NURSING NR 326 Mark Klimek Review (Recording 1)

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Recording 1: 1. Knowledge 2. Confidence 3. Skill- exam proficiency  “You can apply what you don’t know, you have to apply what you do know.”  Have to achieve a little less than averag... e on this test to pass.  Boards does not test your knowledge of lists, it tests your knowledge of principles. Acid/Base Balance:  Lab values  convert to words  ROME  If the pH and the bicarb are both in the same direction = metabolic  If they are in different directions = respiratory  pH= acidoic and alkalosis (7.35-7.45)  Bicarb (HCO3)= 22-26 (2+2+2=6)  Up and normal is not the same direction so it would still be respiratory  Principle: As the pH goes, so does my patient (when pH goes up, patient goes up & when pH goes down, patient gowns down) EXCEPT for potassium o Alkalosis- irritability, hyper-reflexes (3,4), tachypnea, tachycardia, borborygmi ileus (increased bowel sounds) o Acidosis- hyporeflexia, bradycardia, lethargy, obtunded, paralytic ileus, coma  What acid base imbalance patient needs an ambu bag at the bedside? Acidosisrespiratory distress  What acid base imbalance patient needs suction at the bedside? Alkalosis- bc they could seize and aspirate  Kussmual respirations- Mac Kussmual = metabolic acidosis  Adynamic= without movement Causes of acid/base imbalance:  What causes something is the opposite of what the signs and symptoms are.  Is it Lung? – Respiratory problem  Is the patient over ventilating (alkalosis) or under ventilating (acidosis)? o Vent= respiratory o Over= alkalosis o Under= acidosis  Ventilation= gas exchange (SaO2) NOT respiratory rate.  If it is NOT LUNG= metabolic  Metabolic alkalosis= prolonged gastric vomiting or suctioning (only things that are metabolic alkalosis) b/c you are loosing acid  For everything else, that isn’t lung or vomiting/suctioning pick metabolic acidosis.  IF YOU DON’T KNOW WHAT IT IS  METABOLC ACIDOSIS VENTILATORS:  Alarms o High pressure- triggered by increased resistance to airflow (machine is having to push to hard to get hair into the lungs).  Obstructions: (click & drag)  Kinks in tubing unkink the tubing  Water condensation empty the water  Mucous secretions in airway turn/cough/deep breath, then suction (ONLY SUCTION AS NEEDED) o Low pressure- triggered by decreased resistance to airflow (machine is saying “that was too easy”  Disconnections:  Disconnection of main tubing  reconnect  Oxygen sensor tubing  plug sensor back in  HOLD  Respiratory Alkalosis- over ventilating  ventilator setting may be too high  Respiratory Acidosis- under ventilating  ventilator settings are too low Recording 2: ALCOHOLISM Psychodynamics:  Number one problem in abuse is DENIAL o You can use the alcohol rule in any abuse o Number one bc you cant treat someone that denies they have a problem o Denial- refusal to accept reality of a problem o You treat denial by CONFRONTING it- difference between what they say and what they do (“you say you aren’t an alcoholic but you already drank a 6 pack and its 10 o clock in the morning”) o Aggression attacks the person, confrontation attacks the problem  ON BOARDS NEVER ATTACK PERSON o When confronting an issue with staff:  Good answer = “I”  Bad answer= “you”  Ex: NOT-“you wrote the order incorrectly” instead, “I am having a difficult time interpreting what you want”  DABDA- denial, anger, bargaining, depression, acceptance (stages of grief o Denial is healthy and normal in loss and grief o You don’t confront in this situation you support it  When you get a question about denial you have to determine if it is loss or abuse o Abuse- CONFRONT o Loss- SUPPORT  Number two problem in abuse: o Dependency- when abuser makes significant other do things for them or make decisions for them  Ex: “would you call my boss”  Abuser= dependent o Codependency- when significant other derives positive self esteem from making decisions for the abuser  Ex: “Aren’t I such a good spouse because I did that, cause I don’t know anyone else that would do it for that jerk” o How to treat it?  SET LIMITS AND ENFORCE THEM  say “NO” to those things that you are feeding into  Work on the self esteem for the codependent person  “I’m saying no, and I’m a good person because I’m saying NO”  MANIPULATION: when abuser gets significant other to do things for him/her when it is not in the best interest of the significant other o Nature of the act is dangerous or harmful o Different from dependency:  If what significant other is asked to do is neutral = dependency/codependency  Ex: 49 year old alcoholic asks 50 year old husband to go buy alcohol (not harmful for 50 year old man to go buy alcohol)  If what significant other is asked to do is harmful = manipulation  Ex: 49 year old alcoholic gets 17 year old daughter to go buy alcohol (dangerous b/c its illegal for 17 year old to buy alcohol) o How to treat?  SET LIMITS AND ENFORCE THEM  Its easier to treat b/c no one likes to be manipulated and there is no self esteem issue Alcoholism Terms:  Wernicke’s- encephalopathy  Korsakoffs- psychosis  Wernicke-Korsakoff- number one psychosis induced by vitamin B1 or thiamine deficiency (loose touch with reality, go insane, b/c you have a deficiency in B1) o Symptoms- amnesia (memory loss) with confabulation (making up stories) o REDIRECT- takes what he can’t do and rechannel to something he can do.  Ex: If he says he wants to go to Obama’s cabinet meeting  you redirect by saying “why don’t you take a shower and we will watch CNN to see what’s going on at the white house today.”  DON’T PRESENT REALITY- they cant learn reality o Characteristics:  Preventable- take vitamin B1  Stop it from getting worse by taking B1  Irreversible Drugs used to treat alcoholism:  Antabuse (Disulfiram) o Aversion therapy- develop a hatred for alcohol o Creates an unpleasant reaction to alcohol o Onset & duration- 2 weeks o Patient teaching- avoid all forms of alcohol including mouthwash, aftershave, perfume & cologne, insect repellents, any OC that ends in –elixir, alcohol based hand sanitizers, uncooked icings (vanilla extract), red wine vinaigrette Overdose/Withdrawal:  Every ABUSED drug is either an upper or a downer o First question- upper or a downer?  Uppers- caffeine, cocaine, PCP/LSD (hallucinogens), methamphetamines (crystal meth), Adderall  Signs and symptoms- things go “up”  euphoria, tachycardia, restlessness, irritability, diarrhea, borborygmi bowels, 3-4 reflexes, seizure (suction @ bedside)  Downers- everything that isn’t upper is a downer  Signs and symptoms- things go “down”  lethargic, respiratory arrest (ambu bag @ bedside) o Second Question- overdose or withdrawal?  Overdose/intoxication- too much  Withdrawal- not enough  If you don’t have enough upper makes everything go down  If you don’t have enough downer makes everything go up  UPPER OVERDOSE LOOKS LIKE DOWNER WITHDRAWL  DOWNER OVERDOSE LOOKS LIKE UPPER WITHDRAWL  Respiratory arrest/depression- downer overdose & upper withdrawal  Seizure- upper overdose, downer withdrawal  Number one most abused class of drug that is not an upper or downer  LAXATIVES in elderly Drug Addiction in Newborn:  ALWAYS assume intoxication NOT withdrawal at birth  After 24 hours assume withdrawal [Show More]

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