Mark Klimek Lectures 1-12 TEST 100% Correct verified solutions 2024/2025, Exams of Health sciences

Download Mark Klimek Lectures 1-12 TEST 100% Correct verified solutions 2024/2025 and more Exams Health sciences in PDF only on Docsity! Mark Klimek Lectures 1-12 TEST 100% Correct verified solutions 2024/2025 Normal values: pH: CO2: HCO3: Normal values: pH: 7.35-7.45 CO2: 45-35 HCO3: 22-26 Finish the saying: As the pH goes, so... As the pH goes, so goes my patient, except for Potassium Ex: If pH is low, everything is low, except Potassium Ex: If pH is high, everything is high, except Potassium What are some symptoms of alkalosis? - tachycardia - tachypnea - HTN - seizures - irritability - spastic - diarrhea - borborgymi - hyperreflexia (3+, 4+) - hypokalemia What is the nursing intervention for alkalosis? pt needs suctioning because of seizures What are some symptoms of acidosis? - bradycardia - constipation - absent bowel sounds - flaccid - obtunded - lethargy - coma hyporeflexia (0, 1+) - bradypnea - low BP - respiratory arrest - hyperkalemia What is the nursing intervention for acidosis? pt needs to be ventilated with an Ambu bag because of respiratory arrest Match the following with either acidosis or alkalosis: Over-ventilating: Under-ventilating: Match the following with either acidosis or alkalosis: Over-ventilating: Alkalosis Under-ventilating: Acidosis Depression Acceptance What is the #2 psychological problem? Dependency or Co-Dependency What is dependency? When the abuser gets a significant other so make decisions for them or do thing for them What is co-dependency? When the significant other derives self-esteem for doing things/making decisions for the abuser What type of relationship does dependency and co-dependency have? it is a symbiotic yet pathological relationship. the dependent gets a "free ride" from the co-dependent while the co-dependent feels good from doing stuff for the abuser How to treat dependency/co-dependency? - Confront the abuser - Teach the co-dependent pt how to set limits and enforce them (learning how to say no, agree in advance on what requests are allowed, work on self-esteem) What is manipulation? When the abuser gets the significant other fo do things for them that is not in the best interest of the significant other. This can be dangerous and harmful to the significant other. How is manipulation similar to dependency? in both, the dependent person gets the co-dependent person to do things or make decisions What is the difference between manipulation and dependency? if what the significant other is being asked to do is not inherently dangerous and harmful, then it is dependency/co-dependency How to treat manipulation? set limits and enforce them What is Wernicke-Korsakoff? psychosis induced by vitamin B1 (thiamine) deficiency What are the primary s/s of Wernicke-Korsakoff? - Amnesia (severe memory loss) - Confabulation (making up stories that the pt truly believes is reality) How to respond to confabulation? Redirect the pt What are the 3 characteristics of Wernicke-Korsakoff? 1. Preventable (take B1) 2. Irreversible (will kill brain cells) 3. Arrestable (take B1) What does Vitamin B1 do? Metabolizes alcohol. A thiamine deficiency will cause alcohol in to build up in the body and kill brain cells. What does Antabuse do? Alcohol deterrent What is aversion therapy? a type of behavior therapy designed to make a patient give up an undesirable habit by causing them to associate it with an unpleasant effect. works better in theory than reality What is the onset and duration of Antabuse/Revia? 2 weeks What should you include in your patient teaching for a pt on Antabuse/Revia? Avoid all forms of alcohol to avoid N/V, death - Ex: Mouthwash, hand sanitizer, cologne, perfume, aftershave, elixir, most OTC liquid medicine, insect repellant, vanilla extract (unbaked icing), vinaigrette True or false: Red wine vinaigrette has alcohol in it false What is the first thing you should ask if you get an overdose/withdrawal question? "Is the drug an upper or a downer?" What are examples of "upper" drugs? - Caffeine - Cocaine - PCP/LSD - Methamphetamines - Adderall What are examples of "downer" drugs? if it is not an upper, then it is a downer What are some s/s of "upper" drugs? Things go UP! - Euphoria - Seizures - Restlessness - Irritability - Hyperreflexia - Tachycardia - Increased bowel sounds - Diarrhea What are some s/s of "downer" drugs? Serious, life-threatening, resistant, gram-neg infections Which drugs end in -mycin that are NOT aminoglycosides? - Azithromycin - Clarithromycin - Erythromycin all have THRO in the middle so THRO them off the list What are the toxic effects of aminoglycosides? - Ototoxicity (monitor hearing, balance, tinnitus, CN8 toxicity) - Nephrotoxicity (monitor creatinine) How often do you administer aminoglycosides? q8h Why should you not give someone PO aminoglycosides to treat a serious infection? PO -mycins are not absorbed, and therefore would not have any systemic effects Which 2 cases would you give PO aminoglycosides? 