⭐ 🧪 🧫
MARK K NCLEX REVIEW
ACID BASES
– As the pH goes_(up or down)__, so goes my patient (except for K, there
is an inverse relationship) if it’s acidotic= everything shuts down (ex.
respiratory depression, bradycardia), if it’s alkalosis=everything is
enhanced (ex. vomiting, borborygmi, tachycardia, seizure)
– if the ph and the bicarb are both in the same direction it’s metabolic
– think: is it lung? if not its metabolic
– if it doesn’t have to do with vomiting or suctioning, it’s alkalosis
– IF YOU DONT KNOW WHAT IT IS OR WHAT TO PICK based off the rules
above, it’s metabolic acidosis
Mackussmal : Metabolic Acidosis/ Diabetic Keto acidosis (Kussmal’s respirations)
– In an acidotic environment everything shuts down
Pay more attention to the modifying phrase than to the original noun!!!!!!!
For select all that applies: select only what you KNOW, it’s never only one and
it’s never all
– What causes something is the opposite of the signs and symptoms
(diarrhea causes acidosis but once you get acidotic the sign will be
paralytic ileus and your bowels shut down)
– Ask yourself “is it lung?” if it is then it’s respiratory
then ask…
– is the patient over or under ventilating?
– over-alkalosis (respiratory alkalosis) think alkalosis means high
– under-acidosis (respiratory acidosis) think acidosis means low
respiratory rate is irrelevant, ventilation has to due with gas exchange (Sa02 is
ventilation) (respiratory rate is often the opposite, don’t pay attention to it)
– ex. PCA pump (depresses respirations, under ventilation, respiratory
acidosis)
If it isn’t lung it’s metabolic !
– If the patient has prolonged gastric vomiting or suctioning pick Alkalosis
(losing acid=basic)
– for everything else that is not lung pick metabolic acidosis
, – if it’s not vomiting or suctioning it’s acidosis
– if it’s not lung it’s metabolic
– if you don’t know what to pick, pick metabolic acidosis
VENTILATION
high pressure alarm triggered by increase resistance to airflow (machine having to
push too hard to get the air into the lungs) (obstruction)
– tubing might be kinked (undo the kink)
– water might be condensing (empty the water)
– mucous secretions in airway (turn cough deep breathe, if it doesn’t work,
hyper ventilate then suction (PRN NEVER SCHEDULED, only if they
cannot mobilize with turn cough and deep breathing)
– click & drag question style:
. check for kinks
. empty water from tubing
. turn cough deep breathe
. suction only PRN
Low pressure alarms: decreased resistance (that was too easy to push the breathe
in) decreased resistance (disconnection)
– disconnection with main tubing (reconnect)
– O2 sensor tubing disconnected, small black coated wire, goes along
tubing and hooks into hole, senses FIO2, if disconnected leaves a whole
(plug sensor back in)
•Respiratory Alkalosis (over ventilating means the ventilator settings may be too
high)
•Respiratory Acidosis ( under ventilating means the ventilator settings may be too
low)
If pt is on vent and is respiratory acidosis, cannot come off bc he is under
ventilated on ventilator
If pt is on vent and is respiratory alkalosis, he can come off be he is being over
ventilated on the ventilator
NEVER pick an answer when you didn’t do something but someone else has to do
something
,ALCOHOLISM
psychodynamics
– #1 problem in alcoholism is denial
– denial allows abuser to keep doing it without having to answer for it
– #1 problem of ALL abusive problems is denial
– Denial: refusal to accept reality of a problem
– Treat denial by confrontation (point out the difference in what they say
they do) THIS IS CONFRONTATION
– ex. you say you’re not a alcoholic but it’s 6am and you already drank a 6
pack
– CONFRONTATION IS NOT AGGRESSION, AGGRESSION ATTACKS
PERSON, CONFRONTATION ATTACKS PROBLEM
– THEY DENY, YOU CONFRONT
– BUT denial is also a HEALTHY form of grieving & this denial gets support
not confrontation
– # 2 problem of abuse, dependence/codependency
– dependent is abuser
– codependence is when significant other derives positive self esteem from
doing things for abuser
– set limits and enforce them
– Teach them to say no in other words
– work on the self esteem of the codependent person
manipulation
– when the abuser gets the significant other to do things not in the best
interest of the other. The nature of the acts is harmful.
