LECTURE 1 ** DON’T MIX UP S&S and CAUSATION - often
what causes something is the opposite of the S&S - ex.
diarrhea will cause a metabolic acidosis but once you
ACID BASES are acidotic your bowel shuts down and you get a
• learn how to convert lab values to words paralytic illeus
• the rule of the B’s
= if the pH and the BiCarb are both in the same
• when you get scenarios:
direction -> metabolic
-> if it’s a lung scenario = respiratory
Hint: draw arrows beside each to see directions
- then check if the client is over-ventilating
* down = acidosis
(alkalosis) or under-ventilating (acidosis) -
* up = alkalosis
remember to look at the words (ex. over, under,
- respiratory -> has no b in it; if in other directions
ventilating) -> “as the pH goes so goes my PT” ->
(or if bicarb is normal value)
VENTILATING DOESN’T MEAN RESPIRATORY RATE;
- KNOW NORMAL pH, BiCarb, CO2 resp. rate is irrelevant w/ acid-base, ventilation has to do
with gas exchange not resp. rate (look at the SaO2 -> if
• Hint: DON’T MEMORIZE LISTS…know principles your resp. rate is fast but SaO2 is low you are under-
(they test knowledge of principles by having you ventilating) -> ex. PCA pump - What acid-base disorder
generate lists..) - for “select all” questions indicates they need to come off of it? = respiratory
- ex. in general/principle what do opioids/pain acidosis (resp. depression -> resp. arrest) —> if it’s not
meds do? = sedate you, CNS depressors * ex. lung, it’s metabolic
what does dilaudid do? don’t memorize specifics or a • metabolic alkalosis - really only one scenario = if
list of dilaudid, know principles of opioids (such as the PT has prolonged gastric
sedation, CNS depression -> lethargy, flaccidity, reflex vomiting/suctioning - because you are losing
+1, hypo-reflexia, obtunded) ACID
- boards don’t test by lists because all * ex. GI surgery w/ NG tube with suctioning for
books/ classes have different lists 3 days; hyperemesis graviderum
- otherwise everything else that isn’t lung you
• principles of S&S acid bases: as the pH goes so pick metabolic acidosis (DEFAULT)
goes my patient (except K+)
* ex. hyperemesis graviderum w/ dehydration
- pH up = PT up -> body system gets more acute renal failure, infantile diarrhea
irritable, hyper-excitable (EXCEPT K+)
-> alkalosis - think of a body system and go
• remember, you only have 4 to pick from: -
high: hyper-reflexive (+3, +4 [2 is normal]), respiratory alkalosis - respiratory acidosis -
tachypnea, tachycardia, borborygmi, seizure - metabolic alkalosis - metabolic acidosis
pH down = PT down -> body systems shut
down (EXCEPT K+) • pay more attention to the modifying phrases than
-> acidosis - think of a system and go low: the original noun
hypo-reflexive (+1, 0), bradycardia, lethargy, - ex. person w/ OCD who is now psychotic (psychotic
obtunded, paralytic illeus, respiratory arrest trumps OCD); hyperemesis with dehydration (pay
• ex. which acid-base disorders need an ambu-bag at attention to dehydration)
the bedside? = acidosis (resp. arrest)
• ex. which acid-base disorders need suction at the
bedside? = alkalosis (seize and aspirate) VENTILATION
• Mac Kussmaul - Kussmaul’s (compensatory • ventilators -> know alarm systems (you set it up so
respiratory mechanism) is only present in only 1 of that the machine doesn’t use less than or more
the 4 metabolic (acid-base) disorders than specific amounts of pressure)
a) high pressure alarm = increased resistance
* M = metabolic AC = acidosis
to airflow (the machine has to push too hard to
• most common mistake with select all questions = selecting get air into lungs)
one more than you should (stop when you select the ones - from obstructions:
you know! don’t get caught up on the “could be’s”) i. kinks in tubing (unkink it)
• Hint: don’t select none or all on select all that apply ii. water condensation in tube (empty it!) iii.
questions (never only one and never all) mucous secretions in the airway (change
positions/turn, C&DB, and THEN suction) ***
• Causes of Acid-Base Imbalance: suction is only PRN!!!
