LECTURE 1 ** DON’T MIX UP S&S and CAUSATION
- often what causes something is the opposite of the S&S
- ex. diarrhea will cause a metabolic acidosis but once
ACID BASES
you are acidotic your bowel shuts down and you get a
• learn how to convert lab values to words paralytic illeus
• the rule of the B’s
= if the pH and the BiCarb are both in the same
• when you get scenarios:
direction -> metabolic -> if it’s a lung scenario = respiratory
Hint: draw arrows beside each to see directions - then check if the client is over-ventilating
* down = acidosis (alkalosis) or under-ventilating (acidosis)
* up = alkalosis - remember to look at the words (ex. over, under,
- respiratory -> has no b in it; if in other directions ventilating) -> “as the pH goes so goes my PT”
(or if bicarb is normal value) -> VENTILATING DOESN’T MEAN RESPIRATORY
- KNOW NORMAL pH, BiCarb, CO2 RATE; resp. rate is irrelevant w/ acid-base,
ventilation has to do with gas exchange not resp.
• Hint: DON’T MEMORIZE LISTS…know principles rate (look at the SaO2 -> if your resp. rate is fast
(they test knowledge of principles by having you but SaO2 is low you are under-ventilating)
generate lists..) - for “select all” questions -> ex. PCA pump - What acid-base disorder
- ex. in general/principle what do opioids/pain indicates they need to come off of it? = respiratory
meds do? = sedate you, CNS depressors acidosis (resp. depression -> resp. arrest)
* ex. what does dilaudid do? don’t memorize specifics —> if it’s not lung, it’s metabolic
or a list of dilaudid, know principles of opioids (such • metabolic alkalosis - really only one scenario = if
as sedation, CNS depression -> lethargy, flaccidity, the PT has prolonged gastric vomiting/suctioning
reflex +1, hypo-reflexia, obtunded) - because you are losing ACID
- boards don’t test by lists because all books/ * ex. GI surgery w/ NG tube with suctioning for
classes have different lists 3 days; hyperemesis graviderum
- otherwise everything else that isn’t lung you
• principles of S&S acid bases: as the pH goes so pick metabolic acidosis (DEFAULT)
goes my patient (except K+) * ex. hyperemesis graviderum w/ dehydration
- pH up = PT up -> body system gets more acute renal failure, infantile diarrhea
irritable, hyper-excitable (EXCEPT K+)
-> alkalosis - think of a body system and go • remember, you only have 4 to pick from:
high: hyper-reflexive (+3, +4 [2 is normal]), - respiratory alkalosis - respiratory acidosis
tachypnea, tachycardia, borborygmi, seizure - metabolic alkalosis - metabolic acidosis
- pH down = PT down -> body systems shut
down (EXCEPT K+) • pay more attention to the modifying phrases than
-> acidosis - think of a system and go low: the original noun
hypo-reflexive (+1, 0), bradycardia, lethargy, - ex. person w/ OCD who is now psychotic (psychotic
obtunded, paralytic illeus, respiratory arrest trumps OCD); hyperemesis with dehydration (pay
• ex. which acid-base disorders need an ambu-bag at attention to dehydration)
the bedside? = acidosis (resp. arrest)
• ex. which acid-base disorders need suction at the VENTILATION
bedside? = alkalosis (seize and aspirate) • ventilators -> know alarm systems (you set it up so
• Mac Kussmaul - Kussmaul’s (compensatory that the machine doesn’t use less than or more than
respiratory mechanism) is only present in only 1 of specific amounts of pressure)
the 4 metabolic (acid-base) disorders a) high pressure alarm = increased resistance
* M = metabolic AC = acidosis to airflow (the machine has to push too hard to
get air into lungs)
• most common mistake with select all questions = selecting - from obstructions:
one more than you should (stop when you select the ones i. kinks in tubing (unkink it)
you know! don’t get caught up on the “could be’s”)
ii. water condensation in tube (empty it!)
• Hint: don’t select none or all on select all that apply iii. mucous secretions in the airway (change
questions (never only one and never all)
positions/turn, C&DB, and THEN suction)
*** suction is only PRN!!!
• Causes of Acid-Base Imbalance: -> priority questions = you would check
- scenarios and what acid-base disorder would
kinks first, suction is not first
result (what would cause an imbalance)
, b) low pressure alarm = decreased resistance
to airflow (the machine had to work too little
to push air into lungs)
- from disconnections:
i. main tubing (reconnect it duh!)
ii. O2 sensor tubing (which senses FiO2 at
the airway/trach area; black coated wire
coming from machine right along the
tubing - reconnect!)
