ACID BASE BALANCE
1. Rule of B’s
a. If the pH and the Bicarb are Both in the same direction, then it is metabolic
2. Signs and Symptoms
a. As the pH goes, so goes my patient, except for potassium
i. as pH goes up, systems gets irritable
ii. as pH goes down, systems shut down
1. UP pH (Alka...
overventilating or underventilating if overventilating
pick alkalosis if underventilating
delirium tremens
Written for
NUR
All documents for this subject (951)
Seller
Follow
FLOYYD
Reviews received
Content preview
MARK KLIMEK AUDIO
TAPES
[Document subtitle]
[DATE]
[COMPANY NAME]
[Company address]
,Mark Klimek Audio Tape 1
ACID BASE BALANCE
1. Rule of B’s
a. If the pH and the Bicarb are Both in the same direction, then it
is metabolic
2. Signs and Symptoms
a. As the pH goes, so goes my patient, except for potassium
i. as pH goes up, systems gets irritable
ii. as pH goes down, systems shut down
1. UP pH (Alkalosis)
a. HTN
b. Tachycardia
c. Tachypnea
d. Seizures
e. Irritability
f. Spastic
g. Diarrhea
h. Borborygme
i. Hyperreflexia, (3,4)
j. Hypokalemia
2. DOWN pH (Acidosis)
a. Hypotension
b. Bradycardia
c. Constipation
d. Absent bowel sounds
e. Flaccid
f. Bradypnea
g. Hyperkalemia
h. Lethargy
i. Obtunded (one step down from lethargy)
j. Paralytic ileus
k. Coma
l. Respiratory arrest
b. MacKussmaul
i. The only acid base to cause Kussmaul respirations is
Metabolic Acidosis
1. Causes
a. First ask yourself, “Is it lung?” If yes, then it’s respiratory. Then
ask yourself: “Are they overventilating or underventilating. If
overventilating, pick alkalosis. If underventilating, pick acidosis.
b. If it is not lung, then it is metabolic. If the patient has prolonged
gastric vomiting or suction, pick alkalosis. For everything else
that
, isn’t lung, pick metabolic acidosis. When you don’t know what to
pick, choose metabolic acidosis.
VENTILATORS
1. High pressure alarms are triggered by increased resistance to air flow.
2. High pressure alarms are triggered by resistance to airflow and can be
caused by obstructions of 3 types: kinked tube, (unkink) action, water
in tube (empty) action, mucus in airway (turn, cough and deep
breathe) action. Lastly suction
3. Low pressure alarms are triggered by decrease resistance to airflow and
can be caused by disconnections of the tubing (reconnect it) or oxygen
sensor tube (reconnect it UNLESS tube is on the floor- bag them and
call RT if this happens) (black coated wirey tubing that piggy backs the
tubing, measure FiO2)
4. Respiratory alkalosis means the ventilator settings may be too high.
5. Respiratory acidosis means the ventilator settings may be too low.
6. What does “wean” mean? Gradually decrease with the goal of getting
off altogether
, Mark Klimek Audio Tape 2
ALCOHOLISM/ ABUSE
1. #1 Psychological problem is denial. (1 patient)
a. Denial is the refusal to accept the reality of their problem.
b. Treating denial: confront it by pointing out to the person the
difference between what they say and what they do. In
contrast, support the denial of loss and grief.
i. Abuse vs. Loss
ii. Denial and Loss and Greif Stages; DABDA
1. Denial- healthy normal 1st action therefore you support
2. Anger
3. Bargaining
4. Depression
5. Acceptance
c. When dealing with a psychodynamic problem between staff use the
word I not the word you. ex. I seem to be frustrating you vs. Why
do you not like me.
2. #2 Psychological problem is Dependency/ Codependency (2 patients)
a. Dependency: When the abuser gets the Significant Other to do things
for them or make decisions for them
b. Codependency: When the Significant Other derives positive
self- esteem from doing things for or making decisions for the
abuser
c. When treating dependency/codependency: Set limits and enforce
them. Agree in advance on what requests are allowed, then enforce
the agreement.
3. Manipulation: (1 patient) when the abuser gets the significant other to do
things for him/her that are not in the best interest of the significant
other. The nature of the act is harmful or dangerous to the significant
other.
a. Treating manipulation: set limits and enforce.
i. Easier to treat
4. Alcoholism
a. Wernicke’s (Korsakoff’s) Syndrome: psychosis induced by Vitamin
B1 (thiamine) deficiency
b. Primary symptoms of Wernicke’s (Korsakoff’s) Syndrome:
amnesia (memory loss) with confabulation (make up stuff)
c. Characteristics of Wernicke’s (Korsakoff’s) Syndrome
i. Preventable (take vitamin)
ii. Arrestable (take vitamin)
iii. Irreversible (kills brain cells)
d. Disulfaram (Antabuse/Revia) is aka Aversion Therapy
e. Onset and duration of effectiveness of Disulfaram (Antabuse/Revia):
2 weeks
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller FLOYYD. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $15.99. You're not tied to anything after your purchase.
