Med-Surg Final Exam Review A+ 2023
Med-Surg Final Exam Review
A+ 2023
Fluid and Electrolyte
Sodium: 135-145
Potassium: 3.5-5.0
Calcium: 8.6-10.2
Magnesium: 1.3-2.3
Chloride: 97-107
Hypernatremia > 145
• Causes: excess fluid/water loss, too much Na+, heat stroke, DI
• S&S: thirst, elevated temp., dry swollen tongue, stick mucosa, neuro signs, restlessness and
weakness, Inc. HR/BP
• Management: hypotonic, isotonic (D5W), adequate tube feeding
Hyponatremia < 135
• Causes: overuse diuretics, adrenal insufficiency, SIADH, N/V/D, anticonvulsants
• S&S: poor skin turgor, dry mucosa, headaches, decreased salivation, low BP, N, abdominal cramping,
neuro changes (AMS, seizures and coma), edema, anorexia
• Management: water restriction and sodium replacement
Hypercalcemia > 10.2
• Causes: Malignant tumor, hyperparathyroidism, immobility
• S&S: muscle weakness, constipation, anorexia, N/V, dysrhythmias, decreased DTR, bone pain,
dehydration, mental changes
• Management: ambulation, encourage fluids, fiber for constipation
Hypocalcemia < 8.6
• Causes: post thyroidectomy, pancreatitis, hypoparathyroidism, renal failure, corticosteroids, antacids
w/ aluminum
• S&S: tetany, increased DTR, numbness/tingling, Trousseaus/Chvostek sign, seizures, respiratory
depression, SOB, D, decreased HR/BP
• Management: vitamin D and calcium supplements, increased calcium in diet, IV calcium gluconate,
weight bearing exercises
, Med-Surg Final Exam Review A+ 2023
Hyperkalemia > 5.0
• Causes: kidney injury, K sparring diuretics, metabolic acidosis, Addison's disease, burns and certain
medications
• S&S: peaked T, muscle weakness, tachycardia, dysrhythmias, paralysis, colic, cramps, abdominal
distension, anxiety
• Management: K+ diet restriction, monitor HR, lungs, urine and ABGs
Hypokalemia < 3.5
• Causes: D/V, gastric suctioning, diuretics, GI loss, poor intake, digoxin toxicity
• S&S: fatigue, anorexia, N/V, dysrhythmias, muscle weakness/cramps, paresthesia, glucose
intolerance, dec. muscle strength/DTR
• Management: cardiac monitoring, kidney functioning (BUN, creatinine), UO
Fluid volume deficit (FVD) dehydration from loss of water and increased sodium
• Clinical manifestations: increased temp, poor capillary refill, pale skin, tachycardia, poor skin turgor,
weak pulse, postural hypotension, hypovolemia, confusion, weight loss, dry mucous membranes,
oliguria, concentrated urine, weakness, muscle cramps, sunken eyes
• Labs:
o ↑Hemoglobin�h emotocrit
o ↑serum�urine osmo�specific gravity
o ↑BUN �creatinine
o ↓urine sodium
Hypokalemia occurs with GI and renal loss, Hyperkalemia occurs with adrenal insufficiency
Hyponatremia occurs with increased thirst and ADH release, hypernatremia results from increased insensible
losses and DI
, Med-Surg Final Exam Review A+ 2023
Respiratory
Asthma
• S&S: chest tightness, cough, wheezing, dyspnea
• Medications
o Quick-relief medications
▪ SABA- albuterol
▪ Anticholinergics- ipratropium (Atrovent)
o Long-acting control medications
▪ Corticosteroids- prednisone, Medrol
▪ LABA- Salmeterol
▪ Mast cell stabilizers- Cromolyn
• Potential complications: status asthmaticus, respiratory failure, pneumonia & atelectasis
o S&S of status asthmaticus- labored breathing, prolonged exhalation, engorged neck veins,
wheezing
o Rising CO2 levels can lead to respiratory acidosis which could lead to respiratory failure
TB
• S&S: fatigue, malaise, anorexia, weight loss, low grade temperature (late afternoon), night sweats,
chronic cough (productive), hemoptysis in advanced stage
• Transmitted airborne, diagnosis with Mantoux test, interferon y release essay or chest x-ray; TB blood
test preferred for those who received the BCG vaccine
• Treatment is for 6 to 12 months, ensure ratification and prevent relapse
• Education: important hygiene measures, including mouth care, covering the mouth and nose when
coughing and sneezing, proper disposal of tissues, and hand hygiene
Pneumonia
• S&S: sudden onset of chills, rapidly rising fever (101-105°), pleuritic chest pain that is aggravated by
deep breathing and coughing, tachypnea (25-45 breaths/min) the pt. is in respiratory distress with SOB
and use of accessory muscles
o Other: fatigue, bradycardia, upper respiratory tract infection (nasal congestion and sore
throat), orthopnea, headache, rash, myalgia, pharyngitis
• Diagnosis is made by: history of recent URTI, psychical exam, chest x-ray, blood culture (bacterium),
sputum culture