• ventilators -> know blood gases
- resp. alkalosis = ventilation settings might be
set too high (OVER-VENTILATING)
- resp. acidosis = ventilation settings might be set
too low (UNDER-VENTILATING)
• ex. weaning a PT off ventilator -> should not be
under-ventilated, they need the ventilator; if they are
over-ventilating then they can be weaned
• never pick an answer where you don’t do something
and someone else has to do something
,LECTURE 2 - how do you tell the difference between manipulation
& dependency?
ABUSE (Psych and Med-Surge) -> NEUTRAL vs. NEGATIVE (look at what they’re
Psychological Aspect/Psycho-Dynamics being asked to do)
-> if the sig. other is being asked to do something
• # 1 psychological problem is the same in any/all
abusive situations = DENIAL neutral (no harm) its dependency/co-dependency
- abusers have an infinite capacity for denial so that -> if the sig. other is being asked to do something
they can continue the behavior w/o answering for it that will harm them or is dangerous to them they
are manipulated
• can use the alcoholism rules for any abuse
- ex. # 1 psych problem in child abuse, gambling or • how do you treat manipulation?
cocaine abuse is denial - set limits and enforce them -> “NO”
• why is denial the problem? HOW CAN YOU TREAT - easier to treat than dependency/co-dependency
SOMEONE WHO DENIES/DOESN’T RECOGNIZE because no one likes to be manipulated (no positive
THEY HAVE A PROBLEM self-esteem issue going on)
• denial = refusal to accept the reality of a problem • ex. how many PT’s do you have w/ denial? = 1
• treat denial by CONFRONTING the problem (it’s not ex. how many PT’s do you have w/ dependency/co-
the same as aggression which attacks the person, not dependency = 2
the problem) = they DENY you CONFRONT ex. how many PT’s do you have w/ manipulation = 1
- pointing out to the person the difference between
what they say and what they do Alcoholism
- Hint: never pick answers that attack the person Wernicke’s & Korsakoff’s
-> ex. bad answers have bad pronouns - “you” - typically separate BUT boards lumps them together
-> ex. good answers have good pronouns - “I”, “we” - wernicke’s = encephalopathy
-> ex. “you wrote the order wrong” vs. “I’m having - korsakoff’s = psychosis (lose touch with reality)
difficulty interpreting what you want” -> tend to go together, find them in the same PT
• loss and grief -> for this denial you must SUPPORT it • Wernicke Korsakoff’s syndrome:
- DABDA = denial, anger, bargaining, depression, acceptance a) psychosis induced by Vit. B1 (Thiamine) deficiency
• Hint: for questions about denial, you must look to see - lose touch w/ reality, go insane because of no B1
if it is LOSS or ABUSE b) primary symptom -> amnesia w/ confabulation
- loss/grief = support - significant memory loss w/ making up stories
- abuse = confront - they believe their stories
• How do you deal w/ these PT’s?
• #2 psychological problem in abuse = DEPENDENCY, - bad way = confrontation (because they believe what
CO-DEPENDENCY they are saying and can’t see reality)
- dependency = when the abuser gets significant other - good way = redirection (take what the PT can’t do
to do things for them or make decisions for them and channel it into something they can do)
-> the dependent = abuser • Characteristics of Wenicke Korsakoff’s:
- co-dependency = when the significant other derives a) it’s preventable = take Vit. B1 (co-enzyme needed
positive self-esteem from making decisions for or for the metabolism of alcohol which keeps alcohol
doing things for the abuser from accumulating and destroying brain cells)
-> the abuser gets a life w/o responsibilities * PT doesn’t have to stop drinking
-> the sig. other gets positive self-esteem (which is b) it’s arrestable = can stop it from getting worse by
why they can’t get out of the relationship) taking Vit. B1
• how do you treat it? * also not necessary to stop drinking
- set limits and enforce them c) it’s irreversible (70% of cases) -> Hint: On boards,
-> start teaching sig. other to say NO (and they answer w/ the majority (ex. if something is majority
have to keep doing it) of the time fatal, you say it’s fatal even if 5% of the
- must also work on the self-esteem of the co-dependent time it’s not)
(ex. I’m a good person because I’m saying “no”) • Drugs for Alcoholism:
• manipulation = when the abuser gets the sig. other DISULFIRAM (Antabuse)
to do things for them that are not in the best interest of = aversion therapy -> want PT’s to develop a gut
the sig. other hatred for alcohol
- the nature of the act is dangerous/harmful -> interacts w/ alcohol in the blood to make you very ill
- how is manipulation like dependency? -> works in theory better than in reality
-> in both the abuser is getting the other person to -> onset & duration: 2 weeks (so if you want to
do something for them drink again, wait 2 weeks)
, - PT teaching = avoid ALL forms of alcohol to avoid • Alcohol Withdrawal Syndrome vs. Delirium Tremens
nausea, vomiting & possibly death - they are both different! not the same
-> including mouthwash, aftershaves/colognes/perfumes a) every alcoholic goes through withdrawal 24 hrs.
