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NCLEX Acid Base Balance Ventilators - Document preview page 1

NCLEX Acid Base Balance Ventilators - Page 1

Document preview content for NCLEX Acid Base Balance Ventilators

NCLEX Acid Base Balance Ventilators

NCLEX study guide on acid-base balance and ventilator interpretation. Covers key lab values, metabolic vs. respiratory conditions, and opioid effects—designed to help nursing students master critical care concepts for NCLEX success.

Alice Edwards
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NCLEX Acid Base Balance Ventilators - Page 1 preview imageBEST,UPDATEDNCLEX STUDY GUIDEL E C T U R E N O T E STABLE OF CONTENTS - (2} STUDY GUIDESKeep Calm and Pass NCLEXw i t h BestlectureNotesReviewAnticholinergic vs.Cholinergic Effects
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NCLEX Acid Base Balance Ventilators - Page 2 preview imageKEEP CALMandPASS NCLEX1.Acid-base balanoe/ventilatoraRule of the Brs.. If the p H & the bicarb are both in the same direction = metabolicIf they are in different directions =respiratory7pH =7.35-7.45acidosis 'alkalosisHCO3 (bicarb) =22-26(2-2+2 = 6)CO2 =45"33ex:pH: 7.30 = jbicarb: 20 = 1 = metabolic acidosisex:pH: 7.58 = ‘bicarb: 32 = * = metabolic alkalosisex:pH: 7.22 =¥bicarb: 30 = f = respiratory acidosisex:You are providing care to a client with the following blood gas results: pH 7.32, CO2 49, HCO329. PO2 8 0 &SaO2 90%. Based on the results:the client is experiencing:I = acidosis,. 1 = respiratory-opioid: CNS depressant. know the symptoms (sedation, respiratory depression, etc)..♦principle: acid base signs/symptoms..
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NCLEX Acid Base Balance Ventilators - Page 3 preview imagea s the p H goes... s o goes m y patient!!!-when pH goes up: patient goes up.,(everything gets irritable!]-when pH goes down; patient goes down](systems in your body shut down). . . e x c e p t with potassium:when pffgoes up; potassium goes down... when pH goes down;potassium goesup!(up) alkalosis: irritibility. hyper-reflexia (3 & 4), tach}pnea:tachycardia,borborygnii(increased bowel sounds), seizure, aspirate..(down) acidosis: hypo-refleKia, bradycardia, lethergy (obtunded), paralytic ileus (decreasedbowel sounds): coma, respiratory arrest (ambu-bag!!)Kussmaul breathingis adeep and laboredbreathingpattern often associatedwithseveremetabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure...JIACKussmaul!!M :metabolicAC:acidosisex:pT hasrespiratory' acidosis...(select all that apply)..+1 reflexesdiarhheaadynamic ileusspasmurinary’ retentiontachycardiaand degree mobits type 2 heart blockhypokalemiaSATAquestions:*never only' 1... never all o f them*diarhhea uriWcausea metabolic acidosis., but once you get addodic,it will shut pour bowelsdown = paraipfic ileus...with scenarios., always ask first"is it lung?" = respiratory...then ask if the pt isover-ventilating o runder-ventilatingover-ventilating = alkalosisunder-ventilating = acidosis...it's about the SaOa!!! (pay attention!!)if it isn’t lung =metabolic.,if pt has prolonged gastricvomitingo r suctioning... it’s alwaysm e t a b o l i c aiitalosis...why? losing acid = becomes basic..for everything else that is not lung - choosemetabolic acidosis..-if you d e n t know the answer,., always answermetabolic acidosis..
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NCLEX Acid Base Balance Ventilators - Page 4 preview imageventilatorsalarms.. Sigh pressure alarm... triggered by increasure resistance to airflow., (machine ispushing too hard to get air into the lungs),respiratory alkalosis3 obstructions:kinkin tubing [get kink out),water condensing within the tube[emptytube),mucus secretions in the airway[turn, cough, deep breathe... then suction)., suctionas needed!! *in that order*...foujpressure alarm., decreased resistance (too easy for the machine..)respirator;7acidosisLow pressure alarms are triggered by decreased resistance to airflow & can becaused by disconnections of the main tubing or oxygen sensor tubing...Tubing(reconnect it!) - oxygen sensor tube (reconnect it UNLESS tube is o n tthe floor - bag them & call Respiratory therapist if this happens)Respiratoiy alkalosis = ventilator setting maybe too high.Respiratory acidosis = ventilator setting maybe too low.What does "wean" mean? gradually decrease with the goal of getting off altogetherex:Doc says wean off ’/ent in AM... bam AEG's showr e s p . acidosis...a)follow orderb)cal] respiratoryc)hold order., call docd)begintodecrease the settingsMASLOWsPriorities [HIGHest - LOWest)physiologicalsafetycomfortpsychological (problems withintheperson)social (problemswithother people)spiritualex:Arrange from HIGHest - LOWest...denial spiritual distress, pain in elbow, fall risk, pathological family dynamics & electrolyteimbalance...= electrolyte imbalance [psyiological), fall risk (safety), pain in elbow (comfort), denial(psychological), pathological family djuamics (social) & spiritual distress (spiritual)alcoholism., (or any abuse)# 1 problem = denial*refusalto accept the reality of a problem*You treat denial byconfronting it...
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NCLEX Acid Base Balance Ventilators - Page 5 preview imagepronouns ~good: i...bad: you...positions ~good: i'm having a difficult time reading this...bad: you wrote it wrong..loss &grief: Denial Anger Eargining Depression Acceptancedon't confront it; support it..ex:You have a pt that just hand a hand amputated & theresay, "I can't wait to get back to placing thepiano"... You say"Oh;how long have you played, etc? - youNEVERsay "You can t because youonly have i hand"abuse = confrontloss = support# 2 problem = dependency*when the abuser get the significant other to do something.. "Callmy boss, i'm sick"* (abuser gets to keep abusing..)= co-dependency*calls the boss*... (positive self esteem)How to treat this?!?Set limits and enforce them...Learn to sayNO!manipulation =when the abuser gets the significant other to do things for him or her... thenature of the act is dangerous or harmfulhow is it like dependency? the abuser is getting the other person to do somethingno harm =dependent / co-dependent(wife buying alcohol for husband)dangerous/harmful =manipulated(kid buying alcohol for father)...depends on legal/illegal.......Wernicke-Korsakoff Syndrome (WKS)is a neurological disorder. Wernicke'sEncephalopathyand KorsakoffsPsychosisare the acute andchronicphases:respectively,of the same disease. WKS is caused by a deficiency in ihe Bi uitamin thiamineThiamine (Ei)plays a role in metabolising glucose to produce energy for the brain.primary symptom of WKS= amnesia with confabulation(making up stories) *they believethe lie..*ex:You have a pt who believes he is Ronald Regan's Natioal Security Officer... And they want to goto a cabinet meeting... :/ WHAT DO YOU DO?!? Redirect!! ('well, why don’t you get a showerand then well go watch CNN and see what the news is in Washington D.C.")WKSis...-It's preventable &arrestable (stop it from getting worse) -Take vitamin B i-Irreversible... *About 70%*
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NCLEX Acid Base Balance Ventilators - Page 6 preview imageAntibuse (disulfiram)-alcoholism medication *aversion therapy!*It can treat problem drinking by creating an unpleasant reaction to alcohol. It's used in recoveryprograms that include medical supervision and counseling.How long does it take to pet info& outof their system...a iceeitsPatient teaching - teach how to avoid-VAUSEA. UOAflUNG & DEATHxVO;mouthwash; aftershaves:perfumes colognes, insect repellants, -elixer (Robitussin),alcohol-based hand santizers, un-cooked icings (vanilla extract)...Homeuer,they CAN have RED WINE MNAGERETTE!Oi'erdoses/Withdrawals...Everyabuseddrug is either anupperor adowner...♦Laxative (not upper or dovmer) but can be abused by the elderly..UPPERS: caffiene, cocaine, PCP/LSD, methaphetamines, adderall..Signs,'symptoms: things go up... euphoria; tachycardia, restlessness, irritibility, diarhhea,re/Zex3/4,spastic - suction!!’DOWNERS: heroin, alcohol, marijuana, etc.Sign/symptoms: things go „ - lethargic, respiratory depression, bradycardia; reflex 1/2, -ambubag!!!2 steps...Step 1: ask yourself, is it anUpper o r DounerStep2:ask yourself,is i:anOverdose(too much) orWithdrawal(not enough)If they say: "overdosed on an upper" (too much upper)... picktilings!!If they say: "downer & intoxication" (too much DOWNER)... pick . things!!If they say: "withdrawal downer" (don’t have enough downer too little!)Toolittle downer makes everythingg o up..Too little upper makes everythingg o d o w n . .Upper overdose LOOKS LIKE downer withdrawal...Downer overdose LOOKS LIKE upper withdrawal...2 situtions (highest priority') =Respiratory depression/nrrestDowner overdose/upper withdrawal..Seizure:Upper overdose/ downer withdrawal...
