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MARK KLIMEK NCLEX REVIEW-
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Rule of the B's: If the and the are in the same direction then it is meta pH, Bicarb, Both, Bolic pH 7.30 HCO3 20 โ= acidosis; โ= metabolic pH 7.58 HCO3 32 โ= alkalosis; โ= metabolic pH 7.22 HCO3 30 โ= acidosis; โ= respiratory You are providing care to a client with the following blood gas results: pH 7.32, CO 49, HCO3 29, PO2 80, and SaO2 90%. Based on these results, the client is experiencing: โ= acidosis; โ= respiratory MacKussmaul The only acid base to cause Kussmaul respirations is Metabolic ACidosis As the goes, so goes except for pH, my patient, Potassium Up i.e alkalosis
hyokalemia, alkalosis, HTN, Tachycardia, Tachypnea, Seizures, Irritability, Spastic, Diarrhea, Borborygmi( i.e increased bowel sound), hyperreflexia, etc Down i.e acidosis hyperkalemia, resp arrest, htn, bradycardia, constipation, absent bowel sounds, flacid, bradypnea Causes of acid-base imbalances: First ask yourself, "Is it ?" If yes, then it's
. Then ask yourself: "Are they or. If , pick . If , pick lung, respiratory, overventilating, underventilating, overventilating, alkalosis, underventilating, acidosis Causes of acid-base imbalances: If it's not lung, then it's. If the patient has vomiting or suction, pick. For everything else that isn't lung, pick. When you don't know what to pick, choose metabolic, prolonged gastric, alkalosis, metabolic acidosis, metabolic acidosis High pressure alarms are triggered by resistance to air flow. This means the machine is beginning to push too hard to get air into the lungs. increased High pressure alarms are triggered by increased resistance to airflow and can be caused by obstructions of three types: action, action, action
- kinked tube - You unkink,
- water condensing in tube. Here you just empty. 3) mucus secretions in airway- Here you 1st cough and deep breathe, change positions, and suction if those dont work.
- Psychological (problems within the person)
- Social (problems with other people)
- Spiritual Arrange from highest to lowest priority using Maslow's: Denial Spiritual Distress Pain in Elbow Fall Risk Pathological Family Dynamics Electrolyte Imbalance Electrolyte Imbalance (Physiological) Fall Risk (Safety) Pain in Elbow (Comfort) Denial (Psychological) Pathological Family Dynamics (Social) Spiritual Distress (Spiritual) The #1 problem in abuse is denial It is the number 1 problem in all abuses!! Denial is the to accept the of their problem refusal, reality
You Treat denial by: it by pointing out to the person the difference between what they and what they. In contrast, the denial of loss and grief. confront, say, do, support Note- Never use aggression!! Rather confront. What are the 5 stages of grief? DABDA. Denial Anger Bargain Depression Acceptance Dependency: When the gets the Significant Other to do things for them or make decisions for them abuser Codependency: When the derives positive from doing things for or making decisions for the Significant Other, self-esteem, abuser
Primary symptoms of Wernicke's (Korsakoff's) Syndrome: with Amnesia (memory loss), confabulation (make up stories) Characteristics of Wernicke's (Korsakoff's) Syndrome:
preventable (take vitamin) arrestable i.e you can stop it from getting worse (take vitamin B1) irreversible i.e its 70% (kills brain cells) Antabuse/Revia or dysyfuriam is aka Therapy AversioN I.E a strong hatred for something. we do this because we want alcoholic to hate taking alcohol. Onset and duration of effectiveness of Antabuse/Revia: 2 weeks i.e they have to be on the drug for two weeks before the meds work. And they have to be off the drug for 2 weeks before they can take alcohol again. Patient teaching with Antabuse/Revia: Teach them to Avoid forms of to avoid , , all, alcohol, nausea, vomiting, death
What are examples of products that contain alcohol? mouth wash, cologne, perfume, aftershave, elixir, most OTC liquid medicines, insect repellant, vanilla extract, vinagerettes, hand sanitizer. They cant also take uncooked icings. Every abused drug is? either an UPPER or a DOWNER what are the names of the Uppers?
