KEEP CALM
and
PASS NCLEX
with
MARK KLIMEK
Review
1.
Acid-base balance/ventilators
Rule of the B’s.. If the pH & the bicarb are both in the same direction = meta bolic
If they are in different directions = respiratory
pH = 7.35-7.45 acidosis/alkalosis
HCO3 (bicarb) = 22-26 (2+2+2 = 6)
CO2 = 45-35
ex:
pH: 7.30 =
bicarb: 20 = = metabolic acidosis
ex:
pH: 7.58 =
bicarb: 32 = = metabolic alkalosis
ex:
pH: 7.22 =
bicarb: 30 = = respiratory acidosis
ex:
You are providing care to a client with the following blood gas results: pH 7.32, CO2
,as the pH goes… so goes my patient!!!
-when pH goes up; patient goes up.. (everything gets irritable!)
-when pH goes down; patient goes down! (systems in your body shut down)
…except with potassium: when pH goes up; potassium goes down… when pH g
potassium goes up!
(up) alkalosis: irritibility, hyper-reflexia (3 & 4), tachypnea, tachycardia, borboryg
(increased bowel sounds), seizure, aspirate..
(down) acidosis: hypo-reflexia, bradycardia, lethergy (obtunded), paralytic ileus (de
bowel sounds), coma, respiratory arrest (ambu-bag!!)
Kussmaul breathing is a deep and labored breathing pattern often associated w
metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure…
Kussmaul! !
M: metabolic
AC: acidosis
ex:
pT has respiratory acidosis… (select all that apply)..
+1 reflexes
diarhhea
adynamic ileus
spasm
urinary retention
tachycardia
2nd degree mobits type 2 heart block
hypokalemia
SATA questions: *never only 1… never all of them*
diarhhea will cause a metabolic acidosis.. but once you get acidodic, it will shut you
down = paralytic ileus
…with scenarios.. always ask first “is it lung?” = respiratory
…then ask if the pt is over-ventilating or under-ventilating?
over-ventilating = alkalosis
under-ventilating = acidosis
…it’s about the SaO2!!! (pay attention!!)
if it isn’t lung = metabolic..
if pt has prolonged gastric vomiting or suctioning… it’s always metabolic alka
why? losing acid = becomes basic..
,ventilators
alarms.. high pressure alarm… triggered by increasure resistance to air flow.. (mach
pushing too hard to get air into the lungs).. respiratory alkalosis
3 obstructions: kink in tubing (get kink out), water condensing within the tub
tube), mucus secretions in the airway (turn, cough, deep breathe… then suction
as needed!! *in that order*…
low pressure alarm.. decreased resistance (too easy for the machine..)
respiratory acidosis
Low pressure alarms are triggered by decreased resistance to airflow & can
caused by disconnections of the main tubing or oxygen sensor tubing… Tub
(reconnect it!) - oxygen sensor tube (reconnect it UNLESS tube is
the floor - bag them & call Respiratory therapist if this happens)
Respiratory alkalosis = ventilator setting may be too high.
Respiratory acidosis = ventilator setting may be too low.
What does “wean” mean? gradually decrease with the goal of getting off altogether
ex:
Doc says wean off vent in AM… 6am ABG’s show resp. acidosis…
a) follow order
b) call respiratory
c) hold order.. call doc
d) begin to decrease the settings
MASLOW ’s Priorities (HIGHest - LOWest)
physiological
safety
comfort
psychological (problems within the person)
social (problems with other people)
spiritual
ex:
Arrange from HIGHest - LOWest…
denial, spiritual distress, pain in elbow, fall risk, pathological family dynamics & elec
imbalance…
= electrolyte imbalance (psyiological), fall risk (safety), pain in elbow (comfort), den
(psychological), pathological family dynamics (social) & spiritual distress (spiritual)
2.
, pronouns ~
good: i…
bad: you…
positions ~
good: i’m having a difficult time reading this…
bad: you wrote it wrong..
loss & grief: Denial An
nger Bargining Depression Accceptance
don’t confront it; support it..
ex:
You have a pt that just hand a hand amputated & they say, “I can’t wait to get back to
piano”… You say “Oh, how long have you played, etc? - you NEVER say “You can’t
only have 1 hand”
abuse = confront
loss = support
#2 problem = dependency *when the abuser get the significant other to do somet
my boss, i’m sick”* (abuser gets to keep abusing..)
= co-dependency *calls the boss*… (positive self esteem)
How to treat this?!? Set limits and enforce them… Learn to s
manipulation = when the abuser gets the significant other to do things for him or h
nature of the act is dangerous or harmful
how is it like dependency? the abuser is getting the other person to do something
no harm = dependent / co-dependent (wife buying alcohol for husband)
dangerous/harmful = manipulated (kid buying alcohol for father)
…depends on legal/illegal………….
Wernicke-Korsakoff Syndrome (WKS) is a neurological disorder. Wernicke's
Encephalopathy and Korsakoff's Psychosis are the acute and chronic phases, re
of the same disease. WKS is caused by a deficiency in the B1 vitamin thiamine. Thi
plays a role in metabolizing glucose to produce energy for the brain.
primary symptom of WKS = amnesia with confabulation (making up stories) *th
the lie..*
ex:
and
PASS NCLEX
with
MARK KLIMEK
Review
1.
Acid-base balance/ventilators
Rule of the B’s.. If the pH & the bicarb are both in the same direction = meta bolic
If they are in different directions = respiratory
pH = 7.35-7.45 acidosis/alkalosis
HCO3 (bicarb) = 22-26 (2+2+2 = 6)
CO2 = 45-35
ex:
pH: 7.30 =
bicarb: 20 = = metabolic acidosis
ex:
pH: 7.58 =
bicarb: 32 = = metabolic alkalosis
ex:
pH: 7.22 =
bicarb: 30 = = respiratory acidosis
ex:
You are providing care to a client with the following blood gas results: pH 7.32, CO2
,as the pH goes… so goes my patient!!!
-when pH goes up; patient goes up.. (everything gets irritable!)
-when pH goes down; patient goes down! (systems in your body shut down)
…except with potassium: when pH goes up; potassium goes down… when pH g
potassium goes up!
(up) alkalosis: irritibility, hyper-reflexia (3 & 4), tachypnea, tachycardia, borboryg
(increased bowel sounds), seizure, aspirate..
(down) acidosis: hypo-reflexia, bradycardia, lethergy (obtunded), paralytic ileus (de
bowel sounds), coma, respiratory arrest (ambu-bag!!)
Kussmaul breathing is a deep and labored breathing pattern often associated w
metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure…
Kussmaul! !
M: metabolic
AC: acidosis
ex:
pT has respiratory acidosis… (select all that apply)..
+1 reflexes
diarhhea
adynamic ileus
spasm
urinary retention
tachycardia
2nd degree mobits type 2 heart block
hypokalemia
SATA questions: *never only 1… never all of them*
diarhhea will cause a metabolic acidosis.. but once you get acidodic, it will shut you
down = paralytic ileus
…with scenarios.. always ask first “is it lung?” = respiratory
…then ask if the pt is over-ventilating or under-ventilating?
over-ventilating = alkalosis
under-ventilating = acidosis
…it’s about the SaO2!!! (pay attention!!)
if it isn’t lung = metabolic..
if pt has prolonged gastric vomiting or suctioning… it’s always metabolic alka
why? losing acid = becomes basic..
,ventilators
alarms.. high pressure alarm… triggered by increasure resistance to air flow.. (mach
pushing too hard to get air into the lungs).. respiratory alkalosis
3 obstructions: kink in tubing (get kink out), water condensing within the tub
tube), mucus secretions in the airway (turn, cough, deep breathe… then suction
as needed!! *in that order*…
low pressure alarm.. decreased resistance (too easy for the machine..)
respiratory acidosis
Low pressure alarms are triggered by decreased resistance to airflow & can
caused by disconnections of the main tubing or oxygen sensor tubing… Tub
(reconnect it!) - oxygen sensor tube (reconnect it UNLESS tube is
the floor - bag them & call Respiratory therapist if this happens)
Respiratory alkalosis = ventilator setting may be too high.
Respiratory acidosis = ventilator setting may be too low.
What does “wean” mean? gradually decrease with the goal of getting off altogether
ex:
Doc says wean off vent in AM… 6am ABG’s show resp. acidosis…
a) follow order
b) call respiratory
c) hold order.. call doc
d) begin to decrease the settings
MASLOW ’s Priorities (HIGHest - LOWest)
physiological
safety
comfort
psychological (problems within the person)
social (problems with other people)
spiritual
ex:
Arrange from HIGHest - LOWest…
denial, spiritual distress, pain in elbow, fall risk, pathological family dynamics & elec
imbalance…
= electrolyte imbalance (psyiological), fall risk (safety), pain in elbow (comfort), den
(psychological), pathological family dynamics (social) & spiritual distress (spiritual)
2.
, pronouns ~
good: i…
bad: you…
positions ~
good: i’m having a difficult time reading this…
bad: you wrote it wrong..
loss & grief: Denial An
nger Bargining Depression Accceptance
don’t confront it; support it..
ex:
You have a pt that just hand a hand amputated & they say, “I can’t wait to get back to
piano”… You say “Oh, how long have you played, etc? - you NEVER say “You can’t
only have 1 hand”
abuse = confront
loss = support
#2 problem = dependency *when the abuser get the significant other to do somet
my boss, i’m sick”* (abuser gets to keep abusing..)
= co-dependency *calls the boss*… (positive self esteem)
How to treat this?!? Set limits and enforce them… Learn to s
manipulation = when the abuser gets the significant other to do things for him or h
nature of the act is dangerous or harmful
how is it like dependency? the abuser is getting the other person to do something
no harm = dependent / co-dependent (wife buying alcohol for husband)
dangerous/harmful = manipulated (kid buying alcohol for father)
…depends on legal/illegal………….
Wernicke-Korsakoff Syndrome (WKS) is a neurological disorder. Wernicke's
Encephalopathy and Korsakoff's Psychosis are the acute and chronic phases, re
of the same disease. WKS is caused by a deficiency in the B1 vitamin thiamine. Thi
plays a role in metabolizing glucose to produce energy for the brain.
primary symptom of WKS = amnesia with confabulation (making up stories) *th
the lie..*
ex:
