NCLEX MARK KLIMEK wi
Review
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 49, HC
80 & SaO2 90%. Based on the results, the client is experiencing: = acidosis, = respirator
-opioid: CNS depressant.. know the symptoms (sedation, respiratory depression, etc)..
,a.s the.. pH goe..s… so goe..s my pa.tie..nt!!!
whe..n pH goe..s up; pa.tie..nt goe..s up.. (e..ve..rything ge..ts irrita.ble..!)
whe..n pH goe..s down; pa.tie..nt goe..s down! (syste..ms in your body shut down)
…e..xce..pt with pota.ssium whe..n pH goe..s up; pota.ssium goe..s down whe..n pH goe..s
pota.ssium goe..s up
(up) a.lka.losis: irritibility, hype..r-re..fle..xia. (3 & 4), ta.chypne..a., ta.chyca.rdia., borboryg
(incre..a.se..d bowe..l sounds), se..izure.., a.spira.te....
(down) a.cidosis: hypo-re..fle..xia., bra.dyca.rdia., le..the..rgy (obtunde..d), pa.ra.lytic ile..u
(de..cre..a.se..d bowe..l sounds), coma., re..spira.tory a.rre..st (a.mbu-ba.g!!)
Kussma.ul bre..a.thing is a. de..e..p a.nd la.bore..d bre..a.thing pa.tte..rn ofte..n a.ssocia.te
se..ve..re.. me..ta.bolic a.cidosis, pa.rticula.rly dia.be..tic ke..toa.cidosis (DKA.) but a.lso kid
fa.ilure..… MA.C Kussma.ul
M: me..ta.bolic
A.C: a.cidosis
e..x: pT ha.s re..spira.tory a.cidosis… (se..le..ct a.ll tha.t
a.pply)..
+1 re..fle..xe..s
dia.rhhe..a.
a.dyna.mic ile..us
spa.sm urina.ry
re..te..ntion
ta.chyca.rdia.
2nd de..gre..e.. mobits type.. 2 he..a.rt block hypoka.le..mia.
SA.TA. que..stions: *ne..ve..r only 1… ne..ve..r a.ll of the..m*
dia.rhhe..a. will ca.use.. a. me..ta.bolic a.cidosis.. but once.. you ge..t a.cidodic, it will shut y
down = pa.ra.lytic ile..us
…with sce..na.rios.. a.lwa.ys a.sk first “is it lung?” = re..spira.tory …the..n
a.sk if the.. pt is ove..r-ve..ntila.ting or unde..r-ve..ntila.ting? ove..r-
ve..ntila.ting = a.lka.losis unde..r-ve..ntila.ting = a.cidosis
…it’s a.bout the.. Sa.O2!!! (pa.y
a.tte..ntion!!) if it isn’t lung = me..ta.bolic..
if pt ha.s prolonge..d ga.stric vomiting or suctioning… it’s a.lwa.ys me..ta.bolic a.lka.losis w
a.cid = be..come..s ba.sic..
for e..ve..rything e..lse.. tha.t is not lung - choose.. me..ta.bolic a.cidosis..
-if you don’t know the.. a.nswe..r… a.lwa.ys a.nswe..r me..ta.bolic a.cidosis
,ve..ntila.tors
a.la.rms.. high pre..ssure.. a.la.rm… trigge..re..d by incre..a.sure.. re..sista.nce.. to a.ir flow.
(ma.chine.. is pushing too ha.rd to ge..t a.ir into the.. lungs).. re..spira.tory a.lka.losis
3 obstructions: kink in tubing (ge..t kink out), wa.te..r conde..nsing within the.. tube.. (e..m
mucus se..cre..tions in the.. a.irwa.y (turn, cough, de..e..p bre..a.the..… the..n suction)..
ne..e..de..d!! *in tha.t orde..r*…
low pre..ssure.. a.la.rm.. de..cre..a.se..d re..sista.nce.. (too e..a.sy for the.. ma.chine....)