- cocaine
- PCP/LSD ie psychdelic hallucinogen
- meth
- caffeine
- ADHD drugs - ( Aderall)
- bath salts signs and symptoms of uppers? Just know everything goes up!! Euphoria, restlessness, irritability, boborygymi, spastic, seizures.
Delirium Tremens Patients with are not a danger to themselves or others. Patients with are dangerous to self and others Alcohol Withdrawal Syndrome. Delirium Tremens AWS or DT: semiprivate room, any location AWS AWS or DT: private room near the nurse's station DT AWS or DT: Regular diet AWS AWS or DT: Clear liquid or NPO diet (risk for aspiration) DT AWS or DT: Up at liberty
AWS
AWS or DT: Restricted to bedrest with no bathroom privileges DT AWS or DT: No restraints AWS AWS or DT: Usually restrained with either vest or 2 point locked leathers (1 arm and 1 leg) DT AWS or DT: Give anti-HTN medication Both AWS or DT: Give tranquilizer Both AWS or DT: Give multivitamin to prevent Wernicke's Both
What is the toxic effect of aminoglycosides and what must you monitor? ototoxicity; monitor hearing, balance, and tinitus The human ear is shaped like a so another toxic effect of aminoglycosides is so monitor kidney, nephrotoxicity, vertigo i.e dizziness, creatinine Note- The creatine is the best indicator for kidney function. The number " " drawn inside the ear reminds you of cranial nerve and frequency of administration 8, 8, Q8H What is route for aminoglycosides? IV or IM Do not give aminoglycosides PO because they are not absorbed but only give expect in these 2 cases:
- (due to high level)
- Pre-op surgery
- hepatic encephalopathy or liver coma- thats when the ammonia gets too high.
- Pre op bowel surgery- given to clean the bowels out.
Who can sterilize my bowel? Neo- Kan Neomycin and kanomycin are drugs that can sterilize the bowels. What is the reason for drawing Trough and Peak levels? Narrow therapeutic level When do you ALWAYS draw the Trough? 30 minutes before next dose for all routes When do you draw the Peak level of Sublingual medications? 5 - 10 minutes after drug dissolves When do you draw the Peak level of IV medications? 15 - 30 minutes after medication is finished if you get two value in the same range like 10;15, 10;30 and 11am. Choose 11am When do you draw the Peak level of IM medications? 30 - 60 minutes after injecting it
When it comes to Biological Agents: Category is , Then Category , Then Category A, the worst, B, C Small Pox Inhaled transmission/ on airborne precautions dies from epticemia- no treatment rash starts around mouth first Category A Tularemia chest symptoms dies from respiratory failure treat with streptomycin Category A Anthrax spread by inhalation looks like the flu dies from respiratory failure treat with supro, PCN, and streptomycin Category A
Plague spread by inhalation has the 3 H's: Hemoptysis (coughing up blood), Hematemesis (vomiting up blood), Hematochezia (blood in stool) deis from respiratory failure and DIC (bleed to death) treat with Doxycycline and Mycins no longer communicable after 48 hours of treatment Category A Hemorrhagic illnesses primary symptoms are petechiae (pinpoint spots) and ecchymoses (bruising) high % fatal Category A Botulism it is ingested has 3 major symptoms: descending paralysis, fever, but is alert dies from respiratory arrest Category A What are some examples of chemical agents that cause bioterrorism? Mustard gas Cyanide Phosgine chlorine Sarin
What do you use when cleansing patients exposed to chemical agents? All chemical agents require only soap and water cleansing except Sarin, which requires bleach. Which agents do you isolate the patient for? Biological Agents Which agents do you decontaminate for? Chemical Agents How does decontamination work? Gather exposed people Take to decontamination center where people remove clothing, shower, dress in non-contaminated clothes, then release to other services Put contaminated clothing in special bag and throw away (be sure not to touch it) Calcium Channel Blockers: they are like what for your heart. What does that mean? Valium. it means it relaxes the heart. Calcium Channel Blockers: inotropoic, chronotropic, dromotropic Negative
All these simply relaxes the heart i.e they calm it down.
