MARK KLIMEK STUDY GUIDEAcid BaseAs the ph goes the patient goes and except for potassiumpH goes up potassium goes downpH goes down potassium goes uppH upalkalosis Hyper, tachy, increased, elevated, exaggerated, increasing, excessive. Irritability, diarrhe

MARK KLIMEK STUDY GUIDEAcid BaseAs the ph goes the patient goes and except for potassiumpH goes up potassium goes downpH goes down potassium goes uppH 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 blockTetany- muscle spasms, hyper muscles, hyper hyper contractilityCardiac arrest- slow downMAC-Kussmal Kussmal only occurs in Metabolic ACidosisCauses of acid base imbalances:Ask yourself is it Lung? If it does= respiratoryIs the client overventilating or under?? If they are over---Alkalosis…If under—acidosis.Too much PCA pump what acid base can result… depress respirations, underventilation… respiratory ACIDOSIS. Near drowning—Respiratory acidosisAcute panic anxiety- Respiratory alkalosisIf it isn’t lung its metabolic.If client has PROLONGED gastric vomiting or suctioning—METABOLIC ALKALOSIS For everything else that isn’t lung pic metabolic acidosis that doesn’t have to do with suctioning or vomitingMetabolic Acidosis if we don’t know what to pick!

Respiratory rate is highly unreliable use your gases, 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!Kink. - UNKINKWater condensing in tubing. GET WATER OUTMucous. Suction is not best answer… TURN COUGH AND DEEP BREATHE. If that doesn’t work SUCTION!Low pressure alarm!Due to DISCONNECTIONS!Main tube disconnected- 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 reconnectRespiratory Alkalosis- Over VentilatingRespiratory Acidosis- Under VentilatingDON’T ASK ANOTHER PEOPLE. DON’T USE CHICKEN QUESTIONS. TAKE CARE OF IT YOURSELFETOH,Abuse,Overdose vs. Withdrawal, & MycinIn abuse**“Maslow” RankingPhysiologic needsSafety needsComfort needsPsychological needsSociological needsSpiritual needsAlcoholic with fractured foot which would be priority?His denials?His pain?His break***Adequate pain control is number one for palliative carePsychodynamic- what’s their major malfunction?Abusers- greatest psychological priority is denial! Refusal to accept reality with problem.Confront denial in abusers!

“You say you aren’t an alcoholic but it’s 10 am and you’ve drank a fifth of whiskey and a 6 pack.”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 “I’m a wonderful person because I do this for them and no one else would”Set limits for the abuser and enforce them. No you call your boss, etc. Work on self esteem of the codependent person. Abusers manipulate people to do stuff that is harmful to significant other.Dependency vs manipulateDependency- not harmful husband buys wife alcoholManipulative- harmful 17-year-old buys alcohol for mom Wernickes-KorsakoffPsychosis induced by vitamin b1 deficiency –thiamineLose touch with reality because you lack the B vitaminAmnesia with confabulation- memory loss with making up stories because you can’t remember. They don’t know they made it up that’s what makes them psychotic. The believe their stories. These people have dementia-break from reality due to brain damageDON’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 b1Its irreversible because its brain damage.GOAL:For wernickes client memory- client will maintain current memory.DEMENTIA- NEVER IMPROVEMENT!! MAINTAIN!Antabuse/DisulfiramForm of aversion therapyIf 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/WithdrawalPrinciples:Every abused is an upper or downerIs it upper or downer??Uppers:CaffeineCocainePCP/LSD (psychedelic hallucinogens)Amphetamines (METH) “speed”Bath saltsADHD drugs Adderall and Ritalin These are all stimulants. Make things go up because they are uppers. You will see hyper, tachy, irritable, diarrhea, tremors, seizures.Downers:Everything else.Qualudes- downersFentanylThings go downWORST THING= respiratory distressYou go opposite way drug does during withdrawal!!!You withdrawal from upper you go down. You withdrawal from downer you go up.Overdose on upper- tachycardiaOverdose on lower- bradycardiaWithdrawal from an upper- bradycardiaWithdrawal from a downer- tachycardiaClonus- very jumpy reflexesALWAYS ASSUME BABY IS INTOXICATED AND NOT WITHDRAWING at birth or in first 24 hours unless they tell you differently.