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1
Q

You treat denial by ____?

A

You treat denial by confronting it

2
Q

What are the stages of grief ?

A

DABDA

Denial Anger Bargining Depression Acceptance

3
Q

Wernicke’s(Korsakoff’s) Syndrome is only for

A

Alcoholics

4
Q

Wernicke’s(Korsakoff’s) Syndrome is

What happens to the client ?

This is a form of what ?

A

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

5
Q

primary symptom of WKS

A

amnesia with confabulation (making up stories) they believe
the lie..

6
Q

You will not metabolize the Alcohol you drink without____?

A

Vitamin b1

7
Q

Without vitamin b1 alcohol stays in the blood and raise to toxic level and ____

A

Destroy brain function

8
Q

WKS

Characteristics: 
i. Preventable 
1.  
ii. Arrestable 
1.  
iii. Irreversible 
1.
A

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

9
Q

Dementia goal should be never improvement! The goal is ____?

A

Maintenance or slowing further Deterioration

10
Q

Revia /Disulfiram (drugs used for ??? And is what kind of therapy ????

A

drugs used for alcoholism

And aversion therapy

11
Q

REVIA®

(naltrexone) use for

A

Aversion Therapy

12
Q

Signs of alkalosis
7
6

A
Tachycardia   
• Tachypnea 
• Diarrhea 
• Tremors 
• Seizure 
• Hyperreflexia 
• Agitated
Borborygmi (↑ bowel sounds) 
• Hypertension 
• Palpitations 
• Tetany 
• Anxiety/Panic 
• Poly
13
Q

S/S of acidosis

A
Bradycardia   
• Bradypnea 
• Hypotension 
• ↓ lucidity 
• anorexia 
• coma 
• lethargy 

cardia arrest
• suppressed, decreased, falling

14
Q

High Pressure Alarms are triggered by

A

High Pressure Alarms are triggered by ↑ resistance to air flow and can
be caused by obst ruct ions of three types

15
Q

3 type of high pressure obstructions

A

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

16
Q

Low Pressure Alarms are triggered by ↓

A

Low Pressure Alarms are triggered by ↓ resistance to air flow and can
be caused by disconnections

17
Q

2 types of disconnections with low pressure alarms

A

caused by disconnections of the main tubing or oxygen sensor tubing

18
Q

How do we fix disconnections?

A

(reconnect it UNLESS tube is on t

the floor - bag them &; call Respiratory therapist if this happens)

19
Q

Respiratory alkalosis = ventilator setting may be too ____.

Respiratory acidosis = ventilator setting may be too ____.

A

Respiratory alkalosis = ventilator setting may be too high.

Respiratory acidosis = ventilator setting may be too low.

20
Q

You don’t confront loss & grief . You_____?

A

Support it

21
Q

What is the number one problem with any type of abuse?

A

1 problem = denial refusal to accept the reality of a problem

22
Q

The second problem with any type of abuse is

co-dependency calls the boss… (______?)

A

2 problem = dependency *when the abuser get the significant other to do something

co-dependency calls the boss… (positive self esteem)

23
Q

abuse =

loss =

A
abuse = confront 
loss = support
24
Q

manipulation =

A

manipulation = when the abuser gets the significant other to do things for him or her… the
nature of the act is dangerous or harmful

25
Q

What does “wean” mean?

A

What does “wean” mean? gradually decrease with the goal of getting off altogether

27
Q

MASLOW’s 6 Priorities (HIGHest - LOWest)

A
MASLOW’s Priorities (HIGHest - LOWest) 
physiological 
safety 
comfort 
psychological (problems within the person) 
social (problems with other people) 
spiritual
27
Q

How do you treat dependency?

A
  1. Set boundary (limits) and enforce them. Agree inadvance on what requests are allowed then enforce
    the agreement
  2. Work on the self-esteem of the codependent
    person.

Learn to say no

28
Q

How do you treat manipulation

A
  1. Set limits and enforce

2. Its easier to treat than dependency/codependency because nobody likes to be manipulated

29
Q

ANTABUSE®

(disulfiram is for ___?

A

Alcoholism

30
Q

REVIA®

(naltrexone) is used for ___?

A

Alcoholism

31
Q

What is aversion therapy

A

It can treat problem drinking by creating an unpleasant reaction to alcohol. It’s used in recovery
programs that include medical supervision and counseling

32
Q

What it the Onset and duration of effectiveness of anatbuse/revia ?

A

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

33
Q

Patient teaching:for Antabuse/revia avoid NAUSEA, VOMITING & DEATH
?

What 9 things should they stop taking

A

Patient teaching: Avoid ALL forms of alcohol to avoid nausea,
vomi t ing, and possibly death, including:

  1. )Mouthwash
  2. )aftershave
  3. ) Hand sanitizer
  4. )perfumes/cologne,
  5. )insect repellant.
  6. )elixirs
  7. ) uncooked icing (vanilla extract)
34
Q

Every abused drug is either an upper or a downer…

*_______ (not upper or downer) but can be abused by the ______?

A

Every abused drug is either an upper or a downer…

*Laxative (not upper or downer) but can be abused by the elderly

35
Q

Name 6 upper drugs

A
  1. )Caffeine
  2. )Cocaine
  3. ) PCP/LSD (Psychedelic hallucinogens)
  4. ) Methamphetamines-speed
  5. ) ADHD- adderrall/Ritalin
  6. )Bath Salts (Cath-Kath)
36
Q

Upper Signs/symptoms: things go up… euphoria, tachycardia, restlessness, irritibility, diarhhea, reflex
3/4, spastic - suction!!!

A

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!!!

37
Q

Name 3 downers

A

Everything that’s not a upper like -

heroin, alcohol, marijuana,

38
Q

S & s of drowners

A
  1. )Bradycardia
  2. )Hypotension
  3. ) Constipation
  4. )Constricted pupils •
  5. ) Respiratory arrest
  6. )Decreased core body temp
  7. ) Flaccidity
39
Q

Overdose =

A

Too much

40
Q

Withdrawal=

A

Not enough

41
Q

If they say: “overdosed on an upper” (too much ____)… pick ____ things!!

A

If they say: “overdosed on an upper” (too much upper)… pick ↑ things!!

42
Q

If they say: “downer &; intoxication” (too much ________)… pick ___ things!!

A

If they say: “downer & intoxication” (too much DOWNER)… pick ↓ things!!

43
Q

Withdraw form a downer and everything goes

A

Up

44
Q

Withdraw from upper and everything goes

A

Down

45
Q

2 situtions of uppers and downers (highest priority) =

Respiratory depression/arrest:=

Seizure:=

A

Respiratory depression/arrest: Downer overdose/upper withdrawal..

Seizure: Upper overdose/downer withdrawal

46
Q

What do you assume with drug addiction in newborns 24hours after birth ??? Intoxication or withdrawals

A

Always assume intoxication (first 24 hours after birth), then after this time, assume withdrawal

47
Q

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.

A

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.

48
Q

What are the interventions for AWS?

A

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

49
Q

What are the 5 interventions for DT’s?

A
  1. ) Private-near nurses station
  2. ) Clear liquids or NPO
  3. ) Restricted bedrest (no B1 multi-vitamin (to prevent
  4. ) Should be restrained (2 pt leather restraints) or vest . Check every 15 mins
  5. ) 2 extremity restricted—arm on one side and leg on one, one upper extremity and one opposite lower extremity
50
Q

AWS always precedes Delirium Tremens

But Delirium Tremens doesn’t always follow AWS

A

AWS always precedes Delirium Tremens

But Delirium Tremens doesn’t always follow AWS

51
Q

How often do you check restraints?

How often do you do Neurovascular checks rotate the restraints?

A

Every 15 min

Every minimum 2hours but you could do it every hour

52
Q

What do AMINOGLYCOSIDES stand for ?

A

a mean old mycin

53
Q

What are AMINOGLYCOSIDES ?

A

Powerful antibiotics—to treat severe, life-threatening, resistant
infections

54
Q

AMINOGLYCOSIDES end in ___?

A

Mycin/micin But not thromycin

55
Q

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

A

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

56
Q

DAily weight Best indicator

A

Fluid balance

57
Q

Bun is good Indicator over?

A

Do you Dehydration

58
Q

The best indicat reversing shock

A

Urine output -This is the only time you pick this

59
Q

What number should tie think of when you think aminoglycocides?

A

The number 8 drawn inside the ear reminds you of:

i. Cranial nerve 8 (Drug toxic to)
ii. Frequency of administration: Every 8 hour

60
Q

What is the route of administration for aminoglycocides?

A

Im or iv

61
Q

Don’t give aminoglycocides Po because ? Except in what case ?

A

do not give PO, because they are not absorbed

Will kill bacteria in your bowel

62
Q

What 3

time do you want a sterile bowl ?

A
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

63
Q

Thee phrase Tap= what for aminoglycocides

A

T: trough: when the drug is at its lowest…
A: adminster
P: peak: when the drug is at its highest…

64
Q

Why do we do a TAP?!

A

(narrow therapeutic window) what works/what kills

65
Q

What is the trough( drug is it’s lowest) and peak ?

Sublingual

IV

IM

SQ

PO

A

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.

66
Q

Thiamine (B1) plays a role in

A

metabolizing glucose to produce energy for the brain.

67
Q

What are the 2mycin used for the purpose of bowel sterilization?

