Mark Klimek Lectures 1 to 12 Nursing Notes Questions and Verified Correct Verified Answers

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GUIDE• MarkKlimek’s Lecture



Lecture 1— Acid-BaseBalance Dumping/HH
Ventilators Electrolytes: K+, CA, MG,
and NA
Lecture 2— Alcohol TXfor HyperKalemia
Wernicke
Overdose and Withdrawal Lecture 7— Thyroid (Hyper-, Hypo-)
S/Sx Adrenal Cortex (Addison
Aminoglycosides Disease,Cushing)
PeakandTrough Toys
Laminectomy
Lecture 3— Drug Toxicities (Lithium,
Lanoxin, Dilantin, Bilirubin, Lecture 8— LabValues




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Aminophylline) Five Deadly Ds



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Kernicterus Neutropenic Precaution
Dumping/HH sy
Electrolytes: K+, CA, MG, Lecture 9— Psych Drugs
and NA Tri
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TXfor HyperKalemia Benzo
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Lecture 4— Crutches Lithium
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Canes Prozac
Walkers Haldol
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Delusions Clozaril
Hallucinations Zoloft
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Psychosis
Psychotic and Non-Psychotic Lecture 10— MaternityandNeonatology
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Hallucination
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Illusion Lecture 11— FetalComplications
Delusion Stages of Labor
Assessments
Lecture 5— Diabetes Mellitus Variations for NB
Diabetes Insipidus Maternity Meds
SIADH Medication Hints
Insulin Psych Tips
DKA Operational Stages
HHNK
Lecture 12— Prioritization
Lecture 6— Drug Toxicities (Lithium, Delegation
Lanoxin, Dilantin, Bilirubin, Staff Management
Aminophylline) Guessing Strategies
Kernicterus


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Lecture1•Mark Klimek•92:21



Acid/BaseBalance(Start times: 30:00)

In order to solve acid-base disorders, it is
important to know the normal values for
pH,CO2andHCO3(bicarbonate),which are
shown below
 pH 7.35to7.45
 CO2 35to45
 HCO3 22to26

Thefirstvaluetolookatinanacid-base disorder
is the pH




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 IfpHis<7.35,theacid-baseimbalance is




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acidotic
 IfpHis<7.45,theacid-baseimbalance is
alkalotic sy
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Now,todetermineiftheimbalanceismetabolicorrespiratory,determinewhetherHCO3goes in the same or
opposite direction with pH
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 RuleoftheBs:IfpHandBicarbmovebothinthesamedirection,thentheacid-base imbalance is
metabolic … Otherwise, it is respiratory
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Example #1
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 pH 7.3 Acidotic
 HCO3 20 Metabolic
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 Thisisanexampleof metabolic acidosis
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Example #2
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 pH 7.58 Alkalotic
 HCO3 32 Metabolic
 Thisisanexampleof metabolic alkalosis

Example #3
 pH 7.22 Acidosis
 HCO3 35 Respiratory
 Thisisanexampleof respiratory acidosis

Asthe pH goes, so goes mypatient, except for Potassium … That means
 IfpH islow, everythingislow, except potassium
 IfpH ishigh, everythingishigh, except potassium




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IfpH goes over 7.45, this isalkalosis
 Thereforeeverythingisup:tachycardia,tachypnea,HTN,seizures,irritability,spastic, diarrhea,
borborygmi (increase bowel sounds), hyperreflexia (3+, 4+)
 However,potassium isopposite. Therefore, hypokalemia
 Whatisthenursingintervention?
o Ptneedsuctioningbecause of seizures

IfpHgoes below 7.35, this isacidosis
 Therefore,everythingisdown:bradycardia,constipation,absentbowelsounds,flaccid, obtunded,
lethargy, coma hyporeflexia (0, 1+), bradypnea, low BP
 However,potassiumishigh(hyperkalemia)
 Whatisthe nursing intervention?
o Ptneeds tobe ventilatedwithanAmbu bag—respiratory arrest

So,rememberthat“MACKussmaul”istheonlyacid-baseimbalancetocauseMetabolic ACidosis with
Kussmaul respirations




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Causes of Acid/Base imbalance




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Firstaskyourself, “IsitLUNG?…If yes,then itisrespiratory
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 Thenask yourself, “Arethey overventilating or underventilating?
o IfUNDERventilating, then pick acidosis—pH isunder 7.35
Et
o IfOVERventilating, then itisalkalosis, pHisover 7.45
o-

Whattypeof acid-basederangementispresentinthefollowing condition?
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 In labor?
o Respiratoryalkalosis … Overventilating—pH increases … Alkalosis)
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 Drowning?
o Respiratory acidosis … Underventilating—pH decreases … Acidosis
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 Ptison PCA (patient-controlled anesthesia) pump?
o Ventilationisdown … Respiratory acidosis
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IfitisnotLUNG,thenitismetabolic.Ifthepatienthasprolonged gastric
vomiting or suction (sucking out acid), pick alkalosis
 Foreverythingelsethat isn’tlung,pickmetabolicacidosis
 So,whenyoudon’tknowwhattopick,pickmetabolic acidosis

Tip
 Setyour default setting toMetabolic Acidosis
 Alwayspayattentiontomodifyingphraseratherthanoriginal noun

Figure 1. Patient-
controlledanesthesia
(PCA) pump.




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