Xavier University - Ateneo de Cagayan In

partial fulfillment of the requirements for

NCM 112 LEC - CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION,

CARDIOLOGY, GASTROINTESTINAL, FLUID & ELECTROLYTE, INFECTIOUS,
INFLAMMATORY and IMMUNOLOGIC RESPONSE, CELLULAR ABERRATION,
ACUTE and CHRONIC

Concept Map on the 3 Types of Fluid Imbalances

Submitted by:
Enguio, Rhy Kenji
Espinosa, Zenju
Fallarna, Ashley Jenn
Galarrita, Ferdinand
Guillermo, Justine Jean
Gutoc, Jasimah
Janolino, Rhea Mae
Jimenez, Aleks
Labasano, Kayle Mae
Lagua, Jade Godwin
Lacdo-o, Ariel
Moreno, Edmund Zheen Regor

BLOCK BSN 3 - NE, GROUP 2

Submitted on:
August 17, 2022

Precipitating Factors
PREDISPOSING FACTORS
Precipitating Factors
Age
PRECIPITATING FACTORS
DM Type 1
Encourage pt to limit
sodium intake
Enforce fluid restriction
Encourage ambulation or
Administer diuretics
Excess fluid volume r/t
compromised regulatory
Hemodialysis or
peritoneal dialysis mechanisms
intraarterial spaces
Blood test Decreased BUN & HCT
Serum Osmolality
Decreased serum osmolality
Test
and handle with care
LEGENDS
Predisposing Factors
Precipitating Factors
Disease Process
Clinical Manifestations
Leads to
Manifested by
Managed by
PREDISPOSING FACTORS
Ileus
Diarrhea
Vomiting 
Gastric tube
Hyperglycemia 
Azetonuria with diabetes mellitus 
Increased perspiration
Renal dysfunction (polyuria)
Age Systemic infections, fever 
Gastrointestinal (GI) fistula
Internal and External Blood Loss
Insufficient or decreased fluid intake
Pancreatitis, peritonitis, cirrhosis, ascites,
adrenal insufficiency
Monitor the amount of fluid that
enters and leaves the patient’s body.
Increased loss of fluids, exceeding sodium
Determine the patient’s weight every Sodium loss is greater than water loss
excretion
day.
Decreased glomerular filtration rate
Leads to Increased solute concentration in Dizziness (orthostatic/postural
Administer Hypotonic electrolyte solution Decreased serum osmolality
Keep the patient hydrated. extracellular fluid hypotension)
Solute concentration maintains normal
Perform Fluid Challenge Test serum osmolality
Employ pharmacologic management. Muscle weakness and lethargy
Administer Isotonic Electrolyte Crystalloid Shift of water from extracellular space into
Decreased skin turgor
Solution Increased blood osmolality intracellular space, thus cells swell and Nausea
Weak pulse, tachycardia
Dry mouth, dry skin cerebral edema may occur
Deficient Fluid Volume related to acute Decreased blood pressure
Administer Hypertonic Solutions Thirst and/or nausea Elevation liver and pancreatic enzymes
To give supportive measures to help diarrhea 
patients resume activities of daily Diarrhea
Administer Colloid Solutions living or ADLs.
HYPERTONIC FVD HYPOTONIC FVD
HCT (Hematocrit) Blood Test
Increase Oral fluid intake Ensure proper hydration. Decreased urination (oliguria), concentrated urine Decreased glomerular filtration rate
Weight loss Potassium Blood Test
Sodium Blood Test
Ensure proper nutrition.
Urine Osmolarity Test
ISTONIC FVD Blood Urea Nitrogen (BUN)  Test
Relieve pain experienced by the Urine Specific Gravity Test
patient.
Urine Sodium and Chloride Test
Maintain normal body temperature.
Heart failure PREDISPOSING FACTORS
Kidney failure/kidney dysfunction
Liver failure
Prolonged corticosteroid therapy
Hormonal changes Intestinal obstructions
Excessive intake of sodium
Vein Obstructions
Excessive administration of sodium-containing IV fluids
Excessive intake of fluids Pancreatitis, or inflamed pancreas
Trauma
Age
FLUID
Infection
Radiation
Increased total body sodium content IMBALANCES Allergic reactions
Surgery
Decreased plasma proteins
Increased serum osmolality Lymphatic blockages
Increased capillary permeability
Increased release of ADH from the
posterior pituitary
Inhibited diuretic response
Increased H2O reabsorption in the Change pt's position every Encourage adequate fluid intake,
distal tubule of the kidneys 2hrs. avoiding caffiene and use of
aspartame and limiting intake
Keep pt's legs elevated higher during late evening.
Risk for impaired skin integrity r/t to
than the heart.
Increased fluid retention in the body Acute weight gain onset of skin breakdown secondary to
Administer IV Fluids
Decreased oncotic pressure Increased hydrostatic pressure Recommend good handwashing
edema
(Colloids)
isometric bed exercises within and proper perineal care.
client’s level of tolerance.
FLUID VOLUME EXCESS
Crackles Have the patient perform the
(hypervolemia) activity more slowly, in a longer
Peripheral edema time with more rest or pauses, Admnister diuretics
Fluid loss from intravascular and Tachycardia
Shortness of breath or with assistance if necessary.
Deficient fluid volume
Hypotension
Plasma dilution Increased volume of circulating fluid Pulmonary congestion Chest x-ray
Have the patient perform the Abdominal x-ray/ultrasound Oliguria Impaired urinary elimination
Place pt in Semi-Fowler's or Fluid accumulation in interstitial
activity more slowly, in a longer
Risk for impaired gas exchange r/t  High-Fowler’s position. spaces
Increased BP time with more rest or pauses,
Increased workload on the heart and alveolar-capillary membrane secondary or with assistance if necessary Chest x-ray Edema Liver function test, albumin test
increased pressure on the blood
to fluid accumulation 
Bounding pulse vessels Ascites
Encourage adequate bed rest THIRD SPACE FLUID Fluid volume excess related to fluid
Hematocrit and hemoglobin
periods.
Distended jugular SHIFT buildup in interstitial space
vein
Decreased cardiac output r/t Assist with pt's activities of
daily living.
increased afterload secondary to
fluid overload 
Provide a relaxing environment Elevate edematous extrmeeties
and minimize stressors. Limit sodium intake
Elevate the pt's legs.
Nursing Diagnosis
Nursing Management
Medical Management
Diagnostic Test
Detected through
Nursing Diagnosis
 BIBLIOGRAPHY

Textbook Sources:
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