Lecture Flashcards
You treat denial by ____?
You treat denial by confronting it
What are the stages of grief ?
DABDA
Denial Anger Bargining Depression Acceptance
Wernicke’s(Korsakoff’s) Syndrome is only for
Alcoholics
Wernicke’s(Korsakoff’s) Syndrome is
What happens to the client ?
This is a form of what ?
This neurological disorder
Psychosis induced by Vi tamin B1 (Thiamine) deficiency
So client loses touch with reality because they have a vitamin deficiency
This a form of Dementia
primary symptom of WKS
amnesia with confabulation (making up stories) they believe
the lie..
You will not metabolize the Alcohol you drink without____?
Vitamin b1
Without vitamin b1 alcohol stays in the blood and raise to toxic level and ____
Destroy brain function
WKS
Characteristics: i. Preventable 1. ii. Arrestable 1. iii. Irreversible 1.
Characteristics:
i. Preventable
1. By giving B1 vitamins
ii. Arrestable
1. Can stop from getting worse- not imply better
iii. Irreversible
1. Dementia symptoms don’t get better—only worse
Dementia goal should be never improvement! The goal is ____?
Maintenance or slowing further Deterioration
Revia /Disulfiram (drugs used for ??? And is what kind of therapy ????
drugs used for alcoholism
And aversion therapy
REVIA®
(naltrexone) use for
Aversion Therapy
Signs of alkalosis
7
6
Tachycardia • Tachypnea • Diarrhea • Tremors • Seizure • Hyperreflexia • Agitated
Borborygmi (↑ bowel sounds) • Hypertension • Palpitations • Tetany • Anxiety/Panic • Poly
S/S of acidosis
Bradycardia • Bradypnea • Hypotension • ↓ lucidity • anorexia • coma • lethargy
cardia arrest
• suppressed, decreased, falling
High Pressure Alarms are triggered by
High Pressure Alarms are triggered by ↑ resistance to air flow and can
be caused by obst ruct ions of three types
3 type of high pressure obstructions
a. Kinked Tube
i. NRS ACTION: Unkink i t
b. Water in tubing (caused by condensat ion)
i. NRS ACTION: Empty i t /Remove H2O
c. Mucus in ai rway
i. NRS ACTION: Turn, C&DB; only use suct ion if C&DB fails, as a last resort
Low Pressure Alarms are triggered by ↓
Low Pressure Alarms are triggered by ↓ resistance to air flow and can
be caused by disconnections
2 types of disconnections with low pressure alarms
caused by disconnections of the main tubing or oxygen sensor tubing
How do we fix disconnections?
(reconnect it UNLESS tube is on t
the floor - bag them &; call Respiratory therapist if this happens)
Respiratory alkalosis = ventilator setting may be too ____.
Respiratory acidosis = ventilator setting may be too ____.
Respiratory alkalosis = ventilator setting may be too high.
Respiratory acidosis = ventilator setting may be too low.
You don’t confront loss & grief . You_____?
Support it
What is the number one problem with any type of abuse?
1 problem = denial refusal to accept the reality of a problem
The second problem with any type of abuse is
co-dependency calls the boss… (______?)
2 problem = dependency *when the abuser get the significant other to do something
co-dependency calls the boss… (positive self esteem)
abuse =
loss =
abuse = confront loss = support
manipulation =
manipulation = when the abuser gets the significant other to do things for him or her… the
nature of the act is dangerous or harmful
What does “wean” mean?
What does “wean” mean? gradually decrease with the goal of getting off altogether
How do you treat dependency?
- Set boundary (limits) and enforce them. Agree inadvance on what requests are allowed then enforce
the agreement - Work on the self-esteem of the codependent
person.
Learn to say no
How do you treat manipulation
- Set limits and enforce
2. Its easier to treat than dependency/codependency because nobody likes to be manipulated
ANTABUSE®
(disulfiram is for ___?
Alcoholism
REVIA®
(naltrexone) is used for ___?
Alcoholism
What is aversion therapy
It can treat problem drinking by creating an unpleasant reaction to alcohol. It’s used in recovery
programs that include medical supervision and counseling
What it the Onset and duration of effectiveness of anatbuse/revia ?
2 weeks
*Take drugs 2 weeks and builds up in blood to a level that when drinking alcohol will become horribly sick; if off for two
weeks, will be able to drink without sickness again
Patient teaching:for Antabuse/revia avoid NAUSEA, VOMITING & DEATH
?
