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Rule of B's for ABGs - if the pH and the Bicarb are Both in the same direction it is metaBolic normal pH normal Bicarb - pH: 7.35-7.45 Bicarb: 22-26 Kussmul respirations - MACkussmul= metabolic acidosis S&S of acid-base imbalance - as the pH goes, so goes my patient except for potassium UP: (alkolosis):decreased K+, highest risk for seizures DOWN: (acidosis): increased K+, highest risk for respiratory arrest causes of respiratory acid-base imbalance - lung=respiratory overvent or undervent overvent= alkolosis undervent=acidosis causes of metabolic acid-base imbalance - not lung=metabolic prolonged gastric vomiting or suction=metabolic alkolosis (losing acid) everything else=metabolic acidosis high pressured ventilator alarms - triggered by increase resistance to air flow and can be caused by obstruction of three types: kinked tube: unkink it water in tube: empty it mucus in airway: turn, cough, deep breathelow pressured ventilator alarams - triggered by decreased resistance to air flow and can be caused by disconnections: tubing: reconnect if not contaminate if contaminated (below bed level): call first, then bag, reconnect respiratory alkalosis vs acidosis - alkalosis: ventilator setting may be too high (overvent) acidosis: ventilator setting may too low (undervent) HOLD - high pressured alarms obstruction low pressured alarms disconnection Maslow - 1. physiological 2. safety 3. comfort 4. psychological 5. social 6. spiritual #1 problem in substance abuse - denial: refusal to accept the reality of their problem treatment: confront it by pointing out to the person the difference between what they say and what they do. however, in grief and loss support denial dependency/codependency - dependency: when abuser gets SO to do things for them or make decisions for them codependency: when the SO derives positive self-esteem from doing things for or making decisions for the abusertreating dependency/codenpendency - set limits and enforce them. agree in advance what requests are allowed then enforce the agreement work on the self-esteem of the codependent person manipulation - when abuser gets the SO to do things for him/her that are no in the best interest of the SO. nature of the act is dangerous or harmful to SO treatment of manipulation - set limits and enforce them easier to treat than dependency/codependency because no body likes being manipulated wenicke's korsakoff syndrome - psychosis caused by a lack of B1 (thiamine) deficiency primary symptom: amnesia with confabulation -preventable -arrestable -irreversible antabuse/revia (disulfiram) - aversion therapy onset/duration of effectiveness: 2 weeks pt teaching: avoid all forms of alcohol to avoid nausea, vomiting, death uppers - cocaine, caffeine, PCP/LSD, methamphedimines, ADHD meds (amphetimines), bath salts S&S: increase everything, pupils dilate (mydriasis), seizures downers - codeine, heroin, alcohol, marijuana S&S: decrease everything, pupils constrict (miosis), respiratory arrest overdose vs withdrawal - upper overdose: everything is high upper withdrawal: everything is low