CM1 Test 2

The nurse provides care for the clients in the pediatric clinic. The nurse understands that according to Ericsson stages of psychosocial development developing a sense of personal control in a sense of independence occurs during which time period?

18 months to three years

Bicarbonate

20-28 mEq/L

PaCO2

35-45mmHg

pH

7.35-7.45

PaO2

75-100

O2 serum

95-100

Chloride normal range

98-106 mEq/L

Which patient should the nurse closely monitor for the risk factors of metabolic acidosis?

A patient with a pancreatic fistula that is draining

community acquired pneumonia

Acquired outside a healthcare facility Diagnosis: history, onset, chest x-ray, sputum culture, culture and sensitivity (C&S) Treatment: antibiotics, incentive spirometry, P&PD (postural percussion and drainage: tapping on back while leaning over- most often in kids) Complications: pleural effusion, atelectasis, bacteremia- infection in bloodstream

Major depressive disorder Adulthood (Symptoms)

Alterations in appetite and weight Sleep disturbances Fatigue Concentration disturbances Feelings of worthlessness

Anorexia symptoms

Amenorrhea Yellow skin Lanugo- thin body hair to keep body warm (no fat) Muscle weakening Constipation Abnormal lab values CT scan EEG changes CV abnormalities Hormone problems Impaired renal function

s/s Major depressive disorder

Anhedonia- loss of pleasure Avolition- lack of motivation Anergia Psychomotor agitation Psychomotor retardation- everything is slowing down Vegetative signs: changes in sleep, bowel functions, eating, and sex Decrease in personal care Unrealistic expectations Flat affect Weeping Helpless, hopeless, worthless, powerless Suicidal thought with or without plan (SI) Memory, concentration impaired Negative expectations of self and future Anger and irritability Weight changes Slow speech/thoughts Dysthymic- general sadness

Aspiration Pneumonia

Aspiration: The accidental inhalation of material into the respiratory tract. Risk factors for development of aspiration pneumonia: Choking on food or liquids meant for GI tract (dysphagia) Decreased LOC, impaired CNS Misplaced nasogastric feeding tube- x ray check Newborns who inspire before expiring

Metabolic Acidosis intervention

Assessment (FIRST) Decreased BP? Is the respiratory system compromising for something? Positioning - Keep airway open - If low BP, we don't want to sit them straight up in the bed, so balance the positioning - depends on what is occurring with the patient (not with low BP) Safety - decreased LOC, lethargic IVF- usually first to improve perfusion (isotonic) Treat underlying problem Education: prevention Prevent complications Manage chronic illnesses

disulfiram

Aversion Therapy Inhibits Drinking Unpleasant Symptoms- makes you sick when drinking Can result in getting really sick Demonstrate Sobriety Begins 5-10 minutes Lasts 30-120 minutes Avoid hidden Alcohol

confabulation

Both people with dementia and alcoholism can have confabulation aka blackouts

Metabolic alkalosis cause

Can be caused by different kidney disorders (can't excrete bicarb), but usually they are unable to excrete H as well and results in acidosis Severe vomiting Excessive GI suction Diuretics Excessive NaHCO3- administration

CIWA

Clinical Institute Withdrawal Assessment - measures the progress of withdrawal - discover dose of benzo

Late signs of inadequate oxygenation

Combativeness Unresponsive/Coma Dyspnea at rest Use of accessory muscles/retractions/pause for breath Cyanosis- late! Cool, clammy skin

Major depressive disorder interventions

Communication: clear, short, concrete, add silence Therapeutic use of silence Activities that increase pt. Self-esteem Work with pt. to identify cognitive distortions

Which term describes a client who drinks 2 drinks per day with no negative consequences?

Daily drinker

Alcohol withdrawal Early

Everything speeds up Tremors (shakes)- 6-8 hrs Agitated Mood swings (anxious, depressed) BP/HR go up

Kidneys are responsible for acid base balance

Excrete or hold hydrogen ions as needed Can generate bicarbonate Takes kidneys 24hrs to compensate

Respiratory alkalosis cause

Hyperventilation- panic attack Hypoxemia from acute pulmonary disorders

Respiratory acidosis cause

Hypoventilation COPD Pneumonia Pneumothorax Sedatives Opioids Anything impairing gas exchange Anesthesia Respiratory failure

A patient has the following arterial blood gases: HCO3 38, pH 7.50, PaCO2 50. Which of the following signs may this patient exhibit as a compensatory mechanism?

