Mark Klimek Yellow Book 2023 with verified questions and answers

If the pH and the BiCarb are both in the same direction then it is? Metabolc If the pH is up it is? Alkalosis As the pH goes so goes my patient except for? Potassium If the pH is down it is? Acidosis If the pH is up my patient with show signs and symptoms of? Increase... like tachycardia,diarrhea and borborygmi If the pH is down my patient will show signs and symtoms of? Decrease... like decreased output, bradycardia and constipation If my pH is up my potassium (K+) is ? Down If my pH is down my potassium (K+) is? Up If my patient is overventilating I should choose? Respiratory Alkalosis If my patient is underventilating I should choose? Respiratory Acidosis If my patient has prolonged gastric vomiting or suction I choose? Metabolic Alkalosis If it is not lung or prolonged vomiting or suctioning I choose? Metabolic Acidosis Kussmal Respirations Metabolic Acidosis ( Remember MacKussmal Before measuing ABGs you should check what? Allen's test. Should be positive. Pt makes a fist and pressure is applied to the ulnar and the radial arteries Ulnar pressure is released and color should return in 7 seconds (means it's positive and OK to take ABG's). Definition of Compensation PH is normal! It is never compensated if it is abnormal. If PH normal look in the direction it is going. Closer to Acidic? (7.35) acidosis. Then look at Bicarb & figure out which is abnormal. If Bicarb is out of range, it's metabolic acidosis. If C02 is abnormal, it's Respiratory Acidosis :) If your pt is acidotic and you need to pick a symptom Pick the symptom where everything is DOWN. ( And vice Versa) Ex: 2 degree Morbitz Type 2 BLOCK. ---- Down direction If you don't know what causes an acid base balance, pick Metabolic Acidosis If in doubt in ABGs, always pick Headache, nausea, weakness & numbness+ tingling. It can be either up or down. High pressure alarms are triggered when? They cannot push air in High pressure alarms are caused by what three types of obstructions? Kinking, Water in dependant loops and mucus in the airway. If kinking in the tube is present you? Unkink If water is present in the dependant loops you? Open system and empty water. If mucus is present you? Turn them, cough and have them deeo breath first. If ineffective you then suction. Don't suction unless Coughing & deep breathing is deemed inappropriate. In order to suction, you must be able to hear Mucus in the lung Low pressure alarms are triggered when? It is to easy to push air in. Low pressure alarms are normally caused by? Disconnection If the tubing is disconnected you? Reconnect If O2 sensor line is disconnected you? Reconnect In a vented client respiratory alkalosis means the vent setting may be too? High In a vented client respiratory acidosis means the vent may be too? Low What do you do if the patients disconnected tube is on the floor? Bag them, (call for help) get new tube and then reconnect. First question to ask if the low pressure alarm sounds Where is the tubing?! HOLD H- High Pressure O- Obstruction L- Low D- Disconnections Never put anything in YOUR scope of practice On anyone else Make sure your answer is PATIENT FOCUSED. TAKE CARE OF YOUR PATIENT! Don't answer based on staff, building, machine, etc. PATIENT FIRST. What does wean mean? Decrease Gradually What do you do if the patients disconnected tube is on the chest? Reconnect ... if its above the waist its ok. Remember is PSYCH if you are asked to Prioritize, Don't forget MASLOW! 