1. Hepatic encephalopathy where ammonia level is elevated 2. Pre-op bowel surgery to sterilize the bowel Which 2 PO aminoglycosides sterilize the bowel? "Neo Kan" 1. Neomycin 2. Kanamycin What is the #1 producer of ammonia? e. coli What is peak and trough? Peak: highest blood level of a drug Trough: lowest blood level of a drug "TAP" levels draw trough, administer drug, draw peak When is trough drawn? 30 minutes before next dose Why are trough and peak levels drawn? because of a drug's narrow therapeutic window or index When is peak drawn for SubL? IV? IM? SubQ? PO? SubL: 5-10 minutes after drug is dissolved IV: 15-30 minutes after drug is finished (bag empty) IM: 30-60 minutes SubQ: Depends on insulin PO: Not necessary You give 100 mL of a drug at 200 mL per hour (the drug takes 30 minutes to run). If you hang the drug at 10 a.m., it will finish running at 10:30 a.m. When will the drug peak? 1. 10:15 a.m. 2. 10:30 a.m. 3. 10:45 a.m. 4. 11:00 a.m Two right answers—pick 11:00 a.m.In this case, play the "Price Is Right"—go with the highest time w/o going over True or false: The same drug given by 2 different routes at the same time will have different peaks true True or false: 2 different drugs given at the same time and route will peak together true What do calcium channel blockers do? relax and slow down the heart What does positive inotrophy mean? Chronotrophy? Dromotrophy? (+) Inotrophy: Increase cardiac contractile force → ventricles empty more completely → improved cardiac output (+) chronotrophy: Increase rate of impulse formation at SA node → Accelerate HR (+) dromotrophy: Increase speed that impulses from SA to AV node (increase conduction velocity) What does negative inotrophy mean? Chronotrophy? Dromotrophy? (-) inotrophy: Weaken/decrease force of myocardial contraction (-) chronotrophy: Decrease rate of impulse formation at SA node → decelerate HR (-) dromotrophy: Decrease speed that impulses from SA to AV node (decrease conduction velocity) Do Calcium Channel Blockers have positive or negative inotropic, chronotropic, dromotropic effects on the heart? negative When do you want to relax and slow down the heart? What do Calcium Channel Blockers treat? "A, AA, AAA" A = Antihypertensive AA = AntiAngina AAA = AntiAtrialArrythmia How to treat supraventricular arrhythmias? "ABCDs" A = Adenocard → fast IV push (<8 sec + 20 mL NS) B = Beta-blockers (-olol) C = CCBs D = Digitalis (digoxin, Lanoxin) Do beta-blockers have negative or positive inotropic, chronotropic, dromotropic effects on the heart? negative How to treat v-fib and asystole? - defib for v-fib (shock 'em!) - epinephrine and atropine for asystole What is the purpose of a chest tube? To re-establish negative pressure in the pleural space What is the pleural space? space between the lung (visceral pleura) and chest wall (parietal pleura) What does a chest tube do for someone with pneumothorax? remove air What does a chest tube do for someone with hemothorax? remove blood What does a chest tube for someone with hemopneumothorax? remove air and blood A chest tube is placed in a pt for a hemothorax (blood). What would you (the RN) report to the physician? a. Chest tube is not bubbling b. Chest tube drains 800 mL in the first 10 hours c. Chest tube is not draining d. Chest tube is intermittently bubbling C The chest tube is supposed to drain instead of bubble. What are the locations of a chest tube? Apical + basilar Apical chest tubes remove _____ air Basilar chest tubes remove _______ blood or fluid Should an apical chest tube be bubbling or draining? bubbling Should a basilar chest tube be bubbling or draining? draining Pt presents with a unilateral hemopneumothorax. How to care for this pt? Place an apical chest tube for the pneumothorax and a basilar for the hemothorax Pt presents with bilateral pneumothorax. How to care for this pt? Place apical chest tube on the right and left Where would you place a chest tube for a postop right pneumonectomy? Does not need a chest tube since the right lung was removed What happens if a closed chest drainage device is knocked over? Ask the pt to take a deep breath and set the device back up NOT a medical emergency What to do if the water seal of the chest tube breaks? 