ANTICHOLINERGIC CHOLINERGIC

Studocu is not sponsored or endorsed by any college or university Mark klimek notes - NCLEX Nursing (Columbus State Community College) Studocu is not sponsored or endorsed by any college or university Mark klimek notes - NCLEX Nursing (Columbus State Community College) Downloaded by Victor Muia ([email protected]) lOMoARcPSD|22689903

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 Downloaded by Victor Muia ([email protected]) lOMoARcPSD|22689903

• 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

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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

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