HYPERNATREMIA and HYPONATREMIA (Sodium)

Submitted by:

Ayes, Fedelaine Longcanaya, Reymond Piano, Menissa Sacay, Shiela Mae Corregidor, Maria Leofe
Submitted to:

Mrs. Rowena Ang

Clinical Instructor

Sodium

A cation which is the most abundant electrolyte in the extracellular fluid - Normal count ranges 135-145 mEq/L
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Functions of Sodium
Maintaining the tonicity and concentration of extracellular fluid Acid-base line (reabsorption of sodium ions and excretion of hydrogen ions) Nerve conduction Neuromuscular function Glandular secretion Water balance

Sources of Sodium

Table salt Baking soda Condiments Monosodium glutamate Additives Food seasonings Meat Fish Poultry Eggs Pickled foods Olives

Sodium Electrolyte Imbalances HYPERNATREMIA

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Excessive serum levels of the sodium cation relative to body water

Pathophysiology
Increased sodium intake Sodium levels increase Water shift from cells to the ECF Cellular dehydration Decreased myocardial contractility Aldosterone and ADH are suppressed

Signs and Symptoms

Dry, swollen tongue Flushed skin Hypertension, dyspnea (with hypervolemia) Low-grade fever Orthostatic hypotension and oliguria Sticky mucous mebrane Twitching

Nursing Diagnosis
Deficient knowledge Disturbed thought process Ineffective tissue perfusion: cardiopulmonary Risk for deficient fluid volume

 Risk for injury

Management: Medical
Activity, as tolerated Administration of salt-free solutions (such as dextrose in water) followed by infusion of half-normal saline solution to prevent hyponatremia Discontinuation of drugs that promote sodium retention Sodium-restricted diet Obtain a drug history to check for drugs that promote sodium retention. Assist with oral hygiene. Watch for signs of cerebral edema during fluid replacement therapy.

Nursing

Pharmacologic
Diuretics Vasopressin if the patient has diabetes insipidus

HYPONATREMIA

- Serum sodium level less than 135 mEq/L

Pathophysiology
Excessive water intake Sodium level decreases Intracellular edema Brain herniation Brain cells compensate by; Reducing cerebral blood flow Shifting CSF Decreasing brains osmolality

Signs and Symptoms

Dry mucous membrane Orthostatic hypotension Poor skin turgor Rales or crackles Rapid, bounding pulse

Nursing Diagnosis
Acute confusion Decreased cardiac output Impaired oral mucous membrane Ineffective breathing pattern Nausea Risk for injury

Management: Medical
Activity, as tolerated High-sodium diet Restricted fluid intake Restrict fluid intake Give prescribed I.V. fluids. Provide a safe environment. Institute seizure precautions, if needed.

Nursing

Pharmacologic
Demeclocycline or lithium Hypertonic (3% or 5%) saline solution (with serum sodium levels below 110mEq/L) Normal saline solution Oral sodium supplements