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Objectives
￮ Describe the processes involved in
regulating fluid and electrolyte balance
￮ Identify risk factors that can affect fluid-
electrolyte imbalances
FLUID AND ELECTROLYTES
￮ Determine appropriate clinical
assessment data and laboratory
Maria Victoria V. Bongar, RN
Assistant Professor
examinations
University of Santo Tomas College of Nursing ￮ Apply the nursing process on patients
with fluid-electrolyte imbalances

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Composition of body fluids

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MOVEMENT OF BODY FLUIDS

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Copyright 2008 by Pearson Education, Inc.

Active Transport
Movement of Body Fluids
￮ Active Transport
￮ Diffusion
￮ Osmosis
￮ Filtration

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ACTIVE TRANSPORT
Diffusion
￮ Substances can move across cell membrane from a
less concentrated solution to a more concentrated
one.
￮ Metabolic energy is expended (ATP) .
￮ Important in maintaining the differences in sodium
and potassium ion concentration of ECF and ICF.

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Copyright 2008 by Pearson Education, Inc.

Osmosis Osmosis
￮ Water moves through a membrane that separates
fluids and different particle concentration
￮ Osmotic pressure
￮ Inward-pulling force caused by particles in the
fluids
￮ When particle concentration in the interstitial
compartment changes , osmosis occur rapidly and
moves water into or out of the cells

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Osmolality Filtration

￮ Sodium (Na)
￮ is the greatest determinant of serum osmolality.

￮ Tonicity – osmolality of a solution

￮ Isotonic – same osmolality as body fluids

● Normal saline, 0.9% sodium chloride

￮ Hypertonic – higher osmolality than body

fluids
● 3% sodium chloride
￮ Hypotonic – lower osmolality than body fluids

● ½ normal saline, 0.45% sodium chloride

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FILTRATION
￮ Process whereby fluid and solutes move
together across a membrane from one
compartment to another.
￮ From an area of higher pressure to one of lower
pressure.
￮ Net effect of four forces , two that tend to
move fluid out of the capillaries and small
venules and two that tend to move fluid back to
them
FILTRATION
￮ Hydrostatic pressure – pressure exerted by a fluid
within a closed system on the walls of a container in
which it is contained.
￮ Colloid osmotic pressure (Oncotic pressure)–
inward-pulling force by blood proteins that helps
move fluid from the interstitial area back to the
capillaries
￮ Filtration pressure – pressure in the compartment
that results in the movement of fluid and substances
dissolved in fluid out of the compartment.
￮ Difference between the hydrostatic pressure and osmotic
pressure.

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Fluid Regulation

￮ Fluid intake
￮ Thirst (hypothalamus)

￮ Fluid output
￮ Urine, insensible loss and feces

￮ Maintaning homeostasis
￮ Kidneys

￮ ADH
FLUID BALANCE ￮ RAAS

￮ Atrial Natriuretic peptide

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Average Fluid intake and output Fluid Regulation

Fluid Intake Amount Fluid output Amount

￮ Antidiuretic Hormone (ADH)
Ingested 1100-1400 mL Skin 500-600mL ￮ Regulates the osmolality of the body fluids

(fluids) (insensible by influencing how much water is excreted

and sweat) in the urine
Ingested 800-1000 mL Lungs 400 mL ￮ Renin-Angiotensin Aldosterone System
(food) (insensible) ￮ Regulates ECF volume by influencing how

Metabolism 300 mL Gastrointestin 100-200mL much sodium and water are excreted in the
al urine
Urine 1200-1500 mL/Hr ￮ Atrial Natriuretic Peptide
(0.5-1mL/kg ￮ Regulates ECV by influencing how much
BW/Hr)
water and sodium is are excreted in the
Total 2200-2700 mL Total 2200-2700 mL urine

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Fluid Imbalance

Extracellular Fluid Imbalance

￮ ECV deficit
￮ Insufficient isotonic fluid in the

extracellular compartment
￮ hypovolemia

￮ ECV excess
FLUID IMBALANCE ￮ Too much isotonic fluid in the

extracellular compartment
￮ Ex. Excessive Na intake – edema

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Fluid Imbalance Fluid Imbalance

Osmolality Imbalance
￮ Hypernatremia Clinical dehydration
￮ Water deficit (hypertonic condition)
￮ ECV deficit and hypernatremia
leading to excess Na ￮ Common in gastroenteritis with severe
￮ dehydration diarrhea and vomiting
￮ Hyponatremia
￮ Water excess or water intoxication

￮ Gain of more water (hypotonic

condition) than salt loss

￮ Brain cells swell - seizures

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Importance of Electrolyte Balance

￮ Maintaining fluid balance

￮ Contributes to acid-base regulation
￮ Facilitates enzyme reactions
￮ Important in transmission of
neuromuscular reactions
ELECTROLYTE BALANCE

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Electrolyte Balance Electrolytes

￮ Sodium (Na+) – most abundant cation in ECF
￮ Electrolyte intake and absorption
￮ Major contributor to serum osmolality.
￮ Electrolyte distribution ￮ Functions largely in controlling & regulating water
￮ Plasma concentration of K, Ca and Mg and balance.
Phosphate is major intracellularly and lesser ￮ Serum Na+ = 135-145 mEq/L
in plasma ￮ Bacon, processed cheese, table salt

￮ Electrolyte output ￮ Potassium (K+)

￮ Major cation in ICF, small amount in plasma and
￮ Increase in output requires an increase in
interstitial fluid.
electrolyte input
￮ Serum K+= 3.5 – 5.0 mEq/L
￮ Vital for skeletal, cardiac, and smooth muscle
activity.
￮ Fruits & vegetables, meat, fish, milk, orange juice.

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￮ Magnesium (Mg++)
￮ 2
nd most abundant IC cation, found in the
Calcium (Ca++)
￮
skeleton & ICF.
￮ 99% composition in the skeletal system ￮ Serum Mg++ = 1.5 – 2.5 mEq/L
￮ 1%, vital in regulating muscle contraction ￮ Necessary for protein and DNA synthesis within
and relaxation, neuromuscular and cardiac the cells.
function. ￮ Cereal grains, nuts, dried fruit, legumes, green

￮ Milk products, dark green leafy vegetables, leafy vegetables.

canned salmon. ￮ Chloride (Cl-)
￮ Major anion of ECF.
￮ Total serum Ca++ = 8.5 – 10.5 mg/dL
￮ Serum Cl- = 95 – 108 mEq/L
￮ Ionized serum Ca++ = 4.0 – 5.0 mg/dL
￮ With sodium, regulates serum osmolality and
blood volume.
￮ Buffer in the exchange of O2 & CO2 in RBCs.
￮ Same foods as sodium.

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￮ Phosphate (PO4)
￮ Major anion of ICF, also found in ECF, bone,

skeletal muscle, nerve tissue.

￮ Serum PO4 = 2.5 – 4.5 mg/dL

￮ Essential for functioning of muscles, nerves and

RBC; also in the metabolism of protein, fat &
CHO.
￮ Meat, fish, poultry, milk products, legumes.

￮ Bicarbonate (HCO3-)
￮ Present in both ICF & ECF.
￮ Regulates acid-base balance as an essential ACID-BASE BALANCE
component of the carbonic acid-bicarbonate
buffering system.

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Regulation of Acid-Base Balance

￮ Acid Production
￮ Cellular metabolism usually creates 2 acids

= carbonic acid and metabolic acid

￮ Acid Buffering
￮ Buffers – pairs of chemical that works

together to maintain normal pH of body

fluids (HCO3)
￮ Acid Excretion
￮ Lungs (carbonic acid)

￮ Kidneys (metabolic acid)

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Buffers

￮ Prevent excessive Lungs

changes in pH
￮ Major buffer in ECF is ￮ Regulate acid-base balance by eliminating or
retaining carbon dioxide
HCO3 and H2CO3 ￮ Does this by altering rate/depth of respirations
￮ Faster rate/more depth = get rid of more
￮ Other buffers include: CO2 and pH rises
￮ Slower rate/less depth = retain CO2 and
￮ Plasma proteins
pH lowers
￮ Hemoglobin
￮ Phosphates

Copyright 2008 by Pearson Education, Inc.

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Copyright 2008 by Pearson Education, Inc.

Kidneys

￮ Regulate by selectively excreting or

conserving bicarbonate and hydrogen
ions
￮ Slower to respond to change

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Nursing History

￮ Age
￮ Children and older adults

￮ Environment
￮ Temperature

￮ Dietary intake
￮ Diarrhea , vomiting, drainage

￮ Lifestyle
NURSING ASSESSMENT ￮ Alcohol intake

￮ Medications

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Medical History Physical Assessment

￮ Recent Surgery ￮ Weight

￮ Same time everyday , same amount of
￮ Acute illness/ trauma
clothing , same equipment
￮ Respiratory disorders

￮ Burns
￮ Input monitoring
￮ Fluid intake include all liquid that a person
￮ Trauma
eats (ex. Gelatin , ice cream , soups) and
￮ Chronic illness drinks , including via enteral feedings
￮ Cancer ￮ Output monitoring
￮ Heart failure ￮ Include urine, diarrhea , gastric suction and

￮ Oliguric renal disease surgical drains

￮ Catheter – q shift or q hour

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Evaluation of edema NANDA Nursing Diagnosis

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NANDA Nursing Diagnosis NANDA Nursing Diagnosis

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Nursing Interventions
NANDA Nursing Diagnosis
￮ Monitoring
￮ Fluid intake and output

￮ Cardiovascular and respiratory status

￮ Results of laboratory tests

￮ Assessment
￮ Client’s weight

￮ Location and extent of edema, if present

￮ Skin turgor and skin status

￮ Specific gravity of urine

￮ Level of consciousness, and mental

status

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Nursing Interventions
￮ Fluid intake modifications
￮ Dietary changes
￮ Parenteral fluid, electrolyte, and blood
replacement
￮ Other appropriate measures such as:
￮ Administering prescribed medications and
oxygen
￮ Providing skin care and oral hygiene
￮ Positioning the client appropriately
￮ Scheduling rest periods
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Promoting fluid and electrolyte
balance
￮ Maintain normal body weight
￮ Learn about, monitor, manage side effects
of medications
￮ Recognize risk factors
￮ Seek professional health care for notable
signs of fluid imbalances
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Practice Guidelines:
facilitating fluid intake
￮ Explain reason for required intake and
amount needed
￮ Establish 24 hour plan for ingesting fluids
￮ Set short term goals
￮ Identify fluids client likes and use those
￮ Help clients select foods that become
liquid at room temperature
￮ Supply cups, glasses, straws
￮ Serve fluids at proper temperature
￮ Encourage participation in recording intake
￮ Be alert to cultural implications
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Promoting fluid and electrolyte
balance
￮ Consume 6-8 glasses water daily
￮ Avoid foods with excess salt, sugar,
caffeine
￮ Eat well-balanced diet
￮ Limit alcohol intake
￮ Increase fluid intake before, during, after
strenuous exercise
￮ Replace lost electrolytes
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Patient Teaching :
Fluid and electrolyte balance
￮ Promoting fluid and electrolyte balance
￮ Monitoring fluid intake and output
￮ Maintaining food and fluid intake
￮ Safety
￮ Medications
￮ Measures specific to client’s problems
￮ Referrals
￮ Community agencies and other sources of
help
￮ Facilitating fluid intake
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Practice Guidelines:
Restricting Fluid intake
￮ Explain reason and amount of restriction
￮ Help client establish ingestion schedule
￮ Identify preferences and obtain
￮ Set short term goals; place fluids in small
containers
￮ Offer ice chips and mouth care
￮ Teach avoidance of ingesting chewy, salty,
sweet foods or fluids
￮ Encourage participation in recording intake
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Correcting imbalances
￮ Oral replacement–
￮ If client is not vomiting

￮ If client has not experienced excessive fluid

loss
￮ Has intact GI tract and gag and swallow

reflexes
￮ Restricted fluids may be necessary for fluid
retention–
￮ Vary from nothing by mouth to precise

amount ordered
￮ Dietary changes

￮ Oral supplements–

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SUPPORTING PHYSIOLOGIC PATTERNS :

ELIMINATION

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Bowel Elimination
￮ Expulsion of feces from the rectum
￮ Voluntary contraction of the abdominal
muscles and by forceful expiration with glotis
SUPPORTING closed increased abdominal pressure (Valsalva
PHYSIOLOGIC Maneuver)

PATTERNS : FECAL
ELIMINATION

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Factors influencing Bowel

Elimination
￮ Age
￮ Diet
￮ Fluid intake
￮ Physical activity
￮ Psychological factors
￮ Personal habits
￮ Position during defecation

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Factors influencing Bowel

Elimination Normal Characteristics of Stools
￮ Pain ￮ Color: yellow/golden brown
￮ Pregnancy ￮ Odor: Aromatic
￮ Surgery and Anesthesia ￮ Amount: Depends on bulk of food intake (150-
￮ Medications 300 gms/day.
￮ Diagnostic Tests ￮ Consistency: Soft, formed
￮ Shape: Cylindrical
￮ Frequency: Variable (1-2/day to 1 every 2-3
days)

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Alteration in the Characteristics of Common Fecal Elimination

Stools Problems
￮ Acholic Stool – gray, pale or clay-colored stool ￮ Constipation
￮ Absence of stercobilin (biliary obstruction) ￮ Fecal Impaction
￮ Hematochezia – passage of stool with bright red ￮ Diarrhea
blood , may be indicative of lower GI bleeding ￮ Flatulence
￮ Melena – passage of black, tarry stool , may be ￮ Fecal Incontinence
indicative of Upper GI bleeding
￮ Steatorrhea – greasy,bulky, foul-smelling stool ￮ Hemorrhoids
￮ Presence of undigested fats (hepatobiliary –
pancreatic disorders)

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Constipation Types of laxatives

￮ Passage of small, dry, hard stools or no stools
for a period of time.
￮ Nursing Interventions:
￮ Adequate fluid intake (1500-2000 ml/day)
￮ High-fiber diet (provide bulk).
￮ Establish regular pattern of defecation.
￮ Respond immediately to the urge to
defecate.
￮ Minimize stress (decrease peristalsis).
￮ Adequate activity & exercise (promote
muscle tone).
￮ Assume sitting or semi squatting position.
￮ Administer laxatives as ordered.
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￮ Chemical irritants – provide chemical
stimulation to intestinal wall (Dulcolax, castor
oil, Senokot).
￮ Stool lubricants – lubricate the feces &
facilitates expulsion (mineral oil).
￮ Stool softeners – soften the stool (Colace).
￮ Bulk formers – increase bulk of the feces,
thereby, increasing mechanical pressure &
distention of the intestine (Metamucil).
￮ Osmotic agents – attract fluids from the
intestinal capillaries to the stool (Milk of
Magnesia, Duphalac)
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Nursing Interventions to relieve

Fecal Impaction fecal impaction
￮ Mass or collection of hardened, putty-like feces ￮ Manual extraction or
in the folds of the rectum.
fecal disimpaction as
￮ Person is unable to voluntarily evacuate the
stool. ordered.
￮ Assessment: ￮ Increase fluid intake.
￮ Absence of bowel movement (3-5 days);
￮ Sufficient bulk in
￮ Passage of liquid fecal seepage;

￮ Hardened fecal mass upon palpation;

diet.
￮ Nonproductive desire to defecate & rectal ￮ Adequate activity &
pain; exercise.
￮ Anorexia, body malaise;
￮ Abdominal fullness or bloating;
￮ Nausea & vomiting.

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Diarrhea Diarrhea
￮ Frequent evacuation of watery stools. ￮ Antidiarrheal medications as ordered.
￮ Associated with increased GI motility, & rapid
passage of fecal contents. ￮ Do not administer antidiarrheal at the start of
￮ Nursing Interventions: diarrhea (protective mechanism to get rid of
￮ Replace fluid & electrolyte losses; bacteria & toxins).
￮ Provide good perianal care;

￮ Promote rest;

￮ Diet: Bland foods, low fiber, BRAT, avoid

excessively hot/cold fluids, potassium-rich
foods/fluids.

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Flatulence Nursing Interventions

￮ Presence of excessive gas in the intestines ￮ Avoid gas-forming foods.
(tympanitic).
￮ Due to swallowed air, bacterial action in large ￮ Provide warm fluids to drink.
intestine & diffusion from blood. ￮ Early ambulation (post-op clients).
￮ Common Causes: ￮ Adequate activity & exercise.
￮ Constipation;
￮ Meds that decrease intestinal motility; ￮ Limit carbonated beverages, use of drinking
￮ Anxiety; straws & chewing gum.
￮ Eating gas-forming foods;
￮ Rectal tube insertion as ordered.
￮ Rapid food or fluid ingestion;
￮ Improper use of drinking straw; ￮ Carminative enema as ordered.
￮ Excessive drinking of carbonated beverages;
￮ Administer cholinergics as ordered
￮ Gum chewing, candy sucking, smoking;
￮ Abdominal surgery.
(Prostigmin).

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Promotion and maintenance of

Fecal Incontinence normal bowel elimination
￮ Involuntary elimination of bowel ￮ Privacy
contents.
￮ Timing
￮ Cerebral cortex injury – unable to initiate
￮ Nutrition and Fluids
the motor response required to inhibit
defecation voluntarily. ￮ Exercise
￮ Sacral spinal cord injury – unable inhibit ￮ Positioning
voluntary anal sphincters to postpone
defecation.
￮ Disoriented/confused clients – lost the
social inhibition.

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Enema Types of Edema

￮ Purposes: CLEANSING ENEMA
q To relieve constipation ￮ Stimulates peristalsis by irritating the colon &
q To relieve flatulence rectum.
q To administer medication
￮ High enema – to clean as much of the colon as
q To lower body
possible (1000 ml).
temperature
￮ Low enema – to clean the rectum & sigmoid
q To evacuate feces in
preparation for diagnostic colon (500 ml).
procedure or surgery

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Nursing Interventions in enema

Types of Edema Administration:
CARMINATIVE ENEMA ￮ Check the doctor’s order.
￮ To expel flatus (60-180 ml). ￮ Provide privacy.
RETENTION ENEMA ￮ Promote relaxation.
￮ Introduces oil into the rectum & sigmoid colon,
￮ Position the client.
then retained 1-3 hrs.
￮ Adult – left lateral position
￮ Soften the feces and lubricates the rectum &
￮ Infant/small children – dorsal recumbent
anal canal to facilitate passage of feces.
position
RETURN FLOW ENEMA/ HARRIS FLUSH/
COLONIC IRRIGATION ￮ Rectal tube sizes
￮ Adult: Fr. 22-32
￮ To expel flatus (300-500 ml).
￮ Chlidren: Fr. 14-18

￮ Infant: Fr. 12

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Enema Enema
￮ Lubricate 5 cm (2 in) of rectal tube. ￮ After introduction of the solution, press
￮ Allow solution to flow through the connecting tube & buttocks together.
rectal tube to expel air before insertion of rectal tube.
￮ Insert 7-10 cm (3-4 in) of rectal tube gently in rotating ￮ Ask the client not to flush the toilet, so as
motion. to observe the return flow.
￮ Introduce solution slowly. ￮ Do perianal care.
￮ Change the position to distribute solution well in the
colon (high enema); remain left lateral position for low ￮ Make relevant documentation.
enema.
￮ If abdominal cramps occur during introduction of
solution, temporarily stop the flow by clamping the
tube.

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Normal Characteristics of Urine

￮ Color: Amber-Straw
￮ Odor: Aromatic-upon voiding
￮ Transparency: Clear
￮ PH: Slightly Acidic
● (Range: 4.6-8,
￮ Specific Gravity: 1.010-1.025

SUPPORTING PHYSIOLOGIC PATTERNS :

URINARY ELIMINATION

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Problems in Urinary Elimination Altered

Urine Composition
￮ Urinary Tract Infection:
￮ RBC (hematuria), WBC, Pus (pyuria),

Bacteria (bacteriuria)
￮ Albumin (albuminuria)
￮ Protein (proteinuria)
￮ Casts (cylindriuria)
￮ Diabetic Ketoacidosis:
￮ Glucose (glycosuria), Ketones (ketonuria)

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Altered Urine Production Urinary Incontinence

￮ Polyuria (diuresis) - More than 100 ml/hr or
2500 ml/day
￮ Oliguria -Less than 30 ml/hr or 500 ml/day
￮ Anuria (urinary suppression) – 0 to 10 ml/hr
￮ Total incontinence – continuous & unpredictable
loss of urine
￮ Stress incontinence – leakage of less than 50 ml
of urine resulting from a sudden increase in intra-
abdominal pressure (coughing, sneezing, laughing
or exerting physically)
￮ Urge incontinence – sudden strong desire to
urinate
￮ Functional incontinence – involuntary
unpredictable passage of urine
￮ Reflex incontinence – involuntary loss of urine
occurring at predictable intervals

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Causes of Urinary Incontinence Managing Urinary Incontinence

￮ UTI ￮ Continence (Bladder) Training
￮ Urethritis ￮ Bladder training – postponing of voiding
￮ Pregnancy according to timetable rather than according to
￮ Volume overload urge void
￮ Delirium ￮ Habit training – timed voiding or scheduled

￮ Restricted mobility toileting

￮ Prompted voiding – supplements habit training
￮ Psychologic causes
by encouraging the client to try to use the toilet
and reminding the client when to void.
￮ Pelvic Muscle Exercises (Kegel exercise)
- strengthens pelvic floor muscles and can
reduce or eliminate episodes of incontinence.

