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

c.↑ pH= alkaline B.Values a.Normal pH = 7.35 – 7.45 b.Normal Bicarb= 22-26 c.PaO2= 80-100 mmHg d.PaCO2= 35-45 mmHg e.SaO2= 95-100% C.Signs & Symptoms of Acid-Base Imbalance a.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

a.First ask, “Is it Lung?” i.If YES-! then it is Respiratory b.

Then ask yourself:

i.Are they Overventilating or Underventilating?

1.If Overventilating ! pick Alkalosis 2.If Underventilating ! pick Acidosis c.If not lung, then it’s Metabolic i.If the patient has prolonged gastric vomiting or suction, pick Metabolic Alkalosis ii.For everything else that isn’t lung, pick Metabolic Acidosis 1.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 p rioritize

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,