Acid base gasses - Rule of the B’’s If the pH and the Bi...

Acid base gasses ABG interpretation Rule of the B’’s If the pH and the Bicarb (HCO3) are both in the same direction then it is metabolic Decrease in pH = acidosis Increase in pH = alkaline Values Normal pH = 7.35-7.45 Normal Bicarb = 22-26 PaO2 = 80-100 mmHg PaCO2 = 35-45 mmHg SaO2 = 95-100% Signs and symptoms of Acid-Base imbalances As the pH goes, so goes the patient except for potassium (because it will try to compensate) pH UP K+ DOWN (alkalosis) Tachycardia Tachypnea Diarrhea Tremors Seizure Hyperreflexia Agitated Borborygmi (increased bowel sounds) Hypertension Palpitations Tetany anxiety/panic Die due to seizure pH DOWN K+ UP (Acidosis) Bradycardia Bradypnea Hypotension Decreased lucidity Anorexia Coma Lethargy Cardiac arrest

Suppressed, decreased, falling Die due to respiratory arrest Kussmaul (MacKussmaul) Rapid and deep respirations Only seen in metabolic acidosis This is a compensatory mechanism Causes of acid-base imbalance First ask “it is lung?’ Yes -> then it is respiratory Then ask yourself Are they over ventilating or under ventilating?If over ventilating -> pick alkalosis If under ventilating -> pick acidosis Rate has nothing to do with ventilation (high rate and low SaO2 = under ventilating) Low rate and high SaO2 is over ventilating If not lung, then it’s metabolic If the patient has prolonged gastric vomiting or suction, pick metabolic alkalosis For everything else that isn’t lung pick metabolic acidosis Also, if you don’t know what to pick choose metabolic acidosis Alcoholism/any form of abuse Note: remember in psych question if you are asked to prioritize DO NOT forget

Maslow! Use the following priorities:

Physiological Safety Comfort Psychological Social Spiritual Also, all psych patients start as med surg patient… rule out all feasible med answers before picking psych answers Pain is not the priority, pain falls under the “comfort”

We don’t give pain medication until we know what is happening Psychodynamics of Alcoholism The #1 psychological problem in abuse is DENIAL

Definition: refusal to accept the reality of their problem

Treatment:

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 (BC the use of denial is serving a functioning process) dependency/Codependency

Dependency: when the abuser gets the significant other to do

things for them

Codependency: when the significant other derives positive self-

esteem from doing other things for or making decisions for the abuser

Treatment:

Set boundaries (limits) and enforce them. Agree in advance on what requests are allowed then enforce the agreement Work on the self-esteem of the codependent person Manipulation

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

Treatment:

Set limits and enforce It's easier to treat than dependency/codependency because nobody likes to be manipulated Wernicke’s (Korsakoff’s) Syndrome- only seen in alcoholism Psychosis induced by Vitamin B1 (Thiamine) deficiency Thiamine is necessary for the metabolism of alcohol to occur

Primary symptom: amnesia with confabulation (making up stories to fill

in memory loss– believe as true)

Characteristics:

Preventable: by giving B1 vitamins

Arrestable: can stop from getting worse- not imply better

Irreversible: dementia symptoms don’t get better– only worse

Psychotic doesn’t know when they are confabulating and the truth Our goal with dementia is maintenance/slowing of symptoms antabuse/Revia Disulfiram (drugs used for alcoholism) Aversion therapy You get a patient to associate something that you want them to stop doing with a very negative experience

Onset and duration of effectiveness: 2 weeks

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

Patient teaching: avoid ALL forms of alcohol to avoid nausea, vomiting,

and possibly death including:

Mouthwash, aftershave, perfumes/cologne, insect repellant, vinaigrettes (salad dressing), vanilla extract, elixirs (contains alcohol-OTC med), alcohol prep pad, alcohol sanitizers Overdose vs Withdrawal

Uppers: MEMORIZE

Names:

Caffeine Cocaine PCP/LSD (psychedelic hallucinogens) Methamphetamines ADHD- adderall/Ritalin Bath salts (Cath-Kath)

signs/symptoms:

Tachycardia Hypertension Diarrhea Agitation Tremors Clonus