Module 5: Basic Nursing Interventions to Promote Physiologic Health | FUNDA12022 | AUF_CON

Basic Nursing Interventions to Promote 8. Avoiding tight-fitting clothes and wearing cotton
Physiologic Health underclothes can reduce the occurrence of urinary
tract infection. True
Sources: Modules & Lecture (May 17 & 19, 2022)
9. In good health, the body is maintained by a balance
Angeles University Foundation | 2nd Sem | 2nd Cycle | Fundamentals of Nursing Practice
of fluids, electrolytes, acids and bases. True
10. Solutes are components of a solution that can
dissolve gases. False

MODULE 5 OVERVIEW
PART 1: MOBILITY, HYGIENE, AND OXYGENATION
● The human body consists of a complex network of
intricate and interacting systems. Drawing on a
PART 1.1: MOBILITY
comprehensive knowledge base, nurses are
● An individual’s ability to move within and interact
cognizant of a host of factors that influence physical
with the environment and the ability to move from
health as they provide care to support optimal
one location to another.
physiologic function.
● Maintaining the correct position of the body while
● This module includes nursing interventions to
at rest contributes to comfort and prevents strain on
promote healthy physiologic responses in mobility
the muscles. A regimen of good positioning prevents
and exercise, hygiene, skin integrity and comfort,
pressure sores (decubitus ulcer) and joint
oxygenation, nutrition, urinary and bowel care, fluid
contractures. Frequent movement also improves
and electrolyte balance.
muscle tone, respiration, and circulation. The nurse
● Our ability to move is an essential aspect of our well-
should learn a number of positions, so that patients
being. Psychophysiological self-regulation and
can be repositioned approximately every 2 hours.
overall health are affected by our activities. It is also
● The aim in moving the patient is to put the least
Important for nurses to know exactly how much
possible stress on the patient’s joints and skin.
assistance a client needs for hygienic care.
Patient positioning is designed to maintain body parts
● Most people in good health give little thought to their
in correct alignment so that they remain functional
respiratory function. Changing position frequently,
and unstressed.
ambulating and exercising usually maintain adequate
● Many patients are unable to move at all or need
ventilation and gas exchange. In nutrition, energy is
assistance in moving. It is the nurse’s responsibility to
provided for the full range of physical and mental
help move patients, direct them in the best techniques
activities that make up human life.
for self-movement, and see that enough people are
● In good health, a delicate balance of fluids,
on hand to ensure the safety of the patient and staff
electrolytes and acids and bases is maintained in the
during transfer.
body. Nurses need to be sensitive to the elimination
● A patient’s mobility or ability to move and be active
needs of a patient whether an actual or potential
affects not only his physical but also his emotional
problem.
well-being. Mobility is essential to an individual’s
independence; a fully immobilized person is as
PRE-DISCUSSION ACTIVITY
vulnerable and dependent as an infant.
1. Hygiene is an individual’s ability to move within and
● Activity keeps the mind and body active.
interact with the environment and the ability to move
Musculoskeletal inactivity or immobility adversely
from one location to another. False
affects all body systems. Exercise – even passive
2. A nurse must position a patient in bed every 2 hours
ROM exercises – helps prevent muscle atrophy,
and every 20 to 30 minutes if in sitting position. True
prevent muscle contractures, and maintain
3. Moisture in contact with the skin for more than a short
circulation. Exercise increases muscle strength,
time can result in increased bacterial growth and
tone, and mass. It also enhances the condition of
irritation. True
other body systems.
4. Body odors are caused by constant skin care and
● Normal movement and stability are the result of an
bathing. False
intact musculoskeletal system, an intact nervous
5. Deep breathing and coughing exercises are ways in
system, and intact inner ear structures responsible for
promoting oxygenation. True
equilibrium. Body movement requires coordinated
6. Lifestyle, economic status and religious practices
muscle activity and neurologic integration. It
does not affect one’s nutritional status. False.
involves four basic elements:
7. Use of bubble baths can reduce the occurrence of
urinary tract infection. False

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A. ALIGNMENT AND POSTURE a. Balance, smooth, purposeful movement is

a. Proper body alignment and posture brings the result or proper functioning of the cerebral
body parts into position in a manner that cortex, cerebellum, and basal ganglia.
promotes optimal balance and maximal i. The cerebral cortex initiates
body function whether the client is standing, voluntary motor activity.
sitting, or lying down. ii. The cerebellum coordinates the
b. Proper body alignment enhances lung motor activities of movement.
expansion and promotes efficient circulatory, iii. The basal ganglia maintain posture.
renal, and gastrointestinal functions. b. Exercise maintains or increases muscle
c. The term posture means maintaining optimal strength and endurance and helps maintain
body position. It means a position that most cardiopulmonary function.
favors function, requires the least muscular i. Exercise - It is a type of physical
work to maintain, and places the least strain activity defined as a planned,
on muscles, ligaments, and bones. structured, and repetitive bodily
B. JOINT MOBILITY movement performed to improve
a. Joints are the functional units of the health and maintain fitness to
musculoskeletal system. achieve an optimal state of health.
b. The bones of the skeleton articulate at the ii. It involves the active contraction and
joints, and most of the skeletal muscles relaxation of muscles
attach to the two bones at the joint. iii. Goal: Physical strength and Activity
c. The range of motion (ROM) of a joint is the tolerance
maximum movement that is possible for that
joint. Joint range of motion varies from TYPES OF EXERCISE
individual to individual. A. ISOTONIC (DYNAMIC) EXERCISE
C. BALANCE a. Involves exercise in which the muscle
a. Body balance is achieved when you balance shortens to produce muscle contraction and
a relatively low center of gravity over a wide, active movement. Most physical conditioning
stable base of support. exercises are isotonic, as are ADLs and
b. The base of support is the foundation. active ROM exercises (those initiated by the
c. This function is governed by the cerebellum client).
and the inner ear. b. Isotonic exercises increase muscle tone,
d. Proprioception is the term used to describe mass, and strength and maintain joint
the awareness of the position of the body and flexibility and circulation.
its parts. c. During isotonic exercise, both heart rate and
e. Proprioceptors located on nerve endings in cardiac output quicken to increase blood flow
muscles, tendons, and joints monitor to all parts of the body.
proprioception. d. Increase muscle tone, mass, cardiac rate and
D. COORDINATED MOVEMENT output.
e. Examples:
PRINCIPLE OF BODY MECHANICS i. Pushing or pulling a stationary
A. WIDEN THE BASE OF SUPPORT BY object.
SEPARATING THE FEET TO A COMFORTABLE ii. Using a trapeze to lift body off the
DISTANCE. bed
B. BRING THE CENTER OF GRAVITY CLOSER TO iii. Lifting the buttocks off the bed by
THE BASE OF SUPPORT TO INCREASE pushing
BALANCE. B. ISOMETRIC (STATIC) EXERCISE
a. This is achieved by: a. Exercises in which there is muscle
i. Bending the knees contraction without moving the joint (muscle
ii. Flexing hips until squatting and length does not change).
maintaining proper back alignment b. These exercises involve exerting pressure
by keeping the trunk erect against a solid object and are useful for
C. COORDINATED MOVEMENT strengthening abdominal, gluteal, and
quadriceps muscle; for maintaining strength