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NCLEX Acid Base Balance Ventilators - Page 7 preview imageex:Overdose on cocaine: UPPER/OVERDOSE.. (too much UPPER) *aka everything goes •*What would you expect to see? (select all that apply)-im'tabilifg.reflex 3/4, increased temp, borborygmi (increased bowel sounds)Withdrawing from cocaine.. -Mate surethe RRisabove 12! NeedNARCAN!!!Drug addiction in the NEWBORN fronufaceAlways assume intoxication, not withdrawal a t birth..After 24 hours - it's in withdrawal..You are caring for an infant born to a equaline (pain killer) addicted mother...Itis 24 hoursafter the birth... What do you expect to see.. SELECTALLTHATAPPLY:difficulttoconsole,low core body temp,exaggerated startle reflex,respiratory depression;seizure risk, shrillhigh pitchcry...alcohol withdrawls = 24 (stable; not life threatening) *AWS*delirium tremens = 72 hours (unstable; can kill you) *DTS*AWS:regular diet, semi-private anywhere.u p a d lib. n o restraints..PTS:NPO/clear liquid (seizure), private/nearnurse s station, restricted bed rest(bedpans/urinals).restrained (VEST o r 2 point locked leathers *1 a r r n & oppositeleg*)...xWS& DTS get aanti-hypertensive (B? pill) - everything is going up - keep everything down...They both get a tranquilizer.; because their up... multivitamin *bi* to prevent WKS.DRUGS :aminoglyco cides - powerful antibiotics (theBIG GUNS!!.!)think:a m e a n old rnycin=serious.; life threatening.; resistent, gram negative(TB.etc.)... if itends in mycin = mean old mycin♦not mean old mycins: erythro mycin, zithromycin:clarithromycin (thro)if it has thro = throw i t off the list...toxic effects:mycin = mice (ears)... oto- toxic!! -monitorhearing, tinnitus,vertigo (equalibrium)human ear shaped Eke kidney...nephro-toxicity!-monitor creatinine (best indicator forkidney function)... 8 (fits in a kidney) toxic to cranial # S and you administer them Q8H... route:IM or IV.. do not give PO, because they are not absorbed..OPAL mycins:hepatic c o m a(liver coma) amonia level gets too high.,pre-op b o w e l surgery7(toclean the bowel)...action: sterilize the bowel... which?!neomgcin a n d canomgcin" Who can sterilizem y bowel?! NEO KAN!!.1" @T:trough:when the drug is at its lowest...A:adminsterP:peak:when the drug is at its highest...Why do we doaTAP?!(narrow therapeutic window)what works/what kills.
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NCLEX Acid Base Balance Ventilators - Page 8 preview imageLasiks: 10-120 (wide)Dig: 0.125-0.25 (narrow7) DO a TAP!IV push..TROUGH: b4 sub:5 0 mins., bit1: 5 0 mtns..k j IM: 3 0mins... 6 4 subQ:3 0mins., b j POr3 0mins..PEAK; after sub?3-10mins.,afteriu: 25-30 mins.. after IM; 30-60 mins... after subQ; SEEDiabetes lecture..after PO: DON'T WORRY ABOUT IT..Calcium Channel Blockers:are Eke VALIUM for yourV !!!...calms you down., calms the heart down!negative inotropic, negative chronotropic negative dromotropic = calm/relax... cardiacdepressant-what d o they treat: antihvpertensives;anti-angina, anti-atrial-aarrhi,thmianS\T (atrial)Side effects: HA, HTNName:ends i n -dapine... + Cardizem A- Vernpimii..Cardizem (can be continous IV)-Check BP: HoldCCE if SYSTOLIC is<i o o !Cardiac Arrthymias - knowing how7to read EKG strips...Know thesep a tterns I!1)normal sinus rhythm2 ) v-fib (no pattern)3 )v-tach (there's a pattern)4 ) asystole
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NCLEX Acid Base Balance Ventilators - Page 9 preview imagea flutterQ P Sde-polarization =ventricularP wave = a t r i a l6 rhythms...-a lack of QRS's = asystole-saw tooth = a flutter-chaotic= atriai/fbrilation-chaotic = ventricular fibrillation-QRS = ventriculartachycardia (bizzarre)-periodicbizarre wide QRS = PVC {law priority... can elevate to moderate: if there are morethan 6/min.. or more than 6 PVC's in a row., or if the PVC falls a n the T v.'ave of the previousbeat) PVC’s never reach HIGH..LETHAL arrhytmias..{they will kill you i n 8 minutes o r less)-nsystate(HIGH)
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NCLEX Acid Base Balance Ventilators - Page 10 preview image-ufib (HIGH)...have in common: NO cardiac output (pulse).. NO brain perfusion.♦Potentially* LIFE threateningv-tach... (they have a cardiac output)TREATMENTS...PVCs/V-TACH: Ventricular...A (arnioderone)Atrial: ABCD'sadenocard (adenosine)',push in <8 seconds... *asystole for about 3 0 seconds!*betablockers(side effects: HA/HTN) *no asthma!*calcium channelblockers...digitalis(digoxin, lanoxin)V-FIB: you D-FIB... Shock them!Asystole: EPI & atropine..CHEST TUBES-purpose: re-establish negative pressure in the pleural space (need negative pressure for airexchange)♦Lootfor the reason w h y itw a splaced!*pnemothorax(air = positive pressure., put chest tube in to re-establish negative pressure!)hemothorax(blood= positive pressure., put chest tube in to re-establish negative pressure!)pneumohemo(air & blood = positive pressure., put chest tube in to re-establish negativepressure?)...what do you expect from a hemo chest tube: drain blood...LOCATION of the tube.. APICAL (high.: air) & BASILAR (bottom; blood)example: unilateral pneumohemo.. apical for pneumo & basilar for h e m obilateral p n e u m o : 2 apicalschest trauma:unilateral (always assume its unilateral)post o p R pneumonectomy ( n o chest tube!!)TROUBLE SHOOTING:Knocked it over... DON’T freak out!Water seal breaks...?CLAMPIT!!! (so nothing gets in)..CUTIT AWAY FROM BROKENDEUCE...SUBMERGETUBE UNDER STERILE WATER!!!UNCLAMP IT...FIRST: CLAMPBEST: SL7BMERGE(re-establishes water seal)KNOW FIRST vs BEST...V-Fib.. BAD!FIRST: place backboard..BEST: chest compressions..What do you do if the chest tube gets pulled out?FIRST:takes a gloved hand and cover the hole..BEST:cover it with vaseline gauze!!
