ATI MEDSURG FINAL EXAM STUDY GUIDE
1. Understand the ABG’s and how to decide if a patient is in resp acidosis
or resp alkalosis, metabolic acidosis, or metabolic alkalosis.
2. Understand the function of potassium, sodium, and calcium in the
body- especially the heart and how to administer these electrolytes. Be
able to correct the calcium using the calculation.
- Sodium: Na
- Normal value: 135-145
- Hyponatremia <135
- Common imbalance in the elderly caused by Na loss
or water gain
- Symptoms: decrease BP, poor skin turgor, headache,
nausea, cramps
- If seizure occurs: small infusion of 3%-5% NaCl
SLOWLY
- Hypernatremia >145
- Sodium gain or water loss
- Problem with elderly/pts who can’t sense thirst or
don’t meet fluid needs
- Symptoms: increase in temp, dry swollen tongue,
neuro symptoms/changes=FIRST sign usually
- Potassium: K
- Normal value: 3.5-5.0
- K+ necessary for normal cardiac rhythms, necessary for
skeletal and smooth muscle contraction, K+ helps make
glycogen deposit in the liver
1
, - K imbalances can be life threatening
- Hyperkalemia >5.0
- Manifestations: cardiac changes & dysrhythmias,
ECG shows tented T waves, arrhythmias, muscle
weakness, GI cramps
- Management: Give diuretics to excrete K+, 10 units
regular insulin IV push with glucose (1 amp D50),
Beta-2 agonist (albuterol MDI), Kayexalate (ion-
exchange resin)
- Hypokalemia <3.5
- Manifestations: fatigue, dysrhythmias, DTRs,
constipations, muscle weakness, anorexia, ECG
changes: flat T waves or inverted T waves or both,
suggesting ischemia, and depressed ST segments
- Med Management: increase PO of K+, give KCL
supplements when patient is on loop or thiazide
diuretics to prevent hypokalemia
- KCl should be administered IV at rate of 10-20 mEq/L
per hour → rapid infusion can cause CARDIAC
ARREST
- Hold KCl unless urine output is at least
0.5 ml/kg of body weight per hour
- Calcium: Ca
- Normal Value: 9-11
- Ca++ works as an enzyme co-factor for clotting and
hormone secretion. Stored in parathyroid glands, maintains
plasma membrane stability-particularly in the cardiac cell
nerve receptors, aids in the transmission of nerve impulses
and contraction of muscles
- Corrected Calcium:
- Measured total serum Ca++ level (mg/dl) = 0.8 x (4.0
– measured albumin level [g/dL]) = corrected total
calcium concentration (mg/dL)
- Pt’s serum calcium level is reported as 7.5 mg/dL and
serum albumin is 2.5 g/dL.
- 4.0 – 2.5 = 1.5 g/dL (albumin difference)
- 1.5 x 0.8 = 1.2
- 1.2 + 7.5 = 8.7 mg/dL (corrected calcium)
- Hypocalcemia: <9
- Manifestations:
2
1. Understand the ABG’s and how to decide if a patient is in resp acidosis
or resp alkalosis, metabolic acidosis, or metabolic alkalosis.
2. Understand the function of potassium, sodium, and calcium in the
body- especially the heart and how to administer these electrolytes. Be
able to correct the calcium using the calculation.
- Sodium: Na
- Normal value: 135-145
- Hyponatremia <135
- Common imbalance in the elderly caused by Na loss
or water gain
- Symptoms: decrease BP, poor skin turgor, headache,
nausea, cramps
- If seizure occurs: small infusion of 3%-5% NaCl
SLOWLY
- Hypernatremia >145
- Sodium gain or water loss
- Problem with elderly/pts who can’t sense thirst or
don’t meet fluid needs
- Symptoms: increase in temp, dry swollen tongue,
neuro symptoms/changes=FIRST sign usually
- Potassium: K
- Normal value: 3.5-5.0
- K+ necessary for normal cardiac rhythms, necessary for
skeletal and smooth muscle contraction, K+ helps make
glycogen deposit in the liver
1
, - K imbalances can be life threatening
- Hyperkalemia >5.0
- Manifestations: cardiac changes & dysrhythmias,
ECG shows tented T waves, arrhythmias, muscle
weakness, GI cramps
- Management: Give diuretics to excrete K+, 10 units
regular insulin IV push with glucose (1 amp D50),
Beta-2 agonist (albuterol MDI), Kayexalate (ion-
exchange resin)
- Hypokalemia <3.5
- Manifestations: fatigue, dysrhythmias, DTRs,
constipations, muscle weakness, anorexia, ECG
changes: flat T waves or inverted T waves or both,
suggesting ischemia, and depressed ST segments
- Med Management: increase PO of K+, give KCL
supplements when patient is on loop or thiazide
diuretics to prevent hypokalemia
- KCl should be administered IV at rate of 10-20 mEq/L
per hour → rapid infusion can cause CARDIAC
ARREST
- Hold KCl unless urine output is at least
0.5 ml/kg of body weight per hour
- Calcium: Ca
- Normal Value: 9-11
- Ca++ works as an enzyme co-factor for clotting and
hormone secretion. Stored in parathyroid glands, maintains
plasma membrane stability-particularly in the cardiac cell
nerve receptors, aids in the transmission of nerve impulses
and contraction of muscles
- Corrected Calcium:
- Measured total serum Ca++ level (mg/dl) = 0.8 x (4.0
– measured albumin level [g/dL]) = corrected total
calcium concentration (mg/dL)
- Pt’s serum calcium level is reported as 7.5 mg/dL and
serum albumin is 2.5 g/dL.
- 4.0 – 2.5 = 1.5 g/dL (albumin difference)
- 1.5 x 0.8 = 1.2
- 1.2 + 7.5 = 8.7 mg/dL (corrected calcium)
- Hypocalcemia: <9
- Manifestations:
2
