Lecture 1 Acid-Base Balance

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Lecture 1— Acid-Base Balance Ventilators

Lecture 2— Alcohol Wernicke Overdose and Withdrawal S/Sx Aminoglycosides Peak and Trough

Lecture 3— Drug Toxicities (Lithium, Lanoxin, Dilantin, Bilirubin, Aminophylline) Kernicterus Dumping/HH

Electrolytes: K+, CA, MG,

and NA TX for HyperKalemia

Lecture 4— Crutches Canes Walkers Delusions Hallucinations Psychosis Psychotic and Non-Psychotic Hallucination Illusion Delusion

Lecture 5— Diabetes Mellitus Diabetes Insipidus SIADH Insulin DKA HHNK

Lecture 6— Drug Toxicities (Lithium, Lanoxin, Dilantin, Bilirubin, Aminophylline) Kernicterus Dumping/HH

Electrolytes: K+, CA, MG,

and NA TX for HyperKalemia

Lecture 7— Thyroid (Hyper-, Hypo-) Adrenal Cortex (Addison Disease, Cushing) Toys Laminectomy

Lecture 8— Lab Values Five Deadly Ds Neutropenic Precaution

Lecture 9— Psych Drugs Tri Benzo MAOI Lithium Prozac Haldol Clozaril Zoloft

Lecture 10— Maternity and Neonatology

Lecture 11— Fetal Complications Stages of Labor Assessments Variations for NB Maternity Meds Medication Hints Psych Tips Operational Stages

Lecture 12— Prioritization Delegation Staff Management Guessing Strategies

GUIDE • Mark Klimek’s Lecture This file was downloaded from StudyLast.com. It is not allowed to publish it elsewhere. Only the buyer can use this file.

Page 20 of 92 In this question, the priory action for the nurse is to submerge the end of the tube under sterile water because doing so prevents air from getting into the chest. At the same time, this allows air or blood from the chest to get out • This solves the problem by reestablishing the water seal

Note Clamping, unclamping, and placing the tube under water must be done in 15 seconds or less

Question You notice on the monitor that a pt has v-fib. Pt is unresponsive and there is no pulse. What is the first step in the management of this pt?

• Place a backboard under pt’s back while pt is supine
• Start chest compression

The first step is to place the backboard under pt’s back. “First” is about order.

Question You notice on the monitor that a pt has v-fib. Pt is unresponsive and there is no pulse. What is the best step in the management of this pt?

• Place a backboard under pt’s back while pt is supine
• Start chest compression

“Best” is about what is the priority. Chest compression is the priority action.

If a chest tube gets pulled out …

• Take a gloved hand and cover the opening (first step)
• Take a sterile Vaseline gauze and tape 3 sides (best step)

Chest tube is bubbling … Ask (1) where it is bubbling, and (2) when it is bubbling?Ask the following 2 questions • Bubbling … Where? In the water seal chamber

• If it is intermittent, it is good (document it)
• If it is continuous, it is bad and indicates a break/leak in the system (find it and tape it)

• Bubbling … Where? In the suction control chamber

• If it is intermittent, suction pressure is too low (increase it at the wall until it is

continuous)

• If it is continuous, it is good (document it)

Analogies • A straight catheter is to a Foley catheter, as a thoracentesis is to a chest tube

• A straight catheter goes in and out … A Foley goes in, secure it, and continuous

drainage

• Thoracocentesis = go in and out … Chest tubes = go in, secure it, and leave it in place

• A Foley has a higher risk of infection than a straight cath • A chest tube has a higher risk of infection than thoracocentesis This file was downloaded from StudyLast.com. It is not allowed to publish it elsewhere. Only the buyer can use this file.

Page 42 of 92 Treatment of Dumping Syndrome • Can do 3 things, as shown below

• Lower HOB (head of bed) during meals and turn pt on the side
• Decrease the amount of fluids 1 or 2 hours before or after meals
• Decrease the amount of Carb content
• These 3 things prevent the stomach to empty quickly or dump its content into the

duodenum • Dumping syndrome … Everything low

What is protein is added in the diet?• Protein does the opposite of carbohydrate • Protein bulks gastric content, takes longer to digest, and moves slower through the gut • Therefore, give

• Low protein in hiatal hernia
• High protein for dumping syndrome

Electrolytes • Memorize these 3 sentences

• Kalemias do the same as the prefix (hypo-, hyper-), except for HR and urine output which

go opposite

• Calcemias do the opposite as the prefix
• Magnesemias do the opposite as the prefix

• Natremias

• HypoNatremia = Volume overload … HyperNatremia = Dehydration

Kalemia(s) • Go in the same direction as the prefix, except for HR and urine output (UO), which go in the opposite direction • Hypo—Symptoms go low with <> hypo, except HR and UO • Hyper—Symptoms go high with hyper, except HR and UO

Some S/Sx of Hyperkalemia

• Brain: seizures, agitation, irritability, loud down

• Heart: tented T waves, ST elevated, tachypnea

• Bowel: diarrhea, borborygmi

• Muscle: spasticity, increase tone, hyperreflexia (3+, 4+)

• Heart rate: down (bradycardia)

• UO: down (oligouria)

Some S/Sx of Hypokalemia • Lethargy, bradypnea, paralytic ileus, constipation, muscle flaccidity, hyporeflexia (0, 1+) • Tachycardia (HR is up) • Polyuria (UO is up) This file was downloaded from StudyLast.com. It is not allowed to publish it elsewhere. Only the buyer can use this file.

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Maternity and Neonatology

Determining the estimated date of delivery • Use the Naegele rule—take first day of last menstrual period (LMP), add 7 days and subtract

• months from it
• For instance, if the last menstrual period of a pt was between June 10 and 15
• The estimated date of delivery = March 17

Weight gained during pregnancy • 1st trimester (12 weeks)

• 1 lb per month = Total of 3 lbs

• 2nd and 3rd trimesters

• Add 1 lb every week

• The ideal weight gained during pregnancy

• 28 lbs, plus or minus 3
• Between 25 to 31 lbs

Alternative method A quick and dirty way to come up with the ideal weight gained during pregnancy is to • Take the number of weeks gestation minus 9

Question A woman is in her 28th week gestation. She gained 22 lbs, what is your impression?• Using the long method

• First trimester (12 weeks) … She gained 3 lbs
• 28 weeks minus 12 weeks = 16 weeks
• Therefore, she would add an extra 16 lbs on her weight
• 3 + 16 = 19 lbs … She has 3 lbs extra than her ideal weight
• Therefore, assess the pt

• Alternatively, subtract 9 from the number of weeks gestation

• 28 – 9 = 19 lbs

Question A pregnant woman at 31 weeks gestation gained 15 lbs. what is your impression?• Using the short method, this pt ideal weight should be

• 31 – 9 = 22 lbs
• However, 22 – 15 = 7 lbs less than the ideal
• Therefore, the nurse needs to assess the biophysical profile (BPP) on the fetus

Lecture 10 • Mark Klimek • 87:50

If weight gained during pregnancy is within •+/–1 to 2 lbs of the ideal weight for the gestational week … Pt is WNL If weight gained is within •+/–3 lbs … Assess her •+/–4 lbs or more… There is trouble operform a BPP on the fetus This file was downloaded from StudyLast.com. It is not allowed to publish it elsewhere. Only the buyer can use this file.