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Medsurg Final Exam Study Guide A+
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MED SURG 1 Final EXAM Study Guide Complete and Updated A+ 100 %Medsurg Final Exam Study Guide A+
Study Guide Final Exam
Fluid & Electrolytes: Fluid Volume Excess, Fluid Volume Deficit, Electrolyte
abnormalities: potassium, sodium, calcium
Fluid Volume Deficit: a reduction in the volume of the ECF- extracellular fluid, which is stored in the
interstitial and intravascular space. AKA: dehydration of the cells & hypovolemia.
• Risk factors include- GI losses- vomiting and diarrhea, burns, skin losses-excessive sweating, renal
losses, hemorrhage, and decreased oral intake of fluids.
• Assessment findings: flattened jugular veins, decreased cardiac output, decreased BP, orthostatic
hypotension, decreased urine output, decreased skin turgor, weight loss, thirst, dry mouth, increased
BUN r/t creatinine: in both are elevated look for liver failure but if just bun is high and creatinine is
normal look for FVD, increased hematocrit
• Nursing interventions: Monitor I&Os hourly, weight the pt daily, administer fluids either PO or IV as
prescribed, then check the patient for signs and symptoms of fluid overload, frequent mouth care,
maintain skin integrity
Fluid Volume Excess: defined, as an increase in body fluid- can be either intravascular or interstitial.
AKA: hypervolemia or fluid overload. Can lead to CHF, and pulmonary edema.
• Risk factors: Abnormal adh production, CHF, steroids, renal failure, increased NA or H2O intake
• Assessments findings: increased BP, bounding pulses, jugular vein distention, S3 heart sound, edema,
pulmonary edema, rapid weight gain, decreased hematocrit- because the red blood cells are diluted,
decreased urine specific gravity- because the solutes in the urine are diluted, shortness or breath and
crackles
• Nursing interventions: Monitor I&Os hourly, weight the pt daily, check for edema, limit Na intake, limit
or restrict fluid intake, ice chips, diuretic therapy as prescribed- then check for fluid depletion, teach
the patient to avoid tight constricting clothes, and skin care
Sodium: 135-145 mEq… h2o goes where Na goes
HYPONATREMIA less than < 135 HYPERNATREMIA greater than >145
Imbalance of water (either too much h2o intake Caused by too much Na intake or too much
or not enough salt, from vomiting diarrhea, water loss (not drinking enough, or losing to
sweating) much water)
Headaches, nausea, abdominal cramps, muscle Restlessness, agitation, weakness, confusion,
twitching, weakness, confusion, change in LOC, coma, muscle twitching, low grade fever,
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, MED SURG 1 Final EXAM Study Guide Complete and Updated A+ 100 %
coma, seizure flushed skin, thirsty
Potassium: 3.5-5.5 mEq: regulated by the kidneys, high K is shown in patients with renal failure. In
renal failure when the potassium is very high it can lead to dysrhythmias, if potassium is very low it can
also cause dysrhythmias. Responsible for muscle contractions and protein synthesis
HYPOKALEMIA less than <3.5 HYPERKALEMIA greater than> 5.5
Skeletal muscle weakness Abdominal cramping, diarrhea
U wave on an EKG Lethal EKG changes
Constipation Hypotension, irregular pulse
Toxic effects of digoxin Irritability
Irregular or weak pulses, orthostatic Muscle weakness
hypotension Nausea
Numbness
Calcium: 8.6-10.2: transmits nerve impulses and helps with regulating muscle contraction and
relaxation- including cardiac muscle, plays a role in blood coagulation
HYPOCALCEMIA less than <8.6 HYPERCALCEMIA greater than> 10.2
Tetany-twitch and seize, laryngeal spasm, Nothing- flaccid, muscle weakness,
carpopedal spasm, facial nerve spasm- hyporeflexia, decreased muscle tone, fatigue,
chvostek’s signs personality changes, arrythmias
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, MED SURG 1 Final EXAM Study Guide Complete and Updated A+ 100 %
Respiratory Nursing care of clients (assessment, diagnosis, including labs and
other diagnostic tests interventions, teaching, complications, evaluation) of clients with:
1. Asthma: chronic inflammatory disease of the airway that causes hyper responsiveness to an allergy
causes mucosal edema, and mucus production. Inflammation of the bronchioles leads to cough chest
tightness wheezing and dyspnea. Difference between asthma and COPD is that asthma is reversible
and there is no distortion or damage of the alveoli. The airways still get a narrow and dead space is
still present in the alveoli but there is no damage or distortion.
▪ Quick relief medications: albuterol & Proventil- bronchodilators have a
vasoconstrictor response.
