\u25cf Acid base gasses
\u25cb ABG interpretation
\u25a0 Rule of the B\u2019\u2019s
\u25cf If the pH and the Bicarb (HCO3) are both in the same direction then it is
metabolic
\u25cf Decrease in pH = acidosis
\u25cf Increase in pH = alkaline
\u25cb Values
\u25a0 Normal pH = 7.35-7.45
\u25a0 Normal Bicarb = 22-26
\u25a0 PaO2 = 80-100 mmHg
\u25a0 PaCO2 = 35-45 mmHg
\u25a0 SaO2 = 95-100%
\u25cb Signs and symptoms of Acid-Base imbalances
\u25a0 As the pH goes, so goes the patient except for potassium (because it will try to
compensate)
\u25a0 pH UP K+ DOWN (alkalosis)
\u25cf Tachycardia
\u25cf Tachypnea
\u25cf Diarrhea
\u25cf Tremors
\u25cf Seizure
\u25cf Hyperreflexia
\u25cf Agitated
\u25cf Borborygmi (increased bowel sounds)
\u25cf Hypertension
\u25cf Palpitations
\u25cf Tetany
\u25cf anxiety\/panic
\u25cf Die due to seizure
\u25a0 pH DOWN K+ UP (Acidosis)
\u25cf Bradycardia
\u25cf Bradypnea
\u25cf Hypotension
\u25cf Decreased lucidity
\u25cf Anorexia
\u25cf Coma
\u25cf Lethargy
\u25cf Cardiac arrest
\u25cf Suppressed, decreased, falling
\u25cf Die due to respiratory arrest
\u25cb Kussmaul (MacKussmaul)
\u25a0 Rapid and deep respirations
\u25a0 Only seen in metabolic acidosis
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\u25a0 This is a compensatory mechanism
\u25cb Causes of acid-base imbalance
\u25a0 First ask \u201cit is lung?\u2019
\u25cf Yes -> then it is respiratory
\u25a0 Then ask yourself
\u25cf Are they over ventilating or under ventilating?
\u25cb If over ventilating -> pick alkalosis
\u25cb If under ventilating -> pick acidosis
\u25cb Rate has nothing to do with ventilation (high rate and low SaO2
= under ventilating)
\u25cb Low rate and high SaO2 is over ventilating
\u25a0 If not lung, then it\u2019s metabolic
\u25cf If the patient has prolonged gastric vomiting or suction, pick metabolic
alkalosis
\u25cf For everything else that isn\u2019t lung pick metabolic acidosis
\u25cb Also, if you don\u2019t know what to pick choose metabolic acidosis
\u25cf Alcoholism\/any form of abuse
\u25cb Note: remember in psych question if you are asked to prioritize DO NOT forget Maslow!
Use the following priorities:
\u25a0 Physiological
\u25a0 Safety
\u25a0 Comfort
\u25a0 Psychological
\u25a0 Social
\u25a0 Spiritual
\u25cb Also, all psych patients start as med surg patient\u2026 rule out all feasible med answers
before picking psych answers
\u25cb Pain is not the priority, pain falls under the \u201ccomfort\u201d
\u25a0 We don\u2019t give pain medication until we know what is happening
\u25cb Psychodynamics of Alcoholism
\u25a0 The #1 psychological problem in abuse is DENIAL
\u25cf Definition: refusal to accept the reality of their problem
\u25cf Treatment:
\u25cb Confront it by pointing out to the person the difference between
what they say and what they do
\u25cb In contrast, support the denial of loss and grief (BC the use of
denial is serving a functioning process)
\u25a0 dependency\/Codependency
\u25cf Dependency: when the abuser gets the significant other to do things for
them
\u25cf Codependency: when the significant other derives positive self-esteem
from doing other things for or making decisions for the abuser
\u25cf Treatment:
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\u25cb Set boundaries (limits) and enforce them. Agree in advance on
what requests are allowed then enforce the agreement
