FLUID, ELECTROLYTE, AND ACID-BASE BALANCE COLLOIDS – do not dissolve in true solutions

FLUID – liquid of the body composed of molecules SOLVENT – can dissolve in solute
WATER – primary body fluid OSMOLALITY – concentration of solutes
70% - 80% of infants
TONICITY – aka OSMOLALITY
60% adults; male
50% female IV THERAPY
45% elderly -to supply fluid when clients are not able to take Orem
-to provide electrolytes to prevent imbalance
INTRACELLULAR FLUIDS – within the cell
-to provide glucose for metabolism
2/3 of body fluid
-to provide water-soluble vitamins and medications
-to establish a lifeline for rapidly needed medications
EXTRACELLULAR FLUIDS – outside the cell.
made of intravascular fluid and plasma IV FLUIDS SOLUTION – for parenteral therapies
TRANSCELLULAR FLUID - smallest; have 1L fluid as a ISOTONIC – balancing electrolytes; hypovolemia
lubricant
HYPERTONIC – more sodium less water
IONS – charged particles
HYPOTONIC – less sodium more water
ELECTROLYTES – capable of conducting electricity
- promote neuromuscular activity VENIPUNCTURE – puncturing the veins
- maintain body fluid volume and osmolarity CONSENT IS NEEDED!!! NO MORE THAN 2 ATTEMPTS IN
-distribute water between fluid compartment IV!!! DISTAL VEINS TO PROXIMAL AREA!!! USE
-regulate acid base imbalances NONDOMINANT HAND!!! STRICT ASEPTIC TECHNIQUE
FACTORS AFFECTING ELECTROLYTE BALANCE FACTORS AFFECTING FLOW RATES
-fluid I&O -position of the extremity
-hormone -position and patency of tubing
-disease -the height of the iv container/bottle
-age and body size -possible infiltration
-trauma -the size of the catheter to the vein
-medications
-diet EQUIPMENT
INPUT IV CATHETERS/CANNULA – inserted into the
- WATER – 1300 ml bloodstream
- FOOD – 1000 ml
O-G-G-P-B-Y
- OXIDATION – 300 ml
OUTPUT ORANGE 14G Massive trauma
- URINE – 1500 ml GRAY 16G Multiple-large volume infusions
- SKIN – 600 ml GREEN 18G BT or large-volume transfusion
- LUNGS – 300 ml PINK 20G Multi-purpose
- FECES – 200 ml BLUE 22G Most chemo infusions
YELLOW 24G Very fragile veins
CATIONS – positive charge
ANIONS – negative charge INFUSION ADMINISTRATION SET
MILLIEQUIVALENT – chemically combining the power of -TROCAR – insertion spike
ion -DRIP CHAMBER
-ROLLER VALVE/CONTROLLER
MILLIGRAM – the weight of the ion -Y-TYPE – secondary port
-LUER LOCK – protective cap
SOLUTES – dissolves in liquid
INTRAVENOUS POLES – rods use to hang the solutions;
CRYSTALLOIDS – salts that dissolve in true solutions
adjustable; 3 ft above the client’s head
TOURNIQUET – use to apply pressure
MACROSET NEEDLE – for adults
MICROSET NEEDLE – for pedia (17 below)
COMMON COMPLICATIONS
CIRCULATORY OVERLOAD – fluid overload
INFILTRATION – needle dislodge from the vein
EXTRAVASATION – EMERGENCY; unintended
administration of vesicant drugs (can form blisters) into
subcutaneous tissue
PHLEBITIS – inflammation of the veins
OSMOTIC PRESSURE – the power of the solution to pull
water across the membrane
COLLOID OSMOTIC PRESSURE/ONCOTIC PRESSURE –
plasma proteins pressure
DIFFUSION – when two solutes of different
concentrations are separated
OSMOSIS – a kind of diffusion where water moves
across the membrane
FILTRATION – fluid, and solutes move together
FILTRATION PRESSURE – from the movement of fluids
out of a compartment
HYDROSTATIC PRESSURE - exerted by the fluid within a
closed system
ACTIVE TRANSPORT - less concentrated to a more
concentrated solution
HYPOTHALAMUS – thirst center in the brain
30 MINS AND 1 HOUR – fluid absorbent time
KIDNEY- the primary regulator of body fluids and
electrolyte balance
NEPHRONS - functional units of the kidney
CATIONS ELECTROLYTES
SODIUM – controlling and regulating water
135 – 145 mEq/L
POTASSIUM – for skeletal, cardiac, and smooth muscle
activities
3.5 – 5 mEq/L
CALCIUM – stored in the skeletal system
8.5 – 10 mEq/L
MAGNESIUM – regulates neuromuscular
1.25 – 2.5 mEq/L
ANION ELECTROLYTES
CHLORIDE – regulate serum and blood volume
95 – 108 mEq/L
PHOSPHATE - 2.5 – 4.5 mEq/L
BICARBONATE - regulates acid-base balance
22 – 29 mEq/L
ACID – release hydrogen in solution
BASES – have a low hydrogen concentration
Ph – the unit of acidity
PH OF ARTERIAL BLOOD – 7.35 – 7.45 pH
BUFFERS – prevents excessive changes in Ph
ACIDOSIS – low ph
ALKALOSIS – high ph
ISOTONIC IMBALANCES - water and electrolytes are lost
or gained in equal proportions
OSMOLAR IMBALANCES – loss or gain of water
HYPOVOLEMIA – fluid volume deficit; loses both water
and electrolytes
HYPERVOLEMIA – fluid volume excess
THIRD SPACE SYNDROME – fluid shifts into an area
where it is not accessible
PITTING EDEMA – edema that leaves small depression
DEHYDRATION – hyperosmolar fluid imbalance
OVERHYDRATION – hypo-osmolar fluid imbalance
HYPOANTREMIA – sodium deficit
HYPERNATREMIA – sodium excess
HYPOKALEMIA – potassium deficit
HYPERKALEMIA – potassium excess
HYPOCALCEMIA - calcium deficit
HYPERCALCEMIA – calcium excess
HYPOMAGNESEMIA - magnesium deficit
HYPERMAGNESEMIA – magnesium excess
HYPOCHLOREMIA – chloride deficit
HYPERCHLOREMIA – chloride excess
HYPOPHOSPHATEMIA – phosphate deficit
HYPERPHOSPHATE – phosphate excess
COMPENSATION – correcting acid-base imbalances
BLOOD TRANSFUSION
4-6 l OF BLOOD CIRCULATING IN THE BODY
-to increase O2 carrying capacity
-to replace circulating blood volume
-provision of protein
-provision of coagulation factors
- to prevent bleeding
-to combat infection
MODE OF TRANSFUSION
-indirect
-Intrauterine (in the uterus; mother and child)
-neonatal exchange transfusion
-autotransfusion (they receive their own blood)
COMPONENTS
- plasma
- serum
- erythrocytes or platelets
NURSING MANAGEMENT
-proper refrigeration
-proper typing and cross-matching
-check the expiration date
-check the serial number
CLEAN GLOVES ONLY
WBC – fights infections
NEUTROPHIL – prevents and limits infection
MONOCYTES – highly phagocytic
EOSINPPHIL – allergic reactions
I – all
D- stress
BASOPHIL – contains histamine
LYMPHOCYTES – integral components of the immune
system
T – Lymphocytes – cell-mediated immunity
B – LYMPHOCYTES – humoral immunity
RBC – carries hemoglobin; lifespan – 120 days
Platelet – hemostasis; lifespan – 10 days

