Mark Klimek Audio Notes 1

Mark Klimek Audio Notes 1 Acid Base ABG’s As pH goes, so does my Pt! Except for K pH and HCO3 in same direction Metabolic

pH and HCO3 in different direction: Respiratory

pH ↓ Pt goes ↓ (HR, RR, all vitals) K goes ↑ hypoexcitable pH ↑ Pt goes ↑ K goes ↓ hyperexcitable Except for K – it does the opposite

pH ↑ : Alkalosis

Seizures, hyperactivity, borborgygmi (↑BS) Kausmal breathing = MacKausamal (Metabolic Acidosis breathing)

Causes of imbalance:

1.Is lung affected?a.Yes-Respiratory 2.Is pt overventilating or underventilating?a.Over-alkalosis b.Under-acidosis 3.Not the lung?a.Then it is Metabolic 4.If pt has prolonged vomiting or suctioning a.Alkalosis

5.If you don’t know: it’s probably metabolic acidosis (It’s super common)

Alcoholism Psychological #1 problem psychologically in alcoholism and all other abusers is denial Denial-refusal to accept the reality of a problem oTreat denial by confronting oDifferentiate what they say versus what they do 1 / 4

Mark Klimek Audio Notes 2 DO NOT confuse confrontation with aggression (attacks the person)

Questions about staff problem interactions: Never choose YOU, choose I

Denial is okay in loss/grief oTreat this denial with support-Do NOT confront Denial Anger Bargaining Depression Acceptance #2 problem dependency/codependency oDependency-abuser gets significant other to do things for them oCodependency-positive self esteem significant other receives from doing things for the abuser oTreat by setting limits and enforce them, say no Manipulation-abuser gets significant other for to do things them that is not in the best interest of the SO oInterest and harmful oIf what being asked to do is neutral-dependency oIf what being asked is harmful or not in best interest-manipulation oTreat manipulation by setting limits and enforce, say no Wernicke’s and Korsakoff oWernickes’-encephalopathy induced by vit B1/ thiamine deficiency oKorsakoff-psychosis induced by vit B1/ thiamine deficiency Primary symptom- amnesia with confabulation Redirect pt to other things Preventable-take vitamin B1/thiamine Arrestable-take vitamin B1/thiamine Irreversible Antabuse (disulfiram) and Revia (naltrexone) oAversion therapy

oOnset: 2 weeks, Duration 2 weeks

oPt teaching avoid all forms of alcohol-mouthwash, aftershave, perfumes/colognes/ insect repellants, OTC ending with elixir, alcohol based hand sanitizer, uncooked icing DO NOT pick red wine vinaigrette Overdose and Withdrawal oEvery abused drug is either upper or downer o1. Is drug upper or downer?

Upper: caffeine, cocaine, pcp/lsd, methamphetamines, Adderall (amphetamine)

Things go up: euphoria, tachycardia, restlessness, irritability, borborygmic, diarrhea, hypereflexia 3+ or 4+, seizures (have suction at bedside)

Downer: If not upper, it is a downer

Things go down: lethargic, bradycardia, respiratory arrest (have ambu-bag

at bedside) o2. Overdose or withdrawal?Overdose/intoxication-Overdose on an upper- everything goes up Overdose downer- everything goes down Withdrawal downer-everything go up Wthdrawal upper-everything go down 2 / 4

Mark Klimek Audio Notes 3 Drug Addiction in Newborns oAlways assume intoxication not withdrawal at birth (before 24 hours) Alcohol withdrawal syndrome vs delirium tremens (DT) oEvery alcoholic goes through alcohol withdrawal after 24 hr of not drinking, only minority go through DT (72 hrs) oAlcohol withdrawal-not life-threatening, not a danger to self or others oDT-life-threatening, danger to self and others AWSDT Regular dietNPO; clear liquids Semi-private anywherePrivate, near nurse’s station No restraintsRestricted bedrest (bedpans, urinals) Must be restrained (vest or 2 point lock leather) Antihypertensive/tranquilizer/Vitamin B1Antihypertensive/tranquilizer/Vitamin B1 Ventilators High Pressure Alarm Obstruction-Increased resistance to airflow oKinks (unkink) oWater condensation (open system and drain tubing) oMucous secretions in airway (TCDB, suction) Low Pressure Alarm-↓ Resistance – machine finding job too easy Disconnected oMain tubing (reconnect) oOxygen sensor (reconnect) If tube goes lower than pt level – contaminated Ventilator overventilating pt can result in resp. alkalosis Ventilator underventilating pt can result in resp. acidosis Amino Glycosides A Mean Old Mycin Amino Glycosides only treat Mean old Infections!Serious, resistant, gram-negative, life-threatening True mean old Mycins don’t have “Thro” If it has “Thro” – Thro it away!

Ex: Zithromycin , erythromycin, clarithromycin

Mean Old Mycins (mice) destroy ears (ototoxicity) and kidneys (nephrotoxicity) 3 / 4

Mark Klimek Audio Notes 4 Must check Creatinine (0.6 -1.3) for Nephrotoxicity – NOT urine output Check hearing, tinnitus, vertigo, dizziness

• Toxic to Cranial nerve 8 (vestibulocochlear) give q8h, IM/IV

Mean Old Mycins do NOT get absorbed – they go in and out and sterilize/clean Hepatic (encephalopathy)coma-reduce ammonia levels. Oral mycins redcues ammonia PO Mean Old Mycins are for bowel sterilizing NeoMYCIN KanoMYCIN Who can sterilize my bowel?? NEO KAN!Drawing TAP Levels (Peak and Trough) For drugs that have a narrow therapeutic window/level and are toxic Digitalis Route determines TAP – Not the drug

TROUGH PEAK

IV 30 MIN BEFORE NEXT DOSEIV 15-30 min after its done IM 30 MIN BEFORE NEXT DOSEIM 30-60 min after its given SubQ-See SUB Q 30 MIN BEFORE NEXT DOSESubling 5-10 min after its in the system PO 30 MIN BEFORE NEXT DOSENo PO peak Heart Rhythms Calcium channel blockers are like valium for the heart Ca Channel Blockers are chill pills for the heart They end in -DEPINE or ZEM Verapamil, Cardizem (Cardizem can be continuous IV drip) Calcium channel blockers are negative inotropic, negative chronotropes, negative dromotropes- fancy way of saying valium for the heart Positive inotropes- are cardiac stimulant

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