\u25cb Work on the self-esteem of the codependent person
\u25a0 Manipulation
\u25cf 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
\u25cf Treatment:
\u25cb Set limits and enforce
\u25cb It’s easier to treat than dependency\/codependency because
nobody likes to be manipulated
\u25cb Wernicke\u2019s (Korsakoff\u2019s) Syndrome- only seen in alcoholism
\u25a0 Psychosis induced by Vitamin B1 (Thiamine) deficiency
\u25cf Thiamine is necessary for the metabolism of alcohol to occur
\u25a0 Primary symptom: amnesia with confabulation (making up stories to fill in
memory loss\u2013 believe as true)
\u25a0 Characteristics:
\u25cf Preventable: by giving B1 vitamins
\u25cf Arrestable: can stop from getting worse- not imply better
\u25cf Irreversible: dementia symptoms don\u2019t get better\u2013 only worse
\u25a0 Psychotic doesn\u2019t know when they are confabulating and the truth
\u25a0 Our goal with dementia is maintenance\/slowing of symptoms
\u25cb antabuse\/Revia
\u25a0 Disulfiram (drugs used for alcoholism)
\u25a0 Aversion therapy
\u25cf You get a patient to associate something that you want them to stop
doing with a very negative experience
\u25a0 Onset and duration of effectiveness: 2 weeks
\u25cf Take drugs 2 weeks and builds up in blood to a level that when drinking
alcohols will become horribly sick; if off for two weeks, will be able to
drink without sickness again
\u25a0 Patient teaching: avoid ALL forms of alcohol to avoid nausea, vomiting, and
possibly death including:
\u25cf Mouthwash, aftershave, perfumes\/cologne, insect repellant, vinaigrettes
(salad dressing), vanilla extract, elixirs (contains alcohol-OTC med),
alcohol prep pad, alcohol sanitizers
\u25cb Overdose vs Withdrawal
\u25a0 Uppers: MEMORIZE
\u25cf Names:
\u25cb Caffeine
\u25cb Cocaine
\u25cb PCP\/LSD (psychedelic hallucinogens)
\u25cb Methamphetamines
\u25cb ADHD- adderall\/Ritalin
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\u25cb Bath salts (Cath-Kath)
\u25cf signs\/symptoms:
\u25cb Tachycardia
\u25cb Hypertension
\u25cb Diarrhea
\u25cb Agitation
\u25cb Tremors
\u25cb Clonus
\u25cb Belligerent
\u25a0 Increase in the symptomatology on the violence scale
\u25cb Seizures
\u25cb Exaggerated, shrill, high pitched cry
\u25cb Difficult to console
\u25a0 Downers
\u25cf Names: everything else
\u25cf Signs\/Symptoms:
\u25cb Bradycardia
\u25cb Hypotension
\u25cb Constipation
\u25cb Constricted pupils
\u25cb Flaccidity
\u25cb Respiratory arrest
\u25cb Decreased core body temperature
\u25a0 Then ask yourself, \u201cAre they talking about overdose or withdrawal?\u201d
\u25cf overdose\/intoxication
\u25cb \u201cI have too much\u201d
\u25cb Too much upper: everything is UP
\u25cb Too much downer: everything is DOWN
\u25cf Withdrawal
\u25cb \u201cI don\u2019t have enough\u201d
\u25cb Too little upper: everything is DOWN
\u25cb Too little downer: everything is UP
\u25cb Drug addiction in the newborn
\u25a0 Always assume intoxication (first 24 hours after birth), then after this time
assume withdrawal
\u25cb Alcohol Withdrawal Syndrome vs Delirium Tremens
\u25a0 Differences:
\u25cf Every alcoholic goes through alcohol withdrawal syndrome (AWS) (after
24 hours)
\u25cf Only a minority get delirium tremens (DT)
\u25cf AWS is not life threatening. DT\u2019s can kill you
\u25cf Patients with AWS are not dangerous to themselves or others. Patients
with DTS are dangerous to self and others<\/p>\n\n\n\n