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in immobilized muscles in casts or traction; b. Exercise also promotes heart health by

and for endurance training. mediating the harmful effects of stress.
c. Isometric exercise produces a mild increase C. RESPIRATORY SYSTEM
in heart rate and cardiac output, but no a. Gas exchange is improved during exercise
appreciable increase in blood flow to other because ventilation and oxygen intake
parts of the body. increase. More toxins are eliminated with
C. ISOKINETIC (RESISTIVE) EXERCISE deeper breathing, and problem solving and
a. Involves muscle contraction or tension emotional stability are enhanced due to
against resistance. These exercises are used increased oxygen to the brain.
in physical conditioning and are often done to b. Adequate exercise also prevents pooling of
build up certain muscle groups. secretions in the bronchi and bronchioles,
b. An increase in blood pressure and blood flow decreasing breathing effort and risk of
to muscle occurs with resistance training. infection.
D. AEROBIC EXERCISE D. GASTROINTESTINAL SYSTEM
a. Activity during which the amount of oxygen a. Exercise improves the appetite and
taken into the body is greater than that used increases gastrointestinal tract tone,
to perform the activity. It uses large muscle facilitating peristalsis.
groups that move repetitively. b. Activities such as rowing, swimming, walking,
b. Aerobic exercises improve cardiovascular and sit-ups work the abdominal muscles and
conditioning and physical fitness. can help relieve constipation.
E. ANAEROBIC EXERCISE E. METABOLIC/ ENDOCRINE SYSTEM
a. Involves activity in which the muscle cannot a. Exercise elevates the metabolic rate, thus
draw out enough oxygen from the increasing the production of body heat and
bloodstream, and anaerobic pathways are waste products and calorie use. During
used to provide additional energy for a short strenuous exercise, the metabolic rate can
time. increase to as much as 20 times the normal
b. This type of exercise is used in endurance rate.
training for athletes such as weight lifting and b. Weight loss and exercise stabilize blood
sprinting. sugar and make cells more responsive to
c. Anaerobic pathways are activated to release insulin.
additional energy during the activity. F. URINARY SYSTEM
a. With adequate exercise, which promotes
BENEFITS OF EXERCISE efficient blood flow, the body excretes water
A. MUSCULOSKELETAL SYSTEM more effectively. In addition, stasis of urine in
a. The size, shape, tone, and strength of the bladder is usually prevented, which in
muscles are maintained with mild exercise turn decreases the risk for urinary tract
and increased with strenuous exercise. infections (UTIs).
Exercise increases joint flexibility, stability, G. IMMUNE SYSTEM
and range of motion. It also significantly a. As respiratory and musculoskeletal effort
reduces weakness, frailty, depression, and increase with exercise, lymph fluid is more
the risk and incidence of falling in older efficiently pumped from tissues into lymph
adults. capillaries and vessels throughout the body.
b. Bone density and strength is maintained b. Decrease the risk for infection
through weight-bearing, which maintains H. PSYCHONEUROLOGICAL SYSTEM
balance between osteoblasts (bone-building a. Mental or affective disorders such as
cells) and osteoclasts (bone-resorption and depression or chronic stress may affect a
breakdown cells). person’s desire to move.
B. CARDIOVASCULAR SYSTEM b. A strong and growing body of evidence
a. Adequate moderate-intensity exercise supports the role of exercise in elevating
increases the heart rate, the strength of heart mood and relieving stress and anxiety.
muscle contraction, and the blood supply to I. SPIRITUAL HEALTH
the heart and muscles through increased a. Yoga style exercise improves the mind-body-
cardiac output. spirit connection, relationship with God, and

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physical well-being by establishing balance in pools in the lower extremities, and central
the internal and external environment. blood pressure drops. Cerebral perfusion is
seriously compromised, and the person feels
PART 1.2: IMMOBILITY dizzy or light-headed and may even faint.
● Do not bend your back, bend your knees d. DEPENDENT EDEMA. When the venous
● Position a client every 2 hours if they are in bed and pressure is sufficiently great, some of the
every 20 to 30 minutesif they are sitting serious part of the blood is forced out of the
● Impaired physical mobility is related to many blood vessel into the interstitial spaces
musculoskeletal disorders that involve joint surrounding the blood vessel, causing
inflammation as well as fractures, bone disorders, edema.
and other disorders that cause decreased mobility. e. THROMBUS FORMATION. Impaired
○ Ex: Gout and osteoarthritis venous return to the heart, hypercoagulability
● Individuals who have inactive lifestyles or who are of the blood, and injury to a vessel wall
faced with inactivity because of illness or injury are at predispose the client to formation of
risk for many problems that can affect major body thrombophlebitis (a clot that is loosely
systems. Whether immobility causes any problems attached to an inflamed vein wall).
often depends on the duration of the inactivity, the C. RESPIRATORY SYSTEM
client’s health status, and the client’s sensory a. DECREASED RESPIRATORY
awareness. MOVEMENT. In an immobile client,
● The following are effects of immobility in different ventilation of the lungs is altered, chest
systems: movement is restricted, and abdominal
A. MUSCULOSKELETAL SYSTEM organs push against the diaphragm,
a. DISUSE OSTEOPOROSIS AND ATROPHY. restricting lung movement and making it
Without the stress of weight-bearing activity, difficult to expand the lungs fully.
the bone demineralizes. Muscles also b. POOLING OF RESPIRATORY
decrease in size, losing most of their strength SECRETIONs. Inactivity allows secretions to
and normal function. pool by gravity, interfering with the normal
b. CONTRACTURES. Permanent shortening of diffusion of oxygen and carbon dioxide in the
the muscle forms when the muscle fibers are alveoli.
not able to shorten and lengthen. Joint c. ATELECTASIS. When ventilation is
deformities such as foot drop, wrist drop, and decreased, pooled secretions may
external hip rotation occur when a stronger accumulate in a dependent area of a
muscle dominates the opposite muscle. bronchiole and block it. In time, the lung lobe
c. STIFFNESS AND PAIN IN THE JOINTS. or the entire lung may collapse.
Without movement, the collagen tissues at d. HYPOSTATIC PNEUMONIA. Pooled
the joint become ankylosed (permanent secretions provide excellent media for
immobile). As the bones demineralize, bacterial growth. Under these conditions, a
excess calcium may deposit in the joints, minor respiratory infection can evolve.
contributing to stiffness and pain. D. METABOLIC SYSTEM
B. CARDIOVASCULAR SYSTEM a. DECREASED METABOLIC RATE. The
a. DIMINISHED CARDIAC RESERVE. basal metabolic rate and gastrointestinal
Decreased mobility creates an imbalance in motility and secretions of various digestive
the autonomic nervous system. The glands decrease as the energy requirements
immobilized person may experience of the body decrease.
tachycardia with even minimal exertion. b. ANOREXIA. Loss of appetite occurs
b. INCREASED USE OF THE VALSALVA because of the decreased metabolic rate and
MANEUVER. The valsalva maneuver refers the increased catabolism that accompany
to holding the breath and straining against a immobility.
closed glottis. This builds up pressure in the c. NEGATIVE CALCIUM BALANCE. Greater
thorax to interfere with returning blood flow to amounts of calcium are extracted from bone
the heart. Cardiac arrhythmias can result if than can be replaced. The absence of weight
the client has preexisting cardiac disease. bearing and of stress on the musculoskeletal
c. ORTHOSTATIC HYPOTENSION. This is a structures is the direct cause of the calcium
common result of immobilization. The blood loss from bones.

