ANTICHOLINERGIC CHOLINERGIC

Mz.ANTICHOLINERGIC vs. CHOLINERGIC EFFECTS

ANTICHOLINERGIC CHOLINERGIC

• ↓ Mucus • Bronchodilation • Dry mouth • Dry eyes • Urinary retention • Dry skin • Constipation • Shut down GI • Prevents V when trying to intubate • Bronchorrhea (large amounts of mucus in airway) • Bronchoconstriction • Salivation • Lacrimating • Urination • Diaphoresis/Diarrhea • GI Upset • Emesis

ACID BASE GASES

• ABG Interpretation
• Rule of the B’s
• If the pH and the BICARB (HCO3)

ii. Are BOTH in the same direction, iii. Then it is METABOLIC

• ↓ pH = acidosis
• ↑ 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 & Symptoms of Acid-Base Imbalance
• As the pH goes, so goes the patient except for Potassium (bc it

will try to compensate) pH UP ↑ K↓ [ALKALOSIS] pH DOWN ↓ K↑ [ACIDOSIS] • Tachycardia • Tachypnea • Diarrhea • Tremors • Seizure • Hyperreflexia • Agitated • Bradycardia • Bradypnea • Hypotension • ↓ lucidity • anorexia • coma • lethargy

• Borborygmi (↑ bowel sounds) • Hypertension • Palpitations • Tetany • Anxiety/Panic • Poly

• cardia arrest • suppressed, decreased, falling

• Causes of Acid-Base Imbalance
• First ask, “Is it Lung?”
• If YES-! then it is Respiratory

b. Then ask yourself:

• Are they Overventilating or Underventilating?
• If Overventilating ! pick Alkalosis
• If Underventilating ! pick Acidosis
• If not lung, then it’s Metabolic
• If the patient has prolonged gastric vomiting or suction,

pick Metabolic Alkalosis ii. For everything else that isn’t lung, pick Metabolic Acidosis

• Also, if you don’t know what to pick choose

Metabolic Acidosis

VENTILATOR ALARMS

• High Pressure Alarms are triggered by ↑ resistance to air flow and can

be caused by obstructions of three types:

• Kinked Tube

i. NRS ACTION: Unkink it

• Water in tubing (caused by condensation)

i. NRS ACTION: Empty it/Remove H2O

• Mucus in airway

i. NRS ACTION: Turn, C&DB; only use suction if C&DB

fails, as a last resort

• Low Pressure Alarms are triggered by ↓ resistance to air flow and can

be caused by disconnections of the:

• Tubing

i. NRS ACTION: Pay attention to where tubing

is…(contamination) ii. If on floor, change out iii. If on chest, clean with alcohol then put back on

• Respiratory Alkalosis (Overventilation) means ventilator settings

may be too HIGH.

• Respiratory Acidosis (Underventilation) means ventilator settings

may be too LOW.

• To “Wean” ! To gradually and incrementally decrease with the goal of

ridding all together

ALCOHOLISM

Note: Remember in a 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

PATIENTS…RULE OUT ALL FEASIBLE MED ANSWERS BEFORE

PICKING PSYCH ANSWERS

• Psychodynamics of Alcoholism
• The #1 psychological problem in abuse is DENIAL.

i. Definition:

• Refusal to accept the reality of their problem.

ii. 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 person)

• DEPENDENCY/CODEPENDENCY

i. Dependency: When the abuser gets the significant other to

do things for them or make decisions for them.

ii. Codependency: When the significant other derives positive

self-esteem from doing other things for or making decisions for the abuser.

iii. Treatment:

• Set boundary (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

i. 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

ii. Treatment:

• Set limits and enforce
• Its easier to treat than dependency/codependency

because nobody likes to be manipulated

• Wernicke’s (Korsakoff’s) Syndrome
• Psychosis induced by Vitamin B1 (Thiamine) deficiency.

b. Primary symptom: amnesia with confabulation (making up

stories to fill in memory loss—believe as true)

c. Characteristics:

• Preventable
• By giving B1 vitamins

ii. Arrestable

• Can stop from getting worse- not imply better

iii. Irreversible

• Dementia symptoms don’t get better—only worse
• Antabuse/Revia
• Disulfiram (drugs used for alcoholism
• Aversion Therapy

c. Onset and duration of effectiveness: 2 weeks

• Take drugs 2 weeks and builds up in blood to a level that

when drinking alch will become horribly sick; if off for two weeks, will be able to drink without sickness again

d. Patient teaching: Avoid ALL forms of alcohol to avoid nausea,

vomiting, and possibly death, including:

• Mouthwash, aftershave, perfumes/cologne, insect repellant,