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NCLEX Acid Base Balance Ventilators - Page 11 preview imageBUBBLING (chest tubes)A sJ:where & when......Sometimes bubbline is good & sometimes it's bad - depends o n where &when!Bubbling, bubbling: bubbling... Where? Water seal.. When? Intermittent = GOOD! Documentthat!Bubbling, bubbling.: bubbling... Where? Water seal... When? Continous = BAD!= LEAK...You do not want continous bubbling in the water seal.Bubbling, bubbling: bubbling... Where? Suction control chamber.. When? Intermittent = BAD...Suction is not high enoughBubbling, bubbling; bubbling... Where? Suction control chamber.. When? Continous = GOOD..Document that!*If something is sealed, should you have a continous bubbling?NO.straightcath is to a foley catheter a s a thoracentesis is to a chest tube..Rules for clamping a tube:doNOTclamplonger than 15 secondswithout a doctor sorder... What happens if you break the water seal? CLAMPit! How long do you have to get itunder water? 15 seconds, or you gotta unclamp.. Ha\e sterile water bottles nearby! Userubbertipdouble clamps...CONGENITAL HEART DEFECTS(trouble or no trouble; either causes a lot of problems orit's nobig deal atall - thereis no in between)TRouBLeTrouble defect shunts blood: RIGHT to LEFT (cyanotic); needs surgery delayed growth,decreased life expectancy, needs more time in the hospital/pediatric cardiologistNO-trouble defect shunts blood: LEFT to RIGHT (pink); doesn't need surgery, normal growth,normal life expectancy, only 24-36 hours in the hospital/ pediatrician ,'NP..40 some congential heart defects..TROUBLE:.Ml start with the letter"T";ifitdoes not start with a'T"; it'snot trouble.TROUBLE:tetrology of faUot, truncus arteriosus, transposition on the great vessels,transposition on the great arteries, tricuspid atresia, total anomalous pulmonary venous return(TAPV), left ventricular hypoplastic syndrome...N O TROL?B££:ventricular septal defect, patent ductus arteriosis, patent foramen o ’ale, atrialseptal defect, pulmonic stenosis.....ALLcongenital heart defect kids (whther trouble or not} will have 2 things in common: theywillall have a murmur(because the shunt of the blood) &they all have a nECHO done.
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NCLEX Acid Base Balance Ventilators - Page 12 preview image4 defects oftetralogyoffallot- VD (ventricular defect)- PS (pulmonary stenosis)- OA (over-riding aorta)- RH (right hypertrophy)VarieD PicturesOf ARancH (initials)INFECTIOUS DISEASE & TRANSMISSION BASED PRECAUTIONS4 types...STANDARD/ UNIVERSAL:CONTACT:for anything enteric (fecal.''oral): c-diff, hepa,cholera, staph infections, RSV(however it is transmitted via droplet), herpes.. PRIVATE ROOMIS PREFERRED.. GLOSES.GOWN, HAND WASHING, DISPOSABLE SUPPLIES..DROPLET1,bugs that travel (sneezing 'coughing): menegitis, hflu (causes epiglotitis)...PRIVATE ROOM I S PREFERRED. MASK, GLOVES, HAND WASHING, PATIENT WEARINGMASK- WHENLEAVING ROOM, DISPOSABLE SUPPLIES..AIRBORNE:measles, mumps, rhubella. TB & varicella chickenpox.. PRIVATE ROOMREQUIRED, MASK, GLOVES, HAND HASHING, SPECIAL FILTER MASK (onfyfor TB),PATIENT WEARING MASK- IFLEAVI-VG ROOM, NEGATIVE AIR FLOW.TB: (transmitted through droplet though)..PPE: Order to put on."'take off...TAKE OFF: in ABCorder...gloves,goggles, gown,mask!PUT ON: reverse ABC for the Gs, but mask comes 2nd.,gown, mask,goggles,gloves!MATHIV’DRIP RATES... volume x drop factor / time in minutes (volume,' hours)micro drips: 6 0 drop.''mlmacro drips: 10 drops 'mlPEDLA.TRIC DOSEchilds weight... 2.2 lbs/kg...IV REPLACEMENT...AlwaysROUND at the END!’[(NCLEX will tell you to where)
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NCLEX Acid Base Balance Ventilators - Page 13 preview image4-CRUTCHES, CANES. WALKERSLocomotion (human functioning): cast, traction, canes, crutches, walkers...CRUTCHES :how do you measure? (for risk reduction: nerve damange)...Length of crutch: 2-3 finger widths below the anterior axillary fold to a point lateral to andslightly in front of the foot.. Hand grip: when properly set, the elbox flexion will be about 30degrees..-How to teach how to use the different bpe of crutch GATES: 2 point, 3 point, 4 point &swingthrough...2 point: 1 crutch,'opposite foot., other crutch,.'other foot..3 point: moving 2 crutches & the bad leg...4 point: move everything separately...Swing through: NON-weight bearing.. *amputations* plant the crutches & swing through...WHEN DO THEY USE THESE...?? Even/or euen; odd/or odd = use the ex'en # of gates whenthe weakness is evenly distributed... Use 2 point (mild), 4 point (severe)., use odd # gate (3),when 1 leg is odd., can't bear weight/amputation = swing through!early stages of RA: 2left above knee amptuee: swing through1st day post op R knee replacement; partial weightbearing allowed: 3advanced stages: 4left hip replacement; 2nd day post op non weight bearing: swing throughbilateral knee replacement: 4bilateral total knee; 3 weeks post op: 2Going up and downstairs with crutches:UP with the GOOD, DOWN with the BAD!CANES :Hoid the cone on thestrongside...WALKERS:Picfc them up, set them doum... If they must tie belongings to the walker; havethem tie if to the side & not the front (can tip over);n o wheels,, tennisballs(per boards!)DELUSIONS, HALLUCINATIONS & ILLUSIONS:*PSYCH*Is my patientNON-pspchotic rs. psychotic?(1st thing you must decide)N O N psychotic(neurotic): has insight and reality based; they know they have a problem...they need "good general therapuetic communication"; that must be uery dgjfaidt, hoio are you/eeiing; iohat do you mean by, can you teil me more?psychotic:has NO insight & is not reality-based; they don't have a problem/they aren't sick;,they blame everyone else... "unique specific strategies"SYMPTOMS:delusions, hallucinations & illusions...delusion = a false fixed idea or belief; there is no sensory component.3 types:paranoid, grandiose(you're christ) &somatic(x-ray vision)hallucination = false fixed sensory (hear, feel, taste, smell, see)
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NCLEX Acid Base Balance Ventilators - Page 14 preview imagemost common hallucination =tmdifori/..then visual... then tactile [feeling), gustatory (taste)..olfactory [smell]most common auditory = voices telling you to harm yourself.illusion = misinterpretation of reality., (sensory) *there is a referent in reality*(something to which a person refers)HOW DO YOU DEALWITH THESE PATIENTS?!?If, psychotic - what is their problem? (What kind of psychosis do they have?)FUNCTIONALpsychosis: they can function in every day life (schizophrenia;schizoaffective disorder,majordepression,manic)DEMENTIA:the brain is damaged (senile, alzheimers, organic brain syndrome)DELIRIUM:FUNCTIONAL: this person has the potential to learn reality/ improve.. Teach reality... Use 4step process., acknowledge feeling, present reality, set a limit, enforce the limit..Example (answer): FEELING:Isee you're angry; you seem upset tell me more of how you'refeeling... REALITY:Iknow thatthevoices are real to you, but they are not real... I'm a nurse,this is a hospital... SET LIMIT: That topic is off limits in our converstion.. We aren't going to talkabout that.. ENFORCE LIMIT:Isee you are too ill to stay reality based, so our conversation isover (it ends the conversation).DEMENTLA: this person canNOTlearn reality... 2 steps: acknowledge feeling & redirect them(channel them from something they can't do to something they can do)... REALITYORIENTATION: person, place & time (always appropriate)... but DON'T present reality...DELIRIUM: this is atemporarysudden dramatic secondary loss of realty-... usually due tosome kind of chemical imbalance in the body.. (*crazyfor the short term; ex: AT. on Feb. 3rdF * , UTI, post-anesthesia, thyroid storm, adrenal crisis, delirium tremens)... REMOVE theunderlying cause = 2 steps:tfte/eelin<j &then reassure(this is temporaryand you will be kept safe).LOOSELYASSCOCLATED = YOURTHOUGHTS xARE ALL OVERTHE PLACE...flight 0 / ideas: gofrom thought to thought to thought...Word salad: babble random words (sicker)Neologism: making up wordsNarrowed self concept: when a (functional)psychoticrefuses to leave their room or changetheir clothes... NURSE would say: "I see you feel uncomfortable.. You do not have to changeyour clothes or leave the room until you feel comfortable or are ready."Ideas of reference: when you think everyone is talking about you...5-DIABETES INSIPIDUS: polyuria & polydipsia leading to dehydration, due to loWxADH.SLADH: oliguria (low urine output) and retaining water (gains weight)DLABETES (mellitus)
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NCLEX Acid Base Balance Ventilators - Page 15 preview imageDiabetes = error of glucose metabolism,polyuria, polydipsiathe less theurine out; the higher the speci/tc gravity...the morethe urine out; the lower the specific gravity...Type i: insuEn dependent, ketosis prone...Type 2: non-insuEn dependent, non-ketosis prone...polyuria (increased urine), polydipsia (increased thirst), polyphagia (increased eating)TREATMENTType i: DIE... diet, insulin, exerciseType 2: DOA... diet, oral hypoglycemic, activityDIET. INSULIN & EXERCISEType 2: calorie restriction, 6 smallmeals...What does insulin do to the blood glucose? LOWERS it?EUTOGLI'CEJlfLA = PEAK...4 types...Regular ( R):onset: 1 hr,,peak: 2 hrs.,duration:4 hrs. clear solution (can be IV drip) *rapidshort acting* RAPID & RUNLantus (Glargine):onset: 1 hr..peak: NONE..duration:12-24LITTLEto NO RISKfor HYPOGLYCEMIA*(can SAFELY give at BEDTIME) *LONG acting*NPH:intermediate acting* onset:6 hrs.,peak: 8-10 hrs.,duration: 12 hrs. cloudy.,suspension *NEVERput anything in an IV bag!* NOT so fast & NOT in the bagHumalog (Lispro):onset: 15 mins.,p e a k :3 0 mins.,duration: 3 hrs. *gtve it WITHMEALS!*.ALIVAIS check expiration dates!!(manufacturer's expiration date is only good when thebottle is closed... after it s open; it expires in 30 days!) *make sure you write the date on thebottle with EXP!*You should teach patients to refridgerate their insulin at home, but it doesn't need to berefridgerated in the hospital....EXERCISE (like another shot of insulin)ex: "and he exercised...’ aka "and he got another shot of insulin".she's going to playsoccer this afternoon"., "she's going to get a shot of insulin this afternoon!"more exercise (more insulin) = really need less insuEnless exercise = need more insuEn
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NCLEX Acid Base Balance Ventilators - Page 16 preview imageSICK days: glucose is going to go up.,still take insulin. even if they're not eating.,takesips of water; they get dehydrated fast. (HYPERGLYCEMIA & DEHYDRATION).. needs tostay active as possible.COMPLICATIONS of diabetes (mellitus)Acute-low blood glucose (tr;<pe i/type2) HYPOGLYCEMIA.. not enough food,too muchinsulin/meds,too much exercise., danger = brain damage (permanent).. S/S:drunk i nshock = staggerin' gait, slurred speech, impaired judgement, delayed reaction time, labile(emotions all over the place), loud/obnoxious.. (vasomotor) low BP;tachycardia, tachpnea, cold,pale, clammy, mottled.. WHAT DO YOU DO?! adminster rapidly metabolizable carbohydrates(sugars):, any juice, candy, milk, honey;icing, jam... ideal combo = sugar plus a starch orprotein.. ORANGE juice & crackers! apple juice & slice of turkey... 1/2 cup skim milk (has bothsugars & protein), if UNCONSCIOUS, give GLUCAGON; IM injection.. DEXTROSE D10/D50;given IV..-DKA(diabetic ketoacidosis/diabetic coma) *only type is*... glucose goes HIGH., too muchfood, not enough medication, not enough exercise..# 1 cause = acute viral upperrespiratory infections (in the last 2 weeks)..So,.iL'ften tftey come info the hospfiaZ& iftefr BS is8 5 0tALlVAlSasJtthe parents "have they had aviral infectioni nthe l a s t s weeks!!!*S/'S: DKA = de.cycrGtion,ketones in their blood/kussmaul breathing (deep & rapid)/K (high)potassium, acidosis (metabolic)/acetone breath, anorexia due tonausea..1VHAT DO YOUDO!?!HYDRATE!! (IVfluids; fast!! 200ml.'hour: regular insulin; normal saline/Dg?) D5doesn't stay in ’reins; goes into the tissues., won't cause HYPERGLYCEMIA (Dio & D50 will!)hyperglycemic hyperosmolar nonketotic coma HHZVK(type 2) = DEHYDRATION... HYDRATEthem!!!!insulin is most essential i n treating DKA!!!higher mortality rate =HHNK,however DKAhas higher priority.♦♦long term complications of diabetes are related to:poor tissue perfusion & peripheralneuropathy...♦lab test: Aic (average glucose rate over 3 months)...you want it to be 6 & <!!7 = need to check on it8 & > = out of control