Hypoventilation (bradypnea)

Respiratory Acidosis intervention

Incentive spirometer Raise HOB (look at BP) T,C,D,B Hydration Cardiac monitoring Respiratory monitoring

Nursing Diagnosis eating disorder

Ineffective coping Denial Anxiety Self Care deficit

Metabolic Alkalosis s/s

Irritability, confusion Restlessness followed by lethargy Dizzy Headache, LOC changes Hyperreflexia,tetanyTremors, muscle cramps- hallmark sign Tingling of fingers and toes Paresthesias Hypocalcemia from increased binding of calcium to albumin when we are alkalotic numbness/tingling around mouth and fingers Tachycardia Dysrhythmias (tachycardia)- potassium shift Decreased respirations- hypoxia

Potassium

K shifts in and out of cells depending on Hydrogen (both cations)

Metabolic acidosis cause

Ketoacidosis Diabetes, eating disorders Lactic acid accumulation (shock) Accumulation of fluids Severe diarrhea loss of bicarb- Cause, not a symptom Kidney disease- kidneys lose ability to reabsorb bicarb and ability to excrete H

first thing we look at in acid base balance

LOC

The nurse is assessing a patient diagnosed with diabetic ketoacidosis. The assessment reveals tachycardia, lethargy, and hyperventilation. Treatment for the ketoacidosis has been initiated. What should the nurse do about the hyperventilation?

Lubricate the patient's lips and allow continued hyperventilation. Hyperventilation is a compensatory response to metabolic acidosis and should be allowed to continue because it helps move the blood pH toward the normal range.

Diabetic ketoacidosis

Metabolic acidosis

Severe diarrhea r/t gastritis

Metabolic acidosis

Bulimia

Metabolic alkalosis

NGT to suction for several days

Metabolic alkalosis

pregnant women acid base imbalance

Metabolic alkalosis could occur in pregnant women IF they are vomiting excessively (loss of acidic GI contents). Often during pregnancy, there is "hyper-emesis" or excessive vomiting which usually resolves after the first trimester.

Metabolic Alkalosis Intervention

Neuro: irritability, lethargy, confusion, headache CV: tachycardia, dysthymia Muscular: tetany, tingling or extremities, muscle cramps, seizures (chevosks test) We are hypocalcemic in states of alkalosis Priority: respiratory!! Bc hypoventilation we want to ensure adequate oxygenation Positioning for adequate breathing and gas exchange (sitting up) Can add oxygen through nasal cannula Cardiac monitor Treat cause (antiemetics)

Patient's with medical issues do not recover as well if struggling with MDD. Does someone have to become suicidal or engage in self-harm to have a diagnosis of MDD?

No.

Healthcare-acquired (Nosocomial)

Not present on admission 48 hrs or more after admission Special risks: 1. Intubated patients- bypassing body's natural infection control 2. Pts on mechanical ventilation 3. Immunocompromised pts * Some of the bacteria that cause hospital-acquired pneumonias have become antibiotic-resistant.

What disease often correlates with anorexia?

OCD

Major depressive disorder Older Adulthood

Older white, widowed males are less likely to seek mental health services and are at highest risk for suicide Distinguish between dementia and depression

Sleep is so important for all of our mental health and one of the important interventions is do what is needed to get our patient's to sleep appropriately.

Please remember that someone with MDD can experience insomnia or hypersomnia.

Major depressive disorder Adolescence (Risk factors)

Prevalence increases with age More common in girls than boys Depressed adolescents may express somatic complaints or have an irritable mood Interview the youth alone, then with the entire family

What defense mechanisms are common with addictions?

Projection - making others feel how you feel Manipulation Rationalization Anger

The nurse provides immediate postoperative care to a client. The client reports a sudden onset of shortness of breath and chest pain. Which action would the nurse take?