(topical stuff will make them nauseous), insect after they stop drinking
repellants, any OTC that ends with “-elixer”, alcohol- - only a minority get delirium tremens
based hand sanitizers, uncooked (no-bake) icings - timeframe -> 72 hrs. (alcohol withdrawal comes 1st)
which have vanilla extract, red wine vinaigrette - alcohol withdrawal syndrome ALWAYS precedes
delirium tremens, BUT delirium tremens does not
• Overdoses & Withdrawals: always follow alcohol withdrawal syndrome
- every abused drug is either an UPPER or DOWNER b) AWS is not life-threatening; DT’s can kill you
-> the other drugs don’t do anything c) PT’s w/ AWS are not a danger to self/others; PT’s
-> #1 abused class of drug that is not an upper or w/ DT’s are dangerous to self/others
downer = laxatives in the elderly - they are withdrawing from a downer so they will
a) first establish if the drug is an upper or downer be exhibiting upper S&S
- uppers (5) = caffeine, cocaine, PCP/LSD (psychedelic - DT’s are dangerous
hallucinogens), methamphetamines, adderol (ADD drug) Differences AWS DT
* S&S -> make you go up; euphoria, tachycardia, in Care
restlessness, irritability, diarrhea, borborygmi, Diet Regular diet NPO/clear liquids
hyper-reflexia, spastic, seize (need suction) (because of risk for seizures which
can cause risk of aspiration)
- downers = don’t memorize names -> anything that
Room Semi-private Private near nurses station
is not an upper is a downer! if you don’t know what anywhere on (dangerous & unstable)
the med is, you have a high chance that it’s a the unit
downer if it’s not part of the uppers list Ambulation Up ad lib Restricted bed rest -> no bathroom
* S&S -> make you go down; lethargy, respiratory privileges (use bedpans/urinals)
depression (& arrest) Restraints No restraints Restraints (because dangerous)
(because not - not soft wrist or 4 point soft
- ex. The PT is high on cocaine. What is critical to assess? dangerous) because they’ll get out
-> NOT resps below 12 because they will be high - need to be in vest or 2-pt. locked
leathers (opposite 1 arm & leg,
-> maybe check reflexes rotate Q2hrs, lock the free
b) are they talking about overdose or withdrawal limbs 1st before releasing the
locked ones)
- overdose/intoxication = too much
They both get ANTI-HYPERTENSIVES &
- withdrawal = not enough TRANQUILIZERS
- ex. the PT has overdosed on an upper -> pick the - because everything is up (downer withdrawal)
S&S of too much upper They both get MULTIVITAMIN w/ B1
- ex. the PT has overdosed on a downer -> pick the
S&S of too much downer • RN’s can accept but RPN’s can’t (because PT is unstable)
- ex. the PT is withdrawing from an upper -> not - on med-surge, the RN who takes them must decrease
enough upper makes everything go down their workload (i.e. reduce PT load if they take a DT PT)
- ex. the PT is withdrawing from a downer -> not -> Hint: on boards, the setting is always perfect
enough downer makes everything go up (i.e. enough staff/time/resources on the unit etc.)
