MARK KLIMEK STUDY GUIDE

MARK KLIMEK STUDY GUIDE

Acid Base As the ph goes the patient goes and except for potassium pH goes up potassium goes down pH goes down potassium goes up pH up(alkalosis) Hyper, tachy, increased, elevated, exaggerated, increasing, excessive.… Irritability, diarrhea, borborygmi= increased bowel sounds.pH down(acidosis) hypo, decreased, scant, absent, a-, brady, depressed, suppressed, oligo,… Pt has acidosis what heart rhythm would you see- second degree heart block Tetany- muscle spasms, hyper muscles, hyper hyper contractility Cardiac arrest- slow down MAC-Kussmal Kussmal only occurs in Metabolic ACidosis

Causes of acid base imbalances:

Ask yourself is it Lung? If it does= respiratory Is the client overventilating or under??If they are over---Alkalosis… If under4acidosis.Too much PCA pump what acid base can result depress respirations, underventilation…… respiratory ACIDOSIS.Near drowning4Respiratory acidosis Acute panic anxiety- Respiratory alkalosis If it isn’t lung its metabolic.If client has PROLONGED gastric vomiting or suctioning4METABOLIC ALKALOSIS For everything else that isn’t lung pic metabolic acidosis that doesn’t have to do with suctioning or vomiting Metabolic Acidosis if we don’t know what to pick!Respiratory rate is highly unreliable use yourgases,lung sounds and saturation!!!

Ventilator- High pressure alarm= increased resistance to airflow. High pressure to push through so look for OBSTRUCTION!!! 3 obstructions, DO IN THIS ORDER!! Least invasive to most!

1.Kink. - UNKINK 2.Water condensing in tubing. GET WATER OUT 3.Mucous. Suction is not best answer TURN COUGH AND DEEP BREATHE. If that doesn’t… work SUCTION!Low pressure alarm!Due to DISCONNECTIONS!

1.Main tube disconnected- 2.Oxygen Sensor line! Plug back in.If tubing hits the floor call respiratory and start bagging!! If it falls on them then on the bed then clean off with alcohol and reconnect Respiratory Alkalosis- Over Ventilating Respiratory Acidosis- Under Ventilating

DON’T ASK ANOTHER PEOPLE. DON’T USE CHICKEN QUESTIONS. TAKE CARE OF IT YOURSELF

ETOH,Abuse,Overdose vs. Withdrawal, & Mycin In abuse**

Denial during loss and grief:

Don’t confront. You support and allow them to continue because it serves a purpose and function.Dependency=abuser gets significant other to make decisions for them or do things for them because they can spend their time drinking.Codependency=significant other derives positive self esteem from doing things for or making decisions for the abuser. So abuser says will you do this for me and the codependent does it and then says to themselves

-DON’T ARGUE WITH THEM, PLAY ALONG!!

Characteristics!!!-Preventable by taking vitamin b1. Don’t have to stop drinking.-Megadose on B1 your blood alcohol will be lower.-Arrestable- you can keep it from getting worse by starting to take your b1 -Its irreversible because its brain damage.

GOAL:

For wernickes client memory- client will maintain current memory.

DEMENTIA- NEVER IMPROVEMENT!! MAINTAIN!

Antabuse/Disulfiram -Form of aversion therapy -If you take this and you drink alcohol, it makes you sick.-Onset and duration is 2 weeks. If you start taking it today it takes 2 weeks. If you stop today it takes 2 weeks to be able to drink again.

-It’s any alcohol. Avoid all forms of alcohol like insect repellents, aftershave, perfumes, colognes, mouthwash, any OTC elixir (Dayquil, Nyquil, etc), vinaigrettes, vanilla extracts (uncooked vanilla icing), alcohol based hand sanitizer.Overdose/Withdrawal

Principles:

-Every abused is an upper or downer -Is it upper or downer??

Uppers:

-Caffeine -Cocaine -PCP/LSD (psychedelic hallucinogens) -Amphetamines (METH)

Downers:

Everything else.Qualudes- downers Fentanyl Things go down WORST THING= respiratory distress You go opposite way drug does during withdrawal!!!You withdrawal from upper you go down.You withdrawal from downer you go up.Overdose on upper- tachycardia Overdose on lower- bradycardia Withdrawal from an upper- bradycardia Withdrawal from a downer- tachycardia Clonus- very jumpy reflexes ALWAYS ASSUME BABY IS INTOXICATED AND NOT WITHDRAWING at birth or in first 24 hours unless they tell you differently.Newborn after 24 hours they are in withdrawal.An infant at 10 min APGAR- intoxicated