Provide supplemental oxygen Oxygen supports vital centers of the body while the cause of the problem is investigated. Although intravenous morphine may be administered eventually if the client is experiencing a myocardial infarction, it is not the initial action and requires a prescription

Anorexia defense mechanisms

Rationalization Projection Isolation Manipulation- hiding food/exercise

Opioid overdose with RR4

Respiratory acidosis

Severe anxiety with RR 40

Respiratory alkalosis

first line of treatment if an antidepressant is warranted

SSRI

Alcohol withdrawal late

Seizures DT (delirium tremors)- life threatening Nausea/ vomiting Sweating Hallucinations- leads to seizures Illusions Paranoia peak is 24-48 hrs

Splitting

Splitting is the compartmentalization of opposite-affect states and failure to integrate the positive and negative aspects of self or others

Eating disorder focus

Strength and energy to lead healthy life BP WNL Cholesterol WNL Blood sugar WNL Menstrual regularity (females)

Respiratory Alkalosis intervention

Treat underlying causes! - Acute or chronic illnesses - Fluid and electrolyte imbalances Assess!! LOC/ respiratory/ cardiac/ renal function - Report changes promptly! Maintain airway: check airway first when patient is unresponsive Monitor intake/output Safety! Decreased LOC can lead to injury Monitor for complications from illness OR treatment! (pain meds) EDUCATION ! - how to manage chronic illnesses

What is cue-Salience?

Trigger The environment itself can result in a relapse

Early signs of inadequate oxygenation

Unexplained apprehension Unexplained restlessness/ irritability Tachypnea Pale Shallow respirations Dyspnea on exertion Tachycardia

States of alkalosis

We are hypocalcemic

bulimia s/s

Weight fluctuation Electrolyte imbalance Parotid swelling Amenorrhea Fatigue Poor dental health Calluses on hands=Russell's sign Extroverted (acting-out)

ECT

a treatment for refractory depression- induced seizure Normalizes brain chemistry- MOST effective treatment for those who do not benefit from antidepressants (meds do not work) Only used after trial of antidepressant medication has failed Short-term memory loss is the most common side effect. May also experience confusion, and disorientation upon awakening Treatment duration and time varies 6-12 treatments (2-3 every week) Need informed consent General anesthesia and muscle-paralyzing agents Non-responsive depression Less risk for pregnant than medications

Cross addicted

addicted to more than one thing

overusing antacids causes?

causes metabolic alkalosis

ETOH withdrawal (KNOW THE MEDS)

chlordiazepoxide- ONLY ALC WITHDRAWAL diazepam and lorazepam- BP every 4-8 hours Phenobarbital (patient cross-addicted to diazepam or another Benzodiazepine) for alcohol withdrawal, longer acting sedative that prevents the pt from having seizures. Prevents DTs)

Group therapy

connect with others in which they can rely on peers and do not feel alone. Also serves as a distraction. Can find coping skills from others. Working on identifying feelings and triggers.

CAGE

cut down, annoyed, guilty, eye opener

Naltrexone Vivitrol

extended release IM used to prevent alcohol relapse. Most common! Lasts 4 weeks

Respiratory Alkalosis s/s

lethargy/confusion/dizziness/headache Tachycardia, dysrhythmias (K) Numbness, tingling, hyperreflexia Seizures Feeling of panic/difficulty concentrating- usually comes first

Respiratory Acidosis s/s

lethargy/confusion/dizziness/headache/ blurred vision Low BP (CO2 vasodilator) Warm flushed skin Seizures Cardiac dysrhythmias- electrolyte imbalances, primarily potassium Hypoventilation (cause)

Asprin toxicity can cause

metabolic acidosis

pH decreases & HCO3 decreases

metabolic acidosis

pH increases & HCO3 increases

metabolic alkolosis

Metabolic Acidosis s/s

more serious Dizziness, headache, confusion (LOC changes) Decreased BP- vasodilation Warm, flushed skin Nausea/vomiting (symptom not cause) Deep, rapid respirations (kussmaul) CNS depression- more quickly developed problems than alkalosis

If contract is signed and broken,

read it back if it is broken (restate)

Naltrexone Trexan

reduces alcohol cravings.

pH decreases & pCO2 increases

respiratory acidosis

pH increases & pCO2 decreases

respiratory alkalosis

Biological addiction

reward pathway- dopamine insitive salience- exposed to reward forms reaction: cause of most first year relapses

Campral

suppresses alcohol craving

wernicke's syndrome

thiamine prevents wernicke's syndrome (memory loss) a degenerative brain disorder - can cause imbalanced walking (low thiamine levels can cause painful calves) - confusion - slow reactions - if not treated can become severe and chronic needing custodial care

hyperaldosteronism would cause?

would cause metabolic alkalosis.