– like dependency bc the abuser gets the other to do things for them
– look at what they are being asked to do (if it is neutral it’s dependency/
codependency) if it’s harmful it’s manipulation
– ex. alcoholic asks 17y/o daughter to buy alcohol for her: manipulation
issue (it puts 17 y/o in harm)
– ex. 49 y/o alcoholic asks 50 y/o husband to go to store to buy alcohol for
her: dependency/codependency issue
– treat manipulation by setting limits and enforcing them, there is no
, –
positive self esteem issue like dependency/codependency
– if your patient is dependent you have 2 patient
– if you patient is a manipulator you have 1 patients
Wernicke-Korsakoff (alcohol)
– Wernicke: encephalopathy
– Korsakoffs: psychosis
#1 psychosis induced by vitamin B1 or thiamine deficiency
– Primary symptom: amnesia with confabulation (memory loss with making
up stories)
– they believe the stories, they think it’s true and don’t know it’s made up
– lose entire decades of memory, make up stories as to what they were
doing in the 90’s
– Treatment: do not confront them, redirect the patient
– don’t present reality, it’s pointless, they can’t learn it
characteristics:
– preventable (take vitamin B1, if they don’t have B1 alcohol goes to brain
and then kills brain cell)
– can stop progression by taking B1
– it is irreversible !
ON BOARDS ALWAYS ALSWER WITH THE MAJORITY
– if something is 70% fatal, then it IS fatal
Antabuse/ Disulfiram
– aversion therapy (strong hatred for something)
– goal is to get alcoholics to HATE alcohol
– works in theory better than it works in reality
– Onset: 2 weeks
– Duration: 2 weeks
– Stop taking Antabuse 2 weeks before drinking
– Teach patients to avoid ALL forms of alcohol such as: mouthwash, after
shave (even topically), perfumes and cologne, insect repellents, OTC that
ends in “elixir”, alcohol based hand sanitizers, uncooked icings (no baked
icings), vanilla extract
– RED WINE VINAIGRETTE DOES NOT HAVE ALCOHOL
OD & WITHDRAWAL
MARK K NCLEX REVIEW
ACID BASES
– As the pH goes_(up or down)__, so goes my patient (except for K, there
is an inverse relationship) if it’s acidotic= everything shuts down (ex.
respiratory depression, bradycardia), if it’s alkalosis=everything is
enhanced (ex. vomiting, borborygmi, tachycardia, seizure)
– if the ph and the bicarb are both in the same direction it’s metabolic
– think: is it lung? if not its metabolic
– if it doesn’t have to do with vomiting or suctioning, it’s alkalosis
– IF YOU DONT KNOW WHAT IT IS OR WHAT TO PICK based off the rules
above, it’s metabolic acidosis
Mackussmal : Metabolic Acidosis/ Diabetic Keto acidosis (Kussmal’s respirations)
– In an acidotic environment everything shuts down
Pay more attention to the modifying phrase than to the original noun!!!!!!!
For select all that applies: select only what you KNOW, it’s never only one and
it’s never all
– What causes something is the opposite of the signs and symptoms
(diarrhea causes acidosis but once you get acidotic the sign will be
paralytic ileus and your bowels shut down)
– Ask yourself “is it lung?” if it is then it’s respiratory
then ask…
– is the patient over or under ventilating?
– over-alkalosis (respiratory alkalosis) think alkalosis means high
– under-acidosis (respiratory acidosis) think acidosis means low
respiratory rate is irrelevant, ventilation has to due with gas exchange (Sa02 is
ventilation) (respiratory rate is often the opposite, don’t pay attention to it)
– ex. PCA pump (depresses respirations, under ventilation, respiratory
acidosis)
If it isn’t lung it’s metabolic !
