All the Mark Klimek NCLEX Lecture materials and Guides plus the Audio Lectures you will ever need for Quick NCLEX Test Readiness ...Updated Fall 2022_2024).Best Rated

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Review

1.

 Acid-base balance/ventilators

Rule of the B’s.. If the pH & the bicarb are both in the same direction = meta bolic

If they are in different directions = respiratory

pH = 7.35-7.45 acidosis/alkalosis

HCO3 (bicarb) = 22-26 (2+2+2 = 6)

CO2 = 45-35

ex:

pH: 7.30 =

 bicarb: 20 =  = metabolic acidosis

ex:

pH: 7.58 =

 bicarb: 32 =  = metabolic alkalosis

ex:

pH: 7.22 =

 bicarb: 30 =  = respiratory acidosis

ex:

 You are providing care to a client with the following blood gas results: pH 7.32, CO2

as the pH goes… so goes my patient!!!

-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 g potassium goes up!

(up) alkalosis: irritibility, hyper-reflexia (3 & 4), tachypnea, tachycardia, borboryg(increased bowel sounds), seizure, aspirate..

(down) acidosis: hypo-reflexia, bradycardia, lethergy (obtunded), paralytic ileus (de bowel sounds), coma, respiratory arrest (ambu-bag!!)

Kussmaul breathing is a deep and labored breathing pattern often associated metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure… Kussmaul !!

M: metabolic

 AC: acidosis

ex:

pT has respiratory acidosis… (select all that apply)..

+1 reflexes

diarhhea

adynamic ileus

spasm

urinary retention

tachycardia

2nd degree mobits type 2 heart block

hypokalemia

SATA questions: *never only 1… never all of them*

diarhhea will cause a metabolic acidosis.. but once you get acidodic, it will shut yodown = paralytic ileus

…with scenarios.. always ask first “is it lung?” = respiratory 

…then ask if the pt is over-ventilating or under-ventilating?

over-ventilating = alkalosis

under-ventilating = acidosis

…it’s about the SaO2!!! (pay attention!!)

if it isn’t lung = metabolic..

if pt has prolonged gastric vomiting or suctioning… it’s always metabolic alk why? losing acid = becomes basic..

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