ACID BASE BALANCE - ACID BASE BALANCE 1. Rule of B’s a. If the pH...

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ACID BASE BALANCE

• Rule of B’s
• If the pH and the Bicarb are Both in the same direction, then it is

metabolic

• Signs and Symptoms
• As the pH goes, so goes my patient, except for potassium
• as pH goes up, systems gets irritable

ii. as pH goes down, systems shut down

• UP pH (Alkalosis)
• HTN
• Tachycardia
• Tachypnea
• Seizures
• Irritability
• Spastic
• Diarrhea
• Borborygme
• Hyperreflexia, (3,4)
• Hypokalemia
• DOWN pH (Acidosis)
• Hypotension
• Bradycardia
• Constipation
• Absent bowel sounds
• Flaccid
• Bradypnea
• Hyperkalemia
• Lethargy
• Obtunded (one step down from lethargy)
• Paralytic ileus
• Coma
• Respiratory arrest
• MacKussmaul
• The only acid base to cause Kussmaul respirations is Metabolic

Acidosis

• Causes
• First ask yourself, “Is it lung?” If yes, then it’s respiratory. Then ask

yourself: “Are they overventilating or underventilating. If

overventilating, pick alkalosis. If underventilating, pick acidosis.

• If it is not lung, then it is metabolic. If the patient has prolonged

gastric vomiting or suction, pick alkalosis. For everything else that

Mark Klimek Audio Tapes 1-12 (Latest Update)

isn’t lung, pick metabolic acidosis. When you don’t know what to pick, choose metabolic acidosis.

VENTILATORS

• High pressure alarms are triggered by increased resistance to air flow.
• High pressure alarms are triggered by resistance to airflow and can be

caused by obstructions of 3 types: kinked tube, (unkink) action, water in

tube (empty) action, mucus in airway (turn, cough and deep breathe) action. Lastly suction

• Low pressure alarms are triggered by decrease resistance to airflow and can

be caused by disconnections of the tubing (reconnect it) or oxygen sensor tube (reconnect it UNLESS tube is on the floor- bag them and call RT if this happens) (black coated wirey tubing that piggy backs the tubing, measure FiO2)

• Respiratory alkalosis means the ventilator settings may be too high.
• Respiratory acidosis means the ventilator settings may be too low.
• What does “wean” mean? Gradually decrease with the goal of getting off

altogether

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ALCOHOLISM/ ABUSE

• #1 Psychological problem is denial. (1 patient)
• Denial is the refusal to accept the reality of their problem.

b. Treating denial: confront it by pointing out to the person the

difference between what they say and what they do. In contrast, support the denial of loss and grief.

• Abuse vs. Loss

ii. Denial and Loss and Greif Stages; DABDA

• Denial- healthy normal 1

st action therefore you support

• Anger
• Bargaining
• Depression
• Acceptance
• When dealing with a psychodynamic problem between staff use the

word I not the word you. ex. I seem to be frustrating you vs. Why do you not like me.

• #2 Psychological problem is Dependency/ Codependency (2 patients)

a. Dependency: When the abuser gets the Significant Other to do things

for them or make decisions for them

b. Codependency: When the Significant Other derives positive self-

esteem from doing things for or making decisions for the abuser

c. When treating dependency/codependency: Set limits and enforce

them. Agree in advance on what requests are allowed, then enforce the agreement.

3. Manipulation: (1 patient) 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 harmful or dangerous to the significant other.

a. Treating manipulation: set limits and enforce.

• Easier to treat
• Alcoholism

a. Wernicke’s (Korsakoff’s) Syndrome: psychosis induced by Vitamin

B1 (thiamine) deficiency

b. Primary symptoms of Wernicke’s (Korsakoff’s) Syndrome: Impaired

Vision, amnesia (memory loss) with confabulation (make up stuff)

• Characteristics of Wernicke’s (Korsakoff’s) Syndrome
• Preventable (take vitamin)

ii. Arrestable (Stop Drinking and take vitamin) iii. Irreversible (kills brain cells/ causes brain damage) iv. Wernicke’s (Korsakoff’s) Syndrome these patients may sometimes black out. They need Re-directing.v.

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• Disulfaram/Naltrexone (Antabuse/Revia) this medication makes the

patient feel sick if drink, its aka Aversion Therapy. Patient will have a strong hatred for alcohol

e. Onset and duration of effectiveness of Disulfaram (Antabuse/Revia):

• weeks

f. Patient teaching with Disulfaram (Antabuse/ Revia): Avoid all forms

of alcohol to avoid nausea, vomiting, and death.

• What are examples of products that contain alcohol? Mouthwash,

cologne, perfume, aftershave, all elixirs- most OTC liquid medicines, insect repellant, vanilla extract (un-cooked icings), hand sanitizer, vinaigrettes dressing, (the patient can have the Red wine vinaigrette dressing)

• Every alcoholic goes through alcohol withdrawal syndrome. Only a

minority get Delirium Tremens. (Delirium Tremens can Kill you)

• Every abused drug is either upper or downer
• Uppers- caffeine, cocaine, PCP/LSD, methamphetamines

(Treats ADHD), Adderall, Bath Salts….

• Signs and symptoms
• Euphoria
• Tachycardia
• Restlessness
• Irritability
• Increased bowels
• Hyperreflexia
• Spastic
• Seizure – have suction machine at the bedside

ii. Downers- everything but uppers

• Signs and symptoms
• Drowsiness
• Lethargy
• Respiratory arrest
• Alcohol Withdrawal Syndrome is not life threatening. Delirium

Tremens can kill you.

• Patients with Alcohol Withdrawal Syndrome are not a danger to

themselves or others. Patients with Delirium Tremens are dangerous to self and others.

**OVERDOSE = TOO MUCH WITHDRAWL = TOO LITTLE**

• Upper Overdose looks like downer withdrawal
• i.e. risk for seizure, need suctioning
• Downer OD looks like Upper withdrawal
• i.e. respiratory arrest/ depression

n. DRUG ABUSE IN NEWBORN: Always assume intoxication not

withdrawal at birth

• right after birth baby is intoxicated

ii. 24 hours after birth, baby is in withdrawal