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NCLEX Acid Base Balance Ventilators - Page 17 preview image6.DRUG TONICITIES[5)Lithium:ANTImania drug for EiPolar..Therapuetic level: o.6-1.2Toxic level: 2 & >Lanoxin (Digoxin) : A-Fib & CHFTherapuetic level: 1-2... 2 can be toxic!Toxic level: 2 & >AminophjdlLne:Airway Anti-Spasmodic*NOTa bronchodilator* (whenabronchodilatordoesn't work in an acute airway problem, give them aminophylline to relax the spasm: then givethe bronchodilator).Therapuetic level: 10-20... 20 can be toxic!Toxic level: 20 & >Dilantin:Used for SeizuresTherapuetic level: 10-20... 20 can be toxic!Toxic level: 20 & >Bilirubin:Waste product from the breakdown of RBCs(only tested in NEWBORNSon the NCLEX)Normal: 9.9 and <Elevated level: 10-20... 20 can be toxic!14-15 *is when they need to be hospitalized*Toxic level: 20 & >Jaundice:yellowing; bilirubin in the skinKernicterusbilirubin the the brain... usually occurs when the level gets around 20..Opisthotonus:a position the baby assumes when they have bilirubin on the brain;HPPERENTEND.. In what position do you place an opisthotonic child?O n their side!DUMPING SYNDROME vs. HLATAL HERNLAHiatal hernia:regurgitation of acid into the esophagus.; because the upper part of yourstomach herniates upward through the diaphragm... *moves in thewrong directioninthecorrect rate*(you want it to empty faster; so it doesn't reflux)S/S:GERD(heartbum & indegestion) *when lying down after eating*Treatment: pZau around luith the headofthe bed (raise); pZau around u.'ith water content juiththe meat(flushfaster) &pou can pZay around iuith the carbohydrate contentof the meal (carbsgo fast)... LOW protein!!Dumping syndrome:gastric contents dump too quickly into the duodenum... hnoves in theright direction,but at thewrong rate *(you 5vant it to empty slower)S/S: *DRUNK*(staggering gait, slurred speech, impaired judgement) &*SHOCK*(tachycardia, tachypnea, cold, daunny, pale) DRUNK + SHOCK =HYPOGLYCEMLA*ACUTE ABDOMINAL DISTRESS*(cramping, pain, doubling over, borborygmi increasedbowel sounds*, diarhhea, bloating; distension)
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NCLEX Acid Base Balance Ventilators - Page 18 preview imageTreatment1Eat with head low & fumed to ffte side, lowfluids with meal and low carb contentin the meals, HIGH protein'!ELECTROLYTESKalerniasd o the SAME AS the prefix, except for heart rate & urine output!!S/S...HYPERkalemia:brain: irritability, restlessness, agitation,,.lungs: tychpneaheart: low heart rateurine: oliguriabo5vel: diarhhea, borborygmimuscles: spasticityreflexes:+3/+4HYPOkalemia:brain: lethergylungs: bradypneaheart: tachycardiaurine: polyuriabowel: constipationmuscles: flaccidityreflexes: 1/2-Cushingsimmonosuppressed (needs PRIVATE room) (aldosterone; retain sodium & water;low on potassium)ex:SATA: HYPERkalemia-c/onus (musclespasm). bradycardiaCalcemias do the OPPOSITE AS the prefix...(if it skeleton or nerve, blame it o n calcium!)S/S...HYPERcalemia:brain: lethergylungs: bradypneaheart: bradycardiaurine: oliguriabowel: constipationmuscles: flaccidityreflexes: 1/2HYPOcalemia:brain: irritability, restlessness, agitation...lungs: tachypneaheart: tachycardiaurine: polyuriabowel: diarhhea
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NCLEX Acid Base Balance Ventilators - Page 19 preview imagemuscles: spasmsreflexes: -+3/+4Chvostek sign: when youtouch their CHEEK, they go into a spasm of the face (neuromuscularirritability associated with a LOW calcium}Trousseau sign:when you put a blood pressure cuff on, blow it up & they go intoaspasm o fthe hand.Afagnesiums d othe OPPOSITE A S the prefix...(in a tie, DON’T pick magnesium!)S/S...HYPERmagnesium:brain: lethergylungs: bradypneaheart: bradycardiaurine: oliguriabowel: constipationmuscles: flaccidityreflexes:1/2HYPOmagnesium:brain: irritability restlessness, agitation...lungs: tachypneaheart: tachycardiaurine: polyuriabowel: diarhheamuscles: spasmsreflexes: +3/+4SodiumsS/S...HYPERnatremia: DEHYDRATION*DKA*DI... HHNK?HYPOnatremia: OVERLOAD*Fluid volume excess* SIADHNUMBNESS & TINGLING(paresthesia) =Earnest signof any electrolyte disorder"circumoral=n u m b & tingling lipsUNIVERSALsign of any electrolyte disorder =MUSCLE weakness (paresis)TREATMENT: (boards should only test potassium)H I G H potassium fwiZIstop your heart)Rules for Potassium:NEVER push IV!-NEVER more than 4 0 o f K per liter o f I V fluid. If morethan 40, question &clarifywithDOCfirst!-HIGH POTASSIUM = worst electrolyteimbalance! *can STOPheart!*
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NCLEX Acid Base Balance Ventilators - Page 20 preview imageSo,howdo we lower potassium?!?!Gire D $ W wifhREGULAR insulin (drive potassiuminto the cell & o u t of the blood) *temporary/fast*!!! "enters early"-Kayexalate "K exits late” (switch the potassium with soldium) *permanent/ilow*So... *Give bothD 5 W w /REG insulin & kayexala te!*...*switching from a life threateningimbalance (HTPERkalemia) for a non-life threatening imbalance (HYPERnatremia): justhydrate!!* @60 drops.'ml *remember!!*ENDOCRINE OverviewHYPERthvroidism:thyroidsim' = "metabolism", because that is what the thyroid does, soHYPERtluroidism = HYPERmetabolismS/S: weightloss, high pulse & BP- irritable, heat intolerance, cold tolerance, exophthalmos(bulging eyes)..GRAVESdisease (running yourself into the grave)Treatments:-radioactive iodine... KNOW:patient needs tob eby themself for 24 hours (restriction ofvisitors).. and then be really carefiil with their urine(flush 3 times!)If the urine is spilled, theymust call thehazmatteam !!Only RISK to the Nurse is the patient's urine (how theradioactivity is excreted!)-PTU(propylthiouracil): *Puts Thyroid Under* ...CANCER drug! KNOW: that it is anIMAILWOsuppressor;monitor WBCs!!-thyroidectomy(most common way used!) "TOTAL (complete) or SUBTOTAL (partial)tyroidectomy*-TOTAL:need lifelong hormone replacements., at risk now for JfliPOcaicemzQ!-SUBTOTAL:do NOT need lifelong hormone replacements., at risk now forH f FROIDSrORAf/CRISISTHYROID Storm = medical EMERGENCY(can cause ERAIN damage!!!)"basically frying your brain t o death, with HYPOXLA!*S/S:super H I G H temps(105 & >);extremely HIGH E P s*ex: 210/18o (strokecategory!)*,severe TACHYCARDLAfex:180-200) &PSYCHOTIC DELIRIUMTreatment:Get temperature D O W N & get the oxygen UP!! "FIRSTivap-to get tempdown: ice packs.. BEST way to get temp down: coolingslantet...OXYGEN(permask @ioL)!!E D O NOT USE TYLENOL -it works inthehypothalamus and isn't going to work atthistime..FYI: Ifit'sa sequence question: oxygen, ice packs, cooling blanket..NEVER. EVERleavepatient!PostOP RISKS:(1st 12 hours): priority = airway & hemmorha e.. (same for both!)(12-48 hours): TOTAL: Tetany (muscular spasms in laraynx: can cut off airway) due to lowcalcium.. SUBTOTAL: ThyroidSTORM!
