NUR 242 — EXAM 2: COMPLETE STUDY GUIDE WITH PATIENT TEACHINGS
UNIT 3: Fluids/Electrolytes/Acid-Base | UNITS 4/5: Cardiovascular | UNIT 6: Urinary/Renal | UNIT 7: GI | Galen Values Throughout
■ Patient & Family Teaching sections are highlighted in BLUE throughout this guide — these are HIGH-YIELD exam topics!
■ All lab values are GALEN COLLEGE STANDARDIZED VALUES from your uploaded screenshots.
■ GALEN STANDARDIZED LAB VALUES — THE ONLY VALUES TO USE ON EXAMS
Lab Test (Galen Value) Normal Range Quick Clinical Tip
Hemoglobin (Hgb) Male: 14-18 g/dL | Female: 12-16 g/dL | Pregnant: >11 Low = anemia | Transfuse if critically low
g/dL
Hematocrit (Hct) Male: 42-52% | Female: 37-47% | Pregnant: >33% Hct ≈ 3× Hgb value
WBC 5,000-10,000 mm³ High = infection | Low = immunosuppression
Platelets 150,000-400,000 mm³ Low <150K = bleeding risk
Sodium (Na+) 135-145 mEq/L <135 = hyponatremia | >145 = hypernatremia
Potassium (K+) 3.5-5.0 mEq/L <3.5 = hypokalemia | >5.0 = hyperkalemia
Calcium (Ca2+) 9-10.5 mg/dL <9 = hypocalcemia | >10.5 = hypercalcemia
Magnesium (Mg2+) Serum: 1.5-2.5 mEq/L | Therapeutic (Mg tx): 3.3-6.6 <1.5 = hypomagnesemia | >2.5 = hypermagnesemia
mEq/L
Glucose 70-110 mg/dL <70 = hypoglycemia | >110 = hyperglycemia
BUN 10-20 mg/dL Elevated = kidney dysfunction or dehydration
Creatinine Male: 0.6-1.2 mg/dL | Female: 0.5-1.1 mg/dL Elevated = kidney damage (more specific than BUN)
GFR 90-120 mL/min <60 = CKD | <15 = kidney failure
INR (warfarin) Normal: 0.9-1.2 | Therapeutic (DVT/A-Fib): 2-3 <2 = clot risk | >3 = bleeding risk
aPTT (heparin) Normal: 30-40 sec | Therapeutic: 1.5-2.5× = ~45-70 sec Notify provider if aPTT >70 sec
PT 11-12.5 sec | On warfarin: 1.5-2.5× normal Monitors warfarin
D-Dimer <500 ng/mL Elevated = DVT/PE (not specific — elevated in many
conditions)
Troponin I 0-0.1 ng/mL | Onset 4-6 hrs | Peak 12-24 hrs MOST SPECIFIC cardiac marker — MI gold standard
Troponin T 0-0.2 ng/mL | Onset 3-4 hrs | Peak 10-24 hrs Also cardiac specific
Myoglobin 10-95 ng/mL (male) | 10-65 (female) EARLIEST marker after MI (rises 1-3 hrs) — NOT
cardiac specific
BNP <100 = No HF | 100-300 = HF present | >300 mild | KEY heart failure marker — released by stretched
>600 moderate | >900 severe ventricles
CK-MB 0% of total CPK Cardiac isoenzyme — elevated in MI
ABG pH 7.35-7.45 <7.35 = acidosis | >7.45 = alkalosis
PCO2 35-45 mmHg >45 = respiratory acidosis | <35 = respiratory alkalosis
HCO3- 22-28 mEq/L <22 = metabolic acidosis | >28 = metabolic alkalosis
SaO2 95-100% <90% = O2 therapy needed
Total Cholesterol <200 mg/dL LDL <130 (no risk) | LDL <70 (cardiac) | HDL >45 male
/>55 female
HgbA1C <6% >6.5% = diabetes | Reflects avg blood glucose past 3
months
TSH 0.5-5 milli-IU/L Low TSH = hyperthyroid | High TSH = hypothyroid
, Lab Test (Galen Value) Normal Range Quick Clinical Tip
Urine Specific Gravity 1.005-1.030 High = concentrated/dehydration | Low = dilute/fluid
overload
Adult HR 60-100 bpm <60 = bradycardia | >100 = tachycardia
Adult BP <120/80 mmHg Stage 1: 130-139/80-89 | Stage 2: ≥140/90 | Crisis:
≥180/120 + symptoms
Adult Respirations 12-20/min <12 = bradypnea | >20 = tachypnea
Adult Temp 18-65 yrs: 97.6-99.5°F | >65 yrs: <98.6°F Fever >100.4°F | Older adults may not spike high
temps
UNIT 3 — FLUIDS, ELECTROLYTES & ACID-BASE (Ch 13-14, pp.255-283)
DEHYDRATION vs FLUID OVERLOAD (pp.255-260)
DEHYDRATION — Not enough fluid: FLUID OVERLOAD — Too much fluid:
• BOX 13.1 Causes: hemorrhage, vomiting, diarrhea, diaphoresis, burns, • BOX 13.1 Causes: excessive IV fluids, kidney failure (late), HF, SIADH,
NPO, diuretics, GI suction, fever, hyperventilation, ileostomy/fistula corticosteroids, water intoxication
• S&S;: tachycardia, thready pulse, hypotension, dry mucous membranes, • BOX 13.3 S&S;: BOUNDING pulse, ↑HR, ↑BP, distended neck/hand
poor skin turgor, dark concentrated urine, LOW UO, sudden weight LOSS, veins, JVD, weight GAIN, pitting edema, moist CRACKLES, ↑RR, SOB,
confusion/lethargy pale cool skin, altered LOC, headache
• Older adults: skin turgor LESS RELIABLE — check oral mucosa, eyes, TREATMENT:
behavior • Fluid restriction + sodium restriction
• Body COMPENSATES: vasoconstriction + ↑ peripheral resistance to • Diuretics (furosemide) to remove excess fluid
maintain BP • HOB elevated; O2 as needed; daily weights
TREATMENT: ■ Older adults with cardiac/kidney/liver/pulmonary disease =
• Mild: oral fluid replacement | Severe: IV 0.9% NS to restore volume HIGHEST RISK for complications
• Monitor VS, UO, daily weights, mental status, skin turgor
■ PATIENT & FAMILY TEACHING — BOX 13.1 / pp.255-256: DEHYDRATION & FLUID BALANCE
✔ Drink WATER — avoid caffeine and alcohol which INCREASE fluid loss (caffeine and alcohol are diuretics)
✔ Match fluid intake with fluid output daily — mild dehydration is common and easy to prevent
✔ Weigh yourself DAILY at the same time, on the same scale, wearing the same clothes
✔ Report SUDDEN weight gain (fluid overload) OR sudden weight loss (dehydration) to your provider
✔ Signs to report immediately: extreme thirst, confusion, very dark urine, swelling in legs, difficulty breathing
✔ During heavy exercise or hot weather: drink MORE water than usual to compensate for sweat losses
✔ Keep accurate record of ALL fluids in AND out if instructed (include ice cream, gelatin — these are fluids at body temp)
SODIUM IMBALANCES (pp.260-261) — Galen Normal: 135-145 mEq/L
HYPONATREMIA Na+ < 135 HYPERNATREMIA Na+ > 145
Causes GI fluid loss, vomiting, diarrhea, diuretics, burns, SIADH, HF, Dehydration, fever, hyperventilation, infection, diaphoresis,
kidney disease, hyperglycemia, excessive water intake Cushing syndrome, corticosteroids, excess Na+ intake
Brain Effect Brain SWELLS (water shifts IN) → cerebral edema + ↑ICP Brain SHRINKS (water shifts OUT) → cell dehydration
Key Symptoms Confusion, lethargy, SEIZURES (older adults: SUDDEN AGITATION, confusion, intense THIRST (hallmark!), muscle
CONFUSION #1 sign), muscle weakness, hypoactive DTRs, twitching, muscle weakness, hypoactive DTRs
N/D/cramps, GI hyperactivity
CV Signs With hypovolemia: weak pulse, ↓BP | With hypervolemia: HR and BP depend on vascular volume status
bounding pulse, ↑BP
Treatment Mild-moderate: 0.9% NS | SEVERE: 3% hypertonic saline Hypotonic IV fluids (D5½NS) or PO fluids if alert Diuretics |
(CRITICAL RESCUE — monitor closely!) Stop drugs causing Sodium restriction Correct SLOWLY — rapid correction
low Na+ Correct SLOWLY — rapid correction causes osmotic causes CEREBRAL EDEMA
demyelination
, ■ PATIENT & FAMILY TEACHING — pp.260-261: SODIUM IMBALANCES
✔ HYPONATREMIA: Watch for confusion — especially in older adults; sudden confusion may be the ONLY sign of low sodium
✔ HYPONATREMIA: Do NOT drink excessive plain water — it dilutes your sodium further (psychiatric polydipsia = water intoxication)
✔ HYPONATREMIA: Avoid over-use of diuretics without provider guidance — they can drop sodium dangerously
✔ HYPERNATREMIA: Drink adequate water daily — thirst means sodium is already rising
✔ HYPERNATREMIA: Reduce SALT intake in your diet (avoid processed foods, canned soups, fast food — all high in sodium)
✔ HYPERNATREMIA: Report fever or prolonged sweating immediately — these can rapidly increase sodium
✔ BOTH: Never stop prescribed medications without talking to your provider first
✔ BOTH: Report symptoms immediately — confusion, muscle weakness, seizures, intense thirst
POTASSIUM IMBALANCES (pp.262-265) — Galen Normal: 3.5-5.0 mEq/L
HYPOKALEMIA K+ < 3.5 HYPERKALEMIA K+ > 5.0
Causes Diuretics (#1 cause), corticosteroids, diarrhea, vomiting, Over-ingestion K+ foods/supplements, salt substitutes, blood
GI/wound drainage, NG suction, diaphoresis, insulin, albuterol, transfusion, kidney failure, ACEi/ARBs, K+-sparing diuretics,
alkalosis, TPN, black licorice, adrenal issues acidosis, crush injuries (K+ released from cells), uncontrolled
DM, tissue damage
CV Signs (ECG) Dysrhythmias, thready pulse, ↓BP ECG: ST DEPRESSION, BRADYCARDIA, hypotension ECG: TALL PEAKED T
flat/inverted T waves, U WAVE WAVES → wide QRS → V-Fib → CARDIAC ARREST
Respiratory Shallow respirations (muscle weakness) Respiratory muscle weakness
Neuromuscular Muscle WEAKNESS (too weak to stand), hand grasp weak, Paresthesias hands/feet, muscle weakness, ↓DTRs
↓DTRs, leg cramps
GI Signs ↓Peristalsis, hypoactive BS, N/V, CONSTIPATION, distension ↑GI motility, DIARRHEA, cramping
Neuro Anxiety, confusion, irritability Anxiety, confusion
Treatment O2 first! (diaphragm = muscle) Oral K+ if mild (preferred) IV K+ STOP potassium inputs Cardiac monitoring/ECG Glucose +
if severe (DILUTED, 5-10 mEq/hr, NEVER IV push — Insulin (shifts K+ into cells) Calcium gluconate IV (protects
CARDIAC ARREST) High-K+ diet Monitor ECG heart) Sodium bicarbonate (corrects acidosis) Dialysis
(kidney failure) Monitor ECG and response
■ NURSING SAFETY PRIORITY — Drug Alert — IV Potassium (p.264)
NEVER give potassium by IV PUSH — causes CARDIAC ARREST. NEVER give IM or SQ — causes tissue necrosis. Must be DILUTED; infuse at
5-10 mEq/hr MAX. Confirm UO ≥30 mL/hr BEFORE giving IV K+. Per Joint Commission NPSG: concentrated K+ must be prepared by pharmacist
only — NEVER stored in patient care areas. If IV K+ infiltrates: STOP IV, remove access, notify provider, photograph site.