blood type antigen antibodies can give can get WHOLE BLOOD (FRESH WHOLE BLOOD) – replace blood
to from volume and all products
A A B A, AB A, O
B B A B, AB B, O PACKED RED BLOOD CELLS – increase oxygen carrying
AB AB NONE AB ALL capacity
O NONE AB ALL O PLATELETS – clients with bleeding disorders or platelets
deficiency; can be stored for 5 days
BLOOD DONATION IS VOLUNTARY!!! FRESH FROZEN PLASMA – expands blood volume and
clotting factor; no need for blood typing and screening;
TYPE O – the universal donor
up to 5 days
TYPE AB – universal receiver
AUTOLOGOUS RED BLOOD CELLS – for blood
RH FACTOR – protein replacement following planned elective surgery
- have +, loss –
ALBUMIN – plasma expanders
ANTIGENS -proteins on the surface of RBCs; unique for
CRYOPRECIPITATE – contains fibrinogen and clotting
every individual
factors
ANTIBODIES – often agglutinin; in blood plasma
COMMON COMPLICATIONS
BLOOD TYPING – determines blood group and RH factor
HEMOLYTIC REACTION – incompatible blood; most fatal
CROSS MATCHING – identify interactions of antigens -fever, chills, diaphoresis, backpains
with their antibodies -headache, dizziness, dyspnea
-palpitations and tachycardia
SCREENING – to protect donor and recipient from
blood-borne disease ALLERGIC REACTIONS – bronchospasm due to sensitivity
in foreign proteins in plasma
-rashes, itchiness, dyspnea
-fever/chills LOWER TRACT
-to infused plasma(mild) -trachea
-antigen-antibody reaction (severe) -bronchi
-lungs
PYROGENIC REACTION – due to sensitivity to leukocyte -alveoli
or platelet antigen; most common
-fever/chills CILIA – hair-like structures that filter the air in the nose
-tachycardia
-headache, palpitations THE FLOW OF AIR
-diaphoresis - sweating NOSE/MOUTH
HEMOLYSIS – incompatible blood type PHARYNX
FEBRILE REACTION – Sensitivity of client’s blood to LARYNX
blood products
TRACHEA
CIRCULATORY OVERLOAD – fast blood administration
RIGHT / LEFT BRONCHI
SEPSIS–contaminated blood was administered
BRONCHIOLES
RELIGIOUS AFFILIATION CONSIDERATIONS
ALVEOLI
JADAISM – blood cannot be consumed in the smallest
quantity DIAPHRAGM – major breathing muscle