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E. URINARY SYSTEM
a. URINARY STASIS. When the client remains
supine, gravity impedes the emptying of urine
from the kidneys and the urinary bladder.
Emptying is not complete and the flow of
urine is slowed down. This in turn results to
urinary retention and incontinence.
b. URINARY INFECTION. Static urine provides
an excellent medium for bacterial growth. ● Provide pillows and blanket to support the client’s
The flushing action of normal urination is position
absent; thus, urinary distention causes tears ● Possible positions: Supine, Low and High Fowler’s
in bladder mucosa allowing infectious position, Right and left lateral recumbent, Prone,
organisms to enter. Sims, and orthopneic position
F. GASTROINTESTINAL SYSTEM ● Position a client in an orthopneic position when they
a. CONSTIPATION. This is a frequent problem are experiencing difficulty of breathing/ DOB. If there
for immobilized clients because of decreased are no available overbed table, ask the client to sit on
peristalsis and colon motility. a chair facing the backrest.
G. INTEGUMENTARY SYSTEM ● Position a client in a trendelenburg position when
a. REDUCED SKIN TURGOR. Prolonged he/she is feeling faint, hypotensive, and nausea by
immobility leads to skin atrophy. Skin elevating the leg to promote blood supply going back
elasticity is gradually lost because of the fluid to the heart.
shifting in between the tissues. ● Position a client in a lithotomy position when a client
b. SKIN BREAKDOWN. Immobility impedes is about to give birth or when a patient will undergo a
circulation and diminishes the supply of procedure such as surgery. Support the feet with
nutrients to specific areas. As a result, skin stirrups.
breakdown and formation of pressure ulcers
can occur.

PART 1.3: POSITIONING A CLIENT

● Positioning a client in good body alignment and
changing the position regularly (every 2 hours if they
are in bed and every 20 to 30 minutes if they are
sitting in a chair) are essential aspects of nursing
care.
○ It helps maintain correct body positioning and
prevent complications that can occur with
prolonged bed rest. When a patient is weak,
frail, in pain, paralyzed, or unconscious, he
can’t readily position and reposition himself.
Thus, he needs assistance from the nurse to
provide or assist him with position changes.
● Assessing the skin and providing skin care before and
after repositioning is also important. Frequent position
changes help prevent muscle discomfort, undue
pressure resulting in pressure ulcers, damage to
superficial nerves and blood vessels, and
contractures. Position changes also maintain muscle
tone and stimulate postural reflexes.
● Pressure ulcers/ Decubitus ulcers/ Bedsores- risk;
can be developed in the back of the head, elbow,
inner ears, shoulder, lower back and buttocks

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HYGIENE INVOLVES CARE OF THE FOLLOWING

● Skin, face, eyes and ears
● Neck and trunk
● Limbs, hands and feet, nails
● Oral cavity
● Perineal-genital area
Dorsal Recumbent

PERSONAL HYGIENE
SUPPORTIVE DEVICES FOR PROPER POSITIONING
● The self-care by which people attend to such
● These devices are useful to support (prevent falls/
functions as bathing, toileting, general body hygiene
bed sores/ injuries) the client’s position.
and grooming.
○ Ex: Bed: Pillows, blanket, mattress

FACTORS INFLUENCING PERSONAL HYGIENE

● Highly personal matter determined by individual
values and practices and varies widely among
individuals.

PART 1.4: HYGIENE

● Hygiene is the science of health and its maintenance.
Personal hygiene is the selfcare by which people
attend to such functions as bathing, toileting, general
hygiene, and grooming. Nurses commonly use the
following terms to describe TYPES OF HYGIENIC
CARE:
○ EARLY MORNING CARE: provided to all
clients as they awaken in the morning
○ MORNING CARE: provided after clients
have breakfast
○ HOURS OF SLEEP OR PM CARE: provided
to clients before they retire for the night

HYGIENE, SKIN INTEGRITY AND COMFORT

● Cleanse the skin
● Promotes circulation
● Promotes sense of well - being
● Opportunity to assess the client

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GENERAL GUIDELINES FOR SKIN CARE iii.TUB BATH – often preferred than
1. An intact, healthy skin is the body’s first line of bed baths because it is easier to
defense. wash and rinse in the tub.
2. The degree to which the skin protects the underlying iv. SHOWER BATH – for clients
tissues from injury depends on the general health of requiring minimal assistance; in
the cells, the amount of subcutaneous, and the some cases, clients are given with
dryness of the skin. shower chair for assistance
3. Moisture in contact with the skin for more than a short v. TOWEL BATH
time can result in increased bacterial growth and vi. CLEANSING BATH
irritation. B. THERAPEUTIC BATH
4. Body odors are caused by resident skin bacteria a. Given for physical effects, such as to
acting on body secretions. soothe irritated skin or to treat an area.
5. Skin sensitivity to irritation and injury varies among b. Usually, the client remains in the bath for a
individuals and in accordance with their health. designated time, often 20 to 30 minutes.
6. Agents used for skin care have selective actions and c. With medication in the water: taking in a
purposes. tub (⅓ or ½ full).
● Note: It is important for nurses to know how much d. The water temperature is generally 37.7°C
assistance a client needs for hygienic care. to 46° for adults, and 40.5°C for infants.
e. THERAPEUTIC BATHS:
BATHING i. Colloidal Oatmeal
● Bath removes accumulated oil, perspiration, dead ii. Cornstarch
skin cells, and some bacteria. iii. Saline Water Bath
● Excessive bathing, however, can interfere with the iv. Sitz Bath
intended lubricating effect of the sebum, causing
dryness of the skin. This is an important PART 1.5: OXYGENATION
consideration, especially for older adults. ● Oxygen, a clear, odorless gas that constitutes
● In addition to cleaning the skin, bathing also approximately 21% of the air we breathe, is
stimulates circulation. A warm or hot bath dilates necessary for proper functioning of all living cells. The
superficial arterioles, bringing more blood and absence of oxygen can lead to cellular, tissue, and
nourishment to the skin. Rubbing with long, smooth organism death. Cellular metabolism produces
strokes from the distal to proximal parts of the carbon dioxide, which must be eliminated from the
extremities is particularly effective in facilitating body to maintain normal acid-base balance. Impaired
venous blood flow return unless there is some function of the system can significantly affect our
underlying condition that would prevent this. ability to breathe, transport gasses, and participate in
● Bathing also produces a sense of well-being. It is everyday activities.
refreshing and relaxing and frequently improves
morale, appearance, and self-respect. RESPIRATION
● Lastly, bathing offers an excellent opportunity for the ● The process of gas exchange between the individual
nurse to assess all clients. The nurse can observe and the environment and involves four components
the condition of the client’s skin and physical (of respiration):
conditions such as edema and rashes. A. VENTILATION OR BREATHING
a. The movement of air in and out of the lungs
TWO CATEGORIES OF BATHS as we inhale and exhale.
A. CLEANSING BATH B. ALVEOLAR-CAPILLARY EXCHANGE
a. Given mainly for hygiene purposes and a. Involves the diffusion of oxygen and carbon
include the following: dioxide between the alveoli and the
i. COMPLETE BED BATH – the nurse pulmonary capillaries
washes the entire body of a C. TRANSPORT OF OXYGEN AND CARBON
dependent client in bed. DIOXIDE BETWEEN THE TISSUES AND THE
ii. PARTIAL BATH – only body parts of LUNGS
the client’s body that might cause D. MOVEMENT OF OXYGEN AND CARBON DIOXIDE
discomfort or odor, if neglected, are BETWEEN THE SYSTEMIC CAPILLARIES AND
washed THE TISSUES

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PULMONARY VENTILATION DEPENDENT NURSING INTERVENTIONS

● The first process of the respiratory system,
ventilation of the lungs (through the act of breathing): OXYGEN THERAPY
inspiration (inhalation) as air flows into the lungs and 24 - 45 %
expiration (exhalation) as air moves out of the lungs. 2 - 6 L/min
● ADEQUATE VENTILATION:
○ Clear airways 40 - 60 - 90 - 100%
○ Intact CNS and respiratory center 5-8, 6-10, 10 - 15L/min
○ Intact thoracic cavity capable of expanding
and contracting
○ Adequate pulmonary compliance and recoil

24 - 40 or 50%
30 - 10 L/min

INDEPENDENT NURSING INTERVENTIONS 30 - 50 %

● Ensuring a patent airway and promoting oxygenation 4- 8 L/min
● Positioning
● Encouraging deep breathing & coughing
○ Inhale deeply & hold your breath for a few
seconds; coughs 2x while exhaling

SUCTIONING

○ Pursed - lip breathing - breath through the

nose and exhale through pursed lips; blow
slowly and purposefully, tightening the 1. Assess for the need
abdominal muscles 2. Prepare the equipment
3. Perform suctioning ONLY for 10-15 seconds when
withdrawing the suction tip.
4. Rinse the catheter and repeat suctioning as
needed. Obtain specimens if required.
5. Provide OT/ NT/ ET/ tracheostomy care.
6. Provide client’s comfort
● Ensuring adequate hydration

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FACTORS AFFECTING RESPIRATORY FUNCTION anesthesia. Hypoventilation may lead to increased

A. AGE levels of carbon dioxide (hypercapnia) or lower
a. In infants, the lungs gradually expand with levels of oxygen (hypoxemia).
each subsequent breath, reaching full ● HYPERVENTILATION is the increased movement of
inflation by 2 weeks of age; changes of aging air into and out of the lungs. During hyperventilation,
affect the respiratory system especially if it is the rate and depth of breathing increase and more
compromised by changes such as infection, carbon dioxide is eliminated than is produced.
surgery, and physical or emotional stress. ● ORTHOPNEA is the inability to breathe easily unless
B. ENVIRONMENT sitting upright or standing. Difficulty breathing or the
a. Altitude, heat, cold, and air pollution affect feeling of being short of breath (SOB) is called
oxygenation; people who have history of lung DYSPNEA. It may occur with varying levels of
disease and altered respiratory function exertion at rest. The client may manifest flaring of the
experience varying degrees of respiratory nostrils, labored-appearing breathing, increased
difficulty. heart rate, cyanosis, and diaphoresis.
C. LIFESTYLE ● Impaired diffusion may affect levels of gases in the
a. Physical exercise or activity increase the blood, particularly oxygen, which does not diffuse as
heart rate and depth of respirations; readily as carbon dioxide. HYPOXEMIA or reduced
sedentary people lack alveolar expansion oxygen levels in the blood may be caused by
and deep-breathing patterns of people with conditions that impair diffusion at the alveolar-
regular activity and are less able to respond capillary level. The cardiovascular system
effectively to respiratory stressors; certain compensates for hypoxemia by increasing heart rate
occupation also predisposes an individual to and cardiac output, to attempt to transport adequate
lung disease. oxygen to the tissues. If the cardiovascular system is
D. HEALTH STATUS unable to compensate, HYPOXIA (insufficient oxygen
a. Healthy persons can provide sufficient to the tissues) results, potentially causing cellular
oxygen to meet the body’s needs injury or death. CYANOSIS (bluish discoloration of
E. MEDICATIONS the skin, nailbed, and mucous membranes) may be
a. Some medications can decrease the rate and present with hypoxemia or hypoxia. Adequate
depth of respirations oxygenation is essential for cerebral functioning. The
F. STRESS cerebral cortex can tolerate hypoxia for only 3 to 5
a. Psychological and physical responses can minutes before permanent damage occurs. With
affect oxygenation chronic hypoxemia, the client often appears lethargic
and fatigued. The client’s fingers and toes may be
OBSTRUCTED AIRWAY clubbed, where the base of the nail becomes swollen
● A COMPLETELY OR PARTIALLY OBSTRUCTED and the ends of the fingers and toes increase in size.
AIRWAY can occur anywhere along the upper or
lower respiratory passageways. An upper airway DEEP BREATHING AND COUGHING
obstruction can occur when a foreign object such as ● The nurse can facilitate respiratory functioning by
food is present, when the tongue falls back into the encouraging deep-breathing exercises and coughing
oropharynx, or when secretions collect in the to remove secretions from the airways. When
passageways. coughing raises secretions, the client may
● The term BREATHING PATTERN refers to the rate, expectorate them. The client is usually taught to
volume, rhythm, and relative ease or effort of purse the lips as if about to whistle and blow slowly
respirations. Normal respiration (eupnea) is quiet, and tighten the abdominal muscles to assist with
rhythmic, and effortless. TACHYPNEA (rapid exhalation. Normal forceful coughing is highly
respirations) is seen with fevers, metabolic acidosis, effective. Normal forceful coughing involves the client
pain, and hypoxemia. BRADYPNEA is an abnormally inhaling deeply and then coughing twice while
slow respiratory rate, which may be seen in clients exhaling.
who have taken drugs such as sedatives. APNEA is
the absence of breathing. HYDRATION
● HYPOVENTILATION is inadequate alveolar ● Adequate hydration maintains the moisture of the
ventilation that may be caused by either slow or respiratory mucous membranes. When the client is
shallow breathing, or both. It may occur because of dehydrated or when the humidity is low, the
diseases of the respiratory muscles, drugs, or respiratory conditions thicken and become tenacious.

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Room humidifiers can provide cool mist to room air. ● The sequence for these activities is as follows:
Nebulizers, on the other hand, are used to deliver positioning, percussion, vibration, and removal of
humidity and medications. secretions by coughing or suction. Each position is
usually assumed for 10 to 15 minutes, although
INCENTIVE SPIROMETRY beginning treatments may start with shorter times and
● Incentive spirometers, also referred to as sustained gradually increase. The nurse should auscultate the
maximal inspiration devices (SMIs), measure the flow client’s lungs, compare the findings to baseline data,
of air inhaled through the mouthpiece and are used and document the amount, color, and character of
to: expectorated secretions.
○ Improve pulmonary ventilation
○ Loosen respiratory secretions OXYGEN THERAPY
○ Facilitate respiratory gaseous exchange ● The medical administration of supplemental oxygen
○ Expand collapsed alveoli is considered to be a process similar to that of
● Incentive spirometers encourage the client to take administering medications. Supplemental oxygen is
long, slow, deep breaths. The client should be indicated for clients who have hypoxemia due to
assisted into an upright sitting position in bed or a reduced ability for diffusion of oxygen,
chair to facilitate maximum ventilation. hyperventilation, or substantial loss of lung tissue due
to tumors or surgery. Others who may require oxygen
TWO TYPES OF INCENTIVE SPIROMETERS are those with severe anemia or blood loss, or similar
A. FLOW-ORIENTED SPIROMETER – consists of one conditions in which there are inadequate numbers of
or more clear plastic chambers containing freely RBCs or hemoglobin to carry the oxygen.
movable-colored balls or disks; the balls are elevated ● Oxygen therapy is prescribed by the physician, who
as the client inhales; it does not measure the specific specifies the concentration, method of delivery, and
volume of air inhaled. depending on the method, liter flow per minute
B. VOLUME-ORIENTED SPIROMETER – measures (L/min). The order may also call for the nurse to titrate
the inhalation volume maintained by the client; when the oxygen to achieve a desired saturation level as
the client inhales, a piston-like plate rises as the client measured by the pulse oximeter. When administering
inspires, and marking on the side indicate the volume oxygen as an emergency measure, the nurse may
of inspiration achieved by the client. initiate therapy, and then contact the physician for an
order.
PERCUSSION, VIBRATION, AND POSTURAL ● Oxygen is supplied in two ways in health care
DRAINAGE facilities: by portable systems (cylinders or tanks) and
A. PERCUSSION is forceful striking of the skin with from wall outlets. Oxygen administered from a
cupped hands. Percussion over congested lung cylinder or wall outlet system is dry. This dehydrates
areas can mechanically dislodge tenacious the respiratory mucous membranes. Humidifying
secretions from the bronchial walls. Percussion is devices that add water vapor to inspired air are thus
avoided over the breasts, sternum, spinal column, essential. A humidifier bottle is attached below the
and kidneys. flow meter gauge so that the oxygen passes through
B. VIBRATION is a series of vigorous quivering water and then through the specific oxygen tubing
produced by hands that are placed flat against the and equipment prescribed for the client. Humidifiers
client’s chest wall. Vibration is used after percussion prevent mucous membranes from drying and
to loosen thick secretions. It is often done alternately becoming irritated and loosen secretions for easier
with percussion. expectoration. Oxygen passing through water picks
C. POSTURAL DRAINAGE is the drainage by gravity of up water vapor before it reaches the client. The more
secretions from different lung segments. The lower bubbles created during this process, the more water
lobes require drainage most frequently because the vapor is produced.
upper lobes drain by gravity. Before postural ● Low-flow and high-flow systems are available to
drainage, the client may be given a bronchodilator or deliver oxygen to the client. The choice of system
nebulization therapy to loosen secretions. The best depends on the client’s oxygen needs, comfort, and
time includes before breakfast, before lunch, in the developmental considerations.
late afternoon, and before bedtime. It is best to avoid End of Part 1: Mobility, Hygiene, And Oxygenation
hours shortly after meals because postural drainage
at these times can be tiring and may induce vomiting.

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PART 2: NUTRITION ■Starches/ Fiber - complex sugar

