Essential Nursing Concepts: Respiratory, IV, and Fluid Balance

Posted on Oct 29, 2025 in Medicine & Health

1. Oxygen Delivery & Safety

Oxygen Delivery Methods:
- Nasal cannula: 1-6 L/min
- Masks: 3-7 L/min
Safety Precautions: Use humidification for high-flow oxygen and avoid sparks near oxygen sources.
Fire Safety: Oxygen supports combustion and is a significant fire hazard. Ensure proper handling.
COPD Oxygen Therapy: Administer low-flow oxygen at 2-3 L/min to prevent respiratory depression.
Signs of Hypoxia: Tachypnea, confusion, cyanosis, restlessness, and dyspnea.
Pulse Oximeter: This device monitors oxygen saturation levels to track the patient’s oxygenation status.

Incentive Spirometry: Encourages deep breathing exercises to prevent atelectasis and pneumonia.
Coughing & Deep Breathing: These techniques help prevent respiratory complications, such as pneumonia.
Preventing Post-Surgical Complications: To prevent atelectasis, encourage early ambulation, movement, and deep breathing exercises.

COPD: Limit oxygen to 2-3 L/min. Avoid excessive oxygen, which can suppress the hypoxic drive and lead to respiratory failure.
Hypoxia: An oxygen deficiency at the cellular level, indicated by symptoms like confusion, tachypnea, and cyanosis.
Artificial Airways: Includes endotracheal tubes and tracheostomies. Suctioning is performed to maintain airway clearance.
Suctioning: Always use a sterile technique and ensure the airway is patent before initiating suctioning.

Pulmonary Ventilation: Consists of inspiration (diaphragm contracts) and expiration (diaphragm relaxes).
Impaired Oxygenation: Leads to tissue damage, particularly affecting vital organs such as the brain and kidneys.
Alveolar Gas Exchange: Oxygen moves from the alveoli into the blood, while carbon dioxide (CO2) moves from the blood into the alveoli for exhalation.

Normal pH Range: The normal blood pH is 7.35-7.45. A pH below 6.8 or above 7.8 is life-threatening.
Respiratory Acidosis: Caused by conditions like airway obstruction, pneumonia, or COPD, leading to elevated CO2 levels.
Metabolic Acidosis: Caused by kidney failure or diabetic ketoacidosis, resulting in a loss of bicarbonate.
Respiratory Alkalosis: Caused by hyperventilation, often due to anxiety or a high fever.
Metabolic Alkalosis: Caused by prolonged vomiting or excessive antacid use.
Compensation Mechanisms: The kidneys compensate for respiratory imbalances, and the lungs compensate for metabolic imbalances.

Functions of Water: Transportation of nutrients, temperature regulation, facilitation of enzymatic reactions, and pH balance.
Dehydration (Fluid Volume Deficit): Signs include dry skin, decreased urine output, and tachycardia. Treatment involves oral or IV fluids.
Fluid Volume Excess: Signs include weight gain, edema, and crackles in the lungs. Monitor lung sounds and daily weight closely.
Key Electrolytes:
- Sodium (Na+): 135-145 mEq/L. Regulates water balance.
- Potassium (K+): 3.5-5 mEq/L. Crucial for nerve and muscle function.
- Calcium (Ca2+): 8.4-10.6 mg/dL. Important for bone health and blood clotting.
- Magnesium (Mg2+): 1.3-2.5 mg/dL. Essential for muscle and nerve function.

Charting Methods:
- Source-Oriented: Information is arranged in chronological order; a disadvantage is the potential for irrelevant data.
- Problem-Oriented Medical Record (POMR): A more structured and concise method focused on patient problems.
- Focus Charting (DAR): Focuses on Data, Action, and Response to care.
- Charting by Exception: Only documents deviations from expected outcomes.
Confidentiality: Always protect patient information and strictly follow HIPAA guidelines.

Monitor Respiratory Status: Use a pulse oximeter, check Arterial Blood Gases (ABGs), and adjust the care plan as needed.
Recognize Early vs. Late Signs of Hypoxia:
- Early Signs: Restlessness, confusion, tachypnea.
- Late Signs: Cyanosis, bradycardia, hypotension.

IV Solutions:
- Isotonic: 0.9% Saline, Ringer’s Lactate. Has the same tonicity as blood.
- Hypotonic: 0.45% Saline. Shifts fluid into cells.
- Hypertonic: 10% Dextrose. Draws fluid out of cells.
Common Complications:
- Infiltration: IV fluid leaks into surrounding tissue (cool to the touch).
- Phlebitis: Inflammation of the vein (red, warm).
- Bloodstream Infection: Signs include fever, chills, and nausea. Always use a sterile technique.
- Extravasation: A vesicant drug leaks into tissue, causing significant tissue damage.

PICC Lines: Peripherally Inserted Central Catheters are used for long-term IV access and are placed in the superior vena cava.
IV Medication Administration: Always follow the Six Rights: Right Patient, Right Medication, Right Dose, Right Route, Right Time, and Right Documentation.
IV Pumps: Used for a controlled flow rate, ensuring accuracy and preventing medication overdose.
Blood Transfusions: Monitor for adverse reactions (e.g., fever, chills). If a reaction occurs, stop the transfusion immediately and administer normal saline.

Hypoxia: An oxygen deficiency at the tissue level.
Cyanosis: A bluish discoloration of the skin, indicating poor oxygenation.
Atelectasis: A partial collapse of the lung, which can lead to pneumonia.
Metabolic/Respiratory Acidosis & Alkalosis: Imbalances in the body’s acid-base homeostasis.
Electrolyte Imbalances: Includes conditions like hyponatremia/hypernatremia (sodium), hypokalemia/hyperkalemia (potassium), and hypocalcemia/hypercalcemia (calcium).
IV Solutions: Categorized as Isotonic, Hypotonic, and Hypertonic.
Arterial Blood Gas (ABG): A test used to assess respiratory and metabolic conditions, especially acid-base imbalances.

COPD Patients: Limit oxygen to 2-3 L/min to avoid suppressing the respiratory drive.
Acid-Base Balance: Check bicarbonate (HCO3) levels to assess metabolic status and CO2 levels to assess respiratory status.
Fluid Volume Deficit: Assess for signs of dehydration, such as dry skin and low urine output.
Fluid Volume Excess: Watch for edema, crackles in the lungs, and sudden weight gain.
Documentation: Ensure all charting is clear, concise, and uses proper medical terminology.