ISLAM – consumption of food with blood is forbidden LUNGS – left: 2 lobes; right: 3 lobes

JEHOVA’S WITNESS – do not eat blood or accept
transfusion of whole blood
OXYGENATION
-to increase oxygen saturation in tissues
-increase oxygen in the blood
-decrease the heart’s extra work
-decrease shortness of breath
EMERGENCY: RNS CAN ADMINISTER
OXYGEN – clear, odorless gas; 21% of the air
RESPIRATION – gas exchange of an individual to the
environment
PULMONARY VENTILATION/BREATHING – between the
atmosphere and the lung
GAS EXCHANGE – diffusion of o2 and co2 between
alveoli and capillaries
RESPIRATORY SYSTEM – enables us to breathe; the
upper and lower tract
UPPER TRACT
-nose
-nares/nostrils
-pharynx
-larynx
-protected by ribs and spine
FISSURES – divide the lungs
RESPIRATORY MEMBRANE – alveolar + capillary walls
EPIGLOTTIS – cover trachea when swallowing
HEMATOCRIT - the percentage of blood that is RBC
EXPECTORATE – spit out
ACT OF BREATHING – inhalation and exhalation
INHALATION – intake of air in the lungs
-muscle contracts
EXHALATION – air out of the lungs
-muscle relax
RIB MUSCLES – muscles between the ribs in the chest
FACTORS AFFECTING THE RESPIRATORY SYSTEM
- health status
-medications
-environment
-age
-lifestyle
-stress
DYSPNEA – shortness of breath
ORTHOPNEA – the difficulty of breathing when supine
ATELECTASIS – collapsed alveoli
PNEUMONOTHORAX – collapsed lungs
FIRE – potential hazard when administering
HUMIDIFIERS - devices that add water vapor to inspired
air
CHEST PHYSIOTHERAPY
-loosens the client’s secretion
-need MD’s order
-correct sequence; PO -PE – VI
POSTURAL DRAINAGE
-10 – 15 mins
-before meals, late afternoon
-AVOID; shortly before meals
VOLUME CYCLED – most common ventilators
VENTILATOR MODELS
1. CONTROLLED - machine delivers a breath at a fixed
rate
2. ASSIST-CONTROLLED - machine senses a client’s
efforts to breathe and delivers a fixed tidal volume with
each effort
3. INTERMITTENT MANDATORY VENTILATION (IMV)–
the client can also breathe spontaneously
4. PRESSURE SUPPORT - client breathes spontaneously
and determines the Ventilator rate

PERCUSSIONS – aka clapping MINUTE VENTILATION – determined by rr and tidal

volume; the amount of gas moving in and out of the
-1-2/ per lung segment
-produce a hollow popping sound lungs in a minute

VIBRATIONS – quivering POSITIVE END-EXPIRATORY PRESSURE - maintenance of

-apply when exhaling positive airway pressure at the end of expiration
-stop when inhaling SUCTIONING
OXYGEN DELIVERY SYSTEM POSITION – conscious: semi-fowler’s; unconscious:
NASAL PRONGS/ CANNULA – comfortable and simple lateral
- 25 – 40% oxygen STERILE TECHNIQUE
VENTURI MASK – accurate prescribed oxygen NOSE-EARLOBE – 13 cm or 5 inches
-24 – 50% oxygen
-for long treatment of COPD (chronic obstructive LUBRICATE- naso: water-soluble; Oro: NSS/ sterile water
pulmonary disease) SIZE
SIMPLE 02 FACE MASK – for short periods of time - adult; 12 – 18
-suffocation - child; 8 – 10
-50-60% oxygen - infant; 5 – 8lungs

NON-REBREATHER RESERVOIR MASK – one-way valve
prevents the client from exhaling back into the bag
-for severe hypoxia
-90 – 95% oxygen
T-TUBE - humidification and enriched oxygen
SOURCE OF OXYGEN
HIGH FLOW – devices that deliver the patient’s entire
voluntary demand
LOW FLOW- do not provide patients with entire
ventilatory requirements
HUMIDIFICATION – addition of heat and moisture to a
gas

WALL OUTLETS HYPERCAPNEA – oxygen excess

OXYGEN CYLINDERS (O2 TANKS) HYPOXEMIA – low oxygen in arterial

-large – when high flow rates are essential
-small – when transporting clients
TYPES OF POSITIVE-PRESSURE VENTILATORS
PRESSURE CYCLED - gas flows into the client until a
predetermined airway pressure is reached
TIME CYCLED - flows for a certain percentage
HYPOXIA – low oxygen in the tissue
PEAK INSPIRATORY FLOW RATE – the fastest flow rate
of air during inspiration
TIDAL VOLUME - the amount of gas moving in and out
of the lungs in each breath
LUNG COMPLIANCE – stretchability of lung tissue
LUNG RECOIL – the tendency of the lung to collapse
SURFACTANT – a lipoprotein produced by alveolar cells
VENTILATION – PERUSION (VQ) MISMATCH –
imbalance between alveolar ventilation and pulmonary
capillary blood flow
URINARY
-aka MICTURING, Voiding, URINATION
STRETCH RECEPTORS – the special sensory nerve in the
bladder
DIURETICS – meds that increase the urine formation
HYPERPLASIA – enlarge prostate glands
UREA – the end product of protein metabolism
-chief organic solute
CREATINE CLEARANCE – to determine glomerular
filtration
BLADDER RETRAINING - - resist or inhibit the sensation
of urgency
HABIT TRAINING – timed or prompted voiding and
scheduled voiding
PELVIC FLOOR MUSCLE – helps to strengthen pelvic
floor muscles
CREDE’S MANEUVER – using manual pressure on the
bladder

MEDULLA OBLONGATA – the respiratory center of the
brain
POLYURIA – aka diuresis; a large amount of urine
POLYDIPSIA – excessive thirst
OLIGURIA – low urine output
IRRIGATION - flushing or washing out with a solution
SUPRAPUBLIC CATHETER – through the abdominal wall
URINARY DIVERSIONS – surgical rerouting of urine
URETEROSTOMY – ureter is bought to the side of the
abdomen

ANURIA – absence of urine
URINARY FREQUENCY – voiding frequently
NOCTURIA – voiding 2x or more at night
URGENCY – strong desire to void
DYSURIA – painful urination
NEPHROSTOMY - divert urine from the kidney to the
renal pelvis
VESICOSTOMY – formed when voiding in the urethra is
not possible
ILEAL CONDUIT – removal of the ileal and intestinal end
is reattached

URINARY HESISTANCY – a delay in initiating urination

ENURESIS – involuntary urination of children CATHETERIZATION

URINARY INCONTINENCE – inability to control urination Meatus – urethra – bladder

STRESS URINARY INCONTINENCE – most common UI; TYPES

weak pelvic floor INDWELLING – can be left in place

URGENCY URINARY INCONTINENCE – overactive NON – INDWELLING – can’t be left in place; STRAIGHT
bladder CATHETER
-INTERMITTENT CATHETER
MIXED URINARY INCONTINENCE – sui and use
SINGE LUMEN – one-time
OVERFLOW URINARY INCONTINENCE – due to the
pressure of the sphincter TWO – Lumen – indwelling foley/ retention catheter

URINARY RETENTION – bladder becomes over intended TRIPLE – for bladder irrigation

1200- 1500 ml/ day – normal urine output

POSTVOID RESIDUAL – urine left in the bladder SIZES
following voiding; 50 – 100 ml normal -male; 16 – 18
kidney-female; 12 – 14
BLOOD UREA NITROGEN – measurement of urea - child; 8 – 10
-infant; 5 - 8