MarkKlimekLectureNotes

MarkKlimekLectureNotes howtoremembers/sforpHimbalances-ANS-"asthepHgoes,sogoesmypatient....exceptpotassium" #1priorityforalkalosis&why-ANS-ptneedssuctioningbecauseofseizures #1priorityforacidosis&why-ANS-ptneedstobeventilatedwithambubagbcof respiratoryarrest whatacid-baseimbalancedoeskussmaulrespirationscause-ANS-metabolicacidosis

acid-baseimbalanceforover/underventilating-ANS-overventilating:respiratory

alkalosis

underventilating:respiratoryacidosis

acid-baseimbalanceforprolongedgastricvomitingorsuction-ANS-metabolicalkalosis reasonsforhighpressurealarmsonvent&whattodoforthem-ANS-1.kinks...unkink it 2.condensedwater...emptyit 3.mucusplugs...turn,cough,deepbreathe,orsuctionPRN reasonsforlowpressurealarmsonvent&whattodoforthem-ANS-1.maintubing disconnection...reconnectit 2.O2sensortubedisconnection...reconnectit *iftubingisonthefloor...bagptandcallrespiratorytherapist* whatacid-baseimbalancewouldtheptbeconsideredreadytobeweanedoffthevent &why-ANS-respiratoryalkalosisb/coverventilating #1psychologicalproblemforanyabusesituation-ANS-DENIAL whenisdenialok-ANS-withloss&grief stagesofgrief:(DABDA)denial,anger,bargaining,depression,acceptance 1 / 4

dependency,co-dependency,&manipulation(whattodoforeachofthem)-

ANS--dependency:abusergetsthesignificantothertodothingsormakedecisionsfor

them...CONFRONTTHEM

-co-dependency:whenthesignificantotherderivesself-esteemfordoingthingsor

makingdecisionsfortheabuser,howeverNOTharmful...SETLIMITS&ENFORCE THEM,sayno,workontheself-esteemofco-dependentperson

-manipulation:abusergetssignificantothertodothingsormakedecisionsthatareNOT

INTHEBESTINTERESTofthesignificantother,harmful&dangerous...SETLIMITS &ENFORCETHEM wernicke(korsakoff)syndrome..whatitis,s/s,whattodo,howtoprevent- ANS-psychosis-inducedencephalopathybyvitaminB1(thiamine)deficiencyfrom alcoholism

s/s:amnesia&confabulation

whattodo:REDIRECTthemwhenconfabulatingaboutsomethingthatisnottrue

howtoprevent:takevitaminB1

antabuseandrevia(disulfiram)-ANS-aversiontherapy(developmentofhatredfor alcohol)

onsetANDdurationofeffectiveness:2weeks

ptteaching:avoidallformsofalcoholtoavoidnausea,vomiting,anddeath(includes

mouthwash,cologne,perfume,aftershave,elixirOTCmeds,handsanitizer,insect repellant,vanillaextract...CANhaveredwinevinigarettes)

whataretheupper&downerdrugswiths/s-ANS-uppers:

-caffeine -cocaine

-LSD/PCP

-methamphetamines -adderall s/s:euphoria,seizures,restlessness,irritability,hyperreflexia(3+,4+),tachycardia, borborygmi,diarrhea 2 / 4

downers:

-over135others;ifit'snotanupper,it'sadowner

s/s:lethargic,respiratorydepression/arrest,constipated

highestpriorityinanuppervsdowner-ANS-upper:suctioningduetoseizures

downer:intubation/ventilationduetorespiratoryarrest

overdosevswithdrawalinanupperandadowner-ANS-overdoseonanupper:too

much

overdoseonadowner:toolittle

withdrawalonaupper:toolittle

withdrawalonadowner:toomuch

drugabuseinanewborn:intoxicationvswithdrawal-ANS-intoxicationinanewbornis

lessthan24hoursafterbirth withdrawalis24hoursormoreafterbirth

alcoholwithdrawalvsdeliriumtremens-ANS-alcoholwithdrawal:

-occursafter24hoursafterdrinking -nonlifethreateningtoselforothers -regulardiet -semiprivateroom,anywhereonunit -ptisupandabletomovearound -norestraints

deliriumtremens:

-occursafter72hoursafterdrinking -lifethreateningtoselforothers -NPOorclearliquiddiet -privateroom,nearnursingstation -restrictedbedrest -restraints(vestor2-pointlockletters) 3 / 4

whattogivetobothaptinalcoholwithdrawal&deliriumtremens-ANS-anti-HTN medication,tranquilizer,&multivitamincontainingB1 aminoglycosides-ANS-"meanoldmycins" -biggunsofABX -endinmycin(gentamycin,vancomycin,clindamycin,streptomycin)butNOTthedrugs endingin-thromycin -whattheytreat:TB,septicperitonitis,fulminatingpyelonephritis,septicshock,infection from3rddegreeburnwoundcovering>80%ofthebody -whattheydon'ttreat:sinusitis,otitismedia,bladderinfection,viralpharyngitis,&strep throat -toxiceffects:CN8toxicity(monitorhearing-#1,balance,tinnitus)&nephrotoxicity (monitorcreatinine) -givenIMorIVbecausePOisnotabsorbed.POonlygivenforhepaticencephalopathy (whenammonialevelsgettoohigh)orpre-opbowelsurgery(tosterilizethebowel)

-whichaminoglycosidessterilizethebowel:neomycin&kanamycin

-drawTAP(trough,administer,peak)onmycins whenaretroughandpeaklevelsdrawnofeachroute-ANS-*troughisalwaysdrawn30 minbeforenomattertheroute*

peaks:

SubL-5to10minutesafterthedrugisdissolved IV-15to30minutesafterthedrugisfinished(NOTwhenitshung) IM-30to60minutes SubQ-dependsoninsulin PO-notnecessary calciumchannelblockers-ANS--theyrelaxandslowdowntheheart -endsin-dipine+verapimilandcardizem(diltiazem)--continuousIVdripsotitrateto makesystolic>100...."dippinginthecalciumchannel"

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