Mark Klimek Audio Notes 1
Nclex-RN study
Acid Base ABG’s
As pH goes, so does my Pt! Except for K
pH and HCO3 in same direction Metabolic
pH and HCO3 in different direction: Respiratory
pH ↓ Pt goes ↓ (HR, RR, all vitals) K goes ↑ hypoexcitable
pH ↑ Pt goes ↑ K goes ↓ hyperexcitable
Except for K – it does the opposite
pH ↑ : Alkalosis
• Seizures, hyperactivity, borborgygmi (↑BS)
Kausmal breathing = MacKausamal (Metabolic Acidosis breathing)
Causes of imbalance:
1. Is lung affected?
a. Yes-Respiratory
2. Is pt overventilating or underventilating?
a. Over-alkalosis
b. Under-acidosis
3. Not the lung?
a. Then it is Metabolic
4. If pt has prolonged vomiting or suctioning
a. Alkalosis
5. If you don’t know: it’s probably metabolic acidosis (It’s super common)
Alcoholism
Psychological
• #1 problem psychologically in alcoholism and all other abusers is denial
• Denial-refusal to accept the reality of a problem
o Treat denial by confronting
o Differentiate what they say versus what they do
• DO NOT confuse confrontation with aggression (attacks the person)
,Mark Klimek Audio Notes 2
• Questions about staff problem interactions: Never choose YOU, choose I
• Denial is okay in loss/grief
o Treat this denial with support-Do NOT confront
• Denial Anger Bargaining Depression Acceptance
• #2 problem dependency/codependency
o Dependency-abuser gets significant other to do things for them
o Codependency-positive self esteem significant other receives from doing things for the
abuser
o Treat by setting limits and enforce them, say no
• Manipulation-abuser gets significant other for to do things them that is not in the best interest of the
SO
o Interest and harmful
o If what being asked to do is neutral-dependency
o If what being asked is harmful or not in best interest-manipulation
o Treat manipulation by setting limits and enforce, say no
• Wernicke’s and Korsakoff
o Wernickes’-encephalopathy induced by vit B1/ thiamine deficiency
o Korsakoff-psychosis induced by vit B1/ thiamine deficiency
▪ Primary symptom- amnesia with confabulation
▪ Redirect pt to other things
▪ Preventable-take vitamin B1/thiamine
▪ Arrestable-take vitamin B1/thiamine
▪ Irreversible
• Antabuse (disulfiram) and Revia (naltrexone)
o Aversion therapy
o Onset: 2 weeks, Duration 2 weeks
o Pt teaching
▪ avoid all forms of alcohol-mouthwash, aftershave, perfumes/colognes/ insect
repellants, OTC ending with elixir, alcohol based hand sanitizer, uncooked icing
▪ DO NOT pick red wine vinaigrette
• Overdose and Withdrawal
o Every abused drug is either upper or downer
o 1. Is drug upper or downer?
▪ Upper: caffeine, cocaine, pcp/lsd, methamphetamines, Adderall (amphetamine)
• Things go up: euphoria, tachycardia, restlessness, irritability, borborygmic,
diarrhea, hypereflexia 3+ or 4+, seizures (have suction at bedside)
▪ Downer: If not upper, it is a downer
• Things go down: lethargic, bradycardia, respiratory arrest (have ambu-bag
at bedside)
o 2. Overdose or withdrawal?
▪ Overdose/intoxication-Overdose on an upper- everything goes up
▪ Overdose downer- everything goes down
▪ Withdrawal downer-everything go up
▪ Wthdrawal upper-everything go down
• Drug Addiction in Newborns
o Always assume intoxication not withdrawal at birth (before 24 hours)
• Alcohol withdrawal syndrome vs delirium tremens (DT)
, Mark Klimek Audio Notes 3
o Every alcoholic goes through alcohol withdrawal after 24 hr of not drinking, only minority go
through DT (72 hrs)
o Alcohol withdrawal-not life-threatening, not a danger to self or others
o DT-life-threatening, danger to self and others
AWS DT
Regular diet NPO; clear liquids
Semi-private anywhere Private, near nurse’s station
No restraints Restricted bedrest (bedpans, urinals)
Must be restrained (vest or 2 point lock
leather)
Antihypertensive/tranquilizer/Vitamin B1 Antihypertensive/tranquilizer/Vitamin B1
Ventilators
High Pressure Alarm
• Obstruction-Increased resistance to airflow
o Kinks (unkink)
o Water condensation (open system and drain tubing)
o Mucous secretions in airway (TCDB, suction)
• Low Pressure Alarm-↓ Resistance – machine finding job too easy
• Disconnected
o Main tubing (reconnect)
o Oxygen sensor (reconnect)
• If tube goes lower than pt level – contaminated
• Ventilator overventilating pt can result in resp. alkalosis
• Ventilator underventilating pt can result in resp. acidosis
Amino Glycosides
A Mean Old Mycin
Amino Glycosides only treat Mean old Infections!
Serious, resistant, gram-negative, life-threatening
True mean old Mycins don’t have “Thro”
If it has “Thro” – Thro it away!