• Management:
Med-Surg Final Exam Review
A+ 2023
Fluid and Electrolyte
Sodium: 135-145
Potassium: 3.5-5.0
Calcium: 8.6-10.2
Magnesium: 1.3-2.3
Chloride: 97-107
Hypernatremia > 145
• Causes: excess fluid/water loss, too much Na+, heat stroke, DI
• S&S: thirst, elevated temp., dry swollen tongue, stick mucosa, neuro signs, restlessness and
weakness, Inc. HR/BP
• Management: hypotonic, isotonic (D5W), adequate tube feeding
Hyponatremia < 135
• Causes: overuse diuretics, adrenal insufficiency, SIADH, N/V/D, anticonvulsants
• S&S: poor skin turgor, dry mucosa, headaches, decreased salivation, low BP, N, abdominal cramping,
neuro changes (AMS, seizures and coma), edema, anorexia
• Management: water restriction and sodium replacement
Hypercalcemia > 10.2
• Causes: Malignant tumor, hyperparathyroidism, immobility
• S&S: muscle weakness, constipation, anorexia, N/V, dysrhythmias, decreased DTR, bone pain,
dehydration, mental changes
• Management: ambulation, encourage fluids, fiber for constipation
Hypocalcemia < 8.6
• Causes: post thyroidectomy, pancreatitis, hypoparathyroidism, renal failure, corticosteroids, antacids
w/ aluminum
• S&S: tetany, increased DTR, numbness/tingling, Trousseaus/Chvostek sign, seizures, respiratory
depression, SOB, D, decreased HR/BP
• Management: vitamin D and calcium supplements, increased calcium in diet, IV calcium gluconate,
weight bearing exercises
, Med-Surg Final Exam Review A+ 2023
Hyperkalemia > 5.0
• Causes: kidney injury, K sparring diuretics, metabolic acidosis, Addison's disease, burns and certain
medications
• S&S: peaked T, muscle weakness, tachycardia, dysrhythmias, paralysis, colic, cramps, abdominal
distension, anxiety
• Management: K+ diet restriction, monitor HR, lungs, urine and ABGs
Hypokalemia < 3.5
• Causes: D/V, gastric suctioning, diuretics, GI loss, poor intake, digoxin toxicity
• S&S: fatigue, anorexia, N/V, dysrhythmias, muscle weakness/cramps, paresthesia, glucose
intolerance, dec. muscle strength/DTR
• Management: cardiac monitoring, kidney functioning (BUN, creatinine), UO
Fluid volume deficit (FVD) dehydration from loss of water and increased sodium
• Clinical manifestations: increased temp, poor capillary refill, pale skin, tachycardia, poor skin turgor,
weak pulse, postural hypotension, hypovolemia, confusion, weight loss, dry mucous membranes,
oliguria, concentrated urine, weakness, muscle cramps, sunken eyes
• Labs:
o ↑Hemoglobin�h emotocrit
o ↑serum�urine osmo�specific gravity
o ↑BUN �creatinine
o ↓urine sodium
Hypokalemia occurs with GI and renal loss, Hyperkalemia occurs with adrenal insufficiency
Hyponatremia occurs with increased thirst and ADH release, hypernatremia results from increased insensible
losses and DI
, Med-Surg Final Exam Review A+ 2023
Respiratory
Asthma
• S&S: chest tightness, cough, wheezing, dyspnea
• Medications
o Quick-relief medications
▪ SABA- albuterol
▪ Anticholinergics- ipratropium (Atrovent)
o Long-acting control medications
▪ Corticosteroids- prednisone, Medrol
▪ LABA- Salmeterol
▪ Mast cell stabilizers- Cromolyn
• Potential complications: status asthmaticus, respiratory failure, pneumonia & atelectasis
o S&S of status asthmaticus- labored breathing, prolonged exhalation, engorged neck veins,
wheezing
o Rising CO2 levels can lead to respiratory acidosis which could lead to respiratory failure
TB
• S&S: fatigue, malaise, anorexia, weight loss, low grade temperature (late afternoon), night sweats,
chronic cough (productive), hemoptysis in advanced stage
• Transmitted airborne, diagnosis with Mantoux test, interferon y release essay or chest x-ray; TB blood
test preferred for those who received the BCG vaccine
• Treatment is for 6 to 12 months, ensure ratification and prevent relapse
• Education: important hygiene measures, including mouth care, covering the mouth and nose when
coughing and sneezing, proper disposal of tissues, and hand hygiene
Pneumonia
• S&S: sudden onset of chills, rapidly rising fever (101-105°), pleuritic chest pain that is aggravated by
deep breathing and coughing, tachypnea (25-45 breaths/min) the pt. is in respiratory distress with SOB
and use of accessory muscles
o Other: fatigue, bradycardia, upper respiratory tract infection (nasal congestion and sore
throat), orthopnea, headache, rash, myalgia, pharyngitis
• Diagnosis is made by: history of recent URTI, psychical exam, chest x-ray, blood culture (bacterium),
sputum culture
• Management:
