GUIDE • Mark Klimek’s Lecture
Lecture 1— Acid-Base Balance Dumping/HH
Ventilators Electrolytes: K+, CA, MG,
and NA
Lecture 2— Alcohol TX for HyperKalemia
Wernicke
Overdose and Withdrawal Lecture 7— Thyroid (Hyper-, Hypo-)
S/Sx Adrenal Cortex (Addison
Aminoglycosides Disease, Cushing)
Peak and Trough Toys
Laminectomy
Lecture 3— Drug Toxicities (Lithium,
Lanoxin, Dilantin, Bilirubin, Lecture 8— Lab Values
Aminophylline) Five Deadly Ds
Kernicterus Neutropenic Precaution
Dumping/HH
Electrolytes: K+, CA, MG, Lecture 9— Psych Drugs
and NA Tri
TX for HyperKalemia Benzo
MAOI
Lecture 4— Crutches Lithium
Canes Prozac
Walkers Haldol
Delusions Clozaril
Hallucinations Zoloft
Psychosis
Psychotic and Non-Psychotic Lecture 10— Maternity and Neonatology
Hallucination
Illusion Lecture 11— Fetal Complications
Delusion Stages of Labor
Assessments
Lecture 5— Diabetes Mellitus Variations for NB
Diabetes Insipidus Maternity Meds
SIADH Medication Hints
Insulin Psych Tips
DKA Operational Stages
HHNK
Lecture 12— Prioritization
Lecture 6— Drug Toxicities (Lithium, Delegation
Lanoxin, Dilantin, Bilirubin, Staff Management
Aminophylline) Guessing Strategies
Kernicterus
Page 1 of 92
,Page 2 of 92
, Lecture 1 • Mark Klimek • 92:21
Acid/Base Balance (Start times: 30:00)
In order to solve acid-base disorders, it is
important to know the normal values for
pH, CO2 and HCO3 (bicarbonate), which
are shown below
pH 7.35 to 7.45
CO2 35 to 45
HCO3 22 to 26
The first value to look at in an acid-base
disorder is the pH
If pH is <7.35, the acid-base imbalance
is acidotic
If pH is <7.45, the acid-base imbalance
is alkalotic
Now, to determine if the imbalance is metabolic or respiratory, determine whether HCO3 goes
in the same or opposite direction with pH
Rule of the Bs: If pH and Bicarb move both in the same direction, then the acid-
base imbalance is metabolic … Otherwise, it is respiratory
Example #1
pH 7.3 Acidotic
HCO3 20 Metabolic
This is an example of metabolic acidosis
Example #2
pH 7.58 Alkalotic
HCO3 32 Metabolic
This is an example of metabolic alkalosis
Example #3
pH 7.22 Acidosis
HCO3 35 Respiratory
This is an example of respiratory acidosis
As the pH goes, so goes my patient, except for Potassium … That means
If pH is low, everything is low, except potassium
If pH is high, everything is high, except potassium
Page 3 of 92
, If pH goes over 7.45, this is alkalosis
Therefore everything is up: tachycardia, tachypnea, HTN, seizures, irritability, spastic,
diarrhea, borborygmi (increase bowel sounds), hyperreflexia (3+, 4+)
However, potassium is opposite. Therefore, hypokalemia
What is the nursing intervention?
o Pt need suctioning because of seizures
If pH goes below 7.35, this is acidosis
Therefore, everything is down: bradycardia, constipation, absent bowel sounds,
flaccid, obtunded, lethargy, coma hyporeflexia (0, 1+), bradypnea, low BP
However, potassium is high (hyperkalemia)
What is the nursing intervention?
o Pt needs to be ventilated with an Ambu bag—respiratory arrest
So, remember that “MAC Kussmaul” is the only acid-base imbalance to cause Metabolic
ACidosis with Kussmaul respirations
Causes of Acid/Base imbalance
First ask yourself, “Is it LUNG? … If yes, then it is respiratory
Then ask yourself, “Are they overventilating or underventilating?
o If UNDERventilating, then pick acidosis—pH is under 7.35
o If OVERventilating, then it is alkalosis, pH is over 7.45
What type of acid-base derangement is present in the following condition?
In labor?
o Respiratory alkalosis … Overventilating—pH increases … Alkalosis)
Drowning?
o Respiratory acidosis … Underventilating—pH decreases … Acidosis
Pt is on PCA (patient-controlled anesthesia) pump?
o Ventilation is down … Respiratory acidosis
If it is not LUNG, then it is metabolic. If the patient has prolonged
gastric vomiting or suction (sucking out acid), pick alkalosis
For everything else that isn’t lung, pick metabolic acidosis
So, when you don’t know what to pick, pick
metabolic acidosis
Tip
Set your default setting to Metabolic Acidosis
Always pay attention to modifying phrase rather than original
noun
Figure 1. Patient-
controlled anesthesia
(PCA) pump.
Page 4 of 92
Lecture 1— Acid-Base Balance Dumping/HH
Ventilators Electrolytes: K+, CA, MG,
and NA
Lecture 2— Alcohol TX for HyperKalemia
Wernicke
Overdose and Withdrawal Lecture 7— Thyroid (Hyper-, Hypo-)
S/Sx Adrenal Cortex (Addison
Aminoglycosides Disease, Cushing)
Peak and Trough Toys
Laminectomy
Lecture 3— Drug Toxicities (Lithium,
Lanoxin, Dilantin, Bilirubin, Lecture 8— Lab Values
Aminophylline) Five Deadly Ds
Kernicterus Neutropenic Precaution
Dumping/HH
Electrolytes: K+, CA, MG, Lecture 9— Psych Drugs
and NA Tri
TX for HyperKalemia Benzo
MAOI
Lecture 4— Crutches Lithium
Canes Prozac
Walkers Haldol
Delusions Clozaril
Hallucinations Zoloft
Psychosis
Psychotic and Non-Psychotic Lecture 10— Maternity and Neonatology
Hallucination
Illusion Lecture 11— Fetal Complications
Delusion Stages of Labor
Assessments
Lecture 5— Diabetes Mellitus Variations for NB
Diabetes Insipidus Maternity Meds
SIADH Medication Hints
Insulin Psych Tips
DKA Operational Stages
HHNK
Lecture 12— Prioritization
Lecture 6— Drug Toxicities (Lithium, Delegation
Lanoxin, Dilantin, Bilirubin, Staff Management
Aminophylline) Guessing Strategies
Kernicterus
Page 1 of 92
,Page 2 of 92
, Lecture 1 • Mark Klimek • 92:21
Acid/Base Balance (Start times: 30:00)
In order to solve acid-base disorders, it is
important to know the normal values for
pH, CO2 and HCO3 (bicarbonate), which
are shown below
pH 7.35 to 7.45
CO2 35 to 45
HCO3 22 to 26
The first value to look at in an acid-base
disorder is the pH
If pH is <7.35, the acid-base imbalance
is acidotic
If pH is <7.45, the acid-base imbalance
is alkalotic
Now, to determine if the imbalance is metabolic or respiratory, determine whether HCO3 goes
in the same or opposite direction with pH
Rule of the Bs: If pH and Bicarb move both in the same direction, then the acid-
base imbalance is metabolic … Otherwise, it is respiratory
Example #1
pH 7.3 Acidotic
HCO3 20 Metabolic
This is an example of metabolic acidosis
Example #2
pH 7.58 Alkalotic
HCO3 32 Metabolic
This is an example of metabolic alkalosis
Example #3
pH 7.22 Acidosis
HCO3 35 Respiratory
This is an example of respiratory acidosis
As the pH goes, so goes my patient, except for Potassium … That means
If pH is low, everything is low, except potassium
If pH is high, everything is high, except potassium
Page 3 of 92
, If pH goes over 7.45, this is alkalosis
Therefore everything is up: tachycardia, tachypnea, HTN, seizures, irritability, spastic,
diarrhea, borborygmi (increase bowel sounds), hyperreflexia (3+, 4+)
However, potassium is opposite. Therefore, hypokalemia
What is the nursing intervention?
o Pt need suctioning because of seizures
If pH goes below 7.35, this is acidosis
Therefore, everything is down: bradycardia, constipation, absent bowel sounds,
flaccid, obtunded, lethargy, coma hyporeflexia (0, 1+), bradypnea, low BP
However, potassium is high (hyperkalemia)
What is the nursing intervention?
o Pt needs to be ventilated with an Ambu bag—respiratory arrest
So, remember that “MAC Kussmaul” is the only acid-base imbalance to cause Metabolic
ACidosis with Kussmaul respirations
Causes of Acid/Base imbalance
First ask yourself, “Is it LUNG? … If yes, then it is respiratory
Then ask yourself, “Are they overventilating or underventilating?
o If UNDERventilating, then pick acidosis—pH is under 7.35
o If OVERventilating, then it is alkalosis, pH is over 7.45
What type of acid-base derangement is present in the following condition?
In labor?
o Respiratory alkalosis … Overventilating—pH increases … Alkalosis)
Drowning?
o Respiratory acidosis … Underventilating—pH decreases … Acidosis
Pt is on PCA (patient-controlled anesthesia) pump?
o Ventilation is down … Respiratory acidosis
If it is not LUNG, then it is metabolic. If the patient has prolonged
gastric vomiting or suction (sucking out acid), pick alkalosis
For everything else that isn’t lung, pick metabolic acidosis
So, when you don’t know what to pick, pick
metabolic acidosis
Tip
Set your default setting to Metabolic Acidosis
Always pay attention to modifying phrase rather than original
noun
Figure 1. Patient-
controlled anesthesia
(PCA) pump.
Page 4 of 92
