Mark Klimek Audio Notes: Acid Base ABG’s
As pH goes, so does my Pt! Except for K
pH and HCO3 in same direction Metabolic
pH and HCO3 in different direction: Respiratory
pH ↓ Pt goes ↓ (HR, RR, all vitals) K goes ↑ hy
...
Mark Klimek Audio Notes: Acid Base ABG’s
As pH goes, so does my Pt! Except for K
pH and HCO3 in same direction Metabolic
pH and HCO3 in different direction: Respiratory
pH ↓ Pt goes ↓ (HR, RR, all vitals) K goes ↑ hypoexcitable
pH ↑ Pt goes ↑ K goes ↓ hyperexcitable
Except for K – it does the opposite
pH ↑ : Alkalosis
Seizures, hyperactivity, borborgygmi (↑BS)
Kausmal breathing = MacKausamal (Metabolic Acidosis breathing)
Causes of imbalance:
1. Is lung affected?
a. Yes-Respiratory
2. Is pt overventilating or underventilating?
a. Over-alkalosis
b. Under-acidosis
3. Not the lung?
a. Then it is Metabolic
4. If pt has prolonged vomiting or suctioning
a. Alkalosis
5. If you don’t know: it’s probably metabolic acidosis (It’s super common)
Alcoholism
Psychological
#1 problem psychologically in alcoholism and all other abusers is denial
Denial-refusal to accept the reality of a problem
o Treat denial by confronting
o Differentiate what they say versus what they do
DO NOT confuse confrontation with aggression (attacks the person)
Questions about staff problem interactions: Never choose YOU, choose I
Denial is okay in loss/grief
o Treat this denial with support-Do NOT confrontMark Klimek Audio Notes 2
Denial Anger Bargaining Depression Acceptance
#2 problem dependency/codependency
o Dependency-abuser gets significant other to do things for them
o Codependency-positive self esteem significant other receives from doing things for the
abuser
o Treat by setting limits and enforce them, say no
Manipulation-abuser gets significant other for to do things them that is not in the best interest of the
SO
o Interest and harmful
o If what being asked to do is neutral-dependency
o If what being asked is harmful or not in best interest-manipulation
o Treat manipulation by setting limits and enforce, say no
Wernicke’s and Korsakoff
o Wernickes’-encephalopathy induced by vit B1/ thiamine d
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