Unit 2, 3, and 4 Review: Chest Tubes, Fluid & Electrolyte Balance, and Acid-Base Balance

Comprehensive practice flashcards for nursing exam prep covering chest tube complications, fluid and electrolyte imbalances, normal serum levels, ECG changes, and ABG interpretation.

What should be checked, and in what specific order, if there is no tidaling in a chest tube system?

Always check for blockage, kink, or lung re-expansion, in that order.

What does continuous bubbling in the water-seal chamber of a chest tube drainage system indicate?

An air leak.

What is the immediate management protocol if a chest tube is accidentally disconnected from the drainage system?

Place the tube end in sterile water, reconnect using sterile technique, and notify the provider.

How should an accidental chest tube removal or dislodgment site be managed immediately?

Cover the site with a sterile occlusive dressing taped on $3$ sides, provide oxygen, and notify the physician urgently.

Why should a chest tube that is bubbling or has an air leak NEVER be clamped unless specifically ordered?

Clamping can cause a tension pneumothorax.

What percentage of body weight is made up of Intracellular Fluid (ICF) and Extracellular Fluid (ECF)?

Intracellular Fluid (ICF) makes up $\thicksim 40capsule$ (or \thicksim 40\text{\textbackslash{}\textpercent}) / \thicksim 40\text{\textbackslash{}\textpercent} of body weight, and Extracellular Fluid (ECF) makes up \thicksim 20\text{\textbackslash{}\textpercent} of body weight.

What is the exact ion movement ratio of the Sodium-Potassium Pump ($\text{Na}^+/\text{K}^+\text{-ATPase}$)?

It pumps $3\text{ Na}^+$ OUT of the cell and $2\text{ K}^+$ INTO the cell.

What type of tonicity does 0.45\text{\textbackslash{}\textpercent}\text{ NaCl} have, and what is a key caution for its administration?

It is a hypotonic solution. Do NOT give it to clients at risk for increased intracranial pressure (IICP) or third-space fluid shifting.

How do blood pressure, pulse, and lab values differ between Fluid Volume Deficit (FVD) and Fluid Volume Excess (FVE)?

FVD has low BP, weak/rapid pulse, and elevated labs ($\text{Hct}$, $\text{Na}^+$, $\text{BUN}$) due to hemoconcentration. FVE has high BP, bounding/full pulse, and decreased labs ($\text{Hct}$, $\text{Na}^+$, $\text{BUN}$) due to hemodilution.

What are the normal serum ranges for Sodium ($\text{Na}^+$) and Potassium ($\text{K}^+$)?

Sodium ($\text{Na}^+$) is $135-145\text{ mEq/L}$ and Potassium ($\text{K}^+$) is $3.5-5.0\text{ mEq/L}$.

What are the normal serum ranges for Calcium ($\text{Ca}^{2+}$) and Magnesium ($\text{Mg}^{2+}$)?

Calcium ($\text{Ca}^{2+}$) is $8.5-10.5\text{ mg/dL}$ and Magnesium ($\text{Mg}^{2+}$) is $1.5-2.5\text{ mEq/L}$.

What is the crucial administration rule for intravenous (IV) potassium replacement?

IV potassium is NEVER given by bolus — it must always be diluted.

What ECG changes are indicative of hypokalemia versus hyperkalemia?

Hypokalemia causes flat T waves, ST depression, and prominent U waves. Hyperkalemia causes peaked T waves and a widened QRS complex.

What ECG changes are seen in hypocalcemia versus hypercalcemia?

Hypocalcemia causes a prolonged QT interval, whereas hypercalcemia causes a shortened ST segment.

What antidote is administered for hypermagnesemia Toxicity?

Calcium gluconate.

What inverse relationship exists between phosphate ($\text{PO}_4^{3-}$) and calcium ($\text{Ca}^{2+}$)?

Phosphate and calcium have an inverse relationship; high phosphate tends to cause low calcium (which can trigger tetany), and vice versa.

What are the normal arterial blood gas (ABG) values for pH, $\text{PaCO}_2$, and $\text{HCO}_3^-$?

pH is $7.35-7.45$, $\text{PaCO}_2$ is $35-45\text{ mmHg}$, and $\text{HCO}_3^-$ is $22-26\text{ mEq/L}$.

How does the ROME mnemonic apply to ABG interpretation?

Respiratory Opposite (pH and $\text{PaCO}_2$ move in opposite directions) and Metabolic Equal (pH and $\text{HCO}_3^-$ move in the same/equal direction).

What acid-base disorder presents with Kussmaul respirations, and what is a classic cause?

Metabolic acidosis, which is strongly associated with Diabetic Ketoacidosis (DKA).

Why do vomiting and gastric suction cause metabolic alkalosis?

They lead to a loss of stomach acid ($\text{HCl}$), which increases the body's proportion of bicarbonate.