re..spira.tor a.cidosis
Low pre..ssure.. a.la.rms a.re.. trigge..re..d by de..cre..a.se..d re..sista.nce.. to a.irfl
ca.n be.. ca.use..d by disconne..ctions of the.. ma.in tubing or oxyge..n se..nsor tub
Tubing (re..conne..ct it!) oxyge..n se..nsor tube.. (re..conne..ct it UNLE..SS tube.. is
the.. floor - ba.g the..m & ca.ll Re..spira.tory the..ra.pist if this ha.ppe..ns)
Re..spira.tory a.lka.losis = ve..ntila.tor se..tting ma.y be.. too high
Re..spira.tory a.cidosis = ve..ntila.tor se..tting ma.y be.. too low
Wha.t doe..s “we..a.n” me..a.n? gra.dua.lly de..cre..a.se.. with the.. goa.l of ge..tting off a.l
e..x:
Doc sa.ys we..a.n off ve..nt in A.M… 6a.m A.BG’s show re..sp. a.cidosis follow
orde..r
ca.ll re..spira.tory hold
orde..r.. ca.ll doc
be..gin to de..cre..a.se.. the.. se..ttings
MA.SLOW ’s Prioritie..s (HIGHe..st - LOWe..st)
physiologica.l
sa.fe..ty
comfort
psychologica.l (proble..ms within the.. pe..rson)
socia.l (proble..ms with othe..r pe..ople..)
spiritua.l
e..x:
A.rra.nge.. from HIGHe..st - LOWe..st…
de..nia.l, spiritua.l distre..ss, pa.in in e..lbow, fa.ll risk, pa.thologica.l fa.mily dyna.mics &
e..le..ctrolyte.. imba.la.nce..…
= e..le..ctrolyte.. imba.la.nce.. (psyiologica.l), fa.ll risk (sa.fe..ty), pa.in in e..lbow (comfort),
(psychologica.l), pa.thologica.l fa.mily dyna.mics (socia.l) & spiritua.l distre..ss (spiritua.l)
a.lcoholism.. (or a.ny a.buse..)
, pronouns ~ good:
i…
ba.d: you…
positions ~ good: i’m ha.ving a. difficult time..
re..a.ding this… ba.d: you wrote.. it wrong..
loss & grie..f: De..nia.l A.nge..r Ba.rgining De..pre..ssion A.cce..pta.nce..
don’t confront it; support it..
e..x:
You ha.ve.. a. pt tha.t just ha.nd a. ha.nd a.mputa.te..d & the..y sa.y, “I ca.n’t wa.it to ge..t ba
the.. pia.no”… You sa.y “Oh, how long ha.ve.. you pla.ye..d, e..tc? - you NE..VE..R sa
be..ca.use.. you only ha.ve.. 1 ha.nd”
a.buse.. = confront
loss = support
#2 proble..m = de..pe..nde..ncy *whe..n the.. a.buse..r ge..t the.. significa.nt othe..r to do
“Ca.ll my boss, i’m sick”* (a.buse..r ge..ts to ke..e..p a.busing..)
= co-de..pe..nde..ncy *ca.lls the.. boss*… (positive.. se..lf e..ste..e..m)
How to tre..a.t this?!? Se..t limits a.nd e..nforce.. the..m… Le..a.rn to
ma.nipula.tion = whe..n the.. a.buse..r ge..ts the.. significa.nt othe..r to do things for him o
the.. na.ture.. of the.. a.ct is da.nge..rous or ha.rmful how is it like.. de..pe..nde..ncy? the..
is ge..tting the.. othe..r pe..rson to do some..thing
no ha.rm = de..pe..nde..nt / co-de..pe..nde..nt (wife.. buying a.lcohol for husba.nd) da.nge..r
ma.nipula.te..d (kid buying a.lcohol for fa.the..r)
…de..pe..nds on le..ga.l/ille..ga.l………
We..rnicke..-Korsa.koff Syndrome.. (WKS) is a. ne..urologica.l disorde..r.
E..nce..pha.lopa.thy a.nd Korsa.koff's Psychosis a.re.. the.. a.cute.. a.nd chronic pha.se..s, r
of the.. sa.me.. dise..a.se... WKS is ca.use..d by a. de..ficie..ncy in the.. B1 vita.min thia.mine
(B1) pla.ys a. role.. in me..ta.bolizing glucose.. to produce.. e..ne..rgy for the.. bra.in.
prima.ry symptom of WKS = a.mne..sia. with confa.bula.tion (ma.king up storie..s) *the..y b
the.. lie....*
e..x:
You ha.ve.. a. pt who be..lie..ve..s he.. is Rona.ld Re..ga.n’s Na.tioa.l Se..curity Office..r…
wa.nt to g to a. ca.bine..t me..e..ting… :/ WHA.T DO YOU DO?!? Re..dire..ct!! (“we..ll, wh
ge..t a. showe..r a.nd the..n we..’ll go wa.tch CNN a.nd se..e.. wha.t the.. ne..ws is in Wa.shi
Review
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 49, HC
80 & SaO2 90%. Based on the results, the client is experiencing: = acidosis, = respirator
-opioid: CNS depressant.. know the symptoms (sedation, respiratory depression, etc)..
