mark_klimek_lectures_1_to_12_240407042102_83dae525.pdf.pdf| Full Q&A | 2026/2027
Kernicterus
GUIDE • Mark Klimek’s Lecture
Lecture 1— Acid-Base Balance Dumping/HH
Ventilators Electrolytes: K+, CA, MG,
and NA
Lecture 2— Alcohol TX for HyperKalemia
Wernicke
Overdose and Withdrawal Lecture 7— Thyroid (Hyper-, Hypo-)
S/Sx Adrenal Cortex (Addison
Aminoglycosides Disease, Cushing)
Peak and Trough Toys
Laminectomy
Lecture 3— Drug Toxicities (Lithium,
Lanoxin, Dilantin, Lecture 8— Lab Values
Bilirubin, Five Deadly Ds
Aminophylline) Neutropenic Precaution
Kernicterus
Dumping/HH Lecture 9— Psych Drugs
Electrolytes: K+, CA, MG, Tri
and NA Benzo
TX for HyperKalemia MAOI
Lithium
Lecture 4— Crutches Prozac
Canes Haldol
Walkers Clozaril
Delusions Zoloft
Hallucinations
Psychosis Lecture 10— Maternity and Neonatology
Psychotic and Non-Psychotic
Hallucination Lecture 11— Fetal Complications
Illusion Stages of Labor
Delusion Assessments
Variations for NB
Lecture 5— Diabetes Mellitus Maternity Meds
Diabetes Insipidus Medication Hints
SIADH Psych Tips
Insulin Operational Stages
DKA
HHNK Lecture 12— Prioritization
Delegation
Lecture 6— Drug Toxicities (Lithium, Staff Management
Lanoxin, Dilantin, Guessing Strategies
Bilirubin,
Aminophylline)
Page 1 of 92
, mark_klimek_lectures_1_to_12_240407042102_83dae525.pdf.pdf| Full Q&A | 2026/2027
Page 2 of 92
Lecture 1 • Mark Klimek • 92:21
Acid/Base Balance (Start times: 30:00)
In order to solve acid-base disorders, it
is
important to know the normal values
for
pH, CO2 and HCO3 (bicarbonate),
which
are shown below
• pH 7.35 to 7.45
• CO2 35 to 45
• HCO3 22 to 26
The first value to look at in an
acid-base
disorder is the pH
• If pH is <7.35, the acid-base imbalance
is acidotic
• If pH is <7.45, the acid-base imbalance
is alkalotic
Now, to determine if the imbalance is metabolic or respiratory, determine whether HCO3 goes
in the same or opposite direction with pH
• Rule of the Bs: If pH and Bicarb move both in the same direction, then the acid-base
imbalance is metabolic … Otherwise, it is respiratory
Example #1
• pH 7.3 Acidotic
• HCO3 20 Metabolic
• This is an example of metabolic acidosis
Example #2
• pH 7.58 Alkalotic
• HCO3 32 Metabolic
• This is an example of metabolic alkalosis
Example #3
• pH 7.22 Acidosis
• HCO3 35 Respiratory
• This is an example of respiratory acidosis
As the pH goes, so goes my patient, except for Potassium … That
means • If pH is low, everything is low, except potassium
• If pH is high, everything is high, except potassium
, mark_klimek_lectures_1_to_12_240407042102_83dae525.pdf.pdf| Full Q&A | 2026/2027
Page 3 of 92
If pH goes over 7.45, this is alkalosis
• Therefore everything is up: tachycardia, tachypnea, HTN, seizures, irritability, spastic,
diarrhea, borborygmi (increase bowel sounds), hyperreflexia (3+, 4+)
• However, potassium is opposite. Therefore, hypokalemia
• What is the nursing intervention?
o Pt need suctioning because of seizures
If pH goes below 7.35, this is acidosis
• Therefore, everything is down: bradycardia, constipation, absent bowel sounds, flaccid,
obtunded, lethargy, coma hyporeflexia (0, 1+), bradypnea, low BP
• However, potassium is high (hyperkalemia)
• What is the nursing intervention?
o Pt needs to be ventilated with an Ambu bag—respiratory arrest
So, remember that “MAC Kussmaul” is the only acid-base imbalance to cause
Metabolic ACidosis with Kussmaul respirations
Causes of Acid/Base imbalance
First ask yourself, “Is it LUNG? … If yes, then it is respiratory
• Then ask yourself, “Are they overventilating or underventilating?
o If UNDERventilating, then pick acidosis—pH is under 7.35
o If OVERventilating, then it is alkalosis, pH is over 7.45
What type of acid-base derangement is present in the following
condition? • In labor?
o Respiratory alkalosis … Overventilating—pH increases …
Alkalosis) • Drowning?
o Respiratory acidosis … Underventilating—pH decreases …
Acidosis • Pt is on PCA (patient-controlled anesthesia) pump?
o Ventilation is down … Respiratory acidosis
If it is not LUNG, then it is metabolic. If the patient has
prolonged
gastric vomiting or suction (sucking out acid), pick alkalosis
• For everything else that isn’t lung, pick metabolic acidosis
• So, when you don’t know what to pick, pick metabolic
acidosis
Tip
• Set your default setting to Metabolic Acidosis
• Always pay attention to modifying phrase rather than original
noun
Figure 1. Patient
controlled anesthesia
(PCA) pump.
, mark_klimek_lectures_1_to_12_240407042102_83dae525.pdf.pdf| Full Q&A | 2026/2027
Page 4 of 92
Ventilator
A ventilator is a machine designed to move breathable air into and out of the lungs, aids
patients who are physically unable to breathe, or breathing insufficiently to breathe … A
ventilators is equipped with a high and a low-pressure alarm
High pressures alarms
are
always triggered by increased
resistance to air flow. Look
for obstructions, i.e.,
• Kinks in tubing …
Solution: unkink the tube
• Condensed water in the
dependent tube …
Solution: empty it
• Mucus plugs … Solution:
Ask pt to turn, cough,
deep
breathe; or suction the
tubing PRN
What is the
appropriate order
to address high pressure alarm
in a mechanical ventilator?
• (1) Unkink. (2) Empty
water out of tubing. (3) turn pt, ask pt to cough or deeply breathe, and (4) suction
Low pressures alarms are always triggered by decrease in resistance. This can be caused
by • Main tubing disconnection
• O2 sensor tube disconnection
• In both cases, reconnect the disconnected tubing unless tube is on floor … Bag pt and call
Respiratory Therapist
The ventilator may be set too high or too low
• Setting is too high … Pt is overventilated
o Respiratory Alkalosis … Panting
• Setting is too low … Pt is underventilated
o Respiratory Acidosis … Pt is retaining CO2
Question
The physician wants to wean pt off vent in the morning. At 6 am, the ABGs say
respiratory acidosis. What would you do next?
• Notify the physician that the pt is not ready to be weaned off the respirator o Pt is is
respiratory acidosis, which means that he is underventilated … Therefore not ready to be
weaned off the ventilator
o If pt were in respiratory alkalosis (overventilated), he should be ready to be weaned off
Kernicterus
GUIDE • Mark Klimek’s Lecture
Lecture 1— Acid-Base Balance Dumping/HH
Ventilators Electrolytes: K+, CA, MG,
and NA
Lecture 2— Alcohol TX for HyperKalemia
Wernicke
Overdose and Withdrawal Lecture 7— Thyroid (Hyper-, Hypo-)
S/Sx Adrenal Cortex (Addison
Aminoglycosides Disease, Cushing)
Peak and Trough Toys
Laminectomy
Lecture 3— Drug Toxicities (Lithium,
Lanoxin, Dilantin, Lecture 8— Lab Values
Bilirubin, Five Deadly Ds
Aminophylline) Neutropenic Precaution
Kernicterus
Dumping/HH Lecture 9— Psych Drugs
Electrolytes: K+, CA, MG, Tri
and NA Benzo
TX for HyperKalemia MAOI
Lithium
Lecture 4— Crutches Prozac
Canes Haldol
Walkers Clozaril
Delusions Zoloft
Hallucinations
Psychosis Lecture 10— Maternity and Neonatology
Psychotic and Non-Psychotic
Hallucination Lecture 11— Fetal Complications
Illusion Stages of Labor
Delusion Assessments
Variations for NB
Lecture 5— Diabetes Mellitus Maternity Meds
Diabetes Insipidus Medication Hints
SIADH Psych Tips
Insulin Operational Stages
DKA
HHNK Lecture 12— Prioritization
Delegation
Lecture 6— Drug Toxicities (Lithium, Staff Management
Lanoxin, Dilantin, Guessing Strategies
Bilirubin,
Aminophylline)
Page 1 of 92
, mark_klimek_lectures_1_to_12_240407042102_83dae525.pdf.pdf| Full Q&A | 2026/2027
Page 2 of 92
Lecture 1 • Mark Klimek • 92:21
Acid/Base Balance (Start times: 30:00)
In order to solve acid-base disorders, it
is
important to know the normal values
for
pH, CO2 and HCO3 (bicarbonate),
which
are shown below
• pH 7.35 to 7.45
• CO2 35 to 45
• HCO3 22 to 26
The first value to look at in an
acid-base
disorder is the pH
• If pH is <7.35, the acid-base imbalance
is acidotic
• If pH is <7.45, the acid-base imbalance
is alkalotic
Now, to determine if the imbalance is metabolic or respiratory, determine whether HCO3 goes
in the same or opposite direction with pH
• Rule of the Bs: If pH and Bicarb move both in the same direction, then the acid-base
imbalance is metabolic … Otherwise, it is respiratory
Example #1
• pH 7.3 Acidotic
• HCO3 20 Metabolic
• This is an example of metabolic acidosis
Example #2
• pH 7.58 Alkalotic
• HCO3 32 Metabolic
• This is an example of metabolic alkalosis
Example #3
• pH 7.22 Acidosis
• HCO3 35 Respiratory
• This is an example of respiratory acidosis
As the pH goes, so goes my patient, except for Potassium … That
means • If pH is low, everything is low, except potassium
• If pH is high, everything is high, except potassium
, mark_klimek_lectures_1_to_12_240407042102_83dae525.pdf.pdf| Full Q&A | 2026/2027
Page 3 of 92
If pH goes over 7.45, this is alkalosis
• Therefore everything is up: tachycardia, tachypnea, HTN, seizures, irritability, spastic,
diarrhea, borborygmi (increase bowel sounds), hyperreflexia (3+, 4+)
• However, potassium is opposite. Therefore, hypokalemia
• What is the nursing intervention?
