ANTICHOLINERGIC CHOLINERGIC

Mz.ANTICHOLINERGICvs.CHOLINERGIC

EFFECTS 1 / 4

ANTICHOLINERGICCHOLINERGIC

Mucus Bronchodilation Drymouth Dryeyes Urinaryretention Dryskin Constipation ShutdownGI PreventsVwhentryingtointubate Bronchorrhea(largeamountsofmucusin airway) Bronchoconstriction Salivation Lacrimating Urination Diaphoresis/Diarrhea GIUpset Emesis

ACIDBASEGASES

A.ABGInterpretation a.RuleoftheB’s i.IfthepHandtheBICARB(HCO3) ii.AreBOTHinthesamedirection, iii.ThenitisMETABOLIC b.pH=acidosis c.pH=alkaline B.Values a.NormalpH=7.35–7.45 b.NormalBicarb=22-26 c.PaO2=80-100mmHg d.PaCO2=35-45mmHg e.SaO2=95-100% C.Signs&SymptomsofAcid-BaseImbalance a.AsthepHgoes,sogoesthepatientexceptforPotassium(bcit willtrytocompensate) pHUPK[ALKALOSIS] pHDOWNK[ACIDOSIS] Tachycardia Tachypnea Diarrhea Tremors Seizure Hyperreflexia Agitated Bradycardia Bradypnea Hypotension lucidity anorexia coma lethargy 2 / 4

Borborygmi(bowelsounds) Hypertension Palpitations Tetany Anxiety/Panic Poly cardiaarrest suppressed,decreased,falling D.CausesofAcid-BaseImbalance a.Firstask,“IsitLung?” i.IfYES-thenitisRespiratory

b.Thenaskyourself:

i.AretheyOverventilatingorUnderventilating?

1.IfOverventilatingpickAlkalosis 2.IfUnderventilatingpickAcidosis c.Ifnotlung,thenit’sMetabolic i.Ifthepatienthasprolongedgastricvomitingorsuction, pickMetabolicAlkalosis ii.Foreverythingelsethatisn’tlung,pickMetabolic Acidosis 1.Also,ifyoudon’tknowwhattopickchoose MetabolicAcidosis

VENTILATORALARMS

1.HighPressureAlarmsaretriggeredbyresistancetoairflowandcan

becausedbyobstructionsofthreetypes:

a.KinkedTube

i.NRSACTION:Unkinkit

b.Waterintubing(causedbycondensation)

i.NRSACTION:Emptyit/RemoveH2O

c.Mucusinairway

i.NRSACTION:Turn,C&DB;onlyusesuctionifC&DB

fails,asalastresort 2.LowPressureAlarmsaretriggeredbyresistancetoairflowandcan

becausedbydisconnectionsofthe:

a.Tubing

i.NRSACTION:Payattentiontowheretubing 3 / 4

is…(contamination) ii.Ifonfloor,changeout iii.Ifonchest,cleanwithalcoholthenputbackon 3.RespiratoryAlkalosis(Overventilation)meansventilatorsettings maybetooHIGH.

4.RespiratoryAcidosis(Underventilation)meansventilatorsettings maybetooLOW.

5.To“Wean”Tograduallyandincrementallydecreasewiththegoalof riddingalltogether

ALCOHOLISM

Note:Rememberinapsychquestionifyouareaskedtoprioritize

DONOTforgetMaslow!Usethefollowingpriorities:

1.Physiological 2.Safety 3.Comfort 4.Psychological 5.Social 6.Spiritual Also,ALLPSYCHPATIENTSSTARTASMEDSURG

PATIENTS…RULEOUTALLFEASIBLEMEDANSWERSBEFORE

PICKINGPSYCHANSWERS

1.PsychodynamicsofAlcoholism a.The#1psychologicalprobleminabuseisDENIAL.

i.Definition:

1.Refusaltoaccepttherealityoftheirproblem.

ii.Treatment:

1.Confrontitbypointingouttothepersonthedifference betweenwhattheysayandwhattheydo.

2.Incontrast,supportthedenialoflossandgrief(BC theuseofdenialisservingafunctioningperson) b.DEPENDENCY/CODEPENDENCY i.Dependency:Whentheabusergetsthesignificantotherto

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