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Mark Klimek Lecture Notes (1)
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Mark Klimek Lecture Notes (1)
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Mark Klimek Lecture NotesAs the ph goes.... so does my pt (except for POTASSIUM) - ANS--ph up s/sx:
excitability, tachycardia, tachypnea, hyperreflexia, restlessness, irratability, seizures
-ph down s/sx: opposity
what is the rule for deciding which ABG for an unknown condition - ANS--if it isn't
respiratory/lungs, vomiting/diarrea, or suctioning... it is probably metabolic acidosis
-s/sx: kussmauls
-ex: dehydration, acute renal failure etc.
which ABG for pt w n/v/d and/or suctioning - ANS-metabolic alkalosis
ventilator: high pressure alarms vs low pressure alarms - ANS--high: increased
resistence caused by obstructions (check for kinks, water in tube, or mucus in airway
(TCDB, then suction if not working))
-low: decreased resistence caused by disconnections (reconnect)
Respiratory acidosis vs alkalosis w ventilators - ANS--acidosis: too much CO2 so you
are underventilating and need to turn up
-alkalosis: too much O2 so you are overventilating and they may be read to wean off
ventilator
Wernicke's (korsakoff's) syndrome - ANS-psychosis induced by vitamin B1 (thiamine)
defiecinecy
-happens w alcoholism
-s/sx: amnesia (memory loss) and confabulation (making up stuff)
-preventable (give V B1), can stop it from getting worse, irreversible
Antabuse/Revia - ANS--aversion (strong hatred for) therapy
-takes 2 weeks to become effective, and 2 weeks till they can drink alchol safely
-avoid all forms: includeing perfume, aftershave, mouthwash
Alcohol withdrawal syndrome (AWD) vs Delirium Tremens (DT) - ANS--only some get
DT and it can kill you
-AWD will happen before DT
-AWD: reg diet, no restraints, up at liberty
-Pulse rate is good indicator of whether or not pt needs more sedation
, -DT: NPO (risk for aspiration), bedrest, private room near nurse station, usually 2 point
or vest)
-both: give ant HTN meds, tranquilizers, multivitamin (B1) to prevent wernicke's
abused drugs: UPPERS - ANS--Caffeine, cocaine, PCP/LSD, methamphetamines,
amphetamiine aspartate monohydrate (Adderal), methylphenadate (ritalin)
-overdose: upper s/sx
-withdrawl: downer s/sx
abused drugs: downers - ANS--every other drug
-overdose s/sx: dowener s/sx(resp depression)
-withdrawal s/sx: upper s/sx (seizures)
Newborn intoxication/withdrawal - ANS--assume intoxication with/in first 24 hrs of birth
-assume withdrawal after that
-intoxication from an upper or withdrawl from a downer: difficult to consule, exaggerated
startle reflex, shrill high pitched cry (increased ICP)
-intoxicaiton from downer or upper withdrawl: resp depression, low cor body temp
aminoglycosides - ANS--"A mean ole Mycin"
-all mycin's except the ones you "thro" away (azithromycin, clarithromycin)
-treat mean ole infections
-MICE (ears); ototoxic (tinnitis, blance, vertigo)and nephrotoxic (draw labs, Cr good)
-get peaks and troughs (30 min next dose)
-ear looks like 8: give Q8 and toxic to cranial nerve 8
all aminoglycosides given IM or IV EXCEPT - ANS---neomycin and kanamycin (bowel
sterilizers
>"who can sterilize my bowen, Neo Kan!"
>give for hepatic encephalopathy and pre-op bowel surgery
-no ototoxic/nephrotoxic
peaks - ANS--IV: 15-30 min after pushed or IV end
-IM: 30-1 hr
-sublingual: 5-10 after dissolved
Calcium Channel Blockers - ANS--"dipine"s (you are diping in CCBs) plus verapamil
and diltiazem
-treat the As: antihypertensive, atril arrhthmias (a flutter, a fib), antiangina
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