Nclex_RN_study Guide

Mark Klimek Audio Notes: Acid Base ABG’s As pH goes, so does my Pt! Except for K pH and HCO3 in same direction Metabolic pH and HCO3 in different direction: Respiratory pH ↓ Pt goes ↓ (HR, RR, all vitals) K goes ↑ hy ...

Mark Klimek Audio Notes: Acid Base ABG’s As pH goes, so does my Pt! Except for K pH and HCO3 in same direction Metabolic pH and HCO3 in different direction: Respiratory pH ↓ Pt goes ↓ (HR, RR, all vitals) K goes ↑ hypoexcitable pH ↑ Pt goes ↑ K goes ↓ hyperexcitable Except for K – it does the opposite pH ↑ : Alkalosis  Seizures, hyperactivity, borborgygmi (↑BS) Kausmal breathing = MacKausamal (Metabolic Acidosis breathing) Causes of imbalance: 1. Is lung affected? a. Yes-Respiratory 2. Is pt overventilating or underventilating? a. Over-alkalosis b. Under-acidosis 3. Not the lung? a. Then it is Metabolic 4. If pt has prolonged vomiting or suctioning a. Alkalosis 5. If you don’t know: it’s probably metabolic acidosis (It’s super common) Alcoholism Psychological  #1 problem psychologically in alcoholism and all other abusers is denial  Denial-refusal to accept the reality of a problem o Treat denial by confronting o Differentiate what they say versus what they do  DO NOT confuse confrontation with aggression (attacks the person)  Questions about staff problem interactions: Never choose YOU, choose I  Denial is okay in loss/grief o Treat this denial with support-Do NOT confrontMark Klimek Audio Notes 2  Denial Anger Bargaining Depression Acceptance  #2 problem dependency/codependency o Dependency-abuser gets significant other to do things for them o Codependency-positive self esteem significant other receives from doing things for the abuser o Treat by setting limits and enforce them, say no  Manipulation-abuser gets significant other for to do things them that is not in the best interest of the SO o Interest and harmful o If what being asked to do is neutral-dependency o If what being asked is harmful or not in best interest-manipulation o Treat manipulation by setting limits and enforce, say no  Wernicke’s and Korsakoff o Wernickes’-encephalopathy induced by vit B1/ thiamine d