NCLEX MARK Lecture Notes and link

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Etsy:1NURSING NOTES101** DON'T MIX UP S4S and CAUSATION- often what cajses someth ng is tne opposite of the SAS- ex. diarrhea will cause a metabolc ac dosis but onceyou are ac dotic yourbowel shuts down and you get aparalytic illeus- when you get scenarios:-> if it's a lung scenario = respiratory- then check if the client is Dver-i/enf'afp(alkalosis)orunder- ventilating (acidosis)- remember to look at the words (ex. over, under,ventilating) -> "as the pH goes so goes my PT"-> VENTILATING DOESN'T MEAN RESPIRATORYRATE; rasp, rale is inetevsrrfw/ acid-base,ventilationhas to co with gas excharge not resp.'ate (look at tie SaO2 -> if your resp. rale is fastbut EaO2 is low you are under-ventilating)-> ex. PCA pump - What acid-base disorderind cates they reed to come off of it? = respiratoryac cosis (resp. depression -> resp. arrest)—> if its not lung, its metabolic• metabolic alkalosis - really only one scenario = ifthe PT has prolonged gastric vomiting/suctioning- because you arelosing ACID"ex. Gl surgery w/ NG tube with suctioning for3 days; hyperemesis graviderum- otherwise everything else that isn't lung youpickmetabolic acidosis (DEFAULT)" ex. hyperemesis graviderum w/dehydrationacute renal failure, infantile diarrhea. remember, you only have 4 to pick from:- respiratory alkalosis- respiratory acidosis- metabolic alkalosis- metabolic acidosisRb6‘sYJERt NOTON UM *NCiexU*LECTURE 1ACID BASES• learn how to convert lab values to words- the rule of theBs= if the pH and the BiCarb are both in the samedirection -> metabolicHint:draw arrows beside each to see directions’ down = ac/cfos/s* up =alkalosis- respiratory -> hasnob init;if in other directions(or if bicarb is normal value)KNOW NORMAL pH, BiCarb, CO2- Hint:DON'T MEMORIZE LISTS...know principles(they test knowledge of principles by having you■generate lists..) -for "select all" questions- ex. in general/principle what do opioids/painmeds do? = sedate you, CNS depressorsFex. what does di audid do?dori I memorizespecificso.ra fefof dtlaudid, know principles of opioids(suchas sedation, CHS deppessian -> l&lhargy, flacc dity,reflex +1, hypo-reflex ia, -Dblunded)- boards don't test by lists because all books/classes have different lists■principles ofS4S acid bases:asthe pH goes sogoes my patient (except K+)- pH up = PT up -> body system gets moreirritable, hyper-excitable (EXCEPT K+)-> alkalosis -think ot a body system and gohigh,hyper-reflexive (+3, +4 [2 is normal]},tachypnea, tachycardia, borborygmi, seizure- pH down = PT down -> body systems shutdown (EXCEPT K+l-> acidosis -thwikof a system and go Sow.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)- Mac Kussmaul -Kussmaul s (compensatoryrespiratory mechanism) is only present inonly1 ofthe 4 metabolic (acid-base) disordersTM = metabolicAC = acidosis■pay more attention tc themodifying phrasesthanthe original noun- ex. personw/OCD whoisnow psychotic (psychotictrumps OCD); hyperemesis with dehydration (payattention to dehydration}VENTILATION- ventilators -> knowalarm systems(you set it upsothat the machine does nt useless thanormore thanspecific amounts of pressure)a} high pressure alarm =increased resistanceto airflow (the machine has to push too hard toget air into lungs)- from obstructions:i. kinks in tubing (unkink it)ii.water condensation in tube (empty it!)iii. mucous secretionsinthe airway (changepositions/turn, C&DB, andTHENsuction)suction is only PRNJII-> priority questions = you would checkkinks first, suction is not first. most common mistake with se ect all questions=selectingone more than you should(stop when you select the onesyou know! don't get caught up on the "could he's”)• Hint:don't select noneoraflonselect all that applyquestions (never only one and never all)- Causes of Acid- Base Imbalance:- scenarios and what acid-base disorder wouldresuttfwhat would cause an imbalance}

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