Mark Klimek Yellow Book (KV), Exam Questions & Answers

Mark Klimek Yellow Book (KV), Exam Questions & Answers-If the pH and the BiCarb are both in the same direction then it is? - Metabolc If the pH is up it is? - Alkalosis As the pH goes so goes my patient except for? ...

Mark Klimek Yellow Book (KV), Exam Questions & Answers-If the pH and the BiCarb are both in the same direction then it is? - Metabolc If the pH is up it is? - Alkalosis As the pH goes so goes my patient except for? - Potassium If the pH is down it is? - Acidosis If the pH is up my patient with show signs and symptoms of? - Increase... like tachycardia,diarrhea and borborygmi If the pH is down my patient will show signs and symtoms of? - Decrease... like decreased output, bradycardia and constipation If my pH is up my potassium (K+) is ? - Down If my pH is down my potassium (K+) is? - Up If my patient is overventilating I should choose? - Respiratory Alkalosis If my patient is underventilating I should choose? - Respiratory Acidosis If my patient has prolonged gastric vomiting or suction I choose? - Metabolic Alkalosis If it is not lung or prolonged vomiting or suctioning I choose? - Metabolic Acidosis Kussmal Respirations - Metabolic Acidosis ( Remember MacKussmal Before measuing ABGs you should check what? - Allen's test. Should be positive. Pt makes a fist and pressure is applied to the ulnar and the radial arteries Ulnar pressure is released and color should return in 7 seconds (means it's positive and OK to take ABG's). Definition of Compensation - PH is normal! It is never compensated if it is abnormal. If PH normal - look in the direction it is going. Closer to Acidic? (7.35) acidosis. Then look at Bicarb & figure out which is abnormal. If Bicarb is out of range, it's metabolic acidosis. If C02 is abnormal, it's Respiratory Acidosis :) If your pt is acidotic and you need to pick a symptom - Pick the symptom where everything is DOWN. ( And vice Versa) Ex: 2 degree Morbitz Type 2 BLOCK. <---- Down direction If you don't know what causes an acid base balance, pick - Metabolic Acidosis If in doubt in ABGs, always pick - Headache, nausea, weakness & numbness+ tingling. It can be either up or down. High pressure alarms are triggered when? - They cannot push air in High pressure alarms are caused by what three types of obstructions? - Kinking, Water in dependant loops and mucus in the airway. If kinking in the tube is present you? - Unkink If water is present in the dependant loops you? - Open system and empty water. If mucus is present you? - Turn them, cough and have them deeo breath first. If ineffective you then suction. Don't suction unless - Coughing & deep breathing is deemed inappropriate. In order to suction, you must be able to hear - Mucus in the lung Low pressure alarms are triggered when? - It is to easy to push air in. Low pressure alarms are normally caused by? - Disconnection If the tubing is disconnected you? - Reconnect If O2 sensor line is disconnected you? - Reconnect In a vented client respiratory alkalosis means the vent setting may be too? - High In a vented client respiratory acidosis means the vent may be too? - Low What do you do if the patients disconnected tube is on the floor? - Bag them, (call for help) get new tube and then reconnect. First question to ask if the low pressure alarm sounds - Where is the tubing?! HOLD - H- High Pressure O- Obstruction L- Low D- Disconnections Never put anything in YOUR scope of practice - On anyone else Make sure your answer is - PATIENT FOCUSED. TAKE CARE OF YOUR PATIENT! Don't answer based on staff, building, machine, etc. PATIENT FIRST. What does wean mean? - Decrease Gradually What do you do if the patients disconnected tube is on the chest? - Reconnect ... if its above the waist its ok. Remember is PSYCH if you are asked to Prioritize, Don't forget - MASLOW! 1. Physiological 2. Safety 3. Comfort - Includes pain 4. Psychological 5. Social 6. Spiritual When prioritizing, always use Maslow + ABCs - For one patient. Don't if you have more than one patient. What is the biggest problem in abuse? - Denial To treat denial you need to? - Confront them. Definition of Denial - Refusal to accept reality of their problem How do you confront? - Point out the difference between what they say and what they do. What is the one circumstance that you as a nurse would support denial? - Loss and Grief Always go - Med surg first. Then Psych What is dependency? - When the abuser gets a significant other so make decisions for them or do thing for them. What is codependency? - When the significant other gets positive self esteem from doing things or making decisions for an abuser. To treat dependency/codependency you ? - Set limits and enforce them. Say NO and follow through. Agree in advance on what requests are allowed, then enforce the agreement.