1. Clamp the tube 2. Cut the tube away 3. Submerge the end of the tube in sterile water 4. Unclamp the tube The water seal chamber of the chest tube in a pt with a pneumothorax/hemothorax breaks. What is the first course of action for the nurse? a. Clamp the tube b. Cut the tube away c. Submerge (or stick) the end of the tube under sterile water d. Unclamp the tube if it was initially clamped A The water seal chamber of the chest tube in a pt with a pneumothorax/hemothorax breaks. What is the priority action for the nurse? a. Clamp the tube b. Cut the tube away c. Submerge (or stick) the end of the tube under sterile water d. Unclamp the tube if it was initially clamped C If the water seal breaks, how long do you have to clamp, unclamp, and place the chest tube under water? 15 seconds or less What to do if a chest tube gets pulled out? - For bugs traveling on large particles through coughing or sneezing to less than 3 feet - Meningitis - H. influenza B (ex: epiglottitis) What does droplet precaution include? - Preferred private room - Can be in same room if cohort is based on culture - Hand wash - Mask, face shield/goggles, gloves - Disposable supply - Dedicated equipment When are airborne precautions in place? "Air MTV" M = MMR T = TB V = Varicella (chickenpox) What does airborne precaution include? - Preferred private room - Can be in same room if cohort is based on culture - Hand wash - Face shield/goggles, gloves - Mask - Keep door closed - Disposable supply & dedicated equipment are not essential - Negative airflow What is the correct order to put on PPE? gown, mask, goggles, gloves What is the correct order to take off PPE? gloves, goggles, gown, mask (alphabetical order) How do you measure the length of crutches? - hold crutch vertically and place tip on ground - 2-3 finger widths between pad and anterior axillary fold - tip is located to a point lateral (6 inches) and slightly in front of foot (6 inches) What is the handgrip measurement for crutches? - angle of elbow flexion is 30 degrees - wrists should be at the level of handgrip Why is measuring crutches important? to reduce risks when ambulating and avoid nerve damage What is a 2 point gait? Move a crutch and opposite foot together, and then the other crutch with opposite foot. When would a patient use a 2 point gait? When they have mild bilateral leg weakness What is a 3 point gait? move 2 crutches + bad leg together, followed by the unaffected leg When would a patient use a 3 point gait? when 1 leg is affected What is a 4 point gait? Move everything separately. Move one crutch, then foot, then crutch, then foot. When would a patient use a 4 point gait? when they have a severe bilateral leg problem What is a swing through crutch gait? affected foot passes tip of both crutches When would a patient use a swing through gait? if they are non-weight bearing such as an amputee Use Even-point gait for even, odd-point gait for odd = even-point = weakness is evenly/bilaterally distributed - 2 point = mild - 4 point = severe odd-point = one leg is affected How do you use the stairs with crutches? "Up with good, down with bad" How do you correctly use a cane? - hold cane on good side - hand grip should be at wrist level How do you correctly use a walker? the patients needs to pick it up, set it down, and walk to it True or false: If the patient needs to tie their belongings onto their walker, they should tie them in front of the walker false, to the side How do you correctly use a walker if the patient is sitting down and wanting to get up? the patient needs to hold onto the chair, stand up, and grab the walker True or false: It is safe to place tennis balls or wheels on a walker false When you get a psych question, what is the first thing you should ask yourself? "Is the patient psychotic or non-psychotic?" What is the difference between a psychotic and non-psychotic patient? What is psychosis of dementia? Actual brain destruction/damage True or false: A patient with psychosis of dementia does NOT have the potential to learn reality true What are some examples of psychosis of dementia? Alzheimer's, stroke, organic brain syndrome, anything "senile" How do you treat a patient with psychosis of dementia? (2 steps) 1. Acknowledge feelings 2. Redirect What is psychosis of delirium? What is it caused by? Temporary, sudden, dramatic, episodic loss of reality is usually caused by some chemical imbalance in the body that is secondary to another issue, such as a UTI, electrolyte imbalance, adrenal crisis, medications How do you treat a patient with psychosis of delirium? (2 steps) 1. Acknowledge feelings 2. Reassure safety and temporariness of condition What is flight of ideas? Jump from word to word (ex: This room is big, I liked the movie BIG when they were on the piano, Elvis could play the piano). What is a word salad? Unrelated combinations of words What is neologism? Inventing word that has no real meaning except for the person What is narrowed self-concept? When they refuse to leave the room or get dressed. (DON'T force them to do it) Respond by saying " I see you are uncomfortable, when you are ready, you can do it" What is idea of reference? you think everyone is talking about you