- scenarios and what acid-base disorder would -> priority questions = you would check
result (what would cause an imbalance) kinks first, suction is not first
b) low pressure alarm = decreased
resistance to airflow (the machine had to work
too little to push air into lungs)
, - from disconnections:
i. main tubing (reconnect it duh!)
ii. O2 sensor tubing (which senses FiO2 at
the airway/trach area; black coated wire
coming from machine right along the tubing -
reconnect!)
• ventilators -> know blood gases
- resp. alkalosis = ventilation settings might
be set too high (OVER-VENTILATING)
- resp. acidosis = ventilation settings might be
set too low (UNDER-VENTILATING)
• ex. weaning a PT off ventilator -> should not be
under-ventilated, they need the ventilator; if they
are over-ventilating then they can be weaned
• never pick an answer where you don’t do
something and someone else has to do something
L Hint: for questions about denial, you must look to see
if it is LOSS or ABUSE
E - loss/grief = support
C - abuse = confront
T • #2 psychological problem in abuse = DEPENDENCY,
U CO-DEPENDENCY
R - dependency = when the abuser gets significant other
to do things for them or make decisions for them -> the
E dependent = abuser
- co-dependency = when the significant other derives
2 positive self-esteem from making decisions for or
doing things for the abuser
-> the abuser gets a life w/o responsibilities -> the
ABUSE (Psych and Med-Surge) sig. other gets positive self-esteem (which is why they
Psychological Aspect/Psycho-Dynamics • # 1 can’t get out of the relationship) • how do you treat it?
psychological problem is the same in any/all - set limits and enforce them
abusive situations = DENIAL -> start teaching sig. other to say NO (and they
- abusers have an infinite capacity for denial so that have to keep doing it)
they can continue the behavior w/o answering for it • - must also work on the self-esteem of the co-dependent
can use the alcoholism rules for any abuse - ex. # 1 (ex. I’m a good person because I’m saying “no”) •
psych problem in child abuse, gambling or cocaine abuse is manipulation = when the abuser gets the sig. other to
denial do things for them that are not in the best interest of the
• why is denial the problem? HOW CAN YOU TREAT sig. other
SOMEONE WHO DENIES/DOESN’T RECOGNIZE - the nature of the act is
THEY HAVE A PROBLEM dangerous/harmful - how is manipulation
• denial = refusal to accept the reality of a problem • like dependency?
treat denial by CONFRONTING the problem (it’s not -> in both the abuser is getting the other person to
the same as aggression which attacks the person, not do something for them
the problem) = they DENY you CONFRONT - pointing - how do you tell the difference between manipulation
out to the person the difference between what they & dependency?
say and what they do -> NEUTRAL vs. NEGATIVE (look at what they’re
- Hint: never pick answers that attack the person -> being asked to do)
ex. bad answers have bad pronouns - “you” -> ex. -> if the sig. other is being asked to do something
good answers have good pronouns - “I”, “we” -> ex. neutral (no harm) its dependency/co-dependency ->
“you wrote the order wrong” vs. “I’m having difficulty if the sig. other is being asked to do something that
interpreting what you want” will harm them or is dangerous to them they are
• loss and grief -> for this denial you must SUPPORT it manipulated
- DABDA = denial, anger, bargaining, depression, acceptance •
, • how do you treat manipulation? uppers (5) = caffeine, cocaine, PCP/LSD (psychedelic
- set limits and enforce them -> “NO” hallucinogens), methamphetamines, adderall (ADD drug)
- easier to treat than dependency/co-dependency * S&S - make you go up; euphoria, tachycardia,
because no one likes to be manipulated (no positive restlessness, irritability, diarrhea, borborygmi, hyper-
self-esteem issue going on) reflexia, spastic, seize (need suction) - downers = don’t
• ex. how many PT’s do you have w/ denial? = 1 ex. memorize names -> anything that is not an upper is
how many PT’s do you have w/ dependency/co- a downer! if you don’t know what the med is, you
dependency = 2 have a high chance that it’s a downer if it’s not part
ex. how many PT’s do you have w/ manipulation = 1 of the uppers list
* S&S -> make you go down; lethargy, respiratory
Alcoholism depression (& arrest)
Wernicke’s & Korsakoff’s - ex. The PT is high on cocaine. What is critical to assess? -
- typically separate BUT boards lumps them > NOT resps below 12 because they will be high ->
together - wernicke’s = encephalopathy maybe check reflexes
- korsakoff’s = psychosis (lose touch with b) are they talking about overdose or
reality) -> tend to go together, find them in the withdrawal - overdose/intoxication = too
same PT • Wernicke Korsakoff’s syndrome: much
a) psychosis induced by Vit. B1 (Thiamine) - withdrawal = not enough
deficiency - lose touch w/ reality, go insane because - ex. the PT has overdosed on an upper -> pick the
of no B1 b) primary symptom -> amnesia w/ S&S of too much upper
confabulation - significant memory loss w/ making - ex. the PT has overdosed on a downer -> pick the
S&S of too much downer
up stories - they believe their stories
- ex. the PT is withdrawing from an upper -> not
• How do you deal w/ these PT’s? enough upper makes everything go down
- bad way = confrontation (because they believe what - ex. the PT is withdrawing from a downer -> not
they are saying and can’t see reality) enough downer makes everything go up
- good way = redirection (take what the PT can’t do • upper overdose looks like = downer withdrawal •
and channel it into something they can do) • downer overdose looks like = upper withdrawal • In
Characteristics of Wenicke Korsakoff’s: a) it’s what 2 situations would resp. depression & arrest be
preventable = take Vit. B1 (co-enzyme needed for your highest priority:
the metabolism of alcohol which keeps alcohol from - downer overdose
accumulating and destroying brain cells) * PT doesn’t - upper withdrawal
have to stop drinking • In what 2 situations would seizure be the biggest
b) it’s arrestable = can stop it from getting worse by risk: - upper overdose
taking Vit. B1 - downer withdrawal
* also not necessary to stop drinking
c) it’s irreversible (70% of cases) -> Hint: On boards, • Drug Abuse in the Newborn:
answer w/ the majority (ex. if something is majority - at birth, always assume intoxication,
of the time fatal, you say it’s fatal even if 5% of the - after 24 hrs -> withdrawal
time it’s not) - ex. caring for infant of a Quaalude (not upper)
• Drugs for Alcoholism: addicted mom 24 hrs. after birth, select all that
DISULFIRAM (Antabuse) apply:
= aversion therapy -> want PT’s to develop a gut -> downer withdrawal so everything is up = exaggerated
hatred for alcohol startle, seizing, high pitched/shrill cry
-> interacts w/ alcohol in the blood to make you very ill • Alcohol Withdrawal Syndrome vs. Delirium Tremens
-> onset & duration: 2 weeks (so if you want to a) every alcoholic goes through alcohol withdrawal
drink again, wait 2 weeks) 24 hrs. after they stop drinking
- PT teaching = avoid ALL forms of alcohol to - only a minority get delirium tremens
avoid nausea, vomiting & possibly death - timeframe -> 72 hrs. (alcohol withdrawal comes 1st)
-> including mouthwash, aftershaves/colognes/perfumes - alcohol withdrawal syndrome ALWAYS precedes
(topical stuff will make them nauseous), insect repellants, delirium tremens, BUT delirium tremens does not
any OTC that ends with “-elixir”, alcohol- based hand always follow alcohol withdrawal syndrome b) AWS is
sanitizers, uncooked (no-bake) icings which have vanilla not life-threatening; DT’s can kill you c) PT’s w/ AWS
extract, red wine vinaigrette are not a danger to self/others; PT’s w/ DT’s are
dangerous to self/others
• Overdoses & Withdrawals: - they are withdrawing from a downer so they will