What 9 things should they stop taking
Patient teaching: Avoid ALL forms of alcohol to avoid nausea,
vomi t ing, and possibly death, including:
- )Mouthwash
- )aftershave
- ) Hand sanitizer
- )perfumes/cologne,
- )insect repellant.
- )elixirs
- ) uncooked icing (vanilla extract)
Every abused drug is either an upper or a downer…
*_______ (not upper or downer) but can be abused by the ______?
Every abused drug is either an upper or a downer…
*Laxative (not upper or downer) but can be abused by the elderly
Name 6 upper drugs
- )Caffeine
- )Cocaine
- ) PCP/LSD (Psychedelic hallucinogens)
- ) Methamphetamines-speed
- ) ADHD- adderrall/Ritalin
- )Bath Salts (Cath-Kath)
Upper Signs/symptoms: things go up… euphoria, tachycardia, restlessness, irritibility, diarhhea, reflex
3/4, spastic - suction!!!
1.)Tachycardia
2.) Hypertension
3.) Diarrhea,
4.)Agitation, restlessness,
irritibility,
5.)Tremors
6.)Clonus
7.)Belligerence
8.)Seizures
9.)Exaggerated, shrill, high pitched cry
10.)Difficult to console
11.) euphoria,
12.),
13.)
14.) reflex 3/4, spastic - suction!!!
Name 3 downers
Everything that’s not a upper like -
heroin, alcohol, marijuana,
S & s of drowners
- )Bradycardia
- )Hypotension
- ) Constipation
- )Constricted pupils •
- ) Respiratory arrest
- )Decreased core body temp
- ) Flaccidity
Overdose =
Too much
Withdrawal=
Not enough
If they say: “overdosed on an upper” (too much ____)… pick ____ things!!
If they say: “overdosed on an upper” (too much upper)… pick ↑ things!!
If they say: “downer &; intoxication” (too much ________)… pick ___ things!!
If they say: “downer & intoxication” (too much DOWNER)… pick ↓ things!!
Withdraw form a downer and everything goes
Up
Withdraw from upper and everything goes
Down
2 situtions of uppers and downers (highest priority) =
Respiratory depression/arrest:=
Seizure:=
Respiratory depression/arrest: Downer overdose/upper withdrawal..
Seizure: Upper overdose/downer withdrawal
What do you assume with drug addiction in newborns 24hours after birth ??? Intoxication or withdrawals
Always assume intoxication (first 24 hours after birth), then after this time, assume withdrawal
Differences:
a. Every alcoholic goes through alcohol withdrawal syndrome
(AWS) (after ____ hours)
DT occurs after ____hours
b. Only a ______ get delirium tremors (DT)
c. _____ is not life threatening. DT’s can kill you.
d.Patients with _______ are not dangerous to themselves or others.
Patients with _____ are dangerous to self and others.
Differences:
a. Every alcoholic goes through alcohol withdrawal syndrome
(AWS) (after 24 hours)
DT occurs after 72 hours
b. Only a minority get delirium tremors (DT)
c. AWS is not life threatening. DT’s can kill you.
d.Patients with AWS are not dangerous to themselves or others.
Patients with DTs are dangerous to self and others.
What are the interventions for AWS?
1.) Semi-private-anywhere
2.) Regular diet
3.) Up Ad Lib (no activity Restricted bedrest (no B1 multi-vitamin (to prevent
restriction)
4.) Do not restrain
What are the 5 interventions for DT’s?
- ) Private-near nurses station
- ) Clear liquids or NPO
- ) Restricted bedrest (no B1 multi-vitamin (to prevent
- ) Should be restrained (2 pt leather restraints) or vest . Check every 15 mins
- ) 2 extremity restricted—arm on one side and leg on one, one upper extremity and one opposite lower extremity
AWS always precedes Delirium Tremens
But Delirium Tremens doesn’t always follow AWS
AWS always precedes Delirium Tremens
But Delirium Tremens doesn’t always follow AWS
How often do you check restraints?
How often do you do Neurovascular checks rotate the restraints?
Every 15 min
Every minimum 2hours but you could do it every hour
What do AMINOGLYCOSIDES stand for ?
a mean old mycin
What are AMINOGLYCOSIDES ?
Powerful antibiotics—to treat severe, life-threatening, resistant
infections
AMINOGLYCOSIDES end in ___?
Mycin/micin But not thromycin
Toxic effects of AMINOGLYCOSIDES?
The most famous feature of the worlds most famous mouse(ears)
i. Toxic effect: ______
ii. Must monitor __, _____,____?
