Sodium (Na+)
135-145 mEq/L
Essential for acid-base, fluid balance, active & passive transport mechanism, irritability & CONDUCTION of nerve-muscle tissue
Hypernatremia:
>145 mEq/L
Signs & Symptoms
FRIED SALT (Big & Bloated)
Flushed skin
Restless, anxious, confused, irritable
Increased BP & fluid retention
Edema (Pitting)
Decreased urine output
Skin flushed & dry
Agitation
Low-Grade fever
Thirst (dry mucous membranes)
Hypernatremia Risk Factors:
Increased sodium intake
- excess oral sodium ingestion
- excess administration of IV fluids w/ sodium
- hypertonic IV fluids
Loss of fluids
- fever
- watery diarrhea
- diabetes insipidus
- excessive diaphoresis
- infection
Decreased sodium excretion
- kidney problems
HEMOCONCENTRATION = INCREASED SODIUM
Hypernatremia Interventions:
If due to loss:
- administer IV infusion
If the cause is inadequate renal excretion of sodium
- give diuretics that promote sodium loss
Restrict sodium & fluid intake as prescribed
Hyponatremia:
<135 mEq/L
Signs & Symptoms:
HYPOVOLEMIC / HYPONATREMIA: DECREASE OF FLUID & SODIUM
HYPERVOLEMIC / HYPONATREMIA: INCREASE BODY WATER THAT IS GREATER THAN SODIUM
SALT LOSS
Stupor/coma
Anorexia ( nausea/ vomiting)
Lethargy (weakness/ fatigue)
Tachycardia (thready pulse)
Limp muscles
Orthostatic hypotension
seizures/ headache
stomach cramping (hyperactive bowels)
Hyponatremia Risk Factors:
Increased sodium excretion
4 D's
-diaphoresis (high fever)
-diarrhea & vomiting
-drains (NGT suction)
-diuretics (thiazide & loop diuretics)
SIADH
Adrenal insufficiency (adrenal crisis)
Inadequate sodium intake
-fasting, NPO, low-salt diet
-kidney disease
heart failure
Hyponatremia Interventions:
ADD SALT
Administer IV sodium chloride infusions (only if due to hypovolemia)
Diuretics (if due to hypervolemia) Hyponatremia-high fluids & low salt = hemodilution
Daily weights: where sodium goes, water flows
Safety (orthostatic hypotension AKA risk for falls)
Airway protection (NPO) Do not give food to a lethargic, confused client can lead to an increased risk for aspiration
Limit water intake: hypervolemic hyponatremia (high fluid & low salt)
Teach about foods high in sodium (canned food, packaged/ processed meats