MARK KLIMEK LECTURE NOTES
how11to11remember11s/s11for11pH11imbalances11-
11answer--"as11the11pH11goes,11so11goes11my11patient....11except11potassium"
#111priority11for11alkalosis11&11why11-11answer--
pt11needs11suctioning11because11of11seizures
#111priority11for11acidosis11&11why11-11answer--
pt11needs11to11be11ventilated11with11ambu11bag11bc11of11respiratory11arrest
what11acid-base11imbalance11does11kussmaul11respirations11cause11-11answer--
metabolic11acidosis
acid-base11imbalance11for11over/under11ventilating11-11answer--
over11ventilating:11respiratory11alkalosis11
under11ventilating:11respiratory11acidosis
acid-base11imbalance11for11prolonged11gastric11vomiting11or11suction11-11answer--
metabolic11alkalosis
reasons11for11high11pressure11alarms11on11vent11&11what11to11do11for11them11-
11answer--1.11kinks...11unkink11it
2.11condensed11water...11empty11it
3.11mucus11plugs...11turn,11cough,11deep11breathe,11or11suction11PRN
reasons11for11low11pressure11alarms11on11vent11&11what11to11do11for11them11-11answer--
1.11main11tubing11disconnection...11reconnect11it
2.11O211sensor11tube11disconnection...11reconnect11it
11*if11tubing11is11on11the11floor...11bag11pt11and11call11respiratory11therapist*
what11acid-
base11imbalance11would11the11pt11be11considered11ready11to11be11weaned11off11the11ve
nt11&11why11-11answer--respiratory11alkalosis11b/c11over11ventilating
#111psychological11problem11for11any11abuse11situation11-11answer--DENIAL
when11is11denial11ok11-11answer--with11loss11&11grief
stages11of11grief:11(DABDA)11denial,11anger,11bargaining,11depression,11acceptance
,dependency,11co-dependency,11&11manipulation11(what11to11do11for11each11of11them)11-
11answer---
dependency:11abuser11gets11the11significant11other11to11do11things11or11make11decision
s11for11them11...11CONFRONT11THEM
-co-dependency:11when11the11significant11other11derives11self-
esteem11for11doing11things11or11making11decisions11for11the11abuser,11however11NOT11
harmful11...11SET11LIMITS11&11ENFORCE11THEM,11say11no,11work11on11the11self-
esteem11of11co-dependent11person
-
manipulation:11abuser11gets11significant11other11to11do11things11or11make11decisions11th
at11are11NOT11IN11THE11BEST11INTEREST11of11the11significant11other,11harmful11&11da
ngerous11...11SET11LIMITS11&11ENFORCE11THEM
wernicke11(korsakoff)11syndrome11..11what11it11is,11s/
s,11what11to11do,11how11to11prevent11-11answer--psychosis-
induced11encephalopathy11by11vitamin11B111(thiamine)11deficiency11from11alcoholism
s/s:11amnesia11&11confabulation
what11to11do:11REDIRECT11them11when11confabulating11about11something11that11is11no
t11true
how11to11prevent:11take11vitamin11B1
antabuse11and11revia11(disulfiram)11-11answer--
aversion11therapy11(development11of11hatred11for11alcohol)
onset11AND11duration11of11effectiveness:11211weeks
pt11teaching:11avoid11all11forms11of11alcohol11to11avoid11nausea,11vomiting,11and11death
11(includes11mouthwash,11cologne,11perfume,11aftershave,11elixir11OTC11meds,11hand11
sanitizer,11insect11repellant,11vanilla11extract...11CAN11have11red11wine11vinigarettes)
what11are11the11upper11&11downer11drugs11with11s/s11-11answer--uppers:
-caffeine
-cocaine
-LSD/PCP
-methamphetamines
-adderall
s/
s:11euphoria,11seizures,11restlessness,11irritability,11hyperreflexia11(3+,114+),11tachycardi
a,11borborygmi,11diarrhea
,downers:
-over1113511others;11if11it's11not11an11upper,11it's11a11downer
s/s:11lethargic,11respiratory11depression/arrest,11constipated
highest11priority11in11an11upper11vs11downer11-11answer--
upper:11suctioning11due11to11seizures
downer:11intubation/ventilation11due11to11respiratory11arrest
overdose11vs11withdrawal11in11an11upper11and11a11downer11-11answer--
overdose11on11an11upper:11too11much
overdose11on11a11downer:11too11little
withdrawal11on11a11upper:11too11little
withdrawal11on11a11downer:11too11much
drug11abuse11in11a11newborn:11intoxication11vs11withdrawal11-11answer--
intoxication11in11a11newborn11is11less11than112411hours11after11birth
withdrawal11is112411hours11or11more11after11birth
alcohol11withdrawal11vs11delirium11tremens11-11answer--alcohol11withdrawal:
-occurs11after112411hours11after11drinking
-non11life11threatening11to11self11or11others
-regular11diet
-semiprivate11room,11anywhere11on11unit