The human ear is shaped like a kidney i. Toxic effect: ______
ii. Monitor:______
1. Best indicator of _______ function
2. _______ mg/dL
Themostfamousfeatureoftheworldsmostfamousmouse(ears)
i. Toxic effect: ototoxicity
ii. Must monitor hearing, balance, tinnitus
b. Thehumanearisshapedlikeakidney i. Toxic effect: nephrotoxicity
ii. Monitor: creatinine
1. Best indicator of kidney function but 24 hr creatinine clearance is better
2. 0.6-1.2 mg/dL
DAily weight Best indicator
Fluid balance
Bun is good Indicator over?
Do you Dehydration
The best indicat reversing shock
Urine output -This is the only time you pick this
What number should tie think of when you think aminoglycocides?
The number 8 drawn inside the ear reminds you of:
i. Cranial nerve 8 (Drug toxic to)
ii. Frequency of administration: Every 8 hour
What is the route of administration for aminoglycocides?
Im or iv
Don’t give aminoglycocides Po because ? Except in what case ?
do not give PO, because they are not absorbed
Will kill bacteria in your bowel
What 3
time do you want a sterile bowl ?
Hepatic encephalopathy 1. Also called Liver Coma, Ammonia-Induced Encephalopathy 2. When want a sterile bowel 3. Due to a high ammonia level
ii. Pre-op Bowel surgery
1. REMEMBER this military sound off:
a. NEOmycin
b. KANmycin
c. WHO CAN STERILIZE MY BOWEL? NEO
KAN
d. ^ PO, 2 bowel sterilizers
3.) c diff
Thee phrase Tap= what for aminoglycocides
T: trough: when the drug is at its lowest…
A: adminster
P: peak: when the drug is at its highest…
Why do we do a TAP?!
(narrow therapeutic window) what works/what kills
What is the trough( drug is it’s lowest) and peak ?
Sublingual
IV
IM
SQ
PO
Sublingual-30 min before next dose &5-10 mins after drug dissolve
IV-30 min before next dose & 15-30 min after drug finished
IM-30 min before next dose & 30-60 min after drug given
SQ-30 min before next dose & See diabetes lecture
PO-30 min before next dose & Forget about it.
Thiamine (B1) plays a role in
metabolizing glucose to produce energy for the brain.
What are the 2mycin used for the purpose of bowel sterilization?
a. NEOmycin
b. KANmycin
Calcium Channel Blockers: are like VALIUM for your
CCB are negative =
Heart because they …calms you down.. calms the heart down!
negative inotropic, negative chronotropic, negative dromotropic = ic
negative inotropic, negative chronotropic, negative dromotropic =
Positive inotropic, negative chronotropic, negative dromotropic =
Ca
calm/relax… cardiac
depressant because the weaken , slow down and depress the heart
Is a cardiac stimulate
-what do they CCB treat
A, A, A-A-A
a. Antihypertensives -they relax the heart and blood vessels so the BP goes down
b. Antianginal (decreases O2 demand by relaxing the heart
c. Anti Atrial Arrthymia (does not tx ventricular arrthymias
D. SVT (atrial)
CCB decrease ___not increase supply to the heart
Oxygen demand not increase oxygen demand
What are the side Effects of CCB ???
Side effects:
HA, because it relaxes the heart and blood vessels
HTN because you get vasodilation in the brain and that gives like a migraine
Bradycardia
CCB End in
-dipine…
Verapimil…
CCB
Cardizem
CCB
Cssn be given continuous IV drip
Hold CCB if SYSTOLIC is
< 100!
QRS de-polarization =
QRS de-polarization = ventricular
P wave=
Atrial
7 rhythms…
- ) asystole
- ) a flutter
- ) atrial fibrillation
- ) ventricular fibrillation
- ) ventricular tachycardia
- ) PVS
- ) normal sinus rhythm
A lack of QRS =
asystole
-saw tooth=
A flutter
-chaotic p waves=
Atrial fibrillation
Chaotic QRS=
ventricular fibrilation
(bizzarre)=
Tachycardia
-periodic bizarre wide QRS =
PVC
PVC (low priority) and are no concern unless they’re
if there are more
than 6/ in a min.. or more than 6 PVC’s in a row.. or if the PVC falls on the T wave of the previous beat) PVC’s never reach HIGH..
Which LETHAL arrhytmias.. (they will kill you in 8 minutes or less)
- ) asystole
2. ) ventricular fibrillation
ROME:
Respiratory= Opposite:
- pH is high, PCO2 is down (_______?).
