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4. Complaints of pain (except the expected cardiac pain) UNLESS the chest pain is sudden and new.

LPNs: Dressing changes, Suctioning, Urinary Cath, Meds

Sepsis, FVO, BURNS, DRUGS, ASPIRATION, TOXINS

Watch Albumin levels to indicate healthy liver. 

Age & physiology have a lot to do with metabolism- watch out for old people and children Watch out for pregnancy and breast feeding antacids are almost NEVER given with meds Grape fruit juice is a no go Do not alter enteric coding or SR pills Monitor and assessment may be the answer Teaching Never adjust a dose or discontinue a med Avoid OTCs and herbals unless HCP agrees NO ALCOHOL OR CIGARETTES ON THE NCLEX🚬🍹🍾🍷 Wear med alert bracelet if you are on certain meds, insulin, anti seizures, anticoagulant, steroids They all seem pretty common sense. 💩

Ace inhibitors end in "PRIL" (Hptn, chf) Antilepidemics "statins" lower cholesterol Antivirals "VIR" viruses, AIDS Benzodiazepine "PAM" anti anxiety drugs Calcium channel blockers "PINE" Hptn, angina Dysrthymias Corticosteroids "SONE" adrenal insufficiency Nitrates "nitr" Proton pump inhibitors "Zole" ulcers Sulfamides "sulf" infection Thrombocytes "ASE" clot buster thiazides "side" Hptn, edema,CHF Bronchodilator "line" COPD, asthma

If PCO2 causes the imbalance it's respiratory. Normal PCO2=35-45 If HCO3 causes the imbalance it is metabolic. Normal HCO3= 22-26 If PCO2 & HCO3 cause the imbalance than it is combined. Uncompensated = abnormal pH plus one other change Partially compensated=all 3 are abnormal Fully compensated = pH is normal but PCO2 & HCO3 are not.

Causes of METABOLIC ACIDOSIS diabetic ketoacidosis Too much ASPRIN high fat diet Malnutrition Renal failure Severe diarrhea My tip for the metabolic ones: ACIDOSIS COMES FROM THE ASS Causes of METABOLIC ALKALOSIS suction Excessive vomiting Diuretics Excessive sodium bicarbonate Hyper Aldosterone Whole blood transfusion (the preservative screws with the bicarbonate) COMPENSATION FOR BOTH METABOLIC AND RESPIRATORY PROBLEMS WILL BE SEEN WITH A NORMAL pH and a wacky PCO2.

First know that hydrogen ions= acidic and bicarbonate =Alkalosis. Also use a pH of 7.40 as your base line for all questions. Also remember that based on pH and PCO2 =ROME. RESPIRATORY OPPOSITE, METABOLIC EQUAL. For example if your pH is 7.47 which is ⬆️ then your PCO2 is 34 which is ⬇️ they are OPPOSITE ARROWS meaning a respiratory alkalosis. 7.31 pH is ⬇️ PCO2 is 46⬆️ = respiratory acidosis. With metabolic issues your arrows will go in the same way and you determine acidosis or alkalosis based on the pH. POTASSIUM IS ⬆️ ON ACIDOSIS and POTASSIUM IS ⬇️ on alkalosis. Simpler than ROME to remember is that if there is NO RESPIRATORY MENTIONED ITS NOT A RESPIRATORY PROBLEM. RESPIRATORY ACIDOSIS is caused by a condition that depresses or obstructs the airway. RESPIRATORY ALKALOSIS is caused by a condition that over ventilated the lungs. Causes of RESP ACIDOSIS Emphysema. Asthma. COPD. PNA. Pulmonary edema. Pulmonary emboli. CNS depressants (opioids). Brain trauma (depresses the medulla) Causes of RESP ALKALOSIS Fever. Hyperventilating. Hypoxia conditions. Hysteria. Pain. Symptoms of respiratory acidosis Drowsiness. Confusion. Coma. Disrythmias. Feeling warm. Respiratory rate is ⬆️. Symptoms of respiratory alkalosis Drowsiness. Dizziness. Tachy. Anorexia. Nausea. Vomiting Resp rate is ⬇️.

Disopyramide: v tach, supraventricular arrythmias, ventricular arrhythmias. Procainamide: supraventricular arrrhytmias, ventricular arrhytmias, new onset A-FIB. Can cause lupus like syndrome. Flushing mask face, joint pain- men complain about this more than women. Quinidine: A-fib, A-flutter, V-Tach & Malaria. Quinidine=QUEEZY. Has a bitter taste, avoid salt, DIARRHEA Quinidine Toxicity: have to be on it a while, dizzy, tinnitus, visual disturbances.

Admin with heart ♡ rate 60 or better. Slows HR and strengthens force of contraction. "Loading dose" given to establish therapuetic levels. Treats: CHF & AFib. Avoud exposure to light. TOXICITY: predisposed if you have HYPOkalemia. EARLY TOXICITY: nausea & vomiting LATE TOXICITY: visual diaturbances: halos CHILDREN: have GI distress ANTIDOTE: Digibind LEVEL: 0.8-2.0