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Managing Urinary Incontinence

Urinary retention
￮ Managing Skin Integrity ￮ Accumulation of
perform perineal care urine in the
￮ Applying Condom Catheter bladders
- minimal risk of developing UTI
￮ Micturation reflex
PURPOSE:
normally stimulated
￮ Collect urine and control urinary incontinence
at 250-450 mL
￮ Permit client physical activity while controlling
incontinence
￮ Prevent skin irritation

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Clinical Signs of Urinary retention Management of Urinary retention

￮ Discomfort in the pubic area ￮ Crede’s Manuever
• Bladder distention ￮ applying manual pressure on the

• Inability to void or frequent voiding of bladder to promote bladder emptying

small volumes (25- 50mls) ￮ Catheterization
• A disproportionately small amount of fluid ￮ when all of the measures fail to initiate
output in relation to intake voiding
• Increasing restlessness and need to void

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Purpose of Catheterization Purpose of Catheterization

￮ Relieve discomfort or to provide gradual
decompression of a distended bladder
￮ Assess amount of residual urine
￮ Obtain a sterile urine specimen
￮ To empty the bladder completely prior to
surgery
￮ Facilitate accurate measurement
￮ Prevent urine from contaminating an
incision after perineal surgery
￮ Relieve discomfort or to provide gradual
decompression of a distended bladder
￮ Assess amount of residual urine
￮ Obtain a sterile urine specimen
￮ To empty the bladder completely prior to
surgery
￮ Facilitate accurate measurement
￮ Prevent urine from contaminating an
incision after perineal surgery

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Types of Catheter
1. Indwelling catheter
(Retention catheter, Foley catheter) Robinson-Nelaton Robinson Nelaton Straight
Straight Red Rubber Cath Plastic Cath

latex
foley
catheter

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Procedure
￮ Position/draping ￮ Measuring residual urine
￮ Cleaning ￮ Providing catheter care
￮ Lubricate: ￮ Collecting urine specimen
￮ Male- 12.5-17.5 cm (5-7inches)
￮ Wee bag
￮ Female- 2.5-5 cm (1-2 inches)

￮ Length of catheters to be inserted ￮ Male

￮ Male- 17-22.5 cm (7-9 inches) ￮ Female
￮ Female -5-7.5 cm (2-3 inches) ￮ During insertion
￮ Taping ￮ With catheter

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Nursing Interventions for Clients with

Promoting and maintenance of Adequate
Indwelling Catheter
Urinary Elimination
￮ Increase fluid Intake ￮ Provide privacy.
￮ Dietary Measure ￮ Provide fluids to drink.
- acidifying urine reduces the risk of UTI and ￮ Assist the client in the anatomical position of
calculous formation voiding.
Foods: eggs, cheese, meat and poultry, whole ￮ Serve clean, warm & dry bedpan or urinal.
grains, cranberries, plums and prunes and ￮ Allow the client to listen to the sound of
tomatoes running water.
￮ Perineal Care ￮ Dangle fingers in warm water.
￮ Changing the Catheter Tubing ￮ Pour warm water over the perineum.

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Promoting and maintenance of Adequate

Procedure
Urinary Elimination
￮ Position/draping
￮ Promote relaxation. ￮ Cleaning
￮ Provide adequate time for voiding. ￮ Lubricate:
￮ Perform Crede’s maneuver as ordered. ￮ Male- 12.5-17.5 cm (5-7inches)

￮ Applying pressure on the suprapubic ￮ Female- 2.5-5 cm (1-2 inches)

area. ￮ Length of catheters to be inserted

￮ Male- 17-22.5 cm (7-9 inches)
￮ Administer cholinergics (Urecholine) as
￮ Female -5-7.5 cm (2-3 inches)
ordered.
￮ Taping
￮ Last resort: Urinary catheterization

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References
￮ Berman, A. Snyder, S. , Frandsen G., .Kozier, Barbara. (Eds.)
(2016) Kozier & Erb's Fundamentals of nursing :concepts, process,
and practice Upper Saddle River, N.J. : Pearson Prentice Hall,
￮ Potter, P.A., Perrt,A.G., Stockert, P.A., & Hall, A.M. (2017).
Fundamentals of Nursing (9th Ediition) St. Louis Elsevier
￮ Doenges, M., Moorhouse, M. F., & Murr, A. (2010). Nursing Care
Plans : Guidelines for Individualizing Client Care Across the Life
Span.

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THANK YOU
FOR LISTENING

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