Mark Klimek Lecture Outlines

Mark Klimek Lecture Outlines

If the pH and the BiCarb are both in the same direction then it is? - Metabolc

If the pH is up it is? - Alkalosis

As the pH goes so goes my patient except for? - Potassium

If the pH is down it is? - Acidosis

If the pH is up my patient with show signs and symptoms of? - Increase... like tachycardia,diarrhea and borborygmi

If the pH is down my patient will show signs and symtoms of? - Decrease... like decreased output, bradycardia and constipation

If my pH is up my potassium (K+) is ? - Down

If my pH is down my potassium (K+) is? - Up

If my patient is overventilating I should choose? - Respiratory Alkalosis

If my patient is underventilating I should choose? - Respiratory Acidosis

If my patient has prolonged gastric vomiting or suction I choose? - Metabolic Alkalosis

If it is not lung or prolonged vomiting or suctioning I choose? - Metabolic Acidosis

Kussmal Respirations - Metabolic Acidosis ( Remember MacKussmal

Before measuing ABGs you should check what? - Allen's test. Should be positive. Pt makes a fist and pressure is applied to the ulnar and the radial arteries Ulnar pressure is released and color should return in 7 seconds (means it's positive and OK to take ABG's).

Definition of Compensation - PH is normal! It is never compensated if it is abnormal.

If PH normal - look in the direction it is going. Closer to Acidic? (7.35) acidosis.

Then look at Bicarb & figure out which is abnormal. If Bicarb is out of range, it's metabolic acidosis.

If C02 is abnormal, it's Respiratory Acidosis :)

If your pt is acidotic and you need to pick a symptom - Pick the symptom where everything is DOWN. ( And vice Versa)

Ex: 2 degree Morbitz Type 2 BLOCK. <---- Down direction

Mark Klimek Lecture Outlines

If you don't know what causes an acid base balance, pick - Metabolic Acidosis

If in doubt in ABGs, always pick - Headache, nausea, weakness & numbness+ tingling.It can be either up or down.

High pressure alarms are triggered when? - They cannot push air in

High pressure alarms are caused by what three types of obstructions? - Kinking, Water in dependant loops and mucus in the airway.

If kinking in the tube is present you? - Unkink

If water is present in the dependant loops you? - Open system and empty water.

If mucus is present you? - Turn them, cough and have them deeo breath first. If ineffective you then suction.

Don't suction unless - Coughing & deep breathing is deemed inappropriate.

In order to suction, you must be able to hear - Mucus in the lung

Low pressure alarms are triggered when? - It is to easy to push air in.

Low pressure alarms are normally caused by? - Disconnection

If the tubing is disconnected you? - Reconnect

If O2 sensor line is disconnected you? - Reconnect

In a vented client respiratory alkalosis means the vent setting may be too? - High

In a vented client respiratory acidosis means the vent may be too? - Low

What do you do if the patients disconnected tube is on the floor? - Bag them, (call for help) get new tube and then reconnect.

First question to ask if the low pressure alarm sounds - Where is the tubing?!

HOLD - H- High Pressure O- Obstruction L- Low D- Disconnections

Never put anything in YOUR scope of practice - On anyone else

Make sure your answer is - PATIENT FOCUSED.

Mark Klimek Lecture Outlines

TAKE CARE OF YOUR PATIENT!

Don't answer based on staff, building, machine, etc.

PATIENT FIRST.

What does wean mean? - Decrease Gradually

What do you do if the patients disconnected tube is on the chest? - Reconnect ... if its above the waist its ok.

Remember is PSYCH if you are asked to Prioritize, Don't forget - MASLOW!

• Physiological
• Safety
• Comfort - Includes pain
• Psychological
• Social
• Spiritual

When prioritizing, always use Maslow + ABCs - For one patient. Don't if you have more than one patient.

What is the biggest problem in abuse? - Denial

To treat denial you need to? - Confront them.

Definition of Denial - Refusal to accept reality of their problem

How do you confront? - Point out the difference between what they say and what they do.

What is the one circumstance that you as a nurse would support denial? - Loss and Grief

Always go - Med surg first. Then Psych

What is dependency? - When the abuser gets a significant other so make decisions for them or do thing for them.

What is codependency? - When the significant other gets positive self esteem from doing things or making decisions for an abuser.

To treat dependency/codependency you ? - Set limits and enforce them.

Say NO and follow through.Agree in advance on what requests are allowed, then enforce the agreement.

Mark Klimek Lecture Outlines

You also need to work or the self esteem of the codependent.

What is manipulation? - When the abuser gets the significant other fo do things for them that is not in the best interest of the significant other. This can be dangerous and harmful to the significant other.

How do you treat manipulation? - Set limits and enforce.

Why is manipulation easier to treat then dependency/codependency? - Because no one likes being manipulated.

DABDA - D- Denial A- Anger B- Bargaining D- Depression A- Acceptance

Psych Needs, In order - Denial Depend Manipulation

To address a patient's psychological needs, they must be: - STABLE, safe, comfortable.

Pain - Never killed anyone. Definitely NOT the top priority, especially if there are physiological needs in the question that make the patient unstable.

What is Wernickes (Korsakoffs) Syndrome? - Psychosis induced by vitamin B1 (Thiamine) deficiency.

Symptom of Wernickes Korsakoffs syndrome? - Amnesia with confabulation.

= Loss of memory with making up stories to fill in the gaps.

Vitamin B1 helps breakdown? - Alcohol

So without B1 what happens? - Alcohol isn't metabolized correctly goes to the brain and causes Wernickes

Primary symptom of Wernickes? - Amnesia with confabulation (making up stories).

Is Wernickes preventable? - Yes- Take Vitamin B1

Is Wernickes arrestable? - Yes- Take Vitamin B1

Is Wernickes reversible? - No