• Ex: Zithromycin , erythromycin, clarithromycin
Mean Old Mycins (mice) destroy ears (ototoxicity) and kidneys (nephrotoxicity)
• Must check Creatinine (0.6 -1.3) for Nephrotoxicity – NOT urine output
• Check hearing, tinnitus, vertigo, dizziness
Nclex-RN study
Acid Base ABG’s
As pH goes, so does my Pt! Except for K
pH and HCO3 in same direction Metabolic
pH and HCO3 in different direction: Respiratory
pH ↓ Pt goes ↓ (HR, RR, all vitals) K goes ↑ hypoexcitable
pH ↑ Pt goes ↑ K goes ↓ hyperexcitable
Except for K – it does the opposite
pH ↑ : Alkalosis
• Seizures, hyperactivity, borborgygmi (↑BS)
Kausmal breathing = MacKausamal (Metabolic Acidosis breathing)
Causes of imbalance:
1. Is lung affected?
a. Yes-Respiratory
2. Is pt overventilating or underventilating?
a. Over-alkalosis
b. Under-acidosis
3. Not the lung?
a. Then it is Metabolic
4. If pt has prolonged vomiting or suctioning
a. Alkalosis
5. If you don’t know: it’s probably metabolic acidosis (It’s super common)
Alcoholism
Psychological
• #1 problem psychologically in alcoholism and all other abusers is denial
• Denial-refusal to accept the reality of a problem
o Treat denial by confronting
o Differentiate what they say versus what they do
• DO NOT confuse confrontation with aggression (attacks the person)
,Mark Klimek Audio Notes 2
• Questions about staff problem interactions: Never choose YOU, choose I
• Denial is okay in loss/grief
o Treat this denial with support-Do NOT confront
• Denial Anger Bargaining Depression Acceptance
• #2 problem dependency/codependency
o Dependency-abuser gets significant other to do things for them
o Codependency-positive self esteem significant other receives from doing things for the
abuser
o Treat by setting limits and enforce them, say no
• Manipulation-abuser gets significant other for to do things them that is not in the best interest of the
SO
o Interest and harmful
o If what being asked to do is neutral-dependency
o If what being asked is harmful or not in best interest-manipulation
o Treat manipulation by setting limits and enforce, say no
• Wernicke’s and Korsakoff
o Wernickes’-encephalopathy induced by vit B1/ thiamine deficiency
o Korsakoff-psychosis induced by vit B1/ thiamine deficiency
▪ Primary symptom- amnesia with confabulation
▪ Redirect pt to other things
▪ Preventable-take vitamin B1/thiamine
▪ Arrestable-take vitamin B1/thiamine
▪ Irreversible
• Antabuse (disulfiram) and Revia (naltrexone)
o Aversion therapy
o Onset: 2 weeks, Duration 2 weeks
o Pt teaching
▪ avoid all forms of alcohol-mouthwash, aftershave, perfumes/colognes/ insect
repellants, OTC ending with elixir, alcohol based hand sanitizer, uncooked icing
▪ DO NOT pick red wine vinaigrette
• Overdose and Withdrawal
o Every abused drug is either upper or downer
o 1. Is drug upper or downer?
▪ Upper: caffeine, cocaine, pcp/lsd, methamphetamines, Adderall (amphetamine)
• Things go up: euphoria, tachycardia, restlessness, irritability, borborygmic,
diarrhea, hypereflexia 3+ or 4+, seizures (have suction at bedside)
▪ Downer: If not upper, it is a downer
• Things go down: lethargic, bradycardia, respiratory arrest (have ambu-bag
at bedside)
o 2. Overdose or withdrawal?
▪ Overdose/intoxication-Overdose on an upper- everything goes up
▪ Overdose downer- everything goes down
▪ Withdrawal downer-everything go up
▪ Wthdrawal upper-everything go down
• Drug Addiction in Newborns
o Always assume intoxication not withdrawal at birth (before 24 hours)
• Alcohol withdrawal syndrome vs delirium tremens (DT)
, Mark Klimek Audio Notes 3
o Every alcoholic goes through alcohol withdrawal after 24 hr of not drinking, only minority go
through DT (72 hrs)
o Alcohol withdrawal-not life-threatening, not a danger to self or others
o DT-life-threatening, danger to self and others
AWS DT
Regular diet NPO; clear liquids
Semi-private anywhere Private, near nurse’s station
No restraints Restricted bedrest (bedpans, urinals)
Must be restrained (vest or 2 point lock
leather)
Antihypertensive/tranquilizer/Vitamin B1 Antihypertensive/tranquilizer/Vitamin B1
Ventilators
High Pressure Alarm
• Obstruction-Increased resistance to airflow
o Kinks (unkink)
o Water condensation (open system and drain tubing)
o Mucous secretions in airway (TCDB, suction)
• Low Pressure Alarm-↓ Resistance – machine finding job too easy
• Disconnected
o Main tubing (reconnect)
o Oxygen sensor (reconnect)
• If tube goes lower than pt level – contaminated
• Ventilator overventilating pt can result in resp. alkalosis
• Ventilator underventilating pt can result in resp. acidosis
Amino Glycosides
A Mean Old Mycin
Amino Glycosides only treat Mean old Infections!
Serious, resistant, gram-negative, life-threatening
True mean old Mycins don’t have “Thro”
If it has “Thro” – Thro it away!
• Ex: Zithromycin , erythromycin, clarithromycin
Mean Old Mycins (mice) destroy ears (ototoxicity) and kidneys (nephrotoxicity)
• Must check Creatinine (0.6 -1.3) for Nephrotoxicity – NOT urine output
• Check hearing, tinnitus, vertigo, dizziness
