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Acid Base disorders Respiratory alkalosis : Overventilating means ventilator settings may be too high

Respiratory acidosis: Underventilating means the settings are too low

Example 1) Dr. says to wean pt off vent in AM- 6 am ABGs show respiratory acidosis, what would you do?

• Follow the order
• Call respiratory therapy (**never pick answer where you don’t do

something and someone else has to do something**)

• Hold the order and call the doctor
• Begin to decrease the settings

ANSWER:

C. Hold the order and call the doctor: because pt underventilating on the

ventilator and without it he’d be even worse. If he has respiratory alkalosis it could mean he’s being overventalated, which means he doesn’t need the machine.

Mark Klimek Lecture Notes

Lecture 2: Alcoholism, Delirium Tremors & Peak

and Trough

Alcoholism: Psych + Med surg

Psychodynamics- The number one problem of psychological in alcoholism is the

same exact problem for any abuse: DENIAL

• Abusers have an infinite capacity to deny • Denying allows the abuser to keep doing it without having to answer for it • It is number 1 because how can you treat someone who denies they have a problem and until they admit they have a problem.

• Definition of denial: refusal to accept the reality of a problem

How do you treat denial?• Confronting it by pointing out the difference to the person of what they say and what they do

• “okay, you say you are not an alcoholic but its 10 am and you already 1 / 2

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drank a 6 pack”

• “You say you’re not a child abuser but protective services has your

children”

• confrontation (attacks the problem) is not the same as aggression (attacks the person) • Don’t ever choose answer that uses the word YOU with confrontations only the letter I

Deny --> confront • Not with loss and grieving (DABDA- denial, anger, bargaining, depression, acceptance)

What do you do for the denial of loss and grief?• Support it because it serves a function

Dependency and Codependency • Dependency- when the abuser gets the significant other to do things for them or make decisions for them (the abuser is dependent)

• Codependency- when the significant other derives positive self-esteem from making decisions for or doing things for the abuser

• Pathologic and yet symbiotic relationship
• Abuser gets a life without responsibility and a SO gets positive self-

esteem

Treatment?• Set limits and enforce it- teach SO to start saying NO and to keep doing it

• Must work on self-esteem of codependent person first or it will never work- the dependent abuser is going to make them feel bad when they start saying NO and emotionally manipulate them

• Codependent person has to say.. I AM saying NO because I’m a good person- (usually the relationship will break up in the end)

Manipulation • abuser gets SO to do things for him or her that is not in the best interest of the significant other.• Nature of the act is interest and harmful

• This is like dependency because in both situations the abuser is getting the SO to do things for them and you can tell the difference by Neutral vs.Negative

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