A

a. NEOmycin

b. KANmycin

68
Q

Calcium Channel Blockers: are like VALIUM for your

CCB are negative =

A

Heart because they …calms you down.. calms the heart down!

negative inotropic, negative chronotropic, negative dromotropic = ic

69
Q

negative inotropic, negative chronotropic, negative dromotropic =

Positive inotropic, negative chronotropic, negative dromotropic =

Ca

A

calm/relax… cardiac
depressant because the weaken , slow down and depress the heart

Is a cardiac stimulate

70
Q

-what do they CCB treat

A

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)

71
Q

CCB decrease ___not increase supply to the heart

A

Oxygen demand not increase oxygen demand

72
Q

What are the side Effects of CCB ???

A

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

73
Q

CCB End in

A

-dipine…

74
Q

Verapimil…

A

CCB

75
Q

Cardizem

A

CCB

Cssn be given continuous IV drip

76
Q

Hold CCB if SYSTOLIC is

A

< 100!

77
Q

QRS de-polarization =

A

QRS de-polarization = ventricular

78
Q

P wave=

A

Atrial

79
Q

7 rhythms…

A
  1. ) asystole
  2. ) a flutter
  3. ) atrial fibrillation
  4. ) ventricular fibrillation
  5. ) ventricular tachycardia
  6. ) PVS
  7. ) normal sinus rhythm
80
Q

A lack of QRS =

A

asystole

81
Q

-saw tooth=

A

A flutter

82
Q

-chaotic p waves=

A

Atrial fibrillation

83
Q

Chaotic QRS=

A

ventricular fibrilation

84
Q

(bizzarre)=

A

Tachycardia

85
Q

-periodic bizarre wide QRS =

A

PVC

86
Q

PVC (low priority) and are no concern unless they’re

A

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..

87
Q

Which LETHAL arrhytmias.. (they will kill you in 8 minutes or less)

A
  1. ) asystole

2. ) ventricular fibrillation

88
Q

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 (_______?).
A

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).
89
Q

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 _____!

A

-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!

90
Q

Kussmaul breathing is a deep and labored breathing pattern often associated with severe
_______s, particularly diabetic ketoacidosis (DKA) but also kidney failure…
_________Kussmaul!!

A

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

91
Q

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 ______?

A

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

92
Q

Wernicke’s Encephalopathy and Korsakoff’s Psychosis are the _____ and ____ phases

A

Wernicke’s

Encephalopathy and Korsakoff’s Psychosis are the acute and chronic phases

93
Q

AWS & DTS get

A

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

94
Q

Rapid P-wave depolarization’s in a saw-tooth

A

Atrial flutter

95
Q

Chaotic

A

fibrillation

96
Q

Lethal arrhythmias

a.
b.

Lethal Because they have no ____
Without a ____ you die in ____mins

A

Lethal arrhythmias

a. Asystole
b. V-fib

They have no cardiovascular output
Without cardiac output you die in. 8min

97
Q

Potentially life threatening arrhythmia:

A

V tachy

PVC

98
Q

What the treatment for PVC’s

A

Lidocaine(Ventricular, lasts longer),Amiodorone

99
Q

What’s the treatment for V Tach

A

Lidocaine

100
Q

What the treatment for Supraventricular arrhythmias ?

A

i. Adenosine (push fast IV push; usually 8s or faster)
ii. Beta-Blockers(-lol)
iii. Calcium ChannelBlockers
iv. Digoxin(Digitalis)Lanocin

101
Q

What’s the treatment for V-fib

A

V-Fib

i. Best treatment electrically
ii. Shock = 200 Defibrillate

102
Q

What’s the treatment for Asystole
i.
ii.
iii.

A

Asystole

i. Epinephrine
ii. Atropine
iii. S/E anticholinergics

103
Q

bizarre=

A

Tachy

104
Q

Periodic wide, bizarre QRS’s

A

What PVCs

105
Q

6 6 T=

A

PVCs

Be concerned, i f :

  1. More than 6 per minute
  2. 6 in a row
  3. PVC falls on T-wave of previous beat
106
Q

A lack of QRS depolarization’s (a straight line)

A

Asystole

107
Q

Rapid P-wave depolarization’s in a saw-tooth (flutter)

A

Atrial flutter

108
Q

Chaotic P-wave depolarization’s (lacks any discernable

pattern)

A

At r ial f ibr i l lat ion

109
Q

Chaotic QRS depolarization’s

A

Vent r icular f ibr i l lat ion

110
Q

Wide, bizarre QRS’s

A

Vent r icular tachycardia

111
Q

Periodic wide, bizarre QRS’s

A

Premature vent r icular cont ract ions (PVC)

112
Q

Saw tooth=

A

Flutter

113
Q

PVCs are Generally low to moderate priority. unless everyone else has a normal rhythm
i i i . Be concerned, i f

A
  1. More than 6 per minute
  2. 6 in a row
  3. PVC falls of T-wave of previous beat
114
Q

What is the Abcds of atrial treatment?

A

i. Adenosine (push fast IV push; usually 8s or faster)
ii. Beta-Blockers(-lol)
iii. Calcium ChannelBlockers
iv. Digoxin(Digitalis)Lanocin