-pt11is11up11and11able11to11move11around
-no11restraints
delirium11tremens:
-occurs11after117211hours11after11drinking
-life11threatening11to11self11or11others
-NPO11or11clear11liquid11diet
-private11room,11near11nursing11station
-restricted11bed11rest
-restraints11(vest11or112-point11lock11letters)
what11to11give11to11both11a11pt11in11alcohol11withdrawal11&11delirium11tremens11-
11answer--anti-HTN11medication,11tranquilizer,11&11multivitamin11containing11B1
aminoglycosides11-11answer--"mean11old11mycins"
, -big11guns11of11ABX11
-
end11in11mycin11(gentamycin,11vancomycin,11clindamycin,11streptomycin)11but11NOT11th
e11drugs11ending11in11-thromycin
-
what11they11treat:11TB,11septic11peritonitis,11fulminating11pyelonephritis,11septic11shock,1
1infection11from113rd11degree11burn11wound11covering11>80%11of11the11body
-
what11they11don't11treat:11sinusitis,11otitis11media,11bladder11infection,11viral11pharyngitis
,11&11strep11throat
-toxic11effects:11CN811toxicity11(monitor11hearing-
11#1,11balance,11tinnitus)11&11nephrotoxicity11(monitor11creatinine)
-
given11IM11or11IV11because11PO11is11not11absorbed.11PO11only11given11for11hepatic11en
cephalopathy11(when11ammonia11levels11get11too11high)11or11pre-
op11bowel11surgery11(to11sterilize11the11bowel)
-which11aminoglycosides11sterilize11the11bowel:11neomycin11&11kanamycin
-draw11TAP11(trough,11administer,11peak)11on11mycins
when11are11trough11and11peak11levels11drawn11of11each11route11-11answer--
*trough11is11always11drawn113011min11before11no11matter11the11route*
peaks:
SubL11-11511to111011minutes11after11the11drug11is11dissolved
IV11-111511to113011minutes11after11the11drug11is11finished11(NOT11when11its11hung)
IM11-113011to116011minutes
SubQ11-11depends11on11insulin
PO11-11not11necessary
calcium11channel11blockers11-11answer---they11relax11and11slow11down11the11heart
-ends11in11-dipine11+11verapimil11and11cardizem11(diltiazem)--
11continuous11IV11drip11so11titrate11to11make11systolic11>10011....11"dipping11in11the11calc
ium11channel"
-
they11treat:11"A,11AA,11AAA"11Antihypertensive,11AntiAnginal11drugs,11and11AntiAtrialArr
hythmia
how11to11remember11s/s11for11pH11imbalances11-
11answer--"as11the11pH11goes,11so11goes11my11patient....11except11potassium"
#111priority11for11alkalosis11&11why11-11answer--
pt11needs11suctioning11because11of11seizures
#111priority11for11acidosis11&11why11-11answer--
pt11needs11to11be11ventilated11with11ambu11bag11bc11of11respiratory11arrest
what11acid-base11imbalance11does11kussmaul11respirations11cause11-11answer--
metabolic11acidosis
acid-base11imbalance11for11over/under11ventilating11-11answer--
over11ventilating:11respiratory11alkalosis11
under11ventilating:11respiratory11acidosis
acid-base11imbalance11for11prolonged11gastric11vomiting11or11suction11-11answer--
metabolic11alkalosis
reasons11for11high11pressure11alarms11on11vent11&11what11to11do11for11them11-
11answer--1.11kinks...11unkink11it
2.11condensed11water...11empty11it
3.11mucus11plugs...11turn,11cough,11deep11breathe,11or11suction11PRN
reasons11for11low11pressure11alarms11on11vent11&11what11to11do11for11them11-11answer--
1.11main11tubing11disconnection...11reconnect11it
2.11O211sensor11tube11disconnection...11reconnect11it
11*if11tubing11is11on11the11floor...11bag11pt11and11call11respiratory11therapist*
what11acid-
base11imbalance11would11the11pt11be11considered11ready11to11be11weaned11off11the11ve
nt11&11why11-11answer--respiratory11alkalosis11b/c11over11ventilating
#111psychological11problem11for11any11abuse11situation11-11answer--DENIAL
when11is11denial11ok11-11answer--with11loss11&11grief
stages11of11grief:11(DABDA)11denial,11anger,11bargaining,11depression,11acceptance
,dependency,11co-dependency,11&11manipulation11(what11to11do11for11each11of11them)11-
11answer---
dependency:11abuser11gets11the11significant11other11to11do11things11or11make11decision
s11for11them11...11CONFRONT11THEM
-co-dependency:11when11the11significant11other11derives11self-
esteem11for11doing11things11or11making11decisions11for11the11abuser,11however11NOT11
harmful11...11SET11LIMITS11&11ENFORCE11THEM,11say11no,11work11on11the11self-
esteem11of11co-dependent11person
-
manipulation:11abuser11gets11significant11other11to11do11things11or11make11decisions11th
