MarkKlimekLectureNotes howtoremembers/sforpHimbalances-ANS-"asthepHgoes,sogoesmypatient....exceptpotassium" #1priorityforalkalosis&why-ANS-ptneedssuctioningbecauseofseizures #1priorityforacidosis&why-ANS-ptneedstobeventilatedwithambubagbcof respiratoryarrest whatacid-baseimbalancedoeskussmaulrespirationscause-ANS-metabolicacidosis
acid-baseimbalanceforover/underventilating-ANS-overventilating:respiratory
alkalosis
underventilating:respiratoryacidosis
acid-baseimbalanceforprolongedgastricvomitingorsuction-ANS-metabolicalkalosis reasonsforhighpressurealarmsonvent&whattodoforthem-ANS-1.kinks...unkink it 2.condensedwater...emptyit 3.mucusplugs...turn,cough,deepbreathe,orsuctionPRN reasonsforlowpressurealarmsonvent&whattodoforthem-ANS-1.maintubing disconnection...reconnectit 2.O2sensortubedisconnection...reconnectit *iftubingisonthefloor...bagptandcallrespiratorytherapist* whatacid-baseimbalancewouldtheptbeconsideredreadytobeweanedoffthevent &why-ANS-respiratoryalkalosisb/coverventilating #1psychologicalproblemforanyabusesituation-ANS-DENIAL whenisdenialok-ANS-withloss&grief stagesofgrief:(DABDA)denial,anger,bargaining,depression,acceptance 1 / 4
dependency,co-dependency,&manipulation(whattodoforeachofthem)-
ANS--dependency:abusergetsthesignificantothertodothingsormakedecisionsfor
them...CONFRONTTHEM
-co-dependency:whenthesignificantotherderivesself-esteemfordoingthingsor
makingdecisionsfortheabuser,howeverNOTharmful...SETLIMITS&ENFORCE THEM,sayno,workontheself-esteemofco-dependentperson
-manipulation:abusergetssignificantothertodothingsormakedecisionsthatareNOT
INTHEBESTINTERESTofthesignificantother,harmful&dangerous...SETLIMITS &ENFORCETHEM wernicke(korsakoff)syndrome..whatitis,s/s,whattodo,howtoprevent- ANS-psychosis-inducedencephalopathybyvitaminB1(thiamine)deficiencyfrom alcoholism
s/s:amnesia&confabulation
whattodo:REDIRECTthemwhenconfabulatingaboutsomethingthatisnottrue
howtoprevent:takevitaminB1
antabuseandrevia(disulfiram)-ANS-aversiontherapy(developmentofhatredfor alcohol)
onsetANDdurationofeffectiveness:2weeks
ptteaching:avoidallformsofalcoholtoavoidnausea,vomiting,anddeath(includes
mouthwash,cologne,perfume,aftershave,elixirOTCmeds,handsanitizer,insect repellant,vanillaextract...CANhaveredwinevinigarettes)
whataretheupper&downerdrugswiths/s-ANS-uppers:
-caffeine -cocaine
-LSD/PCP
-methamphetamines -adderall s/s:euphoria,seizures,restlessness,irritability,hyperreflexia(3+,4+),tachycardia, borborygmi,diarrhea 2 / 4
downers:
-over135others;ifit'snotanupper,it'sadowner
s/s:lethargic,respiratorydepression/arrest,constipated
highestpriorityinanuppervsdowner-ANS-upper:suctioningduetoseizures
downer:intubation/ventilationduetorespiratoryarrest
overdosevswithdrawalinanupperandadowner-ANS-overdoseonanupper:too
much
overdoseonadowner:toolittle
withdrawalonaupper:toolittle
withdrawalonadowner:toomuch
drugabuseinanewborn:intoxicationvswithdrawal-ANS-intoxicationinanewbornis
lessthan24hoursafterbirth withdrawalis24hoursormoreafterbirth
alcoholwithdrawalvsdeliriumtremens-ANS-alcoholwithdrawal:
-occursafter24hoursafterdrinking -nonlifethreateningtoselforothers -regulardiet -semiprivateroom,anywhereonunit -ptisupandabletomovearound -norestraints
deliriumtremens:
-occursafter72hoursafterdrinking -lifethreateningtoselforothers -NPOorclearliquiddiet -privateroom,nearnursingstation -restrictedbedrest -restraints(vestor2-pointlockletters) 3 / 4
whattogivetobothaptinalcoholwithdrawal&deliriumtremens-ANS-anti-HTN medication,tranquilizer,&multivitamincontainingB1 aminoglycosides-ANS-"meanoldmycins" -biggunsofABX -endinmycin(gentamycin,vancomycin,clindamycin,streptomycin)butNOTthedrugs endingin-thromycin -whattheytreat:TB,septicperitonitis,fulminatingpyelonephritis,septicshock,infection from3rddegreeburnwoundcovering>80%ofthebody -whattheydon'ttreat:sinusitis,otitismedia,bladderinfection,viralpharyngitis,&strep throat -toxiceffects:CN8toxicity(monitorhearing-#1,balance,tinnitus)&nephrotoxicity (monitorcreatinine) -givenIMorIVbecausePOisnotabsorbed.POonlygivenforhepaticencephalopathy (whenammonialevelsgettoohigh)orpre-opbowelsurgery(tosterilizethebowel)
-whichaminoglycosidessterilizethebowel:neomycin&kanamycin
-drawTAP(trough,administer,peak)onmycins whenaretroughandpeaklevelsdrawnofeachroute-ANS-*troughisalwaysdrawn30 minbeforenomattertheroute*
peaks:
SubL-5to10minutesafterthedrugisdissolved IV-15to30minutesafterthedrugisfinished(NOTwhenitshung) IM-30to60minutes SubQ-dependsoninsulin PO-notnecessary calciumchannelblockers-ANS--theyrelaxandslowdowntheheart -endsin-dipine+verapimilandcardizem(diltiazem)--continuousIVdripsotitrateto makesystolic>100...."dippinginthecalciumchannel"
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