Zusammenfassung der Ressource
Sodium
- Hypernatremia
- Causes
- Diabetes
Insipidus
Anmerkungen:
- ADH: Produced in the Hypothalamus & Stored in the Posterior Pituitary Gland. Hypernatremia is Due to Water Loss.
- Central:
Anmerkungen:
- Deficiency of the Synthesis or Release of ADH from the Posterior Pituitary Gland.
- Nephrogenic
- Primay
- Impaired LOC or
Unable to Obtain
Fluids
Anmerkungen:
- This leads to Hypernatremia not being corrected.
- Administration of
Hyperosmolar Tube
feedings
- Excessive
Sweating
- IV administration of
Hypertonic Solution,
Sodium Drugs..
- Intervention
- Drugs/IV
- FVE
- Dilute with Sodium Free IV fluids
- 5%
Dextrose &
Diuretics
- FVD
- Replace fluids orally with Isotonic or
Hypotonic Fluids
- 5% Dextrose
or 0.45 %
Sodium
Saline
- Slowly!!!
Anmerkungen:
- Rapid administration could cause rapid shift back into the cells causing cerebral edema.
- Patient Teaching
- On-Going & Monitoring
- 24 I & O
- Suction
Anmerkungen:
- Seizure (saftey for aspiration)
- Daily Weights
- Urine Specific Gravity >1.025
Anmerkungen:
- Increased Sodium & Fluid Deficit
- Thready Pulses, & flat Neck veins
Anmerkungen:
- Fluid deficit w/ Hypernatremia
- Tachycardia &
Tachypnea
- Changes in
Sensonurim
- Skin Turgor & Mucous Membranes
- Signs & Symptoms
- Diagnositcs
- Low Sodium Levels
- Symptomatic Hypernatremia is Rare
- Thirst , Dry Mouth, Dry Swollen Tongue, Sticky Mucosa
- Apprehension, Restless, Weakness
- Increased Fluid Retention & Increased BP
- Edema or Tenting
Anmerkungen:
- Edema associated with water excess & Tenting associated with fluid Deficit.
- Decreased Urine Output
- Fever Low grade
- Orthostatic Hypotension
- Flushed Skin
- Nursing Dx
Anmerkungen:
- Excessive water Loss or Excessive Sodium Intake
- Risk fo Injury
- Risk For Fluid Volume Deficit
- Risk For electrolyte Imbalance
- Potential Complications: Seizures & Coma leading to potential Complications
- Hyponatremia
- Causes
- Euvolemic Hyponatremia
Anmerkungen:
- Sodium Levels stay Near Normal. (Dilutional Effect)
- SIADH
- Sodium Free
Hypotonic IV
fluids
- Hypovolemic
Hyponatremia
Anmerkungen:
- Decreased Sodium & Water!
*Disaproportionately more Sodium Loss
- Vomiting, Diarrhea,
Diaphoresis, Excessive
Drainage wounds, Trauma
w/ excessive Blood Loss,
DIuretics
- Hypervolemic Hyponatremia
Anmerkungen:
- Increased Sodium & Water.
*Water is Porportionately more Increased!
- Edema
- Congestive Heart
Failure
- Renal Disease
- Nephrotic Syndrome
- Signs & Symptoms
- Decreased DTR
- Hypotension
- Diagnositics
- Low Sodium
- CNS 1st Signs
Anmerkungen:
- Cellular Swelling. Low concentration the fluid goes inside the cells.
- Headaches
- Confusion
- Irritability
- Seizure
- Coma
- Intervention
- Fluid Restriction
(Dilutional
Hyponatremia)
Anmerkungen:
- Dilutional Hyponatremia (fluid Volume Excess). Increased fluids can caused the opposite reaction Hypernatremia
- Severe (seizures)
- 3% Hypertonic
Saline
- SIADH
Treatment
- Vasopressins:
Convaptan & Tolvaptan
Anmerkungen:
- Convaptan: Increase Urine Output w/o loss of Electrolytes such as Na+ & K+. This should NOT be given to a patient with hyponatremia from excessive water loss. Tolvaptan is used in Heart Failure, Liver Cirrhosis and SIADH.
- Medications &
IV (Loss of Na+)
Anmerkungen:
- Eat More Salt!
- Administer Sodium IV
solution (Hypertonic)
Anmerkungen:
- Patient Teaching
- On-Going Monitoring
- Cerebral Edema
Anmerkungen:
- Is a potential Complication when Water moves excesively from extracellular space to Intracellular.
- Hypovolemia
Anmerkungen:
- The fluid will Shift from the less concentrated area to more concentrated. When extraacellular fluid moves into inctracellular there is an increased risk for Hypovolemia. Nurses need to monitor for this potential complication.
- Nursing Dx
- Risk For Injury
Anmerkungen:
- Related to Altered Sensorium & Decreased LOC
- Acute Confusion
- Potential Complications: Severe Neurologic Changes
Anmerkungen:
- If hyponatremia is left untreated, Irreversible neurologic damage can occur.
- Risk for Electrolyte Imbalance
- 135-145 mEq/L
- Critical Value: Below 120mE/L & Above 160mEq/L
- Saftey: High or Low Seizure Precaution
- Muscle
- Nerve
- Kidneys Regulate: Aldosterone, NP & ADH
Anmerkungen:
- Sodium Levels Regulated by the Kidneys. The main function of sodium is to Maintain Body Fluids. Low Sodium Levels Inhibit ADH & NP and trigger Aldosterone Secretion. High Sodium Inhibit Aldosterone and Secrete ADH & NP.
- Maintains Acid-Base Balance
- Maintain BP
- High Risk
Anmerkungen:
- GI loss
Eating Disorders
Continuous IVF
Diuretics