at11are11NOT11IN11THE11BEST11INTEREST11of11the11significant11other,11harmful11&11da
ngerous11...11SET11LIMITS11&11ENFORCE11THEM
wernicke11(korsakoff)11syndrome11..11what11it11is,11s/
s,11what11to11do,11how11to11prevent11-11answer--psychosis-
induced11encephalopathy11by11vitamin11B111(thiamine)11deficiency11from11alcoholism
s/s:11amnesia11&11confabulation
what11to11do:11REDIRECT11them11when11confabulating11about11something11that11is11no
t11true
how11to11prevent:11take11vitamin11B1
antabuse11and11revia11(disulfiram)11-11answer--
aversion11therapy11(development11of11hatred11for11alcohol)
onset11AND11duration11of11effectiveness:11211weeks
pt11teaching:11avoid11all11forms11of11alcohol11to11avoid11nausea,11vomiting,11and11death
11(includes11mouthwash,11cologne,11perfume,11aftershave,11elixir11OTC11meds,11hand11
sanitizer,11insect11repellant,11vanilla11extract...11CAN11have11red11wine11vinigarettes)
what11are11the11upper11&11downer11drugs11with11s/s11-11answer--uppers:
-caffeine
-cocaine
-LSD/PCP
-methamphetamines
-adderall
s/
s:11euphoria,11seizures,11restlessness,11irritability,11hyperreflexia11(3+,114+),11tachycardi
a,11borborygmi,11diarrhea
,downers:
-over1113511others;11if11it's11not11an11upper,11it's11a11downer
s/s:11lethargic,11respiratory11depression/arrest,11constipated
highest11priority11in11an11upper11vs11downer11-11answer--
upper:11suctioning11due11to11seizures
downer:11intubation/ventilation11due11to11respiratory11arrest
overdose11vs11withdrawal11in11an11upper11and11a11downer11-11answer--
overdose11on11an11upper:11too11much
overdose11on11a11downer:11too11little
withdrawal11on11a11upper:11too11little
withdrawal11on11a11downer:11too11much
drug11abuse11in11a11newborn:11intoxication11vs11withdrawal11-11answer--
intoxication11in11a11newborn11is11less11than112411hours11after11birth
withdrawal11is112411hours11or11more11after11birth
alcohol11withdrawal11vs11delirium11tremens11-11answer--alcohol11withdrawal:
-occurs11after112411hours11after11drinking
-non11life11threatening11to11self11or11others
-regular11diet
-semiprivate11room,11anywhere11on11unit
-pt11is11up11and11able11to11move11around
-no11restraints
delirium11tremens:
-occurs11after117211hours11after11drinking
-life11threatening11to11self11or11others
-NPO11or11clear11liquid11diet
-private11room,11near11nursing11station
-restricted11bed11rest
-restraints11(vest11or112-point11lock11letters)
what11to11give11to11both11a11pt11in11alcohol11withdrawal11&11delirium11tremens11-
11answer--anti-HTN11medication,11tranquilizer,11&11multivitamin11containing11B1
aminoglycosides11-11answer--"mean11old11mycins"
, -big11guns11of11ABX11
-
end11in11mycin11(gentamycin,11vancomycin,11clindamycin,11streptomycin)11but11NOT11th
e11drugs11ending11in11-thromycin
-
what11they11treat:11TB,11septic11peritonitis,11fulminating11pyelonephritis,11septic11shock,1
1infection11from113rd11degree11burn11wound11covering11>80%11of11the11body
-
what11they11don't11treat:11sinusitis,11otitis11media,11bladder11infection,11viral11pharyngitis
,11&11strep11throat
-toxic11effects:11CN811toxicity11(monitor11hearing-
11#1,11balance,11tinnitus)11&11nephrotoxicity11(monitor11creatinine)
-
given11IM11or11IV11because11PO11is11not11absorbed.11PO11only11given11for11hepatic11en
cephalopathy11(when11ammonia11levels11get11too11high)11or11pre-
op11bowel11surgery11(to11sterilize11the11bowel)
-which11aminoglycosides11sterilize11the11bowel:11neomycin11&11kanamycin
-draw11TAP11(trough,11administer,11peak)11on11mycins
when11are11trough11and11peak11levels11drawn11of11each11route11-11answer--
*trough11is11always11drawn113011min11before11no11matter11the11route*
peaks:
SubL11-11511to111011minutes11after11the11drug11is11dissolved
IV11-111511to113011minutes11after11the11drug11is11finished11(NOT11when11its11hung)
IM11-113011to116011minutes
SubQ11-11depends11on11insulin
PO11-11not11necessary
calcium11channel11blockers11-11answer---they11relax11and11slow11down11the11heart
-ends11in11-dipine11+11verapimil11and11cardizem11(diltiazem)--
11continuous11IV11drip11so11titrate11to11make11systolic11>10011....11"dipping11in11the11calc
ium11channel"
-
they11treat:11"A,11AA,11AAA"11Antihypertensive,11AntiAnginal11drugs,11and11AntiAtrialArr
hythmia