o Pt need suctioning because of seizures
If pH goes below 7.35, this is acidosis
• Therefore, everything is down: bradycardia, constipation, absent bowel sounds, flaccid,
obtunded, lethargy, coma hyporeflexia (0, 1+), bradypnea, low BP
• However, potassium is high (hyperkalemia)
• What is the nursing intervention?
o Pt needs to be ventilated with an Ambu bag—respiratory arrest
So, remember that “MAC Kussmaul” is the only acid-base imbalance to cause
Metabolic ACidosis with Kussmaul respirations
Causes of Acid/Base imbalance
First ask yourself, “Is it LUNG? … If yes, then it is respiratory
• Then ask yourself, “Are they overventilating or underventilating?
o If UNDERventilating, then pick acidosis—pH is under 7.35
o If OVERventilating, then it is alkalosis, pH is over 7.45
What type of acid-base derangement is present in the following
condition? • In labor?
o Respiratory alkalosis … Overventilating—pH increases …
Alkalosis) • Drowning?
o Respiratory acidosis … Underventilating—pH decreases …
Acidosis • Pt is on PCA (patient-controlled anesthesia) pump?
o Ventilation is down … Respiratory acidosis
If it is not LUNG, then it is metabolic. If the patient has
prolonged
gastric vomiting or suction (sucking out acid), pick alkalosis
• For everything else that isn’t lung, pick metabolic acidosis
• So, when you don’t know what to pick, pick metabolic
acidosis
Tip
• Set your default setting to Metabolic Acidosis
• Always pay attention to modifying phrase rather than original
noun
Figure 1. Patient
controlled anesthesia
(PCA) pump.
, mark_klimek_lectures_1_to_12_240407042102_83dae525.pdf.pdf| Full Q&A | 2026/2027
Page 4 of 92
Ventilator
A ventilator is a machine designed to move breathable air into and out of the lungs, aids
patients who are physically unable to breathe, or breathing insufficiently to breathe … A
ventilators is equipped with a high and a low-pressure alarm
High pressures alarms
are
always triggered by increased
resistance to air flow. Look
for obstructions, i.e.,
• Kinks in tubing …
Solution: unkink the tube
• Condensed water in the
dependent tube …
Solution: empty it
• Mucus plugs … Solution:
Ask pt to turn, cough,
deep
breathe; or suction the
tubing PRN
What is the
appropriate order
to address high pressure alarm
in a mechanical ventilator?
• (1) Unkink. (2) Empty
water out of tubing. (3) turn pt, ask pt to cough or deeply breathe, and (4) suction
Low pressures alarms are always triggered by decrease in resistance. This can be caused
by • Main tubing disconnection
• O2 sensor tube disconnection
• In both cases, reconnect the disconnected tubing unless tube is on floor … Bag pt and call
Respiratory Therapist
The ventilator may be set too high or too low
• Setting is too high … Pt is overventilated
o Respiratory Alkalosis … Panting
• Setting is too low … Pt is underventilated
o Respiratory Acidosis … Pt is retaining CO2
Question
The physician wants to wean pt off vent in the morning. At 6 am, the ABGs say
respiratory acidosis. What would you do next?
• Notify the physician that the pt is not ready to be weaned off the respirator o Pt is is
respiratory acidosis, which means that he is underventilated … Therefore not ready to be
weaned off the ventilator
o If pt were in respiratory alkalosis (overventilated), he should be ready to be weaned off
