MARK KLIMEK STUDY GUIDE

Acid Base

As the ph goes the patient goes and except for potassium

pH goes up potassium goes down

pH goes down potassium goes up

pH up(alkalosis)… Hyper, tachy, increased, elevated, exaggerated,

increasing, excessive. Irritability, diarrhea, borborygmi= increased bowel

sounds.

pH down(acidosis)… hypo, decreased, scant, absent, a-, brady, depressed,

suppressed, oligo,

Pt has acidosis what heart rhythm would you see- second degreeheart block

Tetany- muscle spasms, hyper muscles, hyper hyper contractility

Cardiac arrest- slow down

MAC-Kussmal

Kussmal only occurs in Metabolic ACidosis

Causes of acid base imbalances:

Ask yourself is it Lung? If it does= respiratory

Is the client overventilating or under??

If they are over---Alkalosis…

If under—acidosis.

Too much PCA pump what acid base can result… depress

respirations, underventilation… respiratory ACIDOSIS.

Near drowning—Respiratory acidosis

Acute panic anxiety- Respiratory alkalosis

If it isn’t lung its metabolic.

If client has PROLONGED gastric vomiting or suctioning—METABOLIC

ALKALOSIS

For everything else that isn’t lung pic metabolic acidosis that doesn’t have to

do with suctioning or vomiting

Metabolic Acidosis if we don’t know what to pick!

Respiratory rate is highly unreliable use your gases, lung sounds and

saturation!!!

VentilatorHigh pressure alarm= increased resistance to airflow. High pressure to push

through so look for OBSTRUCTION!!! 3 obstructions, DO IN THIS ORDER!!

Least invasive to most!

1- Kink. - UNKINK

2- Water condensing in tubing. GET WATER OUT

3- Mucous. Suction is not best answer… TURN COUGH AND DEEP

BREATHE. If that doesn’t work SUCTION!

Low pressure alarm!

Due to DISCONNECTIONS!

1. Main tube disconnected2. Oxygen Sensor line! Plug back in.

If tubing hits the floor call respiratory and start bagging!! If it falls on them then

on the bed then clean off with alcohol and reconnect

Respiratory Alkalosis- Over Ventilating

Respiratory Acidosis- Under Ventilating

DON’T ASK ANOTHER PEOPLE. DON’T USE CHICKEN QUESTIONS.

TAKE CARE OF IT YOURSELF

ETOH,Abuse,Overdose vs. Withdrawal, & Mycin

In abuse**

―Maslow‖ Ranking

1. Physiologic needs

2. Safety needs

3. Comfort needs

4. Psychological needs

5. Sociological needs

6. Spiritual needs

Alcoholic with fractured foot which would be priority?

His denials?

His pain?

His break***

Adequate pain control is number one for palliative care

Psychodynamic- what’s their major malfunction?

Abusers- greatest psychological priority is denial! Refusal to accept reality

with problem.

Confront denial in abusers!

―You say you aren’t an alcoholic but it’s 10 am and you’ve drank a fifth of

whiskey and a 6 pack.‖

Denial during loss and grief:

Don’t confront. You support and allow them to continue because it serves a

purpose and function.

Dependency=abuser gets significant other to make decisions for them or do

things for them because they can spend their time drinking.

Codependency=significant other derives positive self esteemfrom doing things

for or making decisions for the abuser. So abuser says will you do this for me

and the codependent does it and then says to themselves ―I’m a wonderful

person because I do this for them and no one else would‖

Set limits for the abuser and enforce them. No you call your boss, etc.

Work on self esteem of the codependent person