- every abused drug is either an UPPER or be exhibiting upper S&S
DOWNER - DT’s are dangerous
1) first establish if the drug is an upper or downer -
, Differenc AWS DT • 2 toxic effects:
es in i) when you see ‘-mycin’, think mice
Care - mice -> ears -> otto toxic
- monitor hearing, tinnitus, vertigo/dizziness ii)
Diet Regular diet NPO/clear liquids
(because of risk for the human ear is shaped like a kidney so next
seizures which can effect is nephrotoxicity
cause risk of - monitor creatinine (not BUN, output, daily
aspiration) weight) * creatinine = the best indicator of
kidney/renal function (pick 24 hr. creatinine
Room Semi-private Private near nurses
anywhere on the unit clearance over serum creatinine if both available)
station
(dangerous &
• #8 (fits nicely in the kidney) reminds you about 2
unstable) things about these drugs
- toxic to cranial nerve 8 = ear nerve
Ambulatio Up ad lib Restricted bed rest -> - administer Q8
n no bathroom • route:
privileges (use
bedpans/urinals) - IM or IV
• do not give PO -> they are not absorbed - if you
Restraint No restraints Restraints give an oral ‘-mycin’ it will go into gut, dissolve, go
s (because not (because through and come out as expensive stool (won’t
dangerous) dangerous) - not
soft wrist or 4 point have any systemic effect)
soft because - EXCEPT in 2 cases = bowel sterilizers:
they’ll get out * hepatic encephalopathy (hepatic coma) = to get
- need to be in vest
or 2-pt. locked ammonia down, oral ‘-mycin’s’ will sterilize the bowel
leathers (opposite 1 by killing Gram-neg bacteria (E. coli) to help bring
arm & leg, rotate down ammonia and won’t harm the damaged liver
Q2hrs, lock the free
limbs 1st before because it doesn’t go through the liver (also gives
releasing the locked diarrhea, more poop out is good) * pre-op bowel
ones) surgery = it sterilizes the gut by killing the E. coli
bacteria
They both get ANTI-HYPERTENSIVES
& TRANQUILIZERS - if oral, no otto or nephro toxicity because not
- because everything is up (downer absorbed - these are neomycin & kanamycin
* Who can sterilize my bowels? NEO KAN
withdrawal) They both get MULTIVITAMIN
w/ B1 • Trough and Peak levels:
- trough = drug at lowest
- peak = drug at highest
** TAP levels - trough administer peak
• RN’s can accept but RPN’s can’t (because PT is unstable) -> draw trough levels first
- on med-surge, the RN who takes them must decrease -> administer your drug
their workload (i.e. reduce PT load if they take a DT PT) -> draw peak levels after drug administration
-> Hint: on boards, the setting is always perfect • Why draw levels? = narrow therapeutic window -
(i.e. enough staff/time/resources on the unit etc.) small difference between what works and what kills
DRUGS - if the drug has a wide range then you wouldn’t
AMINOGLYCOCIDES need to draw TAP levels
• powerful class of antibiotics (when nothing else * ex. Lasix doses range from 5-80mg thus a wide
works pull these outs, the big guns) range so you won’t need TAP levels
- don’t use unless anything else works * ex. Dig doses range from 0.125 - 0.25 so this
• boards love to test these drugs because narrow range needs TAPS levels
they’re dangerous and are a test of safety • A MEAN OLD MYCINS = major class that needs
• think: A MEAN OLD MYCIN TAPs drawn because of narrow window
-> a mean old = they treat serious, life-threatening, • When do you draw TAPS?
resistant, Gram-neg bacteria infections (i.e. a mean -> depends on the route (don’t focus on the
old antibiotic for a mean old infection) med) a) Trough Levels
-> mycin = what they end with (all end w/ -mycin) ** doesn’t matter which route or med, always 30
** not all -mycin’s are aminoglycosides BUT most mins. - sublingual = 30 mins. before next dose
are (the 3 that are not are erythromycin, - IV = 30 mins. before next dose
azithromycin, clarithromycin = throw it off the list!) - IM = 30 mins. before next dose
- Sub-Q = 30 mins. before next dose
what causes something is the opposite of the S&S - ex.