• upper overdose looks like = downer withdrawal
• downer overdose looks like = upper withdrawal
• In what 2 situations would resp. depression & arrest
be your highest priority:
- downer overdose
- upper withdrawal
• In what 2 situations would seizure be the biggest risk:
- upper overdose
- downer withdrawal
• Drug Abuse in the Newborn:
- always assume intoxication, NOT withdrawal at birth
- after 24 hrs -> withdrawal
- ex. caring for infant of a Quaalude addicted mom 24
hrs. after birth, select all that apply:
-> downer withdrawal so everything is up = exaggerated
startle, seizing, high pitched/shrill cry
- often what causes something is the opposite of the S&S
- ex. diarrhea will cause a metabolic acidosis but once
ACID BASES
you are acidotic your bowel shuts down and you get a
• learn how to convert lab values to words paralytic illeus
• the rule of the B’s
= if the pH and the BiCarb are both in the same
• when you get scenarios:
direction -> metabolic -> if it’s a lung scenario = respiratory
Hint: draw arrows beside each to see directions - then check if the client is over-ventilating
* down = acidosis (alkalosis) or under-ventilating (acidosis)
* up = alkalosis - remember to look at the words (ex. over, under,
- respiratory -> has no b in it; if in other directions ventilating) -> “as the pH goes so goes my PT”
(or if bicarb is normal value) -> VENTILATING DOESN’T MEAN RESPIRATORY
- KNOW NORMAL pH, BiCarb, CO2 RATE; resp. rate is irrelevant w/ acid-base,
ventilation has to do with gas exchange not resp.
• Hint: DON’T MEMORIZE LISTS…know principles rate (look at the SaO2 -> if your resp. rate is fast
(they test knowledge of principles by having you but SaO2 is low you are under-ventilating)
generate lists..) - for “select all” questions -> ex. PCA pump - What acid-base disorder
- ex. in general/principle what do opioids/pain indicates they need to come off of it? = respiratory
meds do? = sedate you, CNS depressors acidosis (resp. depression -> resp. arrest)
* ex. what does dilaudid do? don’t memorize specifics —> if it’s not lung, it’s metabolic
or a list of dilaudid, know principles of opioids (such • metabolic alkalosis - really only one scenario = if
as sedation, CNS depression -> lethargy, flaccidity, the PT has prolonged gastric vomiting/suctioning
reflex +1, hypo-reflexia, obtunded) - because you are losing ACID
- boards don’t test by lists because all books/ * ex. GI surgery w/ NG tube with suctioning for
classes have different lists 3 days; hyperemesis graviderum
- otherwise everything else that isn’t lung you
• principles of S&S acid bases: as the pH goes so pick metabolic acidosis (DEFAULT)
goes my patient (except K+) * ex. hyperemesis graviderum w/ dehydration
- pH up = PT up -> body system gets more acute renal failure, infantile diarrhea
irritable, hyper-excitable (EXCEPT K+)
-> alkalosis - think of a body system and go • remember, you only have 4 to pick from:
high: hyper-reflexive (+3, +4 [2 is normal]), - respiratory alkalosis - respiratory acidosis
tachypnea, tachycardia, borborygmi, seizure - metabolic alkalosis - metabolic acidosis
- pH down = PT down -> body systems shut
down (EXCEPT K+) • pay more attention to the modifying phrases than
-> acidosis - think of a system and go low: the original noun
hypo-reflexive (+1, 0), bradycardia, lethargy, - ex. person w/ OCD who is now psychotic (psychotic
obtunded, paralytic illeus, respiratory arrest trumps OCD); hyperemesis with dehydration (pay
• ex. which acid-base disorders need an ambu-bag at attention to dehydration)
the bedside? = acidosis (resp. arrest)
• ex. which acid-base disorders need suction at the VENTILATION
bedside? = alkalosis (seize and aspirate) • ventilators -> know alarm systems (you set it up so
• Mac Kussmaul - Kussmaul’s (compensatory that the machine doesn’t use less than or more than
respiratory mechanism) is only present in only 1 of specific amounts of pressure)
the 4 metabolic (acid-base) disorders a) high pressure alarm = increased resistance
* M = metabolic AC = acidosis to airflow (the machine has to push too hard to
get air into lungs)
• most common mistake with select all questions = selecting - from obstructions:
one more than you should (stop when you select the ones i. kinks in tubing (unkink it)
you know! don’t get caught up on the “could be’s”)
ii. water condensation in tube (empty it!)
• Hint: don’t select none or all on select all that apply iii. mucous secretions in the airway (change
questions (never only one and never all)
positions/turn, C&DB, and THEN suction)
*** suction is only PRN!!!
• Causes of Acid-Base Imbalance: -> priority questions = you would check
- scenarios and what acid-base disorder would
kinks first, suction is not first
result (what would cause an imbalance)
, b) low pressure alarm = decreased resistance
to airflow (the machine had to work too little
to push air into lungs)
- from disconnections:
i. main tubing (reconnect it duh!)
ii. O2 sensor tubing (which senses FiO2 at
the airway/trach area; black coated wire
coming from machine right along the
tubing - reconnect!)
• ventilators -> know blood gases
- resp. alkalosis = ventilation settings might be
set too high (OVER-VENTILATING)
- resp. acidosis = ventilation settings might be set
too low (UNDER-VENTILATING)
• ex. weaning a PT off ventilator -> should not be
under-ventilated, they need the ventilator; if they are
over-ventilating then they can be weaned
• never pick an answer where you don’t do something
and someone else has to do something
,LECTURE 2 - how do you tell the difference between manipulation
& dependency?
ABUSE (Psych and Med-Surge) -> NEUTRAL vs. NEGATIVE (look at what they’re
Psychological Aspect/Psycho-Dynamics being asked to do)
-> if the sig. other is being asked to do something
• # 1 psychological problem is the same in any/all
abusive situations = DENIAL neutral (no harm) its dependency/co-dependency
- abusers have an infinite capacity for denial so that -> if the sig. other is being asked to do something
they can continue the behavior w/o answering for it that will harm them or is dangerous to them they
are manipulated
• can use the alcoholism rules for any abuse
- ex. # 1 psych problem in child abuse, gambling or • how do you treat manipulation?
cocaine abuse is denial - set limits and enforce them -> “NO”
• why is denial the problem? HOW CAN YOU TREAT - easier to treat than dependency/co-dependency
SOMEONE WHO DENIES/DOESN’T RECOGNIZE because no one likes to be manipulated (no positive
THEY HAVE A PROBLEM self-esteem issue going on)
• denial = refusal to accept the reality of a problem • ex. how many PT’s do you have w/ denial? = 1
• treat denial by CONFRONTING the problem (it’s not ex. how many PT’s do you have w/ dependency/co-
the same as aggression which attacks the person, not dependency = 2
the problem) = they DENY you CONFRONT ex. how many PT’s do you have w/ manipulation = 1
- pointing out to the person the difference between
what they say and what they do Alcoholism
- Hint: never pick answers that attack the person Wernicke’s & Korsakoff’s
-> ex. bad answers have bad pronouns - “you” - typically separate BUT boards lumps them together
-> ex. good answers have good pronouns - “I”, “we” - wernicke’s = encephalopathy
-> ex. “you wrote the order wrong” vs. “I’m having - korsakoff’s = psychosis (lose touch with reality)
difficulty interpreting what you want” -> tend to go together, find them in the same PT
• loss and grief -> for this denial you must SUPPORT it • Wernicke Korsakoff’s syndrome:
- DABDA = denial, anger, bargaining, depression, acceptance a) psychosis induced by Vit. B1 (Thiamine) deficiency
• Hint: for questions about denial, you must look to see - lose touch w/ reality, go insane because of no B1
if it is LOSS or ABUSE b) primary symptom -> amnesia w/ confabulation
- loss/grief = support - significant memory loss w/ making up stories
- abuse = confront - they believe their stories
• How do you deal w/ these PT’s?
• #2 psychological problem in abuse = DEPENDENCY, - bad way = confrontation (because they believe what
CO-DEPENDENCY they are saying and can’t see reality)
- dependency = when the abuser gets significant other - good way = redirection (take what the PT can’t do
to do things for them or make decisions for them and channel it into something they can do)
-> the dependent = abuser • Characteristics of Wenicke Korsakoff’s:
- co-dependency = when the significant other derives a) it’s preventable = take Vit. B1 (co-enzyme needed
positive self-esteem from making decisions for or for the metabolism of alcohol which keeps alcohol
doing things for the abuser from accumulating and destroying brain cells)
-> the abuser gets a life w/o responsibilities * PT doesn’t have to stop drinking
-> the sig. other gets positive self-esteem (which is b) it’s arrestable = can stop it from getting worse by
why they can’t get out of the relationship) taking Vit. B1
• how do you treat it? * also not necessary to stop drinking
- set limits and enforce them c) it’s irreversible (70% of cases) -> Hint: On boards,
-> start teaching sig. other to say NO (and they answer w/ the majority (ex. if something is majority
have to keep doing it) of the time fatal, you say it’s fatal even if 5% of the
- must also work on the self-esteem of the co-dependent time it’s not)
(ex. I’m a good person because I’m saying “no”) • Drugs for Alcoholism:
• manipulation = when the abuser gets the sig. other DISULFIRAM (Antabuse)
to do things for them that are not in the best interest of = aversion therapy -> want PT’s to develop a gut
the sig. other hatred for alcohol
- the nature of the act is dangerous/harmful -> interacts w/ alcohol in the blood to make you very ill
- how is manipulation like dependency? -> works in theory better than in reality
-> in both the abuser is getting the other person to -> onset & duration: 2 weeks (so if you want to
do something for them drink again, wait 2 weeks)
, - PT teaching = avoid ALL forms of alcohol to avoid • Alcohol Withdrawal Syndrome vs. Delirium Tremens
nausea, vomiting & possibly death - they are both different! not the same
-> including mouthwash, aftershaves/colognes/perfumes a) every alcoholic goes through withdrawal 24 hrs.
(topical stuff will make them nauseous), insect after they stop drinking
repellants, any OTC that ends with “-elixer”, alcohol- - only a minority get delirium tremens
based hand sanitizers, uncooked (no-bake) icings - timeframe -> 72 hrs. (alcohol withdrawal comes 1st)
which have vanilla extract, red wine vinaigrette - alcohol withdrawal syndrome ALWAYS precedes
delirium tremens, BUT delirium tremens does not
• Overdoses & Withdrawals: always follow alcohol withdrawal syndrome
- every abused drug is either an UPPER or DOWNER b) AWS is not life-threatening; DT’s can kill you
-> the other drugs don’t do anything c) PT’s w/ AWS are not a danger to self/others; PT’s
-> #1 abused class of drug that is not an upper or w/ DT’s are dangerous to self/others
downer = laxatives in the elderly - they are withdrawing from a downer so they will
a) first establish if the drug is an upper or downer be exhibiting upper S&S
- uppers (5) = caffeine, cocaine, PCP/LSD (psychedelic - DT’s are dangerous
hallucinogens), methamphetamines, adderol (ADD drug) Differences AWS DT
* S&S -> make you go up; euphoria, tachycardia, in Care
restlessness, irritability, diarrhea, borborygmi, Diet Regular diet NPO/clear liquids
hyper-reflexia, spastic, seize (need suction) (because of risk for seizures which
can cause risk of aspiration)
- downers = don’t memorize names -> anything that
Room Semi-private Private near nurses station
is not an upper is a downer! if you don’t know what anywhere on (dangerous & unstable)
the med is, you have a high chance that it’s a the unit
downer if it’s not part of the uppers list Ambulation Up ad lib Restricted bed rest -> no bathroom
* S&S -> make you go down; lethargy, respiratory privileges (use bedpans/urinals)
depression (& arrest) Restraints No restraints Restraints (because dangerous)
(because not - not soft wrist or 4 point soft
- ex. The PT is high on cocaine. What is critical to assess? dangerous) because they’ll get out
-> NOT resps below 12 because they will be high - need to be in vest or 2-pt. locked
leathers (opposite 1 arm & leg,
-> maybe check reflexes rotate Q2hrs, lock the free
b) are they talking about overdose or withdrawal limbs 1st before releasing the
locked ones)
- overdose/intoxication = too much
They both get ANTI-HYPERTENSIVES &
- withdrawal = not enough TRANQUILIZERS
- ex. the PT has overdosed on an upper -> pick the - because everything is up (downer withdrawal)
S&S of too much upper They both get MULTIVITAMIN w/ B1
- ex. the PT has overdosed on a downer -> pick the
S&S of too much downer • RN’s can accept but RPN’s can’t (because PT is unstable)
- ex. the PT is withdrawing from an upper -> not - on med-surge, the RN who takes them must decrease
enough upper makes everything go down their workload (i.e. reduce PT load if they take a DT PT)
- ex. the PT is withdrawing from a downer -> not -> Hint: on boards, the setting is always perfect
enough downer makes everything go up (i.e. enough staff/time/resources on the unit etc.)
• upper overdose looks like = downer withdrawal
• downer overdose looks like = upper withdrawal
• In what 2 situations would resp. depression & arrest
be your highest priority:
- downer overdose
- upper withdrawal
• In what 2 situations would seizure be the biggest risk:
- upper overdose
- downer withdrawal
• Drug Abuse in the Newborn:
- always assume intoxication, NOT withdrawal at birth
- after 24 hrs -> withdrawal
- ex. caring for infant of a Quaalude addicted mom 24
hrs. after birth, select all that apply:
-> downer withdrawal so everything is up = exaggerated
startle, seizing, high pitched/shrill cry