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NCLEX Acid Base Balance Ventilators - Page 21 preview image(>48 hours *42-72*): IxVFECITONFYI for INFECTION: NEVER choose infection as a PRIORITY in thej'irst7 2 hoarsforanything!!! ONLY CHOOSEit q/?erthe first7 2 hours!!!HTTPthyroidism: "thyroidsim" = "metabolism"., because that is what the thyroid does, soHYPOtiriToidism = HYPOmetabolismS/S: obese, cold intolerance, heat tolerance, low pulse & BP =AfYYedemaTreatment: give them thyroid hormones: synthroid (levothyroxine)♦CAUTION!!*do NOT sedate these patients: can put themin acoma-iVhat pre-op order would you question?AM BIEN(5H SIf the patient is supposedtobe NPO; make sure you question that they still get their morningpill!! (they NEED it! NEVER hold your thyroid pills unless you have EXPRESS orders to do so).ADREAOCORIEADisease(start with A & C)ex: Cushings,Conns,Addisons..ADDISONS-.UNDERsecretion of the adrenocortexS/S :rfYPERpigmented(tan!) &do NOTadapt to stress(your stress response is to raise yourglucose & BP!) -these people can't do this; glucose & EP goes down = go into shock! Anythingfrom a tooth filling at the dentist or a minor fender bender can cause these., people to stress out& die.. TICKING TIMEBOMB!♦ADDISONS is one o f the RAREST endocrine disorders*ex: for every 600 CUSHINGSpatients, there's 1ADDISONS patients.. *JFKhad this dx; so when he was shot (even if it was inhis shoulder & not his skull), there was never any chance for sumval*Treatment:glucocorticoids(steroids; all e n d i n 'sone’ex: prednisone, dexamethasone &hydrocortisone.. Remember:ADDISONS "ADD a SONE"!!CUSHINGS: OVERsecretion oftheadrenocortex (cushy = more!)S/S:pu#p- mocm/ace, fttrsutism(facial hair), trunkal obesity (big body), gynecomastia(female breats on men), buffalo hump, skinny arm &legs (muscles waste away), retain sodium&water; losing potassium, striae (stretch marks), bruising.("I'm mad; I have an infection";grouchy/irritable & immunosuppressed}fcHIGH glucose*??wsf inzportanfto remember!!*(hyperglycemic!!)'!CUSHman(know this picture!!)
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NCLEX Acid Base Balance Ventilators - Page 22 preview imageTreatmentHYPERsecreting of the adrenocortex = ADRENALectomy'(bilateral)., can causeAddisons though; so they need steriods; making you look like CUSHman againfrcwn&ce♦KID’sTOYS!!!*3 questions to ALWAYSask...-Is itSAFE?-Is itAGE APPROPRIATE?-Is itFEASIBLE?(possible to do easily or conveniently)SAFETY considerations-NO SMALL TOY'Sfor childrenUNDER 4(could put in mouth/aspirate)-NO METAL (die-cast) TOYS, ifOXYGEN isi nuse., (sparks!)-BEWARE o f FOMITES(NON-living object that harbors micro-organisms)What toys are the worst for FOMITES? Stuffed animals...What toy is the best for FOMITES? Hard plastic toys /you can disinfectit!*BEST toy for an IMMUNSUPPRESSED child? HARD PLASTIC action figure!FEASIBILITY consideration-Could they do it?ex: Is swimming a good activity for a 13 year old?Safe; yes.. Age appropriate; yes.. Feasible for a kid in a body cast? NO!!AGE APPROPRIATE considerationsInfantom-6iu:BEST toy:musical mobile*stimulates motor & sensory*...2nd BEST toy:something SOFT & LARGE6 m - p m :♦working onobject permanence*:they know it’s still there even though they can’tsee it* ex: you put a toy under a blanket - if they don’t have it; they!! cry.. if they have it: theyknow to lift the blanket & get it..At this age:your "play' should be teaching them that; that is their big task at this time.BEST toy:cover/uncover toy;play PEEK-a-BOO, the parent putting a blanket over their headand then taking it off, Jack-in-the-Box, etc... 2nd BEST toy: something large/hard..WORSTtoy:musical mobile;they can sit up/reach up and then can stranglate themselves trov.ntace91U-12111:*working on vocalization*: BEST toy: speaking toys; ex: ’Talking" Woody (ToyStory!), Tickle Me Elmo, Teddy Ruxpin, See &Say: "the COW says MOO", etc.. They also needPURPOSEFUL ACTIVITY....VEUERPICK THESE ANSWERS if the. kid is UNDER gm: build, sort, stack, make, construct -why? PURPOSE words!!Toddlers1-3: Best toy:PUSH,'PULL,ex: lawn mower, baby stroller *work on GROSS MOTOR; running,jumping* NO finger dexterity yet; can’t color, use scissors, etc. "Finger painting", yes, becausethey can use their HAND! Finger painting = HAND painting.-They do PARALLEL Play (play along-side, but not with)
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NCLEX Acid Base Balance Ventilators - Page 23 preview imagePreschoolersWork on theirFINE MOTOR(finger dexterity)? work onBALANCE(tricylces,. dance class,iceskates) Characterized byCO-OPERATIVE play(play together in groups)-They like to PRETEND: highly imaginative!School AgeCharacterized by the 3C s-Creative(blank paper & colored pencils)-Collective(collect anything &everything)-Competitive(they don’t like beingtheloser)AdolescentsPeer Group Association (hang out with their friends)Question (pertaining to Nursing): Doyou.let5-S adolescentshang out in a room together?YES!!UNLESS these 3 things:if anyone is fresh post-op(less than 12 hours out ofsurgery),if anyone is immunosuppressedkif anyone has a contagious diseaseLAMINECTOMY(is surgery that creates space by removing the lamina - the bacfcpartof the vertebra thatcoversyour spinal canal. Also tnoion as decompression surgery,lamuiectomgenlargesyour spinal canal io relievepressure onthe spinal cord or nerves).lamina = vertebral spinous processes (posterior)ectomy = removalWHYdo you do this??RELIEVE NERVE R O O T COMPRESSIONS/S of nerve root compression: 3 P’s-pain-paresthesia(numbness & tingling)-paresis(muscle weakness)MOST IMPORTANT thing to pay attention in anyNEUROquestion =LOCATION’.3 locations for laminectomy:-cervical(neck),thoracic(upper back) &lumbar(lower back)Questions pertaining to areas:cervical;diaphragm... #1 ansiver = check out theirbreathing...