– If the patient has prolonged gastric vomiting or suctioning pick Alkalosis
(losing acid=basic)
– for everything else that is not lung pick metabolic acidosis
, – if it’s not vomiting or suctioning it’s acidosis
– if it’s not lung it’s metabolic
– if you don’t know what to pick, pick metabolic acidosis
VENTILATION
high pressure alarm triggered by increase resistance to airflow (machine having to
push too hard to get the air into the lungs) (obstruction)
– tubing might be kinked (undo the kink)
– water might be condensing (empty the water)
– mucous secretions in airway (turn cough deep breathe, if it doesn’t work,
hyper ventilate then suction (PRN NEVER SCHEDULED, only if they
cannot mobilize with turn cough and deep breathing)
– click & drag question style:
. check for kinks
. empty water from tubing
. turn cough deep breathe
. suction only PRN
Low pressure alarms: decreased resistance (that was too easy to push the breathe
in) decreased resistance (disconnection)
– disconnection with main tubing (reconnect)
– O2 sensor tubing disconnected, small black coated wire, goes along
tubing and hooks into hole, senses FIO2, if disconnected leaves a whole
(plug sensor back in)
•Respiratory Alkalosis (over ventilating means the ventilator settings may be too
high)
•Respiratory Acidosis ( under ventilating means the ventilator settings may be too
low)
If pt is on vent and is respiratory acidosis, cannot come off bc he is under
ventilated on ventilator
If pt is on vent and is respiratory alkalosis, he can come off be he is being over
ventilated on the ventilator
NEVER pick an answer when you didn’t do something but someone else has to do
something
,ALCOHOLISM
psychodynamics
– #1 problem in alcoholism is denial
– denial allows abuser to keep doing it without having to answer for it
– #1 problem of ALL abusive problems is denial
– Denial: refusal to accept reality of a problem
– Treat denial by confrontation (point out the difference in what they say
they do) THIS IS CONFRONTATION
– ex. you say you’re not a alcoholic but it’s 6am and you already drank a 6
pack
– CONFRONTATION IS NOT AGGRESSION, AGGRESSION ATTACKS
PERSON, CONFRONTATION ATTACKS PROBLEM
– THEY DENY, YOU CONFRONT
– BUT denial is also a HEALTHY form of grieving & this denial gets support
not confrontation
– # 2 problem of abuse, dependence/codependency
– dependent is abuser
– codependence is when significant other derives positive self esteem from
doing things for abuser
– set limits and enforce them
– Teach them to say no in other words
– work on the self esteem of the codependent person
manipulation
– when the abuser gets the significant other to do things not in the best
interest of the other. The nature of the acts is harmful.
– like dependency bc the abuser gets the other to do things for them
– look at what they are being asked to do (if it is neutral it’s dependency/
codependency) if it’s harmful it’s manipulation
– ex. alcoholic asks 17y/o daughter to buy alcohol for her: manipulation
issue (it puts 17 y/o in harm)
– ex. 49 y/o alcoholic asks 50 y/o husband to go to store to buy alcohol for
her: dependency/codependency issue
– treat manipulation by setting limits and enforcing them, there is no
, –
positive self esteem issue like dependency/codependency
– if your patient is dependent you have 2 patient
– if you patient is a manipulator you have 1 patients
Wernicke-Korsakoff (alcohol)
– Wernicke: encephalopathy
– Korsakoffs: psychosis
#1 psychosis induced by vitamin B1 or thiamine deficiency
– Primary symptom: amnesia with confabulation (memory loss with making
up stories)
– they believe the stories, they think it’s true and don’t know it’s made up
– lose entire decades of memory, make up stories as to what they were
doing in the 90’s
– Treatment: do not confront them, redirect the patient
– don’t present reality, it’s pointless, they can’t learn it
characteristics:
– preventable (take vitamin B1, if they don’t have B1 alcohol goes to brain
and then kills brain cell)
– can stop progression by taking B1
– it is irreversible !
ON BOARDS ALWAYS ALSWER WITH THE MAJORITY
– if something is 70% fatal, then it IS fatal
Antabuse/ Disulfiram
– aversion therapy (strong hatred for something)
– goal is to get alcoholics to HATE alcohol
– works in theory better than it works in reality
– Onset: 2 weeks
– Duration: 2 weeks
– Stop taking Antabuse 2 weeks before drinking
– Teach patients to avoid ALL forms of alcohol such as: mouthwash, after
shave (even topically), perfumes and cologne, insect repellents, OTC that
ends in “elixir”, alcohol based hand sanitizers, uncooked icings (no baked
icings), vanilla extract
– RED WINE VINAIGRETTE DOES NOT HAVE ALCOHOL
OD & WITHDRAWAL