,a.s the.. pH goe..s… so goe..s my pa.tie..nt!!!
whe..n pH goe..s up; pa.tie..nt goe..s up.. (e..ve..rything ge..ts irrita.ble..!)
whe..n pH goe..s down; pa.tie..nt goe..s down! (syste..ms in your body shut down)
…e..xce..pt with pota.ssium whe..n pH goe..s up; pota.ssium goe..s down whe..n pH goe..s
pota.ssium goe..s up
(up) a.lka.losis: irritibility, hype..r-re..fle..xia. (3 & 4), ta.chypne..a., ta.chyca.rdia., borboryg
(incre..a.se..d bowe..l sounds), se..izure.., a.spira.te....
(down) a.cidosis: hypo-re..fle..xia., bra.dyca.rdia., le..the..rgy (obtunde..d), pa.ra.lytic ile..u
(de..cre..a.se..d bowe..l sounds), coma., re..spira.tory a.rre..st (a.mbu-ba.g!!)
Kussma.ul bre..a.thing is a. de..e..p a.nd la.bore..d bre..a.thing pa.tte..rn ofte..n a.ssocia.te
se..ve..re.. me..ta.bolic a.cidosis, pa.rticula.rly dia.be..tic ke..toa.cidosis (DKA.) but a.lso kid
fa.ilure..… MA.C Kussma.ul
M: me..ta.bolic
A.C: a.cidosis
e..x: pT ha.s re..spira.tory a.cidosis… (se..le..ct a.ll tha.t
a.pply)..
+1 re..fle..xe..s
dia.rhhe..a.
a.dyna.mic ile..us
spa.sm urina.ry
re..te..ntion
ta.chyca.rdia.
2nd de..gre..e.. mobits type.. 2 he..a.rt block hypoka.le..mia.
SA.TA. que..stions: *ne..ve..r only 1… ne..ve..r a.ll of the..m*
dia.rhhe..a. will ca.use.. a. me..ta.bolic a.cidosis.. but once.. you ge..t a.cidodic, it will shut y
down = pa.ra.lytic ile..us
…with sce..na.rios.. a.lwa.ys a.sk first “is it lung?” = re..spira.tory …the..n
a.sk if the.. pt is ove..r-ve..ntila.ting or unde..r-ve..ntila.ting? ove..r-
ve..ntila.ting = a.lka.losis unde..r-ve..ntila.ting = a.cidosis
…it’s a.bout the.. Sa.O2!!! (pa.y
a.tte..ntion!!) if it isn’t lung = me..ta.bolic..
if pt ha.s prolonge..d ga.stric vomiting or suctioning… it’s a.lwa.ys me..ta.bolic a.lka.losis w
a.cid = be..come..s ba.sic..
for e..ve..rything e..lse.. tha.t is not lung - choose.. me..ta.bolic a.cidosis..
-if you don’t know the.. a.nswe..r… a.lwa.ys a.nswe..r me..ta.bolic a.cidosis
,ve..ntila.tors
a.la.rms.. high pre..ssure.. a.la.rm… trigge..re..d by incre..a.sure.. re..sista.nce.. to a.ir flow.
(ma.chine.. is pushing too ha.rd to ge..t a.ir into the.. lungs).. re..spira.tory a.lka.losis
3 obstructions: kink in tubing (ge..t kink out), wa.te..r conde..nsing within the.. tube.. (e..m
mucus se..cre..tions in the.. a.irwa.y (turn, cough, de..e..p bre..a.the..… the..n suction)..
ne..e..de..d!! *in tha.t orde..r*…
low pre..ssure.. a.la.rm.. de..cre..a.se..d re..sista.nce.. (too e..a.sy for the.. ma.chine....)
