Nursing Exam 2 Study Guide

Exam 2 Study Guide

• Material Covered: Potter & Perry Chapter 42 (Fluid and Electrolytes), Ignatavicius Chapter 3 (Overview of Health Concepts for Medical-Surgical Nursing), and Lilley Chapters 22 and 54 (Antihypertensive and Anemia Drugs).

Values to Know!

• Electrolytes:

  • Sodium (Na+): 136-145 mEq/L (136-145 mmol/L)
  • Potassium (K+): 3.5-5.0 mEq/L (3.5-5 mmol/L)
  • Chloride (Cl-): 98-106 mEq/L (98-106 mmol/L)
  • Total CO2 (CO₂ total content): 22-30 mEq/L (22-30 mmol/L)
  • Bicarbonate (HCO₃): Arterial 21-28 mEq/L (21-28 mmol/L), Venous 24-30 mEq/L (24-30 mmol/L)
  • Total calcium (Ca2+): 9.0-10.5 mg/dL (2.25-2.62 mmol/L)
  • Ionized calcium (Ca2+): 4.5-5.6 mg/dL (1.05-1.3 mmol/L)
  • Magnesium (Mg2+): 1.3-2.1 mEq/L (0.65-1.05 mmol/L)
  • Phosphate: 3.0-4.5 mg/dL (0.97-1.45 mmol/L)
  • Anion gap: 6 +/- 4 mEq/L (6 +/- 4 mmol/L)

• Arterial Blood Gases:

  • pH: 7.35-7.45
  • PaCO2: 35-45 mm Hg (4.7-6 kPa)
  • PaO2: 80-100 mm Hg (10.7-13.3 kPa)
  • O2 saturation: 95%-100% (0.95-1.00)
  • Base excess: -2 to +2 mm Eq/L (mmol/L)

Metabolic Acidosis - Signs and Symptoms

• Physical Symptoms:
  • Kussmaul respirations
  • Decreased level of consciousness (fatigue, headache, confusion)
  • Abnormal heartbeat (caused by hypokalemia)
  • Abdominal pain (nausea & vomiting)
  • Low BP
• Lab Findings:
  • pH below 7.35
  • HCO₃ below 21

Metabolic Alkalosis – Signs and Symptoms

• Physical Symptoms:
  • Lightheadedness
  • Numbness and tingling (fingers, toes, circumoral)
  • Muscle cramps
  • Decreased level of consciousness
  • Dysrhythmias
• Lab Findings:
  • pH above 7.45
  • PaCO2 below 35
  • HCO₃ normal (uncompensated) above 28 (compensated)

Other Important Information

• Metabolic Acidosis:
  • Chain reaction - acidosis stresses the body, dehydration worsens it, and low potassium disrupts the heart.
  • Metabolic acidosis → dehydration (from fluid loss)
  • Dehydration → hypokalemia (from potassium loss)
  • Hypokalemia → arrhythmias (from disrupted heart signals)
• Respiratory Acidosis & Alkalosis: Defined by pH, PaCO2, and HCO3 levels, different causes, and conditions
• Hyperchloremic Acidosis: Loss of HCO3 in GI tract (diarrhea, laxative abuse)
• Renal Tubular Acidosis: Kidneys unable to excrete acids
• Lactic Acidosis: Sepsis, shock, cardiac arrest
• Diabetic Acidosis: Type 1 Diabetes Mellitus; glucose can't enter cells due lacking insulin.
• Causes and symptoms of each disorder are explained in the document.
• Phlebitis vs. Infiltration: Causes, symptoms, and treatments are described for both.
• Hyperkalemia: Causes, symptoms, and treatment(including lab values and procedures)
• Blood Transfusion Reactions: Types (Febrile non-hemolytic, acute hemolytic, allergic, severe allergic, TRALI, TACO) with symptoms and treatment steps.
• Chronic Diarrhea: Causes - inflammatory bowel disease, infections, medications - and foods that can help alleviate it.
• Normal values of arterial blood gas(PH, Partial pressure of oxygen (PaO2), Partial pressure of carbon dioxide (PaCO2), HCO3 etc): Explained in document.
• Nursing interventions for blood transfusion reactions: Detailed interventions & signs/symptoms for each type of reaction.
• Conditions associated with chronic diarrhea: Malabsorption disorders, infections (like C diff), and lactose intolerance - and their specific symptoms are mentioned.
• Side effects of various drugs: Including anticoagulants (bleeding), opioids (respiratory depression), ace inhibitors (cough, hyperkalemia), calcium channel blockers, and diuretics (hypokalemia).