■ PATIENT & FAMILY TEACHING — pp.262-265 + BOX 28.5: POTASSIUM IMBALANCES
✔ HYPOKALEMIA: Eat potassium-RICH foods daily: bananas, potatoes, oranges/OJ, avocado, tomatoes, beans, prunes, strawberries, lettuce,
spinach
✔ HYPOKALEMIA: If taking a diuretic (water pill), you are likely losing potassium — ask your provider if you need a supplement
✔ HYPOKALEMIA: Report muscle weakness, leg cramps, or an irregular heartbeat RIGHT AWAY — these are signs of low potassium
✔ HYPOKALEMIA: Take oral potassium WITH food or after eating — it has a strong taste and can cause nausea on an empty stomach
✔ HYPERKALEMIA: AVOID high-potassium foods: bananas, oranges, potatoes, avocado, salt substitutes (KCl)
✔ HYPERKALEMIA: Do NOT use salt substitutes (these contain potassium chloride — can cause dangerously HIGH potassium)
✔ HYPERKALEMIA: If you take ACE inhibitors (lisinopril, enalapril) or ARBs, get potassium levels checked regularly
✔ BOTH: NEVER take potassium supplements without a provider order — too much can stop your heart
✔ BOTH: Report palpitations (irregular heartbeat), muscle weakness, or paralysis to your provider IMMEDIATELY
✔ BOX 28.5 — For patients on diuretics: know symptoms of low K+ (muscle weakness, cardiac irregularity) and eat K+-rich foods
CALCIUM IMBALANCES (pp.266-267) — Galen Normal: 9-10.5 mg/dL
HYPOCALCEMIA Ca2+ < 9 mg/dL HYPERCALCEMIA Ca2+ > 10.5 mg/dL
Causes Inadequate intake, lactose intolerance, low Vit D, Hyperparathyroidism, cancer/malignancy, hyperthyroidism,
malabsorption (Crohn's, celiac), diarrhea, end-stage kidney immobility, dehydration, thiazide diuretics, excessive Ca2+
disease, alkalosis, pancreatitis, hyperphosphatemia, or Vit D intake, chronic kidney disease
parathyroid removal, immobility
UNIT 3: Fluids/Electrolytes/Acid-Base | UNITS 4/5: Cardiovascular | UNIT 6: Urinary/Renal | UNIT 7: GI | Galen Values Throughout
■ Patient & Family Teaching sections are highlighted in BLUE throughout this guide — these are HIGH-YIELD exam topics!
■ All lab values are GALEN COLLEGE STANDARDIZED VALUES from your uploaded screenshots.
■ GALEN STANDARDIZED LAB VALUES — THE ONLY VALUES TO USE ON EXAMS
Lab Test (Galen Value) Normal Range Quick Clinical Tip
Hemoglobin (Hgb) Male: 14-18 g/dL | Female: 12-16 g/dL | Pregnant: >11 Low = anemia | Transfuse if critically low
g/dL
Hematocrit (Hct) Male: 42-52% | Female: 37-47% | Pregnant: >33% Hct ≈ 3× Hgb value
WBC 5,000-10,000 mm³ High = infection | Low = immunosuppression
Platelets 150,000-400,000 mm³ Low <150K = bleeding risk
Sodium (Na+) 135-145 mEq/L <135 = hyponatremia | >145 = hypernatremia
Potassium (K+) 3.5-5.0 mEq/L <3.5 = hypokalemia | >5.0 = hyperkalemia
Calcium (Ca2+) 9-10.5 mg/dL <9 = hypocalcemia | >10.5 = hypercalcemia
Magnesium (Mg2+) Serum: 1.5-2.5 mEq/L | Therapeutic (Mg tx): 3.3-6.6 <1.5 = hypomagnesemia | >2.5 = hypermagnesemia
mEq/L
Glucose 70-110 mg/dL <70 = hypoglycemia | >110 = hyperglycemia
BUN 10-20 mg/dL Elevated = kidney dysfunction or dehydration
Creatinine Male: 0.6-1.2 mg/dL | Female: 0.5-1.1 mg/dL Elevated = kidney damage (more specific than BUN)
GFR 90-120 mL/min <60 = CKD | <15 = kidney failure
INR (warfarin) Normal: 0.9-1.2 | Therapeutic (DVT/A-Fib): 2-3 <2 = clot risk | >3 = bleeding risk
aPTT (heparin) Normal: 30-40 sec | Therapeutic: 1.5-2.5× = ~45-70 sec Notify provider if aPTT >70 sec
PT 11-12.5 sec | On warfarin: 1.5-2.5× normal Monitors warfarin
D-Dimer <500 ng/mL Elevated = DVT/PE (not specific — elevated in many
conditions)
Troponin I 0-0.1 ng/mL | Onset 4-6 hrs | Peak 12-24 hrs MOST SPECIFIC cardiac marker — MI gold standard
Troponin T 0-0.2 ng/mL | Onset 3-4 hrs | Peak 10-24 hrs Also cardiac specific
Myoglobin 10-95 ng/mL (male) | 10-65 (female) EARLIEST marker after MI (rises 1-3 hrs) — NOT
cardiac specific
BNP <100 = No HF | 100-300 = HF present | >300 mild | KEY heart failure marker — released by stretched
>600 moderate | >900 severe ventricles
CK-MB 0% of total CPK Cardiac isoenzyme — elevated in MI
ABG pH 7.35-7.45 <7.35 = acidosis | >7.45 = alkalosis
PCO2 35-45 mmHg >45 = respiratory acidosis | <35 = respiratory alkalosis
HCO3- 22-28 mEq/L <22 = metabolic acidosis | >28 = metabolic alkalosis
SaO2 95-100% <90% = O2 therapy needed
Total Cholesterol <200 mg/dL LDL <130 (no risk) | LDL <70 (cardiac) | HDL >45 male
/>55 female
HgbA1C <6% >6.5% = diabetes | Reflects avg blood glucose past 3
months
TSH 0.5-5 milli-IU/L Low TSH = hyperthyroid | High TSH = hypothyroid
, Lab Test (Galen Value) Normal Range Quick Clinical Tip
Urine Specific Gravity 1.005-1.030 High = concentrated/dehydration | Low = dilute/fluid
overload
Adult HR 60-100 bpm <60 = bradycardia | >100 = tachycardia
Adult BP <120/80 mmHg Stage 1: 130-139/80-89 | Stage 2: ≥140/90 | Crisis:
≥180/120 + symptoms
Adult Respirations 12-20/min <12 = bradypnea | >20 = tachypnea
Adult Temp 18-65 yrs: 97.6-99.5°F | >65 yrs: <98.6°F Fever >100.4°F | Older adults may not spike high
temps
UNIT 3 — FLUIDS, ELECTROLYTES & ACID-BASE (Ch 13-14, pp.255-283)
DEHYDRATION vs FLUID OVERLOAD (pp.255-260)
DEHYDRATION — Not enough fluid: FLUID OVERLOAD — Too much fluid:
• BOX 13.1 Causes: hemorrhage, vomiting, diarrhea, diaphoresis, burns, • BOX 13.1 Causes: excessive IV fluids, kidney failure (late), HF, SIADH,
NPO, diuretics, GI suction, fever, hyperventilation, ileostomy/fistula corticosteroids, water intoxication
• S&S;: tachycardia, thready pulse, hypotension, dry mucous membranes, • BOX 13.3 S&S;: BOUNDING pulse, ↑HR, ↑BP, distended neck/hand
poor skin turgor, dark concentrated urine, LOW UO, sudden weight LOSS, veins, JVD, weight GAIN, pitting edema, moist CRACKLES, ↑RR, SOB,
confusion/lethargy pale cool skin, altered LOC, headache
• Older adults: skin turgor LESS RELIABLE — check oral mucosa, eyes, TREATMENT:
behavior • Fluid restriction + sodium restriction
• Body COMPENSATES: vasoconstriction + ↑ peripheral resistance to • Diuretics (furosemide) to remove excess fluid
maintain BP • HOB elevated; O2 as needed; daily weights
TREATMENT: ■ Older adults with cardiac/kidney/liver/pulmonary disease =
• Mild: oral fluid replacement | Severe: IV 0.9% NS to restore volume HIGHEST RISK for complications
• Monitor VS, UO, daily weights, mental status, skin turgor
■ PATIENT & FAMILY TEACHING — BOX 13.1 / pp.255-256: DEHYDRATION & FLUID BALANCE
✔ Drink WATER — avoid caffeine and alcohol which INCREASE fluid loss (caffeine and alcohol are diuretics)
✔ Match fluid intake with fluid output daily — mild dehydration is common and easy to prevent
✔ Weigh yourself DAILY at the same time, on the same scale, wearing the same clothes
✔ Report SUDDEN weight gain (fluid overload) OR sudden weight loss (dehydration) to your provider
✔ Signs to report immediately: extreme thirst, confusion, very dark urine, swelling in legs, difficulty breathing
✔ During heavy exercise or hot weather: drink MORE water than usual to compensate for sweat losses
✔ Keep accurate record of ALL fluids in AND out if instructed (include ice cream, gelatin — these are fluids at body temp)
SODIUM IMBALANCES (pp.260-261) — Galen Normal: 135-145 mEq/L
HYPONATREMIA Na+ < 135 HYPERNATREMIA Na+ > 145
Causes GI fluid loss, vomiting, diarrhea, diuretics, burns, SIADH, HF, Dehydration, fever, hyperventilation, infection, diaphoresis,
kidney disease, hyperglycemia, excessive water intake Cushing syndrome, corticosteroids, excess Na+ intake
Brain Effect Brain SWELLS (water shifts IN) → cerebral edema + ↑ICP Brain SHRINKS (water shifts OUT) → cell dehydration
Key Symptoms Confusion, lethargy, SEIZURES (older adults: SUDDEN AGITATION, confusion, intense THIRST (hallmark!), muscle
CONFUSION #1 sign), muscle weakness, hypoactive DTRs, twitching, muscle weakness, hypoactive DTRs
N/D/cramps, GI hyperactivity
CV Signs With hypovolemia: weak pulse, ↓BP | With hypervolemia: HR and BP depend on vascular volume status
bounding pulse, ↑BP
Treatment Mild-moderate: 0.9% NS | SEVERE: 3% hypertonic saline Hypotonic IV fluids (D5½NS) or PO fluids if alert Diuretics |
(CRITICAL RESCUE — monitor closely!) Stop drugs causing Sodium restriction Correct SLOWLY — rapid correction
low Na+ Correct SLOWLY — rapid correction causes osmotic causes CEREBRAL EDEMA
demyelination
, ■ PATIENT & FAMILY TEACHING — pp.260-261: SODIUM IMBALANCES
✔ HYPONATREMIA: Watch for confusion — especially in older adults; sudden confusion may be the ONLY sign of low sodium
✔ HYPONATREMIA: Do NOT drink excessive plain water — it dilutes your sodium further (psychiatric polydipsia = water intoxication)
✔ HYPONATREMIA: Avoid over-use of diuretics without provider guidance — they can drop sodium dangerously
✔ HYPERNATREMIA: Drink adequate water daily — thirst means sodium is already rising
✔ HYPERNATREMIA: Reduce SALT intake in your diet (avoid processed foods, canned soups, fast food — all high in sodium)
✔ HYPERNATREMIA: Report fever or prolonged sweating immediately — these can rapidly increase sodium
✔ BOTH: Never stop prescribed medications without talking to your provider first
✔ BOTH: Report symptoms immediately — confusion, muscle weakness, seizures, intense thirst
POTASSIUM IMBALANCES (pp.262-265) — Galen Normal: 3.5-5.0 mEq/L
HYPOKALEMIA K+ < 3.5 HYPERKALEMIA K+ > 5.0
Causes Diuretics (#1 cause), corticosteroids, diarrhea, vomiting, Over-ingestion K+ foods/supplements, salt substitutes, blood
GI/wound drainage, NG suction, diaphoresis, insulin, albuterol, transfusion, kidney failure, ACEi/ARBs, K+-sparing diuretics,
alkalosis, TPN, black licorice, adrenal issues acidosis, crush injuries (K+ released from cells), uncontrolled
DM, tissue damage
CV Signs (ECG) Dysrhythmias, thready pulse, ↓BP ECG: ST DEPRESSION, BRADYCARDIA, hypotension ECG: TALL PEAKED T
flat/inverted T waves, U WAVE WAVES → wide QRS → V-Fib → CARDIAC ARREST
Respiratory Shallow respirations (muscle weakness) Respiratory muscle weakness
Neuromuscular Muscle WEAKNESS (too weak to stand), hand grasp weak, Paresthesias hands/feet, muscle weakness, ↓DTRs
↓DTRs, leg cramps
GI Signs ↓Peristalsis, hypoactive BS, N/V, CONSTIPATION, distension ↑GI motility, DIARRHEA, cramping
Neuro Anxiety, confusion, irritability Anxiety, confusion
Treatment O2 first! (diaphragm = muscle) Oral K+ if mild (preferred) IV K+ STOP potassium inputs Cardiac monitoring/ECG Glucose +
if severe (DILUTED, 5-10 mEq/hr, NEVER IV push — Insulin (shifts K+ into cells) Calcium gluconate IV (protects
CARDIAC ARREST) High-K+ diet Monitor ECG heart) Sodium bicarbonate (corrects acidosis) Dialysis
(kidney failure) Monitor ECG and response
■ NURSING SAFETY PRIORITY — Drug Alert — IV Potassium (p.264)
NEVER give potassium by IV PUSH — causes CARDIAC ARREST. NEVER give IM or SQ — causes tissue necrosis. Must be DILUTED; infuse at
5-10 mEq/hr MAX. Confirm UO ≥30 mL/hr BEFORE giving IV K+. Per Joint Commission NPSG: concentrated K+ must be prepared by pharmacist
only — NEVER stored in patient care areas. If IV K+ infiltrates: STOP IV, remove access, notify provider, photograph site.
■ PATIENT & FAMILY TEACHING — pp.262-265 + BOX 28.5: POTASSIUM IMBALANCES
✔ HYPOKALEMIA: Eat potassium-RICH foods daily: bananas, potatoes, oranges/OJ, avocado, tomatoes, beans, prunes, strawberries, lettuce,
spinach
✔ HYPOKALEMIA: If taking a diuretic (water pill), you are likely losing potassium — ask your provider if you need a supplement
✔ HYPOKALEMIA: Report muscle weakness, leg cramps, or an irregular heartbeat RIGHT AWAY — these are signs of low potassium
✔ HYPOKALEMIA: Take oral potassium WITH food or after eating — it has a strong taste and can cause nausea on an empty stomach
✔ HYPERKALEMIA: AVOID high-potassium foods: bananas, oranges, potatoes, avocado, salt substitutes (KCl)
✔ HYPERKALEMIA: Do NOT use salt substitutes (these contain potassium chloride — can cause dangerously HIGH potassium)
✔ HYPERKALEMIA: If you take ACE inhibitors (lisinopril, enalapril) or ARBs, get potassium levels checked regularly
✔ BOTH: NEVER take potassium supplements without a provider order — too much can stop your heart
✔ BOTH: Report palpitations (irregular heartbeat), muscle weakness, or paralysis to your provider IMMEDIATELY
✔ BOX 28.5 — For patients on diuretics: know symptoms of low K+ (muscle weakness, cardiac irregularity) and eat K+-rich foods
CALCIUM IMBALANCES (pp.266-267) — Galen Normal: 9-10.5 mg/dL
HYPOCALCEMIA Ca2+ < 9 mg/dL HYPERCALCEMIA Ca2+ > 10.5 mg/dL
Causes Inadequate intake, lactose intolerance, low Vit D, Hyperparathyroidism, cancer/malignancy, hyperthyroidism,
malabsorption (Crohn's, celiac), diarrhea, end-stage kidney immobility, dehydration, thiazide diuretics, excessive Ca2+
disease, alkalosis, pancreatitis, hyperphosphatemia, or Vit D intake, chronic kidney disease
parathyroid removal, immobility