re..spira.tor a.cidosis
Low pre..ssure.. a.la.rms a.re.. trigge..re..d by de..cre..a.se..d re..sista.nce.. to a.irfl
ca.n be.. ca.use..d by disconne..ctions of the.. ma.in tubing or oxyge..n se..nsor tub
Tubing (re..conne..ct it!) oxyge..n se..nsor tube.. (re..conne..ct it UNLE..SS tube.. is
the.. floor - ba.g the..m & ca.ll Re..spira.tory the..ra.pist if this ha.ppe..ns)
Re..spira.tory a.lka.losis = ve..ntila.tor se..tting ma.y be.. too high
Re..spira.tory a.cidosis = ve..ntila.tor se..tting ma.y be.. too low
Wha.t doe..s “we..a.n” me..a.n? gra.dua.lly de..cre..a.se.. with the.. goa.l of ge..tting off a.l
e..x:
Doc sa.ys we..a.n off ve..nt in A.M… 6a.m A.BG’s show re..sp. a.cidosis follow
orde..r
ca.ll re..spira.tory hold
orde..r.. ca.ll doc
be..gin to de..cre..a.se.. the.. se..ttings
MA.SLOW ’s Prioritie..s (HIGHe..st - LOWe..st)
physiologica.l
sa.fe..ty
comfort
psychologica.l (proble..ms within the.. pe..rson)
socia.l (proble..ms with othe..r pe..ople..)
spiritua.l
e..x:
A.rra.nge.. from HIGHe..st - LOWe..st…
de..nia.l, spiritua.l distre..ss, pa.in in e..lbow, fa.ll risk, pa.thologica.l fa.mily dyna.mics &
e..le..ctrolyte.. imba.la.nce..…
= e..le..ctrolyte.. imba.la.nce.. (psyiologica.l), fa.ll risk (sa.fe..ty), pa.in in e..lbow (comfort),
(psychologica.l), pa.thologica.l fa.mily dyna.mics (socia.l) & spiritua.l distre..ss (spiritua.l)
a.lcoholism.. (or a.ny a.buse..)
, pronouns ~ good:
i…
ba.d: you…
positions ~ good: i’m ha.ving a. difficult time..
re..a.ding this… ba.d: you wrote.. it wrong..
loss & grie..f: De..nia.l A.nge..r Ba.rgining De..pre..ssion A.cce..pta.nce..
don’t confront it; support it..
e..x:
You ha.ve.. a. pt tha.t just ha.nd a. ha.nd a.mputa.te..d & the..y sa.y, “I ca.n’t wa.it to ge..t ba
the.. pia.no”… You sa.y “Oh, how long ha.ve.. you pla.ye..d, e..tc? - you NE..VE..R sa
be..ca.use.. you only ha.ve.. 1 ha.nd”
a.buse.. = confront
loss = support
#2 proble..m = de..pe..nde..ncy *whe..n the.. a.buse..r ge..t the.. significa.nt othe..r to do
“Ca.ll my boss, i’m sick”* (a.buse..r ge..ts to ke..e..p a.busing..)
= co-de..pe..nde..ncy *ca.lls the.. boss*… (positive.. se..lf e..ste..e..m)
How to tre..a.t this?!? Se..t limits a.nd e..nforce.. the..m… Le..a.rn to
ma.nipula.tion = whe..n the.. a.buse..r ge..ts the.. significa.nt othe..r to do things for him o
the.. na.ture.. of the.. a.ct is da.nge..rous or ha.rmful how is it like.. de..pe..nde..ncy? the..
is ge..tting the.. othe..r pe..rson to do some..thing
no ha.rm = de..pe..nde..nt / co-de..pe..nde..nt (wife.. buying a.lcohol for husba.nd) da.nge..r
ma.nipula.te..d (kid buying a.lcohol for fa.the..r)
…de..pe..nds on le..ga.l/ille..ga.l………
We..rnicke..-Korsa.koff Syndrome.. (WKS) is a. ne..urologica.l disorde..r.
E..nce..pha.lopa.thy a.nd Korsa.koff's Psychosis a.re.. the.. a.cute.. a.nd chronic pha.se..s, r
of the.. sa.me.. dise..a.se... WKS is ca.use..d by a. de..ficie..ncy in the.. B1 vita.min thia.mine
(B1) pla.ys a. role.. in me..ta.bolizing glucose.. to produce.. e..ne..rgy for the.. bra.in.
prima.ry symptom of WKS = a.mne..sia. with confa.bula.tion (ma.king up storie..s) *the..y b
the.. lie....*
e..x:
You ha.ve.. a. pt who be..lie..ve..s he.. is Rona.ld Re..ga.n’s Na.tioa.l Se..curity Office..r…
wa.nt to g to a. ca.bine..t me..e..ting… :/ WHA.T DO YOU DO?!? Re..dire..ct!! (“we..ll, wh
ge..t a. showe..r a.nd the..n we..’ll go wa.tch CNN a.nd se..e.. wha.t the.. ne..ws is in Wa.shi