1. Physiological 2. Safety 3. Comfort - Includes pain 4. Psychological 5. Social 6. Spiritual When prioritizing, always use Maslow + ABCs For one patient. Don't if you have more than one patient. What is the biggest problem in abuse? Denial To treat denial you need to? Confront them. Definition of Denial Refusal to accept reality of their problem How do you confront? Point out the difference between what they say and what they do. What is the one circumstance that you as a nurse would support denial? Loss and Grief Always go Med surg first. Then Psych What is dependency? When the abuser gets a significant other so make decisions for them or do thing for them. What is codependency? When the significant other gets positive self esteem from doing things or making decisions for an abuser. To treat dependency/codependency you ? Set limits and enforce them. Say NO and follow through. Agree in advance on what requests are allowed, then enforce the agreement. Work on self esteem of the codependent. What is manipulation? When the abuser gets the significant other fo do things for them that is not in the best interest of the significant other. This can be dangerous and harmful to the significant other. How do you treat manipulation? Set limits and enforce. Why is manipulation easier to treat then dependency/codependency? Because no one likes being manipulated. DABDA D- Denial A- Anger B- Bargaining D- Depression A- Acceptance Psych Needs, In order Denial Depend Manipulation To address a patient's psychological needs, they must be: STABLE, safe, comfortable. Pain Never killed anyone. NOT the top priority, especially if there are physiological needs in the question that make the patient unstable. What is Wernickes (Korsakoffs) Syndrome? Psychosis induced by vitamin B1 (Thiamine) deficiency. Symptom of Wernickes Korsakoffs syndrome? Amnesia with confabulation. = Loss of memory with making up stories to fill in the gaps. Vitamin B1 helps breakdown? Alcohol So without B1 what happens? Alcohol isn't metabolized correctly goes to the brain and causes Wernickes Primary symptom of Wernickes? Amnesia with confabulation (making up stories). Is Wernickes preventable? Yes- Take Vitamin B1 Is Wernickes arrestable? Yes- Take Vitamin B1 Is Wernickes reversible? No What is the goal of patients dementia/organic brain syndrome? Maintain function, Never Improve. What is aversion therapy? When you try and make the patient hate something. Antabuse onset and duration is? 2 weeks Teach a patient taking Antabuse to avoid what? Alochol On top of alcohol a patient taking Antabuse should also avoid what other 7 things? Alcohol Aftershave, Cologne, Perfumes Insect Repellent Elixirs Vanilla Extract Vinaigrettes Handsanitizer Alcohol Prep Pads Vanilla Icing How long does it take for Antabuse to get out of the system so they can drink Alcohol again? 2 weeks What are Elixirs? 95% of liquids. If it is not an antibiotic, assume it is an elixir, so the patient can't have it if on antabuse. This rule applies for diabetics too (elixers also have sugar). What happens if a person on Antabuse ingests alcohol? Nausea, Vomiting, & Possibly Death In Overdose VS Withdrawal, Ask yourself? Is this drug an upper or a downer? What are the five uppers? Caffeine, Cocaine, Methamphetamines, PCP/LSD and ADHD Meds, Bath Salts Downers are? Everything other then the five uppers. Heroin Ativan Valiumn Fetanyl S/S of upper use? Everything goes up Tachycardia Increased BP Irritability Fever Diarrhea +4 Reflexes Pupil Dilation Excitability Seizures Borborygmi ETC. S/S of downer use? Everything goes down Bradycardia Lethargy Constricted Pupils Hyporeflexia Flaccidity Respiratory Depression Then ask yourself: Are they talking about Overdose or Withdrawal? Overdose/Intoxication: I have too much.... Withdrawal: I don't have enough... Overdose of a downer causes everything to go? Down Overdose of an upper causes everything to go? Up Withdrawal of an upper causes everything to go? Down Withdrawal of a downer causes everything to go? Up Upper withdrawal looks like Downer Overdose Downer Withdrawal looks like Upper overdose At birth if the mother was addicted to a substance always assume the newborn is? Overdosed If 24 hours after birth assume the baby is in? Withdrawal Every alcoholic goes through what withing 24 hours after cessation? Alcohol Withdrawal syndrome What is Alcohol Withdrawal Syndrome? Hyper irritability state less than 24 hours after the first drink After 72 hours of alochol withdrawal a small minority may get? Delirium Tremens Can Delirium Tremens kill you? Yes Can Alcohol Withdrawal Syndrome kill you? No Are patients with Alcohol Withdrawal Syndrome a danger to themselves