#2 answer = check out thefunction of theirarms &hands.thoracic';cough & bowels... #1 answer = checkhoivwell they coughlumbar;bladder &legs... #1answer= is their bladder distended o rempty...- 2 answer =h o w is the f u actiono f their legsPOST op laminectomy: #1answer =log rolll3 tilings to mobilizing pt: doNOT dangle them (sit on the edge of the bed), do N O T sit forlonger than 30 minutes &they m a y walk, stand & tie d o w n without restriction..POST opCOMPLICATIONS(depends on LOCATION!!)cervical:trouble breathing after surgery..* 1 complication: PNEUMONLAthoracic:trouble with coughing..# 1 complication: PNEUMONIA & ileus(because bowelswon’t work)lumbar: # 1 complication: urinary7retention & problems with the legs
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NCLEX Acid Base Balance Ventilators - Page 24 preview imageANTERIOR THORACIC(from front through the chest to the spine) laminectomy: will have aCHEST TUBE (pneumothorax !But no others will have a chest tube...Laminectomywith FUSION:they take a bone graft from the iliac crest... If you remove thedisc, you have to get bone from somwhere, so there isn't bone on bone (grinding)! So, there willbe 2 incisions: spine & hip: the most pain will be at the hip frownface-Afosf Weeding £-drainage will be a tthe hip; will haveaJP (Jackson-Pratt) drain...-HIGHEST risk for INFECTION: they are equal..-HIGHEST risk for REJECTION: the spine!Surgeons are using bones from cadavers quite a bit to lower infection rates..DischargeTEACHING:Permanentrestrictions =-NEVERpick up object bybending at the waist; lift with the knees!!-cervical lamscanNEVERlift anything over your head (for life!)-NOmountain biking, jerky moving ride (rollercoasters), horseback riding, etc.Temporaryrestrictions =-doNOT sit longer than30 minutes (6 weeks)-lie flat & log roll (6weeks)-NOdriving (6 weeks)-doNOTanything more than5 lbs: gallonof milk (6 weeks)Remember: MOST IMPORTANT thing to pay attention toin**any*NEUROquestion =LOCATION :8 .LAB VALUES-Afust know and also hawto PRIORITIZE them!!A = LOWpriorityB = LOWpriority, but be concerned (watch them)C = HIGHpriority; critical/do something!!*you CAN leave the bedside*D = H I G Hpriority; extremely critical!! *you canNOTleave the bedside*creatinine (serum):BEST factor to determine P.ENJ.L function...0.6-1.2LevelA*FYI*the only time you should contact the DOC because of a HIGH level creatinine, is if the ptis going for a test/ procedure (the next morning) that involves a DYE; but it is not priority to letthem know (it can wait until bam/yam).
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NCLEX Acid Base Balance Ventilators - Page 25 preview imageIXR:monitors ccmniadm therapy...i n the 2s &3's{ex: 2.1... 3.8)Level C; if4 & >1-do something = (1) alwaysH O L D, (2)ASSESS(focuses assessment on area), (3)PREPARE,(4)GALLdoc.’’respiratory’’etc.ex: (click &:drag)... level of4.7 =HOLD coumadin, ASSESS for bleeding: PREPARE to give vitamin K:CALL doc!-sometimes there's nothing to HOLD, so jump to ASSESS., sometimes there's nothing toPREPARE, so jump to CALL - but you should always go through the process in your mind, soyou don’t miss a step.potassium:(an indicator that something is wrong)3 .5-5.3LevelC;ifLOWASSESS heart, PREPARE to administer potassium, CALL doc.LevelC;ifHIGH *5-4-5.9*H O L Dall potassium..ASSESSthe heart,PREPARE(kayexalate. D5W & regular insulin) &GALLdoc.Remember: if the potassium is =o r > than 6;it's a levelD'. deadlyserious: ptcould DIE. in like the next 2 minutes.. :(HOLD all potassium; ASSESS the heart; PREPARE (kayexalate, D5W& regularinsulin) &■CALL doc***STAT!’! get everyone involved & Y O U stay withyour PT***p H : 7 . 3 5 - 4 5pH in the 6’s (ex: 6.8) is a levelD.ASSESS the I TEALS &GALEdoc & get them thereSTAT!!B U X{blood urea nitrogen): *nttrogert u'cste products in the blood*8 - 2 5If. HIGH, n o BIG deal - ASSESS p t for DEHYDRATION♦FYI* If they give you an elevated blood value & you have NO clue what's going on: & they askfor what would you assess them; DEHYDRATIONis a good answer.hemoglobin: 12-188-iLis a levelB: .ASSESSfor anemia (bleeding or malnutrition)-If <8 ,it 5 a levelC,do something!.ASSESSfor bleeding,PREP.AREto adminster BLOOD &GALLdoc.bi-carb : 22-26HCO3 (chemicalbuffer that keeps the pH of blood from becoming too acidic or too basic),..Abnormalbi-carb is alevel A:d o ntworry ’CO2:(carbon dioxide; getting from an arterial blood gas)35-45A CO2 that is H I G H (like in the 50's); levelC♦Talking about people HTTTfOLTCOPD!!*.ASSESSrespirations,PREPARE,'HA\T pT do PLB!Pursed lip breathing(PLB) is thebreathingtechnique that consists ofexhaling through tightly pressed(pursed lips)and inhaling through nose withmouth closed.... This should FEX’problem;so you shouldn't have toCALL doc.A CO2 that isHIGH(like in the 6o's): levelD(respirator,' FAILLTRE).ASSESSrespiratory status,PREP AREfor INTUBATION/VENTILATE,CALLrespiratorytherapy first, then CALL the doc.(YOU stay with YOLTR pt!!!)
