Lecture Notes NCLEX

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LECTURE 1ACIDBASES- learn how to convert lab values to words- the rule of theB s= if the p H a n d the BiCarb are bothinthe samedirection - > m e t a b o l i cH i n t : draw arrows beside each to see directions* down =acidosis* up = afka/osis- respiratory - > has nobinit; ifin other directions(orifbicarb is normal value)- K N O W N O R M A L p H ,B i C a r b , C O 2. Hint:DON'T MEMORIZE LISTS...knowprinciples(they test knowledge of principles b y having yougenerate lists..) _fo r"select all" queBtiona- ex. in general/prindple what d o opioids/painmeds do? = sedate you, C N S depressors" ex. what coea dilaudid do? dorff memorize specificsor a list of dilaudid, know principles of opioids(suchas sedation, CNS depression -> lethargy, flacc dity,reflex +1, hypo-reflexia, obtundedj- boards dorit test b y lists because all books/classes have different lists* principles of S & Sa c i d b a s e s : a s thep H goes s ogoes m y patient (except K+)- p H u p = P T up - > body system gets moreirritable, hyper-excitable (EXCEPT K + )- > alkalosis -thrnk o fa body system and g ohigh:hyper-reflexive (+3, + 4 [2 i s normal]),tachypnea, tachycardia, borborygmi, seizure- p H down = P T down - > body systemsshutdown (EXCEPT K+)- > acidosis -ffi/nAcof a system and g o iow.hypo-reflexive (+1, 0). bradycardia, lethargy,obtunded, paralytic illeus, respiratory arrest. ex. which acid-base disorders need an ambu-bag atthe bedside? = acidosis(resp. arrest)- ex.which acid-base disorders need suction at thebedside? = alkalosis(seize and aspirate)- M a c Kussmaul -Kussmaul's (compensatoryrespiratory mechanism) is only present inonly 1ofthe 4 metabolic (add-base) disordersFM = metabolicA C = acidosis■most common mistake with se ect all questions =selectingone more than you should(stop when you select tne onesyou know! don't get caught up on the "could be's')■Hint:don't select rroneorail onselect all that applyquestions (never only one a n d never all).C a u s e s o f Acid-Base I m b a l a n c e :- scenarios and what acid-base disorder wouldrestrif {what would cause a n imbalance)** DON'T MIX U P S 4 S and CAUSATION- often what cajses aemelh ng is the opposite of the S&S- ex. diarrhea willcausea metabol c ac idosis but onceyou are ac dotic yourbowel shuts down and you get aparalytic illeus- when you get scenarios:- > if it's a l u n g scenario = respiratory- thencheck if the clientisover-venWatrng(atfcafosrs) o runder-ventilating (acidosis)- remember to look at the words (ex. over, under,ventilating) - > "as the p H goes s o gees m y PT"-> VENTILATING DOESNT MEAN RESPIRATORYRATE; resp. rate isirrelevsnfwlacid-base,ventilation has to co with gas excharge not resp.rate ( oak at t i e SaO2 -> il your resp. rate is fastbut SaO2 is low you are under-ventilating)-> ex. PCA pump - What acid-base disorderindicates they r e e d to come off of it? = respiratoryacidosis (resp. depression ->resp. arrest)—> if itsnot iung, i t s metabolic■metabolic alkalosis -really only one scenario = ifthe P T h a s prolonged gastric vomiting/suctio nin g- because you arelosing ACID1ex. G l surgery w f N G tube with suctioning for3 days; hyperemesis graviderum- o t h e r w i s eeverythinge l s ethat isn't lung youp i c kmetabolic acidosis (DEFAULT)* ex. hyperemesis graviderum w fdehydrationacute renal failure, infantile diarrhea- remember, you only have 4 to pick from:- respiratory alkalosis- respiratory acidosis- metabolic alkalosis- metabolic acidosis- pay more attention to the m o d i f y i n g p h r a s e s thanthe original noun- e x . person w / O C D who is now psychotic (psychotictrumps O C D ) ; hyperemesis with dehydration (payattention to dehydration)VENTILATION- ventilators - > ki'idvsysfe.ms(you set it up sothat the machine doesn t use /ess than ormore thanspecific amounts of pressure)a) h i g h p r e s s u r e a l a r m =increased resistanceto airflow (the machine has to push too hard toget air into lungs)- fromobstructions:i.kinksi n tubing (unkink it)ii.water condensation in tube (empty it!)iii. mucous secretions i n the airway (changepositions/turn C&DB,and THENsuction)suction is only PRNJI1- > priority questions = you would checkkinks first, suction is not first

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