** DON'T MIX UP S&S and CAUSATION -Dft e nwhat causes something is the opposite of the S&S - ex.diarrhea will cause a metabolic acidosis but onceyouare acidotic your bowel shuts down ano you get aparalytic illleus• when you get seenanos:- > if : s alungscenario = respiratory- then check if the client isover-ventilating(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:resp. rate isirrelevantw/ acid-base,ventilation has to dowith gas exchange not resp.rate (look at the SaO2-> ifyour resp. rate is fastbut SaO2 is low you are under-ventilating) -> ex. RCA pump - What acic-base disorderindicates they need to come off of it? = respiratoryacidosis {resp. depression -> resp. arrest} —> if its notiung, its metabolic• metabolic alkalosis- really only one scenario= i fthe P T has prolonged gastricvomiting/suctioning - because you arelosingACID* ex. G l surgery w/ N G tube with suctioning for3 days; hyperemesis graviderum- otherwise everything else that isn't lung youpick metabo/icacidosis (DEFAULT)* ex. hyperemesis graviderum w/ cfenj/drafropacute renal failure, infantile diarrhea■remember, you only have 4 to pick from: -respiratory alkalosis - respiratory acidosis -metabolic alkalosis - metabolic acidosis• pay more attention to themodifying phrasesthanthe originalnoun- ex. person w/ OCD who is now psychotic (psychotictrumps OCD); hyperemesis with dehydration (payattention to dehydration)VENTILATION• ventilators -> knowalarm systems(you setit upsothat the machine doesn't useless than or more thanspecific amounts of pressure)a)high pressure alarm =increased resistanceto airflow (the machine has to push too hard toget air intolungs)- fromobstructions:i. kinks in tubing (unkink it)ii. water condensation in tube (empty it!) iii.mucous secretions in the airway (changepositions/turn, C&DB,andTHENsuction) ***suction i s only PRNII!- > priority questions = you would checkkinks first, suction is not firstLECTURE 1ACID BASES• learn how to convert lab values to words• the rule of the B's= if the p H and the BiCarb are both in the samedirection -> metabolicHint:draw arrows beside each to see directions* down =acidosis* up =alkalosis- respiratory -> has nobin it; 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 yougenerate lists..) -for "select all" questions- ex.ingeneral/principle what d o opioids/painmeds do? = sedateyou,CNS depressors*ex.what does dilaudid do? don'tmemorize specificsorafeiof dilaudid, know principles of opioids{suchassecation. CNS depression -> lethargy, flaccidity.reflex+1, hypo-reflexia. obtundeo)- boards don't test b y lists because allbooks/ classes have different lists• principles of S&S acid bases: a sthe pH goes sogoes m ypatient (except K+)- p H up = P T up -> body system gets moreirritable, hyper-excitable (EXCEPT K+)-> alkalosis -think of a body system and g ohigh',hyper-reflexive (+3, + 4 [2isnormal]),tachypnea, tachycardia, borborygmi, seizure -p H down = P ~ down -> body systems shutdown (EXCEPT K+)-> acidosis -think of a system and go low.hypo-reflexive (+1, 0),bradycardia,lethargy,obtunded, paralytic iIleus, 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 cKussmaul -Kussmaul's (compensatoryrespiratory mechanism) is only present inonly 1ofthe 4 metabolic (acid-base) disorders* M = metabolic A C = acidosis• most common mistake with select all questions= selectingone more than you should(stop when you select the onesyou know! don't get caught up on the "could be's")• Hint:don't select none orallon select all that applyquestions (never only one and never all)• Causes of Acid-Base Imbalance:- scenarios and what acid-base disorder wouldresu/t (what would cause an imbalance)b)l o wpressurea l a r m=decreasedresistanceto airflow (the machine had to worktoo littleto push air into lungs)Preview Mode
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