Mark Klimek NCLEX Review Notes � � Medical-Surgical Essentials

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Mark Klimek NCLEX Review Notes
🏥 Medical-Surgical Essentials

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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, Bilirubin, Lecture 8— Lab Values
Aminophylline) Five Deadly Ds
Kernicterus Neutropenic Precaution
Dumping/HH
Electrolytes: K+, CA, MG, Lecture 9— Psych Drugs
and NA Tri
TX for HyperKalemia Benzo
MAOI
Lecture 4— Crutches Lithium
Canes Prozac
Walkers Haldol
Delusions Clozaril
Hallucinations Zoloft
Psychosis
Psychotic and Non-Psychotic Lecture 10— Maternity and Neonatology
Hallucination
Illusion Lecture 11— Fetal Complications
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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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

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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.

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