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NCLEX Acid Base Balance Ventilators - Page 26 preview imagehematocrit: 36-54 (jxthe hemoglobin: 12-1.8!)elevated hematocrit; abnormal: level B.ASSESSfor DEHYDRATIONp O a (from arterial blood gas;not pulse oxi):7 8 - 1 0 0if it is LOW: tut still in the 70's (ex: 70-77), level C!ASSESSfor respiratory status; give them OXYGEN!’ (youCANdo this WITHOUT an order)FYI: when a pt is HYPOXIC:which rate increases first? respirator,-rate or heartrate?FYI: if you ever work CORONARY care, what are the 2 most common causes of episodictachycardia in heart pt’s? HYPOXIA &DEHYDRATIONif it is LOW in the 6 0 s (ex: 63-69), level D1***When the O2 & the CO2 are both in the 6o's; this is when you need toINTUBATE.-'VENTILATE...CALIrespirator,-therapv first, thenCALLthe doc.(YOU staywith Y O U R pt!!!)ex: (click & drag question):T H R O W o n Oa. -ASSESS, PREP.ARE to intubate,,i-enti late & then cal?respiratarp/doc..8 o % o f the time, you always assess before y o u d o anything..-An example where this is n o t true, if if you had a blood tranfusion going o n andthe patient w a s complaining o f itching... Y o u w o u l d STOP the infusion & thenassess the pt!-ASSESS before you DO, UNLESS delayingDOING puts your p t a t higher risk!BEST vs. FIRST question...BEST: administer O aFIRST: raise head o f bedO a Sats: 9 3-10Anything <than9 3 is alevel C (for NCLEX1!)Inreal life, b e HAPPY7with8 8 & >!!)....ASSESSpt & throw on O2!ForPEDLATRICS: FREAK outifthekid goesBELOW 95!!!FYI: What invalidates for SAO2?ANEMIA falsely elevates it..B N P(brain natriuretic peptide; BEST indicator for CHF):should b e UNDER i o oelevated BNP; level Bsodium: 135-145abnormal: levelB =ASSESS!HIGH= ASSESSfordehydrationLOW= ASSESS foroverload♦If the question says that the level is abnormal & there is achange i n theLOC;the priority ofthe pt goes to a level C (safety issue)
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NCLEX Acid Base Balance Ventilators - Page 27 preview imageWEC:total W E C : s . o o o - n , O D DA N C(absolute neutrophil count};NEEDS t o b e A B O V E 5 0 0C D 4 countN E E D S t o b e A B O V E 2 0 0*when belo5v 200, this is when HIV goes into AIDS*ALL of these, if BELOW the normal count, will be a levelClASSESSfor signs of infection & place them on*VElTj?OPE.X7Cprecautions.1platelets :TRIGGER levels forthrombocytopenicorbleeding PRECAUTIONS...platelet countB E L O W 9 0 , 0 0 0is a levelC...platelet countB E L O W 4 . 0 , 0 0 0is a levelD...R E C : 4-6 millionabnormal count is a levelEMEMORIZE the 5 D si!! (the 550U really NEED to KNOWN)p H & potassium i n the 6 sC 0 2 & O 2 i n the 6 o ' splatelet count LESS than 4 0 , 0 0 0 ...These are the HIGHEST priority pt's!!LEARN all the C s & what to doll! (about 8-10}...9-PSYCH D R U G SKNOWgenericnames!]warfarin = coumadinacetaminophen = tylenolacetylsalicylic acid = aspirinmeperidine= demerolA L L psych drugs cause L O W B P & W E I G H T CHANGES(usually GAINing)...However:some other meds (ex: Prozac) can cause weight LOSS!p h enofliiazines(1st generation typical ANTTpsychotics)--.hey all end in"zine"actions? they don't cure psych diseases; they just reduces symptoms...in LARGE doses- they are ANTTpsychotics"we use ZINEs for the ZANIEs’...in SMALL doses- they are ANTI emetics...they are consideredmajorTRANQUILIZERS *BIG GUNS!!**aminogrpcocides are t o antibiotics.tikephenofhiazines are t o tranquilizers* = they r e b o t h theB I G GENS!S/S:A = antichoh'nergic (dry mouth) *Nursfny di; risfc/or injury*B = blurred vision *2Vursingdx: risk for injury*C = constipationD = drowsiness
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NCLEX Acid Base Balance Ventilators - Page 28 preview imageE = EPS (ertrqpy ramidal symptoms); iifceParxinsons Wursing dr: risfc/ar injury*F = Fotoscnsitiuity (photosentiinty)aG = agrGnulocytosis (LOHrwhite count; immuncwuppressed)TOXIC side effect: HOLD & CALL doc!!!d e c a n o a t e cr D(written after a medication name: ex: thorazine D) = itis IX3NG acting;sometimes it works for 2 weeks; sometimes it works for a month... GwenIMform tononcompliant pt's; usually court ordered.tricyclic antidepressants(old class; grandfathered into the NSSRI class)MOOD elevators...examples: elavil,tofranilaventyl, desyrelS/S:A = anticholinergic (dry mouth)B =blurred visionC = constipationD = drowsinessE = euphoria*The pt must take these for2 - 4 weeks before they s e e beneficial effects!*benzodiazipinesANTIanxiety meds... considered to beminorTRANQUILIZERS-they always have "zep ’ in the name♦diazepam (valium), lorazepam...indications: they are MORE than just minor tranquilizers-can be used as apre-op t o induce anesthesia-can be used as amuscle relaxant-can be used foralcohol withdrawal-can be used to help withseizures-can be used to help ap t fighta ventilator(relaxes them)-they workquickly,but youmust not tofee them longer than2-4 weeks."heparin is t o coumadin a s a tranquilizer is t o a n antidepressant'S/S:A = anticholinergic (dry mouth)B = blurred msicinC = constipationD = drowsinessMAPI's(monoamine oxidase inhibitors)antidepressants-NOT really given anymore; except with the VETERAN hospitals (they are super cheap; theycost only pennies)marplan nardil & parnate (NOT the generic name)S/S:A = anticholinergic (dry mouth)B = blurred visionC = constipationD = drowsinessS i thing that NCLEX t e s t s : P T teaching!!
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NCLEX Acid Base Balance Ventilators - Page 29 preview image-to PREVENTsevere acute, sometimes fatal HYPERtensive crisis: the pt must avoid allTTRAMLVES,..They ARE ALLOItZ D ALL/ruits& veggies,except N OsaladBAR?!*BAR = bananas, avocados & raisins (raisins stands for any DRIED fruit)Grains are fine; cookies, hread:pies :)NO ORGAN meats;liver, kidney, tripe (sheep's stomach), etc.N O PRESER T D meats*smoked, dried, cured, pickled*NO hot dogsor certain processedlunch meats;they contain 'other assorted partsDAIRY:NO cheesesexceptcottage cheese & mozzarella!N O ALCOHOLorCHOCOLATE-Teach the pt's NOT to take over-the-counter meds when they are on a MAOIlithium-used to treat Bipolar disorder (decreases MANIA)-stablilizes nerve cell membranesS/S: 3 P'sPEEingPOOPingParesthesia (numbness & tingling) because the early sign of ALL electrolyte imbalances... YOUcan still GIVE lithium with these S/S; just tell the DOC when they come in.-lithiumTOXICeffects:tremors, metallic taste & severe diarrhea.. HOLD dose &CALL doc!!# 1 intervention: is t o increase fluids!-watchSODIUMlevels!!-if pt is sweating/manic - do NOT give them water; give Gatorade/POWERADE!-lithiumis closely linked to SODIUM;LO TVsodium??ist es lithiumM O R E TOXIC...H I G Hsodiumwill make lithiumineffective .-for lithium to work, theSODIUM level must b e normalprozac(SSRI)-similar to elavil (NSSRI)S/S:A = anticholinergic (dry mouth)B = blurred visionC = constipationD = droivsihessE = euphoria-prozac causesINSOMNLA(give it before NOON; don't give at BEDTIME)-whenchanging the DOSE in adolescents /voung adults; watch for increased suicidalrisk!haldol*the ONLY MAJOR antipsy chotic tranqulizer that CAN b e given to pregnantwomen!*-like phenothiazines (ist generation typical ANTIpsychotics)-has a "decanoate" form; LONGacting IM-basically the same as thorazineS/S:A = anticholinergic (dry mouth)♦Nursingdx: risk for injury*B = blurred vision *2Vursing dx: risk/or injury*
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