● The sum of all the interactions between an organism (polysaccharide)
and the food it consumes. ■ 1gm = 4kcal
● What a person eats and how the body uses it. ■ Classification of Cabs:
● Monosaccharides -
NUTRIENTS Contain 1 sugar unit
● Organic and inorganic substances found in foods that ● Disaccharides - Contain 2
are required for body functioning. sugar units
● Polysaccharides - Contain
NUTRITIVE VALUE many sugar units
● The nutrient content of a specified amount of food. ○ PROTEINS
● Calories ■ Made up of amino acids
● Limit ■ Complete (meat & poultry)
● Get Enough ■ Incomplete (vegetables)
■ 1 gm = 4kcal
■ Protein (metabolism: anabolism and
catabolism)
● Anabolism requires energy
to synthesize/ grow and
build molecules.
● Catabolism requires energy
to break down molecules.
○ LIPIDS
■ Greasy and insoluble in water
■ Soluble in alcohol or ether
■ Fats are lipids that are solid at room
temperature
■ 1 gm = 9kcal
● MICRONUTRIENTS: VITAMINS AND MINERALS
○ MICRONUTRIENTS
■ Vitamins cannot be manufactured by
the body vitamins (fat soluble &
water soluble) and needed in small
quantities.
■ Minerals (macrominerals &
THREE MAJOR FUNCTIONS OF NUTRIENTS microminerals)
1. Provide Energy and Movement ○ VITAMINS
2. Provide Structural Material for body tissues ■ Essential for specific metabolic
3. Regulate body process reactions within the cells.
■ Fat soluble vitamins
ESSENTIAL NUTRIENTS ● Vitamins A,D, E, K
● BASIC NEED- WATER ● Megadose of fat-soluble
○ It is a food and a nutrient. vitamins may lead to
○ Considered as the most basic. toxicity; they are stored in
○ Next to oxygen in importance. our body.
○ Total of 45 liters in a normal adult. ■ Water soluble vitamins
■ ⅔ found in ICF = 30L ● Vitamin C
■ ⅓ found in ECF = 15L ● Vitamin B Complex
● ENERGY PROVIDING: CHO, CHON, FATS
(MACRONUTRIENTS) FACTORS AFFECTING NUTRITION
○ CARBOHYDRATES ● Development
■ Major source of energy ● Gender
■ Simple sugar (monosaccharides and ● Ethnicity and Culture
disaccharides) ● Beliefs about Food

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● Personal Preferences NURSING INTERVENTIONS FOR CLIENT WITH

● Religious Practices MALNUTRITION
● Lifestyle ● Serve food in pleasant and attractive manner
● Economics ● Provide good hygiene measures
● Medications and Therapy ● Assist patient in feeding
● Advertisement ● Place patient in comfortable position
● Psychological Factors ● Colors affect appetite
● Altered Nutrition
NURSING INTERVENTIONS FOR THE CLIENT WITH
ALTERED NUTRITION NAUSEA AND VOMITING
A. MALNUTRITION ● Position client properly
a. It is the lack of necessary or appropriate food ● Provide good oral care measures
substances ● Suction the mouth as needed
b. Two types: Overnutrition and ● Relieve sensation of nausea
Undernutrition ● Replace fluid-electrolyte losses
B. MARASMUS AND KWASHIORKOR ● Administer antiemetic as ordered
MARASMUS KWASHIORKOR
Marasmus patients Kwashiorkor patients are SPECIAL DIETS
suffer from a peeling characterized by a ● CLEAR LIQUID DIET
and alternately distended stomach, ○ Liquids that don’t contain residue
pigmented skin. burns on the skin and ○ Provides fluid and carbohydrates ONLY
diarrhea. ● FULL LIQUID DIET
Marasmus affects kids Kwashiorkor affects kids ○ Foods and fluids that turn to liquid at room
because of a lack of who do not receive temperature
nutritional elements in enough protein in the ● SOFT DIET
the diet. diet. ○ Foods that are soft with reduced fiber
Marasmus affects Kwashiorkor affects kids ○ Foods that may be chopped or pureed
infants and very young who are a bit older. ● DIET AS TOLERATED
kids. ○ Diet that changes according to patient’s
Marasmus patients need Kwashiorkor patients are tolerance
to be treated with treated by adding more ● RESTRICTIVE DIET
additional doses of protein in their diet. ○ Diet that restricts certain foods or a particular
vitamin B and a nutrient
nutritious diet. ○ Ex: Low-fat diet, Low carb diets, etc.

REGULAR DIET
● A balanced diet that supplies the metabolic
requirement
● ENTERAL NUTRITION
○ An alternative method to ensure adequate
nutrition
○ Given when patients are unable to ingest
foods or the upper gastrointestinal tract is
impaired and the transport of food to the
small intestine is interrupted.
● ENTERAL FEEDINGS
● Small bore feeding tubes or through gastrostomy or
jejunostomy tubes Nasogastric tubes
● Used for feeding clients who have adequate gastric
emptying and who require short-term feedings NGT
● Not advised for feeding clients without intact gag and
cough reflex since the risk for accidental placement of
the tube into the lungs
End of Part 2: Nutrition

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PART 3: URINARY AND BOWEL ELIMINATION ALTERED URINE PRODUCTION

● Patterns of urination
PART 3.1: URINARY ELIMINATION ● People void about five to six times a day
● Elimination from the urinary tract is usually taken for A. POLYURIA/ DIURESIS
granted a. Production of abnormally large amounts of
● Only when a problem arise do most people become urine can occur following polydipsia or D.M.
aware of their urinary habits and any associated B. OLIGURIA
symptoms a. Low urine output (<30mL/hr or less than
● Personal habits regarding urination are affected 500/day)
● Essential to health and voiding can be postponed for C. ANURIA
only so long before the urge normally becomes too a. Lack of urine production (0to 10mL/hour)
great to control
FACTORS AFFECTING URINARY ELIMINATION
PHYSIOLOGY OF URINARY ELIMINATION ● Maintaining Normal Urinary Elimination
● Independent nursing functions
○ Promoting fluid intake
○ Maintaining normal voiding habits
○ Assist with toileting
A. URINARY FREQUENCY - Voiding at frequent
intervals.
B. URINARY URGENCY - Sudden strong desire to void.
C. DYSURIA - Painful or difficult voiding.
D. ENURESIS - Involuntary urination.
UPPER URINARY TRACT E. URINARY INCONTINENCE - Involuntary leakage of
● KIDNEYS - spinal column behind the peritoneal urine.
cavity. F. URINARY RETENTION - Accumulation of urine.
○ Bean-shaped organs whose functional unit is G. NEUROGENIC BLADDER - Impaired neurologic
known as nephrons; it functions to remove bladder control.
waste products and regulate water and
electrolytes. URINARY TRACT INFECTION (UTI)
● URETERS - attached to kidneys and carries urinary ● The rate of UTI is greater in women than men
wastes into the bladder.
GUIDELINES IN REDUCING OCCURRENCE OF UTI
LOWER URINARY TRACT 1. Drink eight 8-ounce glasses of water per day to Flush
● URINARY BLADDER - hollow muscular organ that bacteria out of the Urinary system
serves as reservoir for urine. 2. Practice frequent Voiding (2 to 4 hours) to flush
● URETHRA - serves as the passageway of urine from bacteria out of the urethra and prevent organisms
the bladder to the urinary meatus. from ascending into the bladder
● PELVIC FLOOR 3. Avoid using harsh soaps, bubble bath,powder, sprays
● URINATION or irritating chemicals in the perineal area
4. Avoid tight-fitting clothes
MICTURATION 5. Wear cotton Underclothes
● Voiding 6. Instruct females to wipe from front to back
● Refer to the process of emptying the urinary bladder
MANAGEMENT FOR URINARY INCONTINENCE
FACTORS AFFECTING VOIDING 1. CONTINENCE OR BLADDER TRAINING
● Developmental factors a. Lengthen interval
● Psychological factors b. Stabilize bladder
● Fluid and Food Intake c. Diminish urgency
● Medications 2. PELVIC MUSCLE EXERCISE KEGEL EXERCISE
● Muscle Tone 3. MAINTAIN SKIN INTEGRITY
● Pathologic Conditions 4. APPLY EXTERNAL URINARY DRAINAGE
● Surgical and diagnostic procedures DEVICES

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a. Condom or external catheter connected to a ● EXCRETED WASTE - feces or stool

urinary drainage system ● Defecation
● Expulsion of feces/stool from the rectum
● Bowel movement
● FREQUENCY - highly individual, varying from several
times per day to two or three times per week.
● When peristaltic waves move the feces into the
sigmoid colon and the rectum, the sensory nerves in
the rectum are stimulated and the individual becomes
aware of the need to defecate.

FECES
● Normal- 75% water and 25% solid materials
● Soft but formed
● Brown- presence of stercobilin and urobilin (from
bilirubin- red pigment in bile)
● Fecal matter consists of unabsorbed food residue,
mucus, digestive secretions, water and
microorganisms
● Normal feces require a normal fluid intake
● Feces that contain less water-hard and difficult to
expel
● If the feces are moved rapidly through the large
intestine, less water is absorbed and the stool is liquid
● If the movement of the feces and elimination are
URINARY CATHETERIZATION
delayed, an excessive amount of water is absorbed
● Introduction of a catheter into the urinary bladder.
and the stool becomes hard and dry
● Performed only when necessary because of the
danger exists of introducing microorganisms into the
FACTORS THAT AFFECT DEFECATION
bladder- ascends into the ureters and kidneys.
● Development
● Diet
HAZARD IN URINARY CATHETERIZATION
● Activity
• Hazard of infection remains after the catheter is in
● Psychological factors
place because normal defense mechanisms such as
● Defecation habits
voiding are bypassed
● Pain, Medications, Medical Procedures
• Prevent Trauma - insert a catheter along the normal
contour of the urethra damage if it is forced through
strictures at an incorrect angle
• Damage if it is forced through strictures at an incorrect
angle
• Made of rubber or plastics
• Latex or silicone
• Sized by the diameter of the lumen using FRENCH
(Fr) scale: the larger the number, the larger the lumen

PART 3.2: FECAL ELIMINATION DEFECATION

FECAL ELIMINATION
● Nurses frequently are consulted or involved in
assisting clients with elimination problems.
● These problems can be embarrassing to clients and
can cause considerable discomfort
● Elimination of the waste products of digestion from
the body is essential to health

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FECAL ELIMINATION PROBLEMS b. Antidiarrheal

A. CONSTIPATION c. Antiflatulent
a. Mass of hardened feces in the folds of rectum D. PROMOTING REGULAR DEFECATION
b. Less than 3 bowel movements in a week; (ADMINISTERING ENEMAS)
passage of dry, hard stool a. Cleansing enema
B. FECAL IMPACTION b. Carminative enema
a. Mass of hardened feces in the folds of rectum c. Retention enema
C. DIARRHEA d. Return-flow enema
a. Passage of liquid feces accompanied by E. DIGITAL REMOVAL OF FECAL IMPACTION
increased in frequency of defecation a. Breaking up the fecal mass digitally and
D. BOWEL INCONTINENCE removing it in portions.
E. FLATULENCE
a. Three primary sources:
i. Action of bacteria in the chyme
ii. Swallowed air
iii. Gas that diffuses between the
bloodstream and the intestine

PROMOTING REGULAR DEFECATION

● Privacy during defecation BOWEL DIVERSION OSTOMIES
● Encourage to defecate when the urge is recognized
● Provide time for defecation
● Diet for regular normal elimination varies- frequency,
type of foods
A. PROMOTING REGULAR DEFECATION
(NUTRITION & FLUID)
a. FOR CONSTIPATION
i. Add fresh lemon or fruit juice ● ILEOSTOMY - opens into the ileum (small bowel)
ii. Increase daily fluid intake ● COLOSTOMY - opens into the colon (large bowel)
iii. Increase fiber ● To divert and drain fecal material
iv. Promote regular defecation ● Bowel Diversion Ostomies
v. Nutrition and fluids
b. FOR DIARRHEA CLASSIFICATIONS OF BOWEL DIVERSION
i. Bland food OSTOMIES
ii. Encourage oral intake of fluid and A. PERMANENCE
bland food (soft, low fiber) B. ANATOMIC LOCATION
iii. Avoid hot or cold fluids C. SURGICAL CONSTRUCTION OF THE STOMA
iv. Avoid spicy foods and high fiber
v. Promote regular defecation CARE AND MANAGEMENT OF OSTOMY
vi. Nutrition and fluids
c. FOR FLATULENCE CARE OF STOMA
i. Limit carbonated beverages ● Fecal material from colostomy or ileostomy is irritating
ii. Avoid gas- forming foods and limit to the peristomal skin
carbonated beverages ● Assess irritation
iii. Promote regular defecation ● Kept clean and dry
B. PROMOTING REGULAR DEFECATION ● Care and Management of Ostomy
(EXERCISE & POSITIONING) ● OSTOMY APPLIANCE - protect the skin (skin barrier
a. Twisting the body and pouch), collect stool and control odor
b. Turning from side to side ● ACTION - distend the intestine and sometimes to
c. Flexing the body irritate the intestinal mucosa thereby increasing
d. Lifting the legs to the abdomen peristalsis and excretion of feces and flatus
C. PROMOTING REGULAR DEFECATION ● ENEMA SOLUTION - 37.7oC (100oF)- too hot or cold
(TEACHING ABOUT MEDICATION) can cause cramping
a. Cathartics and laxatives

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BOWEL TRAINING PROGRAMS B. ELECTROLYTES

1. Determine the client’s usual bowel habits and factors a. Charged particles, capable of conducting
that help and hinder normal defecation electricity, measured in milliequivalents per
2. Design a plan with the client liter of water (mEq/L).
3. Maintain daily routine for 2 to 3 weeks
End of Part 3: Urinary and Bowel Elimination MOVEMENT OF BODY FLUIDS AND ELECTROLYTES
● Permeability is the ability of substances to pass
PART 4: FLUID, ELECTROLYTE, AND ACID-BASE through a membrane.
BALANCE ● Body fluid compartments are separated from one
● In good health, the body is maintained by a balance another by cell membranes and the capillary
of fluids, electrolytes, acids and bases. membrane.
● HOMEOSTASIS (balance) depends on multiple ● Selectively permeable to solutes
physiologic processes that regulate fluid intake and ● Small particles (ions, oxygen, carbon dioxide) easily
output and the movement of water and the move across these membranes.
substances dissolved in it between the body ● Larger molecules (glucose and proteins) have more
compartments. difficulty moving between fluid compartments.
● Body Fluids and Electrolytes
● 60% of the average healthy adult’s weight is water. METHODS BY WHICH ELECTROLYTES MOVE
● Water is vital to health and normal cellular function A. OSMOSIS
a. Movement of water across cell membranes
DISTRIBUTION OF BODY FLUIDS from less concentrated solution to the more
A. INTRACELLULAR FLUID (ICF) concentrated solution.
a. Found within the cells of the body b. Water moves toward the higher
b. Constitutes approximately 2/3 (66%) of the concentration of solute in an attempt to
total body fluids in adult equalize the concentrations.
c. Vital to normal cell functioning c. Movement of solvent
d. Contains solutes such as oxygen, d. Ex: You are trying to make juice from a
electrolytes and glucose powder. Once you poured water into the
e. Provides a medium in which metabolic powder, the water will move to the solute
processes of the cell take place (more concentrated).
B. EXTRACELLULAR FLUID (ECF) e. SOLUTES - substances dissolved in a liquid.
a. Found outside the cells of the body f. SOLVENTS- component of a solution that
b. Accounts about 1/3 (33%) of total body fluid can dissolve a solute.
c. The transport system that carries nutrients to g. In the body, water is the solvent, solutes
and waste products from the cells (electrolyte, gases, glucose, amino acids,
proteins and waste products (urea))
2 MAIN COMPARTMENTS OF BODY FLUIDS h. OSMOLALITY - total solute concentration
A. INTRAVASCULAR FLUIDS/ PLASMA within a fluid compartment
a. 20% of ECF, found within vascular system i. TONICITY - used to refer to the osmalilty of
B. INTERSTITIAL FLUID one solution in relation to another solution.
a. 75% of ECF, surrounds the cells j. SOLUTIONS:
C. OTHER COMPARTMENTS i. ISOTONIC - NSS, 0.9% NaCl; equal
a. Lymph and transcellular fluids ii. HYPERTONIC - 3% NaCl; causes
(cerebrospinal, pericardial, pancreatic, the cell to shrink; water moves out
pleural, intraocular, biliary, peritoneal and of the cell
synovial fluid). iii. HYPOTONIC - 0.45% NaCl; causes
the cell to swell because water will
COMPOSITION OF BODY FLUIDS move inside the cell
A. IONS k. NSS – Natural Saline Solution
a. An atom or group of atoms that has
acquired a net electric charge cation
anion.
i. caTions are positively charged ions
ii. aNions are negatively charged.

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i. OSMOTIC PRESSURE - power of a d. Other examples: Vomit and chest tube

solution to pull across a drainage
semipermeable membrane; Solvents
move / water move MEASURING EDEMA: PITTING TEST

• To determine the extent of the pitting edema, your

doctor will push on your skin, measure the depth of
the indention, and record how long it takes for your
B. DIFFUSION skin to rebound back to its original position (Source:
a. Being widely spread Healthline).
b. Occurs when two solutes of different • They will then grade it on a scale from 1-4.
concentrations are separated by a
semipermeable membrane. ACID-BASE BALANCE
c. Rate of diffusion varies: size of the ● An important part of regulating the homeostasis of
molecules, concentration of the solution and body fluids is regulating their acidity and alkalinity.
temperature of the solution.
d. Molecules move to a lesser concentrated
solution.

C. FILTRATION
a. Process whereby fluid and solutes move
together across a membrane from an area of
higher pressure to an area of lower pressure.
b. Focus on pressure

D. ACTIVE TRANSPORT
a. Active transport is the energy-requiring
process of pumping molecules and ions
across membranes "uphill" - against a
concentration gradient.
FACTORS AFFECTING BODY FLUID,
REGULATING BODY FLUIDS ELECTROLYTES AND ACID-BASE BALANCE
A. FLUID INTAKE ● Age
a. 2,500 mL of fluid for normal functioning per ● Gender and Body Size
day ● Environmental Temperature
b. 1, 500 mL of fluid intake per day others come ● Lifestyle
from foods and oxidation during metabolism
B. FLUID OUTPUT FLUID IMBALANCES
a. URINE = 1,500 mL per 24 hours ● Isotonic Fluid Imbalance
b. FECES = 100-200 mL ● Osmolar Fluid Imbalance
c. INSENSIBLE WATER LOSS = 1,300mL

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ELECTROLYTE IMBALANCES (Milliequivalents per

litre (mEq/L))
● SODIUM
○ 135-145 mEq/L
○ Hypernatremia: higher than 145
○ Hyponatremia: lower than 135
● POTASSIUM
○ 3.5 -5.0 mEq/L
○ Hyperkalemia: higher than 5
○ Hypokalemia: lower than 3.5
● CALCIUM
○ 8.5 - 10.5 mEq.L
○ Hypercalcemia: higher than 10.5
○ Hypocalcemia: lower than 8.5
UNEXPLAINED NOTES
● MAGNESIUM
• Enteral Replacement of Fluids
○ 1.5 - 2.5 mEq/L
• Restriction of Fluids
○ Hypermagnesemia: higher than 2.5
• Parenteral Replacement of Fluids and Electrolytes
○ Hypomagnesemia: lower than 1.5
• Intravenous Therapy
● PHOSPHATE
○ 2.5 - 4.5 mEq/L • Regulating the rate of infusion
○ Hyperphosphatemia: higher than 4.5 • Devices: Dial-a-flow in line Volume-control set
○ Hypophosphatemia: lower than 2.5 (electronic infusion pump
End of Part 4: Fluid, Electrolyte, and Acid-Base
MONITORING FLUID INTAKE AND OUTPUT Balance
● Measuring and recording all liquid intake and output
during a 24-hour period
● Fluid intake that need to be recorded
● Fluid output that need to be recorded

BLOOD TRANSFUSION
● Informed consent is signed
● Properly types and cross-matching of blood
● IV patency, catheter gauge, compatible fluid
● Pre-transfusion medications and filter set
● Transfusion time runs between 2 and 4 hours; or less
TYPE ANTIGEN ANTIBODY
A A B
B B A
NEITHER A
O BOTH A & B
NOR B
NEITHER A
AB A&B
NOR B

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