MARK KLIMEK NOTES
Mz.ANTICHOLINERGIC vs. CHOLINERGIC EFFECTS
ANTICHOLINERGIC CHOLINERGIC
• ↓ Mucus • Bronchorrhea (large amounts of mucus in
• Bronchodilation airway)
• Dry mouth • Bronchoconstriction
• Salivation
• Dry eyes
• Lacrimating
• Urinary retention
• Urination
• Dry skin • Diaphoresis/Diarrhea
• Constipation • GI Upset
• Shut down GI • Emesis
• Prevents V when trying to intubate
ACID BASE GASES
A. ABG Interpretation
a. Rule of the B’s
i. If the pH and the BICARB (HCO3)
ii. Are BOTH in the same direction,
iii. Then it is METABOLIC
b. ↓ pH = acidosis
c. ↑ pH= alkaline
B. Values
a. Normal pH = 7.35 – 7.45
b. Normal Bicarb= 22-26
c. PaO2= 80-100 mmHg
d. PaCO2= 35-45 mmHg
e. SaO2= 95-100%
C. Signs & Symptoms of Acid-Base Imbalance
a. As the pH goes, so goes the patient except for Potassium (bc it
will try to compensate)
pH UP ↑ K↓ [ALKALOSIS] pH DOW N ↓ K↑ [ACIDOSIS]
• Tachycardia • Bradycardia
• Tachypnea • Bradypnea
• Diarrhea • Hypotension
• Tremors • ↓ lucidity
• Seizure • anorexia
• Hyperreflexia • coma
• Agitated • lethargy
D. Causes of Acid-Base Imbalance
a. First ask, “Is it Lung?”
i. If YES-! then it is Respiratory
b. Then ask yourself:
i. Are they Overventilating or Underventilating?
1. If Overventilating ! pick Alkalosis
2. If Underventilating ! pick Acidosis
c. If not lung, then it’s Metabolic
i. If the patient has prolonged gastric vomiting or suction,
pick Metabolic Alkalosis
ii. For everything else that isn’t lung, pick Metabolic
Acidosis
1. Also, if you don’t know what to pick choose
Metabolic Acidosis
VENTILATOR ALARMS
1. High Pressure Alarms are triggered by ↑ resistance to air flow and can
be caused by obstructions of three types:
a. Kinked Tube
i. NRS ACTION: Unkink it
b. Water in tubing (caused by condensation)
i. NRS ACTION: Empty it/Remove H2O
c. Mucus in airway
i. NRS ACTION: Turn, C&DB; only use suction if C&DB
fails, as a last resort
2. Low Pressure Alarms are triggered by ↓ resistance to air flow and can
be caused by disconnections of the:
a. Tubing
i. NRS ACTION: Pay attention to where tubing
, is…(contamination)
ii. If on floor, change out
iii. If on chest, clean with alcohol then put back on
3. Respiratory Alkalosis (Overventilation) means ventilator settings
may be too HIGH.
4. Respiratory Acidosis (Underventilation) means ventilator settings
may be too LOW.
5. To “Wean” ! To gradually and incrementally decrease with the goal of
ridding all together
ALCOHOLISM
Note: Remember in a psych question if you are asked to prioritize
DO NOT forget Maslow! Use the following priorities:
1. Physiological
2. Safety
3. Comfort
4. Psychological
5. Social
6. Spiritual
Also, ALL PSYCH PATIENTS START AS MED SURG
PATIENTS…RULE OUT ALL FEASIBLE MED ANSWERS BEFORE
PICKING PSYCH ANSWERS
1. Psychodynamics of Alcoholism
a. The #1 psychological problem in abuse is DENIAL.
i. Definition:
1. Refusal to accept the reality of their problem.
ii. Treatment:
1. Confront it by pointing out to the person the difference
between what they say and what they do.
2. In contrast, support the denial of loss and grief (BC
the use of denial is serving a functioning person)
b. DEPENDENCY/CODEPENDENCY
i. Dependency: When the abuser gets the significant other to
, do things for them or make decisions for them.
ii. Codependency: When the significant other derives positive
self-esteem from doing other things for or making
decisions for the abuser.
iii. Treatment:
1. Set boundary (limits) and enforce them. Agree in
advance on what requests are allowed then enforce
the agreement
2. Work on the self-esteem of the codependent
person.
c. MANIPULATION
i. Definition: When the abuser gets the significant other to do
things for him/her that are not in the best interest of the
Significant Other. The nature of the act is dangerous or
harmful to the significant other
ii. Treatment:
1. Set limits and enforce
2. Its easier to treat than dependency/codependency
because nobody likes to be manipulated
2. Wernicke’s (Korsakoff’s) Syndrome
a. Psychosis induced by Vitamin B1 (Thiamine) deficiency.
b. Primary symptom: amnesia with confabulation (making up
stories to fill in memory loss—believe as true)
c. Characteristics:
i. Preventable
1. By giving B1 vitamins
ii. Arrestable
1. Can stop from getting worse- not imply better
iii. Irreversible
1. Dementia symptoms don’t get better—only worse
3. Antabuse/Revia
a. Disulfiram (drugs used for alcoholism
b. Aversion Therapy
c. Onset and duration of effectiveness: 2 weeks
i. Take drugs 2 weeks and builds up in blood to a level that
when drinking alch will become horribly sick; if off for two
weeks, will be able to drink without sickness again
d. Patient teaching: Avoid ALL forms of alcohol to avoid nausea,
vomiting, and possibly death, including:
i. Mouthwash, aftershave, perfumes/cologne, insect repellant,
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