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
,Nclex-RN study.
• DO NOT confuse confrontation with aggression (attacks the person)
• 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
,Nclex-RN study.
• Drug Addiction in Newborns
o Always assume intoxication not withdrawal at birth (before 24 hours)
• Alcohol withdrawal syndrome vs delirium tremens (DT)
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)
, Nclex-RN study.
• Must check Creatinine (0.6 -1.3) for Nephrotoxicity – NOT urine output
• Check hearing, tinnitus, vertigo, dizziness
8 Toxic to Cranial nerve 8 (vestibulocochlear) give q8h, IM/IV
Mean Old Mycins do NOT get absorbed – they go in and out and sterilize/clean
Hepatic (encephalopathy)coma-reduce ammonia levels. Oral mycins redcues ammonia
PO Mean Old Mycins are for bowel sterilizing
• NeoMYCIN
• KanoMYCIN
Who can sterilize my bowel?? NEO KAN!
Drawing TAP Levels (Peak and Trough)
For drugs that have a narrow therapeutic window/level and are toxic
Digitalis
Route determines TAP – Not the drug
TROUGH PEAK
IV 30 MIN BEFORE NEXT DOSE IV 15-30 min after its done
IM 30 MIN BEFORE NEXT DOSE IM 30-60 min after its given
SubQ-See
SUB Q 30 MIN BEFORE NEXT DOSE Subling 5-10 min after its in the
system
PO 30 MIN BEFORE NEXT DOSE No PO peak
Heart Rhythms
Calcium channel blockers are like valium for the heart
Ca Channel Blockers are chill pills for the heart
• They end in -DEPINE or ZEM
• Verapamil, Cardizem (Cardizem can be continuous IV drip)
Calcium channel blockers are negative inotropic, negative chronotropes, negative dromotropes- fancy way of
saying valium for the heart
Positive inotropes- are cardiac stimulant
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
,Nclex-RN study.
• DO NOT confuse confrontation with aggression (attacks the person)
• 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
,Nclex-RN study.
• Drug Addiction in Newborns
o Always assume intoxication not withdrawal at birth (before 24 hours)
• Alcohol withdrawal syndrome vs delirium tremens (DT)
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)
, Nclex-RN study.
• Must check Creatinine (0.6 -1.3) for Nephrotoxicity – NOT urine output
• Check hearing, tinnitus, vertigo, dizziness
8 Toxic to Cranial nerve 8 (vestibulocochlear) give q8h, IM/IV
Mean Old Mycins do NOT get absorbed – they go in and out and sterilize/clean
Hepatic (encephalopathy)coma-reduce ammonia levels. Oral mycins redcues ammonia
PO Mean Old Mycins are for bowel sterilizing
• NeoMYCIN
• KanoMYCIN
Who can sterilize my bowel?? NEO KAN!
Drawing TAP Levels (Peak and Trough)
For drugs that have a narrow therapeutic window/level and are toxic
Digitalis
Route determines TAP – Not the drug
TROUGH PEAK
IV 30 MIN BEFORE NEXT DOSE IV 15-30 min after its done
IM 30 MIN BEFORE NEXT DOSE IM 30-60 min after its given
SubQ-See
SUB Q 30 MIN BEFORE NEXT DOSE Subling 5-10 min after its in the
system
PO 30 MIN BEFORE NEXT DOSE No PO peak
Heart Rhythms
Calcium channel blockers are like valium for the heart
Ca Channel Blockers are chill pills for the heart
• They end in -DEPINE or ZEM
• Verapamil, Cardizem (Cardizem can be continuous IV drip)
Calcium channel blockers are negative inotropic, negative chronotropes, negative dromotropes- fancy way of
saying valium for the heart
Positive inotropes- are cardiac stimulant
