howcanthisb

Another attempt at describing how "ROME" (Respiratory Opposite, Metabolic Equal) works. All that ROME means is that in Respiratory states your CO2 will be in the opposite state (alk vs acid) than what the pH is. And in Metabolic states your HCO3 will be in the same state (acid or alk) as the pH is. In a nutshell, if the Ph and the CO2 are in opposite states, then its a Respiratory condition. If the HCO3 and the Ph are in same state, its a Metabolic state. But here's more..... First: Look at the pH first to determine whether you have an alkalotic or an acidotic condition on your hands. If pH is low, you are dealing with an acidosis. If it's high, then you are dealing with an alkalosis. Easy enough, right? So now you know if your condition is Acid or Alkaline. All you need to know now is whether it's Respiratory or Metabolic. Oh, and remember: even if your pH is w/in normal range (7.35 - 7.45) you still need to make a call. In this case, less than 7.40 is considered acid, and greater than 7.40 is alkaline). Next: look at the CO2. Determine if it's high or low. If it's high, then you have a Respiratory problem. (Again, "respiratory Opposite". So the CO2 will be in the OPPOSITE direction of the pH. This is the "Respiratory OPPOSITE" part of ROME. CO2 high/pH low). So in this case you'd have Respiratory Acidosis. Lastly: look at the HCO3 to see if it's high or low. If it's high (meaning alkaline) AND your pH is high (meaning alkaline), then you have a Metabolic condition. This is the "metabolic EQUAL" part of ROME, where the HCO3 is in the SAME/equal state as the Ph. Both the pH and the HCO3 would be alkaline). Your condition in this case (high/high) then is Met Alkalosis. Other things to remember: if the pH is NOT normal, then the state is NOT compensated. Not normal, not compensated. if both the HCO3 and the CO2 are abnormal, then that's an easy way to know that there IS compensation of some kind. I hope this helps. I understand acid base really well, it's just so darn hard to explain!

Thanks so much for your thoughts and good wishes, everyone. I love all of the constant, undying support on this site. It truly is a community like no other. :):redpinkhe:redbeathe I feel better knowing that many, or maybe even most, never truly feel ready. It's good to know that I'm not alone. Maybe it's just the great fear of the unknown that has me more neurotic and anxiety-ridden than ever before. With our NSG school exams, we know the content we'll be tested on, and we probably even have been given a good test plan from our instructors. With the NCLEX, it's anyone's guess. I know there are lots of fundamentals-type questions, so I have spent a reasonable amount of time studying things like proper posting for different illnesses and have spent countless hours on Infection Control, as everyone says that is a vast area for questions and focused on delegation, yada yada yada just to refresh my memory. But there is so much that is just a big unknown, so I am so freaked not knowing what to expect or how the day will go. Could I possibly have reviewed (and will I remember) every possible disease, condition, med, etc., that I might get a question on? Did I study enough? Just very scary, as you all know. I even have myself all worked up because someone told me we couldn't bring water in, and I am ALWAYS thirsty. I carry water everywhere. So now that has me all worked up. (Is that true, by the way?) But as for today, I am reviewing stuff for the last time. I will try to get to bed at a decent hour. I test at 8:est and have an hour's drive to get there, so I'll be at them very early. I don't think I'll have the courage to do the Pearson trick when I return, but we'll see. Thanks again for the kind words and the encouragement. I will post my results once I know how I did. And GOOD LUCK to all of you when you sit. (I can't wait til this is all behind me.)

Hi everyone. I need some advice. I am getting tachycardic and can't seem to calm myself, as I am genuinely unsure if I am ready for my boards. I am scheduled to sit for the NCLEX in 2 days (Jul 14), but how do I know if I am ready? I feel like I have been heads down, doing nothing but studying for the past few weeks. I have not seen the light of day in weeks. I graduated in May and was a good student. I also took the Kaplan review class, have done thousands of questions from my Saunders 4th edition cd, and have done another 500 or so questions from the Univ of Texas nursing site (http://www.exammaster2.com/wdsentry/utmbrn.htm). So here's my concern. That UTexas site allows me to have it write a random, simulated NCLEX exam, where I can pick the # of questions that I want. I am trying to use this site to gauge my timing, as their tests are timed, and someone recommended the site here on Allnurses, if I'm not mistaken. Anyhow, I do great timewise, but I'm only getting high 60s on that site! I have had it write about six tests for me, all were 60 questions, and all were in the 60s. The lowest score was a 61%, highest was a 69%. To say that I am freaked out is an understatement. As I said, I did about 1500 Saunders Qs and did well on those, but now I"m scared cuz of the UTexas results. How will I know when/if I'm ready for this test? I am so scared now. Should I suck it up and go on Wed, or should I take a few more weeks to prepare? I want it over with but I don't want to take it if I can't pass it. Any insight, thoughts, recommendations (or prayers) would be appreciated. I am so stressed out! Thanks for any help. I am just interested in how others prepped and how you felt going into the thing. Does anyone know when they're ready/fully prepared for success?