ANTICHOLINERGIC CHOLINERGIC

NCLEX mark Klimek transcript- comprehensive-2022

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

ANTICHOLINERGIC vs. CHOLINERGIC EFFECTS

pH DOWN ¯ K­ [ACIDOSIS]

• As the pH goes, so goes the patient except for Potassium (bc it will

try to compensate)

• Tachycardia • Tachypnea • Diarrhea • Tremors • Seizure • Hyperreflexia • Agitated • Borborygmi (­ bowel sounds) • Hypertension • Palpitations • Tetany • Anxiety/Panic • Poly • Bradycardia • Bradypnea • Hypotension • ¯ lucidity • anorexia • coma • lethargy • cardia arrest • suppressed, decreased, falling

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

b. Then ask yourself:

• Are they Overventilating or Underventilating?
• If Overventilating à pick Alkalosis
• If Underventilating à 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” à To gradually and incrementally decrease with the goal of

ridding all together

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

ALCOHOLISM