diarrhea will cause a metabolic acidosis but once you
ACID BASES are acidotic your bowel shuts down and you get a
• learn how to convert lab values to words paralytic illeus
• the rule of the B’s
= if the pH and the BiCarb are both in the same
• when you get scenarios:
direction -> metabolic
-> if it’s a lung scenario = respiratory
Hint: draw arrows beside each to see directions
- then check if the client is over-ventilating
* down = acidosis
(alkalosis) or under-ventilating (acidosis) -
* up = alkalosis
remember to look at the words (ex. over, under,
- respiratory -> has no b in it; if in other directions
ventilating) -> “as the pH goes so goes my PT” ->
(or if bicarb is normal value)
VENTILATING DOESN’T MEAN RESPIRATORY RATE;
- KNOW NORMAL pH, BiCarb, CO2 resp. rate is irrelevant w/ acid-base, ventilation has to do
with gas exchange not resp. rate (look at the SaO2 -> if
• Hint: DON’T MEMORIZE LISTS…know principles your resp. rate is fast but SaO2 is low you are under-
(they test knowledge of principles by having you ventilating) -> ex. PCA pump - What acid-base disorder
generate lists..) - for “select all” questions indicates they need to come off of it? = respiratory
- ex. in general/principle what do opioids/pain acidosis (resp. depression -> resp. arrest) —> if it’s not
meds do? = sedate you, CNS depressors * ex. lung, it’s metabolic
what does dilaudid do? don’t memorize specifics or a • metabolic alkalosis - really only one scenario = if
list of dilaudid, know principles of opioids (such as the PT has prolonged gastric
sedation, CNS depression -> lethargy, flaccidity, reflex vomiting/suctioning - because you are losing
+1, hypo-reflexia, obtunded) ACID
- boards don’t test by lists because all * ex. GI surgery w/ NG tube with suctioning for
books/ classes have different lists 3 days; hyperemesis graviderum
- otherwise everything else that isn’t lung you
• principles of S&S acid bases: as the pH goes so pick metabolic acidosis (DEFAULT)
goes my patient (except K+)
* ex. hyperemesis graviderum w/ dehydration
- pH up = PT up -> body system gets more acute renal failure, infantile diarrhea
irritable, hyper-excitable (EXCEPT K+)
-> alkalosis - think of a body system and go
• remember, you only have 4 to pick from: -
high: hyper-reflexive (+3, +4 [2 is normal]), respiratory alkalosis - respiratory acidosis -
tachypnea, tachycardia, borborygmi, seizure - metabolic alkalosis - metabolic acidosis
pH down = PT down -> body systems shut
down (EXCEPT K+) • pay more attention to the modifying phrases than
-> acidosis - think of a system and go low: the original noun
hypo-reflexive (+1, 0), bradycardia, lethargy, - ex. person w/ OCD who is now psychotic (psychotic
obtunded, paralytic illeus, respiratory arrest trumps OCD); hyperemesis with dehydration (pay
• ex. which acid-base disorders need an ambu-bag at attention to dehydration)
the bedside? = acidosis (resp. arrest)
• ex. which acid-base disorders need suction at the
bedside? = alkalosis (seize and aspirate) VENTILATION
• Mac Kussmaul - Kussmaul’s (compensatory • ventilators -> know alarm systems (you set it up so
respiratory mechanism) is only present in only 1 of that the machine doesn’t use less than or more
the 4 metabolic (acid-base) disorders than specific amounts of pressure)
a) high pressure alarm = increased resistance
* M = metabolic AC = acidosis
to airflow (the machine has to push too hard to
• most common mistake with select all questions = selecting get air into lungs)
one more than you should (stop when you select the ones - from obstructions:
you know! don’t get caught up on the “could be’s”) i. kinks in tubing (unkink it)
• Hint: don’t select none or all on select all that apply ii. water condensation in tube (empty it!) iii.
questions (never only one and never all) mucous secretions in the airway (change
positions/turn, C&DB, and THEN suction) ***
• Causes of Acid-Base Imbalance: suction is only PRN!!!
