HESI EXAM Flashcards
(57 cards)
Normal Values for pH, CO2, and HCO3 (bicarbonate)
pH: 7.35-7.45
CO2: 35-45
HCO3: 22-26
As pH goes, so goes my patient, except for ______
POTASSIUM
That means……
If pH is low, everything is low, except potassium (hyperkalemia in acidosis)
If pH is high, everything is high, except potassium (hypokalemia in alkalosis)
Alkalosis symptoms (pH >7.45)
Tachycardia, Tachypnea, HTN, Seizures, Irritability, Spastic, Diarrhea, Borborygmi (inc bowel sounds), hyperreflexia (3+, 4+)
*Hypokalemia
Priority: Patient needs suctioning because of seizures
Acidosis Symptoms (<7.35)
Bradycardia, Constipation, Absent bowel sounds, Flaccid, Obtunded, Lethargy, Coma, Hyporeflexia (0, 1+), Bradypnea, Low B/P
*Hyperkalemia
Priority: Patient needs to be ventilated with an Ambu bag (respiratory arrest)
MAC Kussmaul
Fast, deep breathing that occur in response to metabolic acidosis
Body tries to remove carbon dioxide, an acid, from the body by quickly breathing it out.
Ex: DKA
OVER ventilating & UNDER ventilating
1) Labor
2) Drowning
3) PCA Pump
If under ventilating pick acidosis (not properly breathing)
If over ventilating pick alkalosis (breathe out all your acid, give brown paper bag)
1) Respiratory alkalosis
2) Respiratory acidosis
3) Respiratory acidosis
Prolonged Gastric Vomitting
Sucking out acid, pick metabolic alkalosis
For Diarrhea (losing base, pick acidosis)
Ventilator (High Pressure Alarm)
Look for obstructions
- Kinks in tubing (unkink the tube)
- Condensed water in the dependent tube (empty it)
- Mucus plug (ask pt to turn, cough, deep breathe; or suction the tubing PRN)
Ventilator (Low Pressure Alarm)
Triggered by decrease in resistance
- Main tubing disconnection
- O2 sensor disconnection
In both cases, reconnect the disconnected tubing unless tube is on the floor….Bag pt and call RT
Ventilator set too high or too low
Setting is too high (pt is over-ventilated) Respiratory alkalosis, panting
Setting is too low (pt is under-ventilated) Respiratory acidosis, pt is retaining CO2
Stages of Grief “DABDA”
Denial (one place where denial is ok is loss and grief)
Anger
Bargaining
Depression
Acceptance
Support loss
Confront abuse
Wernicke and Korsakoff
Wernicke is an encephalopathy
Korsakoff is a psychosis
Psychosis induced by Vit B1, thiamine deficiency
Primary S/Sx: Amnesia (memory loss) and confabulation (making up stories)
Redirect patient
Antabuse and Revia (Disulfiram)
Antabuse- alcohol deterrent
Revia- antidote
Aversion (strong hatred) therapy to make a patient give up alcohol by associating them to an unpleasant effect
Onset (2 weeks)
Teach pt to avoid all forms of ETOH. (Causes N/V & even death)
Avoid: mouth wash, cologne, perfume, aftershave, elixir, most OTC meds, hand sanitizer, & vanilla extract
DO NOT PICK RED WINE VINAIGRETTES….does not have alcohol
Overdose and Withdrawl: Upper or Downer?
Uppers: 1) Caffeine 2) Cocaine 3) PCP/LSD, 4) Meth 5) Adderall (MEMORIZE)
Downers: if it is not an upper, it is a downer
Signs & Symptoms: Upper and Downer
Upper: Euphoria, Seizures, Restlessness, Irritability, Hyperreflexia, Tachycardia, Inc bowel sounds, Diarrhea
Downer: Lethargic, Respiratory depression/arrest, Constipation, etc.
Highest nursing priority to anticipate in an Upper or Downer?
Upper: suctioning due to seizures
Downer: intubation/ventilation due to respiratory arrest
Overdose and Withdrawl Have Opposite Effects
Overdose on an Upper: too much (things go UP!)
Withdrawl on an Upper: opposite effect (things go DOWN!)
Overdose on an Downer: too much (things go DOWN!)
Withdrawl on an Downer: too little (things go UP!)
Drug abuse in Newborns
Always assume overdose, not withdrawl at birth, in a newborn less than 24 hours after birth
24 hours or more after birth, you can assume the newborn is in withdrawl
Alcohol Withdrawl Syndrome vs. Delirium Tremens
Every alcoholic goes through alcohol withdrawl syndrome approximately 24 hours after the person stops drinking (non-life threatening)
However, less than 20% of alcoholics in alcohol withdrawl syndrome progress to delrium tremens (occurs about 72 hours after the person stop drinking) (life threatening to self and others!)
- NPO for seizures, Restricted bed rest, & Restraints for DT.
What two situations would respiratory arrest be a priority???
Overdose of a Downer
Withdrawl of an Upper
Which patients would seizures be a risk for?
Overdose of an Upper
Withdrawl of a Downer
Aminoglycosides “A Mean Old Mycin”
BIG GUNS of ABXs
Use them when nothing else works, unsafe at toxic levels
All aminoglycosides end in -mycin
Gentamycin, Vancomycin, and Clindamycin, Streptomycin, Cleomycin, Tobramycin
Not all drugs ending in mycin are aminoglycosides
Azithromycin, Clarithromycin, Erythromycin….all have THRO in the middle…..so THRO them off the list
Aminoglycosides: Toxic Effects
Mycin—sounds like mice (think ears)…monitor hearing (#1), balance, and tinnitus
The human ears are shaped like a kidney so another toxic effects is nephrotoxicity..therefore monitor Crt
*Crt= Creatinine best indicator for kidney function
24-hour Crt clearance better than serum Crt
Administer mycin q8
Do not give PO (unless hepatic encephalopathy or pre-op bowel surgery to sterilize the bowel)
Neomycin and Kanamycin can sterilize bowel
Troughs and Peaks
“TAP” Levels
Trough is when drugs is at their lowest concentration in the pt’s blood
Peaks is when drugs is at their highest concentration in a pt’s blood
“TAP” Trough, Administer, Peak
Drawn because of drugs narrow therapeutic range
Draw TAP on Mean Old Mycin, Digoxin, Lasix
Trough is always drawn 30 minutes before next dose…