- pH is low, PCO2 is up (________?).
Metabolic= Equal:
- pH is high, HCO3 is high (________?).
- pH is low, HCO3 is low (_______?).
ROME:
Respiratory= Opposite:
- pH is high, PCO2 is down (Alkalosis).
- pH is low, PCO2 is up (Acidosis).
Metabolic= Equal:
- pH is high, HCO3 is high (Alkalosis).
- pH is low, HCO3 is low (Acidosis).
as the pH goes… so goes my patient!!!
-when pH goes up; patient goes up.. (everything gets _____!)
-when pH goes down; patient goes down! (systems in your body __________)
…except with potassium: when pH goes up; potassium goes _____… when pH goes down;
potassium goes _____!
-when pH goes up; patient goes up.. (everything gets irritable!)
-when pH goes down; patient goes down! (systems in your body shut down)
…except with potassium: when pH goes up; potassium goes down… when pH goes down;
potassium goes up!
Kussmaul breathing is a deep and labored breathing pattern often associated with severe
_______s, particularly diabetic ketoacidosis (DKA) but also kidney failure…
_________Kussmaul!!
Kussmaul breathing is a deep and labored breathing pattern often associated with severe
metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure… MAC
Kussmaul!!
M: metabolic
AC: acidosis
prolonged gastric vomiting or suctioning… it’s always ____?
Why?
for everything else that is not lung - choose _______?.
if you don’t know the answer… always answer ______?
prolonged gastric vomiting or suctioning… it’s always metabolic alkalosis
why? losing acid
for everything else that is not lung - choose metabolic acidosis.
if you don’t know the answer… always answer metabolic acidosis
Wernicke’s Encephalopathy and Korsakoff’s Psychosis are the _____ and ____ phases
Wernicke’s
Encephalopathy and Korsakoff’s Psychosis are the acute and chronic phases
AWS & DTS get
AWS & DTS get a anti-hypertensive (BP pill) - everything is going up - keep everything down…
They both get a tranquilizer, because their up…
multivitamin b1 to prevent WKS
Rapid P-wave depolarization’s in a saw-tooth
Atrial flutter
Chaotic
fibrillation
Lethal arrhythmias
a.
b.
Lethal Because they have no ____
Without a ____ you die in ____mins
Lethal arrhythmias
a. Asystole
b. V-fib
They have no cardiovascular output
Without cardiac output you die in. 8min
Potentially life threatening arrhythmia:
V tachy
PVC
What the treatment for PVC’s
Lidocaine(Ventricular, lasts longer),Amiodorone
What’s the treatment for V Tach
Lidocaine
What the treatment for Supraventricular arrhythmias ?
i. Adenosine (push fast IV push; usually 8s or faster)
ii. Beta-Blockers(-lol)
iii. Calcium ChannelBlockers
iv. Digoxin(Digitalis)Lanocin
What’s the treatment for V-fib
V-Fib
i. Best treatment electrically
ii. Shock = 200 Defibrillate
What’s the treatment for Asystole
i.
ii.
iii.
Asystole
i. Epinephrine
ii. Atropine
iii. S/E anticholinergics
bizarre=
Tachy
Periodic wide, bizarre QRS’s
What PVCs
6 6 T=
PVCs
Be concerned, i f :
- More than 6 per minute
- 6 in a row
- PVC falls on T-wave of previous beat
A lack of QRS depolarization’s (a straight line)
Asystole
Rapid P-wave depolarization’s in a saw-tooth (flutter)
Atrial flutter
Chaotic P-wave depolarization’s (lacks any discernable
pattern)
At r ial f ibr i l lat ion
Chaotic QRS depolarization’s
Vent r icular f ibr i l lat ion
Wide, bizarre QRS’s
Vent r icular tachycardia
Periodic wide, bizarre QRS’s
Premature vent r icular cont ract ions (PVC)
Saw tooth=
Flutter
PVCs are Generally low to moderate priority. unless everyone else has a normal rhythm
i i i . Be concerned, i f
- More than 6 per minute
- 6 in a row
- PVC falls of T-wave of previous beat
What is the Abcds of atrial treatment?
i. Adenosine (push fast IV push; usually 8s or faster)
ii. Beta-Blockers(-lol)
iii. Calcium ChannelBlockers
iv. Digoxin(Digitalis)Lanocin
MASLOW’s 6 Priorities (HIGHest - LOWest)
MASLOW’s Priorities (HIGHest - LOWest) physiological safety comfort psychological (problems within the person) social (problems with other people) spiritual