or others? No Are patients with Delirium Tremens a danger to themselves or others? Yes N/I for Delirium Tremens? Private room near nurses station NPO/Clear liquids Restricted bed rest Restraints, tranquilizer, multivitamin (B1 Vitamin/Thiamine) Antihypertensive. N/I for Alcohol Withdrawal Syndrome? Semi-private room anywhere Regular diet Up and ad-lib, no restraint Tranquilizer Multivitamin (B1/Thiamine) Antihypertensive. A two point restraint is? One arm and the opposite leg. N/I for restraints? Check Q15min Rotate sites Q2H All aminoglycosides end in? "mycin" Vancomycin For Aminoglycosides, think: A Mean Old Mycin Aminoglycosides treat? Big gun antibiotics. Treat serious, life threatening, resistant infections If it has "thro" in it you? Throw it out...Zithromycin. It treats a minor infection Toxic effects of aminoglycosides? Ototoxicity Nephrotoxicity Cranial nerve 8 (vestibulocochlear nerve) which senses sound. The one Aminoglycoside that doesn't end in Mycin? Amikacin What is another word for aminoglycoside? Glycopeptide Monitor what with aminoglycoside use? Hearing, balance, tinnitus & creatinine (best indicator of renal function) Best indicator of aminoglycoside toxicity? Ototoxicity (Ears) Frequency of administration for aminoglycosides? Q8H Aminoglycoside route of administration? Im or IV Aminoglycosides are given PO for what two reasons? Hepatic Encephalopathy and Pre-op bowel surgery. What is Hepatic Encephalopathy also called? Liver Coma, Ammonia-Induced Encephalopathy If fluid resuscitation is used in shock, there will be Increased Urine Output Neomycin and Kanmycin are used for what? Bowel sterilzation? Can also be given for C.Diff Who can sterilize my bowel? "Neo" "Kan" If you give aminoglycosides PO, do you have to worry about side effects? No Hepatic Encephalopathy is caused by? High ammonia levels What raises ammonia levels the most? Ecoli in the gut Why do you draw TAP levels? Narrow therapeutic Window When do you draw a trough level? 30 minutes before the next scheduled dose. When do you draw a sublingual peak level? 5-10 minutes after it is dissolved. When do you draw a IV peak level? 15-30 minutes after dose is finished. When do you draw a IM peak level? 30-60 minutes after given If you must pick a time to draw the peak, pick the highest amount of time without going over the limits So for IV, Pick 30 Minutes, not 15. Category A Bio terrorism Agents Most Lethal What are the Category A Bio terrorism Agents? Smallpox Tularemia Anthrax Plague Hemorrhagic Fever, Such as Ebola Botulism Category B A big, long list. Category C. Not very Lethal Hanta Virus Nipeh Virus Small Pox Early Detection Symptom Rash that starts around the mouth Small pox Inhalation. Pt on AIRBORNE Precautions Dies from Septicemia. No treatment Tularemia Inhalation Chest Symptoms Dies from RESPIRATORY FAILURE Treat with Streptomycin Anthrax spreads by Inhalation (AIRBORNE PRECAUTIONS) Anthrax looks like Respiratory FLU Anthrax death occurs from? Respiratory Failure Treat Anthrax with Cipro, Penicillin, Streptomycin Plague spreads by Inhalation 3 H's of Plague Blood Everywhere. H- emoptysis - Coughing up blood H-ematemesis - Blood in Vomitus H-ematochezia - Bright red blood in the diarrhea Plague patients die by DIC and respiratory Distress Hemorrhagic Illnesses (Like Ebola) Petechiae and ecchymoses = Pinpoint Hemorrhage, especially on Chest & Bruising Botulism is Ingested - Most Lethal Dies from Respiratory Arrest 3 Major Symptoms of Botulism Descending Paralysis (Starts in face and goes down) Fever But is Alert Gullian Barre Ascending Paralysis Chemical Agents Mustard Gas, Cyanide, and Phosgine Chlorine Mustard Gas The Chemical Agent causes Blisters Cyanide The Chemical Agent Causes Respiratory Arrest. What do you use to treat Cyanide Poisoning? Sodium Thiosulfate IV What does Phosgine Chloride Cause Choking Sarin, the Nerve Agent, Causes Massive Cholinergic parasympathic response Cholinergic, Parasympathetic effects cause? B-ronchorrhea B-ronchospasm S-Salivation L-acrimating U-rinating Constantly D-iaphoretic + Diarrhea G-I distress E-mesis