- scenarios and what acid-base disorder would -> priority questions = you would check
result (what would cause an imbalance) kinks first, suction is not first
b) low pressure alarm = decreased
resistance to airflow (the machine had to work
too little to push air into lungs)
, - from disconnections:
i. main tubing (reconnect it duh!)
ii. O2 sensor tubing (which senses FiO2 at
the airway/trach area; black coated wire
coming from machine right along the tubing -
reconnect!)
• ventilators -> know blood gases
- resp. alkalosis = ventilation settings might
be set too high (OVER-VENTILATING)
- resp. acidosis = ventilation settings might be
set too low (UNDER-VENTILATING)
• ex. weaning a PT off ventilator -> should not be
under-ventilated, they need the ventilator; if they
are over-ventilating then they can be weaned
• never pick an answer where you don’t do
something and someone else has to do something
L Hint: for questions about denial, you must look to see
if it is LOSS or ABUSE
E - loss/grief = support
C - abuse = confront
T • #2 psychological problem in abuse = DEPENDENCY,
U CO-DEPENDENCY
R - dependency = when the abuser gets significant other
to do things for them or make decisions for them -> the
E dependent = abuser
- co-dependency = when the significant other derives
2 positive self-esteem from making decisions for or
doing things for the abuser
-> the abuser gets a life w/o responsibilities -> the
ABUSE (Psych and Med-Surge) sig. other gets positive self-esteem (which is why they
Psychological Aspect/Psycho-Dynamics • # 1 can’t get out of the relationship) • how do you treat it?
psychological problem is the same in any/all - set limits and enforce them
abusive situations = DENIAL -> start teaching sig. other to say NO (and they
- abusers have an infinite capacity for denial so that have to keep doing it)
they can continue the behavior w/o answering for it • - must also work on the self-esteem of the co-dependent
can use the alcoholism rules for any abuse - ex. # 1 (ex. I’m a good person because I’m saying “no”) •
psych problem in child abuse, gambling or cocaine abuse is manipulation = when the abuser gets the sig. other to
denial do things for them that are not in the best interest of the
• why is denial the problem? HOW CAN YOU TREAT sig. other
SOMEONE WHO DENIES/DOESN’T RECOGNIZE - the nature of the act is
THEY HAVE A PROBLEM dangerous/harmful - how is manipulation
• denial = refusal to accept the reality of a problem • like dependency?
treat denial by CONFRONTING the problem (it’s not -> in both the abuser is getting the other person to
the same as aggression which attacks the person, not do something for them
the problem) = they DENY you CONFRONT - pointing - how do you tell the difference between manipulation
out to the person the difference between what they & dependency?
say and what they do -> NEUTRAL vs. NEGATIVE (look at what they’re
- Hint: never pick answers that attack the person -> being asked to do)
ex. bad answers have bad pronouns - “you” -> ex. -> if the sig. other is being asked to do something
good answers have good pronouns - “I”, “we” -> ex. neutral (no harm) its dependency/co-dependency ->
“you wrote the order wrong” vs. “I’m having difficulty if the sig. other is being asked to do something that
interpreting what you want” will harm them or is dangerous to them they are
• loss and grief -> for this denial you must SUPPORT it manipulated
- DABDA = denial, anger, bargaining, depression, acceptance •
, • how do you treat manipulation? uppers (5) = caffeine, cocaine, PCP/LSD (psychedelic
- set limits and enforce them -> “NO” hallucinogens), methamphetamines, adderall (ADD drug)
- easier to treat than dependency/co-dependency * S&S - make you go up; euphoria, tachycardia,
because no one likes to be manipulated (no positive restlessness, irritability, diarrhea, borborygmi, hyper-
self-esteem issue going on) reflexia, spastic, seize (need suction) - downers = don’t
