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Page 1 of 92 GUIDE • Mark Klimek’s Lecture Lecture 1—Acid-Base BalanceDumping/HH
VentilatorsElectrolytes: K+, CA, MG,
and NA Lecture 2—AlcoholTX for HyperKalemia Wernicke Overdose and Withdrawal Lecture 7—Thyroid (Hyper-, Hypo-) S/SxAdrenal Cortex (Addison AminoglycosidesDisease, Cushing) Peak and TroughToys Laminectomy Lecture 3—Drug Toxicities (Lithium, Lanoxin, Dilantin, Bilirubin, Lecture 8—Lab Values Aminophylline)Five Deadly Ds KernicterusNeutropenic Precaution Dumping/HH
Electrolytes: K+, CA, MG, Lecture 9—Psych Drugs
and NATri TX for HyperKalemiaBenzo MAOI Lecture 4—CrutchesLithium CanesProzac WalkersHaldol DelusionsClozaril HallucinationsZoloft Psychosis Psychotic and Non-Psychotic Lecture 10—Maternity and Neonatology Hallucination IllusionLecture 11—Fetal Complications DelusionStages of Labor Assessments Lecture 5—Diabetes MellitusVariations for NB Diabetes InsipidusMaternity Meds SIADHMedication Hints InsulinPsych Tips DKAOperational Stages HHNK Lecture 12—Prioritization Lecture 6—Drug Toxicities (Lithium,Delegation Lanoxin, Dilantin, Bilirubin,Staff Management Aminophylline)Guessing Strategies Kernicterus
Lecture 1 • Mark Klimek • 92:21
Acid/Base Balance (Start times: 30:00) In order to solve acid-base disorders, it is important to know the normal values for pH, CO2 and HCO3 (bicarbonate), which are shown below pH 7.35 to 7.45 CO2 35 to 45 HCO322 to 26 The first value to look at in an acid-base disorder is the pH If pH is <7.35, the acid-base imbalance is acidotic If pH is >7.45, the acid-base imbalance is alkalotic Now, to determine if the imbalance is metabolic or respiratory, determine whether HCO3 goes in the same or opposite direction with pH Rule of the Bs: If pH and Bicarb move both in the same direction, then the acid- base imbalance is metabolic … Otherwise, it is respiratory Example #1 pH 7.3Acidotic HCO320Metabolic This is an example of metabolic acidosis Example #2 pH 7.58Alkalotic HCO332Metabolic This is an example of metabolic alkalosis Example #3 pH 7.22Acidosis HCO335Respiratory This is an example of respiratory acidosis As the pH goes, so goes my patient, except for Potassium … That means If pH is low, everything is low, except potassium If pH is high, everything is high, except potassium
If pH goes over 7.45, this is alkalosis Therefore everything is up: tachycardia, tachypnea, HTN, seizures, irritability, spastic, diarrhea, borborygmi (increase bowel sounds), hyperreflexia (3+, 4+) However, potassium is opposite. Therefore, hypokalemia What is the nursing intervention?oPt need suctioning because of seizures If pH goes below 7.35, this is acidosis Therefore, everything is down: bradycardia, constipation, absent bowel sounds, flaccid, obtunded, lethargy, coma hyporeflexia (0, 1+), bradypnea, low BP However, potassium is high (hyperkalemia) What is the nursing intervention?oPt needs to be ventilated with an Ambu bag—respiratory arrest So, remember that “MAC Kussmaul” is the only acid-base imbalance to cause Metabolic ACidosis with Kussmaul respirations Causes of Acid/Base imbalance First ask yourself, “Is it LUNG? … If yes, then it is respiratory Then ask yourself, “Are they overventilating or underventilating?oIf UNDERventilating, then pick acidosis—pH is under 7.35 oIf OVERventilating, then it is alkalosis, pH is over 7.45 What type of acid-base derangement is present in the following condition?In labor?oRespiratory alkalosis … Overventilating—pH increases … Alkalosis) Drowning?oRespiratory acidosis … Underventilating—pH decreases … Acidosis Pt is on PCA (patient-controlled anesthesia) pump?oVentilation is down … Respiratory acidosis If it is not LUNG, then it is metabolic. If the patient has prolonged gastric vomiting or suction (sucking out acid), pick alkalosis For everything else that isn’t lung, pick metabolic acidosis So, when you don’t know what to pick, pick metabolic acidosis Tip Set your default setting to Metabolic Acidosis Always pay attention to modifying phrase rather than original noun Figure 1. Patient- controlled anesthesia (PCA) pump.
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