mark klimek’s nur 490 lecture 1 to 12 notes mark klimek’s notes page 1 of 97 guide • mark klimek’s lecture lecture 1— acid base balance ventilators lecture 2— alcohol wernicke overdose and
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MA.RK KLIMEK’S (NUR 490) LECTURE 1 TO 12 NOTES
GUIDE • Mark Klimek’s Lecture Lecture 6— Drug Toxicities (Lithium,
Lanoxin, Dilantin, Bilirubin,
Aminophylline)
Kernicterus
Lecture 1— Acid-Base Balance Ventilators
Dumping/HH
Electrolytes: K+, CA, MG, and
NA TX for HyperKalemia
Lecture 2— Alcohol
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, and NA Lecture 9— Psych Drugs
TX for HyperKalemia Tri
Benzo
MAOI
Lithium
Lecture 4— Crutches Prozac Haldol
Canes Clozaril
Walkers Zoloft
Delusions
Hallucinations
Psychosis
Psychotic and Non-Psychotic Lecture 10— Maternity and Neonatology
Hallucination
Illusion Lecture 11— Fetal Complications Stages of
Delusion Labor
Assessments
Variations for NB
Lecture 5— Diabetes Mellitus Maternity Meds
Diabetes Insipidus Medication Hints
SIADH Psych Tips
Insulin Operational Stages
DKA
HHNK Lecture 12— Prioritization Delegation
Staff Management
Guessing Strategies
Lecture Notes
@ma.rk klimek’s notes
Pa.ge 1 of 97
,Your text here 3
Lecture 1 • Ma.rk Klimek • 92:21
A.cid/Ba.se Ba.la.nce (Sta.rt times: 30:00)
In order to solve a.cid-ba.se disorders, it is
importa.nt to know the norma.l va.lues for
pH, CO2 a.nd HCO3 (bica.rbona.te),
which a.re shown below
• pH 7.35 to 7.45
• CO2 35 to 45
• HCO3 22 to 26
The first va.lue to look a.t in a.n a.cid-
ba.se disorder is the pH
• If pH is <7.35, the a.cid-ba.se
imba.la.nce is a.cidotic
• If pH is <7.45, the a.cid-ba.se
imba.la.nce is a.lka.lotic
Now, to determine if the imba.la.nce is meta.bolic or respira.tory, determine whether HCO3
goes in the sa.me or opposite direction with pH
• Rule of the Bs: If pH a.nd Bica.rb move both in the sa.me direction, then the a.cid-ba.se
imba.la.nce is meta.bolic … Otherwise, it is respira.tory
Exa.mple #1
• pH 7.3 A.cidotic
• HCO3 20 Meta.bolic
• This is a.n exa.mple of meta.bolic a.cidosis
Exa.mple #2
• pH 7.58 A.lka.lotic
• HCO3 32 Meta.bolic
• This is a.n exa.mple of meta.bolic a.lka.losis
Exa.mple #3
• pH 7.22 A.cidosis
• HCO3 35 Respira.tory
• This is a.n exa.mple of respira.tory a.cidosis
Pa.ge 2 of 97
,MA.RK KLIMEK’S (NUR 490) LECTURE 1 TO 12 NOTES
A.s the pH goes, so goes my pa.tient, except for Pota.ssium … Tha.t mea.ns
• If pH is low, everything is low, except pota.ssium
• If pH is high, everything is high, except pota.ssium
If pH goes over 7.45, this is a.lka.losis
• Therefore everything is up: ta.chyca.rdia., ta.chypnea., HTN, seizures, irrita.bility, spa.stic,
dia.rrhea., borborygmi (increa.se bowel sounds), hyperreflexia. (3+, 4+) • However,
pota.ssium is opposite. Therefore, hypoka.lemia.
• Wha.t is the nursing intervention? o Pt need suctioning beca.use of seizures
If pH goes below 7.35, this is a.cidosis
• Therefore, everything is down: bra.dyca.rdia., constipa.tion, a.bsent bowel sounds, fla.ccid,
obtunded, letha.rgy, coma. hyporeflexia. (0, 1+), bra.dypnea., low BP • However,
pota.ssium is high (hyperka.lemia.)
• Wha.t is the nursing intervention?
o Pt needs to be ventila.ted with a.n A.mbu ba.g—respira.tory a.rrest
So, remember tha.t “MA.C Kussma.ul” is the only a.cid-ba.se imba.la.nce to ca.use Meta.bolic
A.Cidosis with Kussma.ul respira.tions
Ca.uses of A.cid/Ba.se imba.la.nce
First a.sk yourself, “Is it LUNG? … If yes, then it is respira.tory
• Then a.sk yourself, “A.re they overventila.ting or underventila.ting?
o If UNDERventila.ting, then pick a.cidosis—pH is under 7.35 o If
OVERventila.ting, then it is a.lka.losis, pH is over 7.45
Wha.t type of a.cid-ba.se dera.ngement is present in the following condition?
• In la.bor? o Respira.tory a.lka.losis … Overventila.ting—pH increa.ses … A.lka.losis)
• Drowning? o Respira.tory a.cidosis … Underventila.ting—pH decrea.ses … A.cidosis
• Pt is on PCA. (pa.tient-controlled a.nesthesia.) pump?
o Ventila.tion is down … Respira.tory a.cidosis
@ma.rk klimek’s notes
Pa.ge 3 of 97
, If it is not LUNG, then it is meta.bolic. If the pa.tient ha.s
prolonged ga.stric vomiting or suction (sucking out a.cid), pick
a.lka.losis
• For everything else tha.t isn’t lung, pick meta.bolic a.cidosis
• So, when you don’t know wha.t to pick, pick meta.bolic
a.cidosis
Tip
• Set your defa.ult setting to Meta.bolic A.cidosis
• A.lwa.ys pa.y a.ttention to modifying phra.se ra.ther tha.n
origina.l noun
Figure 1. Pa.tient-
controlled a.nesthesia.
(PCA.) pump.
Ventila.tor
A. ventila.tor is a. ma.chine designed to move brea.tha.ble a.ir into a.nd out of the lungs, a.ids
pa.tients who a.re physica.lly una.ble to brea.the, or brea.thing insufficiently to brea.the … A.
ventila.tors is equipped with a. high a.nd a. low-pressure a.la.rm
High pressures a.la.rmsa.re
a.lwa.ystriggered by increa.sed
resista.nceto a.irflow. Look
for obstructions, i.e.,
• Kinks in tubing …
Solution: unkink the tube
• Condensed wa.terin the
dependent tube …
Solution: empty it
• Mucus plugs … Solution:
A.skpt to turn, cough, deep
brea.the; or suction the
tubing PRN
Wha.tis the a.ppropria.teorder
to a.ddresshigh pressure a.la.rm
in a mecha.nica.lventila.tor?
•. (1) Unkink. (2) Empty
wa.ter out of tubing. (3) turn pt, a.sk pt to cough or deeply brea.the, a.nd (4) suction
Low pressures a.la.rms a.re a.lwa.ys triggered by decrea.se in resista.nce. This ca.n be ca.used
by
• Ma.in tubing disconnection
• O2 sensor tube disconnection
• In both ca.ses, reconnect the disconnected tubing unless tube is on floor … Ba.g pt a.nd ca.ll
Respira.tory Thera.pist
Pa.ge 4 of 97
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