Mark Klimek NCLEX Review - ABGs and Compensation

ABGs and Acid-Base Imbalances

• ABGs (Arterial Blood Gases) help identify acid-base imbalances.
• Rule of the B's: If pH and Bicarb move in the same direction, it indicates metabolic alkalosis or acidosis.
• Compensated vs. Partially Compensated: Compensated has a normal pH, while partially compensated does not; check the compensating system for abnormalities.
• As pH rises, potassium levels typically decrease, and vice versa, except in cases involving potassium levels.

Signs of Alkalosis and Acidosis

• Signs of Alkalosis: Include hyperkalemia, hypertension, tachycardia, and seizures.
• Signs of Acidosis: Include hyperkalemia, bradycardia, hypotension, and lethargy.
• Metabolic alkalosis may arise from prolonged gastric vomiting, while respiratory issues can indicate acidosis or alkalosis depending on ventilation status.

Ventilator Alarms

• High Pressure Alarms: Triggered by increased resistance; causes include kinked tubing, water in tubes, or mucus in airway.
• Low Pressure Alarms: Triggered by decreased resistance; causes usually involve disconnections in tubing.
• Respiratory alkalosis indicates overventilation, while respiratory acidosis indicates underventilation.

Substance Abuse and Psychological Concepts

• The primary problem in substance abuse is denial; confront this by highlighting inconsistencies in statements and behaviors.
• The five stages of grief: denial, anger, bargaining, depression, and acceptance (mnemonic: DAB-DA).
• Dependency arises when the abuser relies on others, whereas codependency is the significant other's reliance on the abuser’s needs for self-esteem.

Nursing Actions for Substance Abuse

• For dependency and codependency, set and enforce limits, and work on the codependent person's self-esteem.
• Wernicke's Syndrome is induced by thiamine deficiency, characterized by psychosis with memory loss and confabulation.

Aminoglycosides

• Aminoglycosides are potent antibiotics effective against serious infections, all end in "-mycin" but not all "-mycin" drugs are aminoglycosides.
• Examples of aminoglycosides: Streptomycin, Gentamycin, Vancomycin; non-aminoglycoside mycins include Azithromycin and Erythromycin.
• Toxic effects include ototoxicity (hearing) and nephrotoxicity (kidneys); monitor hearing, balance, and creatinine levels.

Heart Medications

• Inotropic effects are related to heart strength; positive inotropes increase strength while negative inotropes decrease it.
• Chronotropic effects are related to heart rate; positive chronotropes increase rate while negative decrease it.
• Dromotropic effects concern the conductivity of the heart; positive enhances while negative inhibits conduction.
• Calcium Channel Blockers and Beta Blockers generally exhibit negative inotropic, chronotropic, and dromotropic effects.

Arrhythmias

• Various arrhythmias are distinguished by their depolarization patterns; lethal arrhythmias include asystole and ventricular fibrillation.
• Treat PVCs with lidocaine and amiodarone, while V-Tach is treated similarly.

Chest Tubes and Complications

• Chest tubes restore negative pressure in the pleural space to keep the lungs inflated.
• Monitor for complications like drainage device breakage, where immediate action involves clamping and replacing the device, or tube dislodgment, which involves covering it with sterile gauze.

Congenital Heart Defects

• Congenital defects are classified as "trouble" when they involve right-to-left shunting, cyanosis, or require surgical intervention.
• Tetralogy of Fallot includes four defects: ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy.

Ambulatory Assistive Devices

• Crutches, canes, and walkers are classified as ambulatory assistive devices; crutches should be measured with specific distal measurements and elbow flexion angles.
• Different crutch gaits include 2-point, 3-point, 4-point, and swing-through, emphasizing the sequence of leg and crutch movements.### Gait Patterns
• Even gaits (2 & 4) indicate weight is evenly distributed.
• Two affected legs suggest mild impairment (faster), while four affected legs indicate severe impairment (slower movement).
• For brace extremities or amputations, use a "swing through" method for mobility.

Crutch and Cane Usage

• Crutches are used with the bad leg while supporting weight.
• Canes should be used on the strong side and advanced with the weak side.
• Walkers should be picked up, set down, and approached for walking; belongings must be placed to the side, not in front.

Biological Agents: Category A

• Includes severe agents that pose the highest risk.
• Key agents include:
  • STAPH B
  • Small Pox: transmitted through inhalation, airborne precautions required, fatal due to septicemia, rash starts around the mouth.
  • Tularemia: causes chest symptoms, leads to respiratory failure, treated with streptomycin.
  • Anthrax: spreads by inhalation and resembles flu symptoms; fatal due to respiratory failure, treated with supro, PCN, and streptomycin.
  • Plague: transmitted via inhalation, characterized by 3 H's: hemoptysis, hematemesis, and hematochezia; fatal due to respiratory failure and DIC, treated with Doxycycline and Mycins.
  • Hemorrhagic illnesses: presents with petechiae and ecchymoses, has a high fatality rate.
  • Botulism: ingested toxin causing descending paralysis, fever while remaining alert, fatal due to respiratory arrest.

Biological Agents: Category B & C

• Category B includes agents that pose lesser risks compared to Category A.
• Category C comprises emerging pathogens, such as:
  • Nipah Virus
  • Hantavirus

Risk Severity of Biological Agents

• Categories suggest severity:
  • Category A: the worst
  • Category B: lesser concern
  • Category C: emerging threats

This quiz covers essential concepts related to arterial blood gases (ABGs) and the rules of compensation in the context of NCLEX exam preparation. It includes important definitions and key concepts that nurses must master to identify and interpret ABG results. Strengthen your understanding of these critical nursing topics with this focused review.