▪ Long acting medications: corticosteroids- prednisone
▪ Leukotriene modifiers- advair
▪ Mixed Advair or Symbicort
▪ Assess breath sounds for wheezing
▪ O2, pulse ox, ABGs,
▪ Assess symptom severity by using peak flow monitoring
▪ Deep breathing exercises
▪ Give fluids, and position the patient upright
▪ Teach About avoiding triggers, nutrition and hydration, rest and sleep, and using
the bronchodilator 30 minutes before any exercise
2. COPD: (bronchitis= the airway problem and emphysema= the alveolar problem) progressive airflow
limitations that are not fully reversible. Chronic Inflammation. Associated with cigarette smoke. You
may not see the damage until later on but it is occurring early. These patients often look fatigued from
working so hard to breathe. COPD starts with chronic bronchitis-which is cough and sputum
production that last for 3 months in each of 2 consecutive years. The airways become narrowed
and mucus filled, the alveoli become damaged fibrous and thickened which makes it very
difficult for oxy to diffuse in and CO2 to diffuse out. Emphysema develops-which is abnormal
distention of the space where the air sits in the alveoli causing destruction of the walls of the alveoli,
and increasing ―dead space‖. The misshaping of the alveoli is what causes the main symptom of
barrel chest. The first sign in elderly people is confusion
▪ ABGs- respiratory acidosis, Chest x-rays, PFTs
▪ Set realistic goals since COPD is not curable
▪ Try to alleviate symptoms and prevent exacerbations and complications
▪ Encourage smoking cessation
▪ Clear secretions
▪ Bronchodilators, corticosteroids, oxygen therapy, antibiotics, chest PT, and airway
management, pursed lip breathing and administer fluid
3. Pneumonia: an inflammation of the lung tissue (parenchyma) caused by bacteria, fungi, parasites, or
, MED SURG 1 Final EXAM Study Guide Complete and Updated A+ 100 %
a virus. There are different types- community (in the hospital less than 48 hour and it presents), or
hospital (presents after longer than 48 hours in the hospital) associated.
▪ Prevention- hand hygiene, vaccine, avoid crowd during flu season.
▪ Antibiotics for bacterial only, Nasal decongestants for viral**
▪ Assessment: vital signs, look for tachypnea and shortness of breathe, Chest xray,
abgs, pulse ox, auscultate the lung sounds
▪ Sputum culture and sensitivity test- first they give broad spectrum anti biotic
while they wait for the results and then the gram stain will determine what type of
antibiotic therapy you would use
▪ Manage hypoxemia and prevent airway obstruction- O2, ventilators, bipap, chest
pt, cough and deep breathe, incentive spirometer, hydration and fluids
4. Pulmonary emboli: a blood clot or a thrombus that becomes lodged in the pulmonary arteries or one
of its branches. This is when is good but the blood flow through the capillaries is blocked and unable to
perfuse. The alveoli are working but the perfusion into the capillaries is not, therefore circulation is not
happening. This diagnosis is often missed, so any patient with unexplained shortness of breath should
be considered. ** Young women who smoke and use oral contraceptives are a high risk!!
▪ Symptoms depend on how much of the vasculature is occluded, but this is a
medical emergency!
▪ O2, IV, ECG, Possibly intubation/ or ventilation/ Anticoagulants (heparin)
5. Thoracentesis: A procedure in which a needle is inserted into the pleural space between the lungs
and the chest wall. This procedure is done to remove excess fluid, known as a pleural effusion, from
the pleural space to help you breathe easier
a. Closed chest drainage: maintenance of a closed system and patency of the tube is essential.
The system flows from the patients chest into the drainage chamber where the secretions or
blood collect, then the air travels into the water seal chamber that lets out under the water
causing bubbles that rise up and go into the third suction control chamber. Trouble shooting the
system includes…
▪ GENTLE BUBBLING in the SUCTION CONTROL chamber is NORMAL, if there isn’t
bubbling there’s a problem
▪ GENTLE TIDALING (with inhalation and exhalation) in the WATER SEAL chamber is
NESSESCARY, if you don't have it then there is an obstruction or the tube came out
or the system is no longer patent.
▪ If there is BUBBLING in the WATER SEAL chamber that is NOT normal
▪ There should also be consistency with the amount of drainage coming out,
eventually it will taper off but if you have collected 200ml in one hour and then
10ml the next that isn’t normal
Cardiac Nursing care of clients (assessment, including labs and other diagnostic
tests, diagnosis, interventions, teaching, complications, evaluation) with: Hypertension, Coronary
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