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mark klimek review tipsRule of B's for ABGs - ANS-if the pH and the Bicarb are Both in the same direction it is
metaBolic
normal pH
normal Bicarb - ANS-pH: 7.35-7.45
Bicarb: 22-26
Kussmul respirations - ANS-MACkussmul= metabolic acidosis
S&S of acid-base imbalance - ANS-as the pH goes, so goes my patient except for
potassium
UP: (alkolosis):decreased K+, highest risk for seizures
DOWN: (acidosis): increased K+, highest risk for respiratory arrest
causes of respiratory acid-base imbalance - ANS-lung=respiratory
overvent or undervent
overvent= alkolosis
undervent=acidosis
causes of metabolic acid-base imbalance - ANS-not lung=metabolic
prolonged gastric vomiting or suction=metabolic alkolosis (losing acid)
everything else=metabolic acidosis
high pressured ventilator alarms - ANS-triggered by increase resistance to air flow and
can be caused by obstruction of three types:
kinked tube: unkink it
water in tube: empty it
mucus in airway: turn, cough, deep breathe
low pressured ventilator alarams - ANS-triggered by decreased resistance to air flow
and can be caused by disconnections:
tubing: reconnect if not contaminate
if contaminated (below bed level): call first, then bag, reconnect
respiratory alkalosis vs acidosis - ANS-alkalosis: ventilator setting may be too high
(overvent)
,acidosis: ventilator setting may too low (undervent)
HOLD - ANS-high pressured alarms
obstruction
low pressured alarms
disconnection
Maslow - ANS-1. physiological
2. safety
3. comfort
4. psychological
5. social
6. spiritual
#1 problem in substance abuse - ANS-denial: refusal to accept the reality of their
problem
treatment: confront it by pointing out to the person the difference between what they say
and what they do.
however, in grief and loss support denial
dependency/codependency - ANS-dependency: when abuser gets SO to do things for
them or make decisions for them
codependency: when the SO derives positive self-esteem from doing things for or
making decisions for the abuser
treating dependency/codenpendency - ANS-set limits and enforce them. agree in
advance what requests are allowed then enforce the agreement
work on the self-esteem of the codependent person
manipulation - ANS-when abuser gets the SO to do things for him/her that are no in the
best interest of the SO. nature of the act is dangerous or harmful to SO
treatment of manipulation - ANS-set limits and enforce them
easier to treat than dependency/codependency because no body likes being
manipulated
wenicke's korsakoff syndrome - ANS-psychosis caused by a lack of B1 (thiamine)
deficiency
primary symptom: amnesia with confabulation
-preventable
,-arrestable
-irreversible
antabuse/revia (disulfiram) - ANS-aversion therapy
onset/duration of effectiveness: 2 weeks
pt teaching: avoid all forms of alcohol to avoid nausea, vomiting, death
uppers - ANS-cocaine, caffeine, PCP/LSD, methamphedimines, ADHD meds
(amphetimines), bath salts
S&S: increase everything, pupils dilate (mydriasis), seizures
downers - ANS-codeine, heroin, alcohol, marijuana
S&S: decrease everything, pupils constrict (miosis), respiratory arrest
overdose vs withdrawal - ANS-upper overdose: everything is high
upper withdrawal: everything is low
downer overdose: everything is low
downer withdrawal: everything is high
alcohol withdrawal syndrome vs delirium tremens - ANS-every alcoholic go through
AWS (24 hrs) only a minority get DT (usually 72 hrs)
AWS is not life-threatening. DT can kill you
PT with AWS are not dangerous to themselves or others. PTs with DT's are dangerous
to self and others
pg 8
aminoglycosides (a mean old mycin) - ANS-antibiotics to treat serious, life-threatening,
resistant
all end in -mycin/micin, but not all drugs that end in -mycin/micin are "a mean old mycin"
(all have thro in them and are opposites of aminoglycosides)
toxic effects of "a mean old mycin" - ANS-think of mice (ears)
ototoxicity
must monitor balance, tinitus, hearing (most important)
ear is shaped like a kidney
nephrotoxicity
monitor creatinine (best indicator of kidney fx)
, #8 drawn inside the ear reminds you
cranial nerve 8
frequency of administration: q8h
route of administration for "a mean old mycin" - ANS-give IV or IM
do not give PO (not absorbed) except in tow cases: sterilize the bowel ->
neonmycin/canmycin
hepatic encephalopathy
also called liver coma, ammonia-induced encephalopathy, due to a high ammonia level
pre-op bowel surgery
remember this military sound-off
Q: who can sterile my bowel?
A: Neo-can
through and peak levels for amonoglycin - ANS-reasons for drawing TAP levels: narrow
therapuetic range
pg 10
category A bioterrorism - ANS-can hurt people worst
S: small pox
T: tularemia
A: anthrax
P: plague
H: hemorrhagic fever
B: botulism
category C bioterrorism - ANS-nipen virus
harita virus
small pox - ANS-person to person
inhaled transmission/on airborne precautions
dies from septicemia. no treatment
rash starts around mouth first-> early finding then quarentine
tularemia - ANS-inhaled, not passed person to person
chest symptoms
dies from respiratory failure
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