• ex. how many PT’s do you have w/ denial? = 1 ex. memorize names -> anything that is not an upper is
how many PT’s do you have w/ dependency/co- a downer! if you don’t know what the med is, you
dependency = 2 have a high chance that it’s a downer if it’s not part
ex. how many PT’s do you have w/ manipulation = 1 of the uppers list
* S&S -> make you go down; lethargy, respiratory
Alcoholism depression (& arrest)
Wernicke’s & Korsakoff’s - ex. The PT is high on cocaine. What is critical to assess? -
- typically separate BUT boards lumps them > NOT resps below 12 because they will be high ->
together - wernicke’s = encephalopathy maybe check reflexes
- korsakoff’s = psychosis (lose touch with b) are they talking about overdose or
reality) -> tend to go together, find them in the withdrawal - overdose/intoxication = too
same PT • Wernicke Korsakoff’s syndrome: much
a) psychosis induced by Vit. B1 (Thiamine) - withdrawal = not enough
deficiency - lose touch w/ reality, go insane because - ex. the PT has overdosed on an upper -> pick the
of no B1 b) primary symptom -> amnesia w/ S&S of too much upper
confabulation - significant memory loss w/ making - ex. the PT has overdosed on a downer -> pick the
S&S of too much downer
up stories - they believe their stories
- ex. the PT is withdrawing from an upper -> not
• How do you deal w/ these PT’s? enough upper makes everything go down
- bad way = confrontation (because they believe what - ex. the PT is withdrawing from a downer -> not
they are saying and can’t see reality) enough downer makes everything go up
- good way = redirection (take what the PT can’t do • upper overdose looks like = downer withdrawal •
and channel it into something they can do) • downer overdose looks like = upper withdrawal • In
Characteristics of Wenicke Korsakoff’s: a) it’s what 2 situations would resp. depression & arrest be
preventable = take Vit. B1 (co-enzyme needed for your highest priority:
the metabolism of alcohol which keeps alcohol from - downer overdose
accumulating and destroying brain cells) * PT doesn’t - upper withdrawal
have to stop drinking • In what 2 situations would seizure be the biggest
b) it’s arrestable = can stop it from getting worse by risk: - upper overdose
taking Vit. B1 - downer withdrawal
* also not necessary to stop drinking
c) it’s irreversible (70% of cases) -> Hint: On boards, • Drug Abuse in the Newborn:
answer w/ the majority (ex. if something is majority - at birth, always assume intoxication,
of the time fatal, you say it’s fatal even if 5% of the - after 24 hrs -> withdrawal
time it’s not) - ex. caring for infant of a Quaalude (not upper)
• Drugs for Alcoholism: addicted mom 24 hrs. after birth, select all that
DISULFIRAM (Antabuse) apply:
= aversion therapy -> want PT’s to develop a gut -> downer withdrawal so everything is up = exaggerated
hatred for alcohol startle, seizing, high pitched/shrill cry
-> interacts w/ alcohol in the blood to make you very ill • Alcohol Withdrawal Syndrome vs. Delirium Tremens
-> onset & duration: 2 weeks (so if you want to a) every alcoholic goes through alcohol withdrawal
drink again, wait 2 weeks) 24 hrs. after they stop drinking
- PT teaching = avoid ALL forms of alcohol to - only a minority get delirium tremens
avoid nausea, vomiting & possibly death - timeframe -> 72 hrs. (alcohol withdrawal comes 1st)
-> including mouthwash, aftershaves/colognes/perfumes - alcohol withdrawal syndrome ALWAYS precedes
(topical stuff will make them nauseous), insect repellants, delirium tremens, BUT delirium tremens does not
any OTC that ends with “-elixir”, alcohol- based hand always follow alcohol withdrawal syndrome b) AWS is
sanitizers, uncooked (no-bake) icings which have vanilla not life-threatening; DT’s can kill you c) PT’s w/ AWS
extract, red wine vinaigrette are not a danger to self/others; PT’s w/ DT’s are
dangerous to self/others
• Overdoses & Withdrawals: - they are withdrawing from a downer so they will
- every abused drug is either an UPPER or be exhibiting upper S&S
DOWNER - DT’s are dangerous
1) first establish if the drug is an upper or downer -
, Differenc AWS DT • 2 toxic effects:
es in i) when you see ‘-mycin’, think mice
Care - mice -> ears -> otto toxic
- monitor hearing, tinnitus, vertigo/dizziness ii)
Diet Regular diet NPO/clear liquids
(because of risk for the human ear is shaped like a kidney so next
seizures which can effect is nephrotoxicity
cause risk of - monitor creatinine (not BUN, output, daily
aspiration) weight) * creatinine = the best indicator of
kidney/renal function (pick 24 hr. creatinine
Room Semi-private Private near nurses
anywhere on the unit clearance over serum creatinine if both available)
station
(dangerous &
• #8 (fits nicely in the kidney) reminds you about 2
unstable) things about these drugs
- toxic to cranial nerve 8 = ear nerve
Ambulatio Up ad lib Restricted bed rest -> - administer Q8
n no bathroom • route:
privileges (use
bedpans/urinals) - IM or IV
• do not give PO -> they are not absorbed - if you
Restraint No restraints Restraints give an oral ‘-mycin’ it will go into gut, dissolve, go
s (because not (because through and come out as expensive stool (won’t
dangerous) dangerous) - not
soft wrist or 4 point have any systemic effect)
soft because - EXCEPT in 2 cases = bowel sterilizers:
they’ll get out * hepatic encephalopathy (hepatic coma) = to get
- need to be in vest
or 2-pt. locked ammonia down, oral ‘-mycin’s’ will sterilize the bowel
leathers (opposite 1 by killing Gram-neg bacteria (E. coli) to help bring
arm & leg, rotate down ammonia and won’t harm the damaged liver
Q2hrs, lock the free
limbs 1st before because it doesn’t go through the liver (also gives
releasing the locked diarrhea, more poop out is good) * pre-op bowel
ones) surgery = it sterilizes the gut by killing the E. coli
bacteria
They both get ANTI-HYPERTENSIVES
& TRANQUILIZERS - if oral, no otto or nephro toxicity because not
- because everything is up (downer absorbed - these are neomycin & kanamycin
* Who can sterilize my bowels? NEO KAN
withdrawal) They both get MULTIVITAMIN
w/ B1 • Trough and Peak levels:
- trough = drug at lowest
- peak = drug at highest
** TAP levels - trough administer peak
• RN’s can accept but RPN’s can’t (because PT is unstable) -> draw trough levels first
- on med-surge, the RN who takes them must decrease -> administer your drug
their workload (i.e. reduce PT load if they take a DT PT) -> draw peak levels after drug administration
-> Hint: on boards, the setting is always perfect • Why draw levels? = narrow therapeutic window -
(i.e. enough staff/time/resources on the unit etc.) small difference between what works and what kills
DRUGS - if the drug has a wide range then you wouldn’t
AMINOGLYCOCIDES need to draw TAP levels
• powerful class of antibiotics (when nothing else * ex. Lasix doses range from 5-80mg thus a wide
works pull these outs, the big guns) range so you won’t need TAP levels
- don’t use unless anything else works * ex. Dig doses range from 0.125 - 0.25 so this
• boards love to test these drugs because narrow range needs TAPS levels
they’re dangerous and are a test of safety • A MEAN OLD MYCINS = major class that needs
• think: A MEAN OLD MYCIN TAPs drawn because of narrow window
-> a mean old = they treat serious, life-threatening, • When do you draw TAPS?
resistant, Gram-neg bacteria infections (i.e. a mean -> depends on the route (don’t focus on the
old antibiotic for a mean old infection) med) a) Trough Levels
-> mycin = what they end with (all end w/ -mycin) ** doesn’t matter which route or med, always 30
** not all -mycin’s are aminoglycosides BUT most mins. - sublingual = 30 mins. before next dose
are (the 3 that are not are erythromycin, - IV = 30 mins. before next dose
azithromycin, clarithromycin = throw it off the list!) - IM = 30 mins. before next dose
- Sub-Q = 30 mins. before next dose
