of the significant other, harmful & dangerous ... SET LIMITS
& ENFORCE THEM
wernicke (korsakoff) syndrome .. what it is, s/s, what to do, how to prevent -
ANS-psychosis-induced encephalopathy by vitamin B1 (thiamine) deficiency from
alcoholism
s/s: amnesia & confabulation
what to do: REDIRECT them when confabulating about something that is not true
how to prevent: take vitamin B1
antabuse and revia (disulfiram) - ANS-aversion therapy (development of hatred for
alcohol)
onset AND duration of effectiveness: 2 weeks
pt teaching: avoid all forms of alcohol to avoid nausea, vomiting, and death (includes
mouthwash, cologne, perfume, aftershave, elixir OTC meds, hand sanitizer, insect
repellant, vanilla extract... CAN have red wine vinigarettes)
what are the upper & downer drugs with s/s - ANS-uppers:
-caffeine
-cocaine
-LSD/PCP
-methamphetamines
-adderall
s/s: euphoria, seizures, restlessness, irritability, hyperreflexia (3+, 4+), tachycardia,
borborygmi, diarrhea
,downers:
-over 135 others; if it's not an upper, it's a downer
s/s: lethargic, respiratory depression/arrest, constipated
highest priority in an upper vs downer - ANS-upper: suctioning due to seizures
downer: intubation/ventilation due to respiratory arrest
overdose vs withdrawal in an upper and a downer - ANS-overdose on an upper: too
much
overdose on a downer: too little
withdrawal on a upper: too little
withdrawal on a downer: too much
drug abuse in a newborn: intoxication vs withdrawal - ANS-intoxication in a newborn is
less than 24 hours after birth
withdrawal is 24 hours or more after birth
alcohol withdrawal vs delirium tremens - ANS-alcohol withdrawal:
-occurs after 24 hours after drinking
-non life threatening to self or others
-regular diet
-semiprivate room, anywhere on unit
-pt is up and able to move around
-no restraints
delirium tremens:
-occurs after 72 hours after drinking
-life threatening to self or others
-NPO or clear liquid diet
-private room, near nursing station
-restricted bed rest
-restraints (vest or 2-point lock letters)
, what to give to both a pt in alcohol withdrawal & delirium tremens - ANS-anti-HTN
medication, tranquilizer, & multivitamin containing B1
aminoglycosides - ANS-"mean old mycins"
-big guns of ABX
-end in mycin (gentamycin, vancomycin, clindamycin, streptomycin) but NOT the drugs
ending in -thromycin
-what they treat: TB, septic peritonitis, fulminating pyelonephritis, septic shock, infection
from 3rd degree burn wound covering >80% of the body
-what they don't treat: sinusitis, otitis media, bladder infection, viral pharyngitis, & strep
throat
-toxic effects: CN8 toxicity (monitor hearing- #1, balance, tinnitus) & nephrotoxicity
(monitor creatinine)
-given IM or IV because PO is not absorbed. PO only given for hepatic encephalopathy
(when ammonia levels get too high) or pre-op bowel surgery (to sterilize the bowel)
-which aminoglycosides sterilize the bowel: neomycin & kanamycin
-draw TAP (trough, administer, peak) on mycins
when are trough and peak levels drawn of each route - ANS-*trough is always drawn 30
min before no matter the route*
peaks:
SubL - 5 to 10 minutes after the drug is dissolved
IV - 15 to 30 minutes after the drug is finished (NOT when its hung)
IM - 30 to 60 minutes
SubQ - depends on insulin
PO - not necessary
calcium channel blockers - ANS--they relax and slow down the heart
-ends in -dipine + verapimil and cardizem (diltiazem)-- continuous IV drip so titrate to
make systolic >100 .... "dipping in the calcium channel"
