Introducing
Your new presentation assistant.
Refine, enhance, and tailor your content, source relevant images, and edit visuals quicker than ever before.
Trending searches
Factors
-Loss of GI Fluids
-Renal Disease
-Adrenal Insufficiency
-Head trauma
-Oat-cell lung tumor
-Psychogenic Polydipsia
-Heart failure
-Use of Diuretics
-Excessive administration of D5W and water supplements for patients receiving hypotonic tube feedings
-Medications associated with water retention (oxytocin and certain tranquilizers
-Hyperglycemia
(Hinkle & Cheever, 2018)
Definition
Refers to serum sodium level that is less than 135 mEq/L (135mmol/L)
Can present as acute or chronic form
Acute Hyponatremia is commonly the result of a fluid overload in a surgical patient.
Chronic Hyponatremia is seen more frequently in patients outside the hospital setting, has a longer duration, and has less serious neurological sequelae.
Exercise-associated hyponatremia occurs during extreme temperatures, because of excessive fluid intake before exercise, or prolonged exercise that results in a decrease in serum sodium.
(Hinkle & Cheever, 2018)
Signs and Symptoms with Rationale
-occurs with moderate to severe fluid loss
-occurs with moderate to severe fluid loss
-due to an osmotic shift of water into brain cells causing edema
-due to dehydration
-due to low blood volume
-due to an osmotic shift of water into brain cells causing edema
-due to dehydration
-due to dehydration
- related to the cellular swelling and cerebral edema associated with hyponatremia
-Hyponatremia can also be seen in severe restrictive eating disorders due to decreased ability of the kidney to excrete free water as a result of low nutritional intake.
-due to dehydration
-related to the cellular swelling and cerebral edema associated with hyponatremia
Incidence
Among hospitalized patients, 15-20% have a serum sodium level of < 135 mEq/L, while only 1-4% have a serum sodium level of less than 130 mEq/L. The prevalence of hyponatremia is lower in the ambulatory setting (Simon, 2019).
Surgical Management
Medical Management
- by mouth
- nasogastric tube
- parenteral route
(Hinkle & Cheever, 2018)
Pharmacologic Management
-Stimulate free water excretion
(Hinkle & Cheever, 2018)
Nursing Interventions: Hyponatremia
Knowledge
Hyponatremia
Chronic Hyponatremia
Acute Hyponatremia
Expected results of medications:
Evidence-Based Interventions: Hyponatremia
-Currently, fluid restriction recommendations in heart failure (HF) are based on expert opinion. After implementing a 1,000-mL/d fluid restriction for 60 days after discharge, outcomes were examined.The 1,000 mL/d fluid restriction led to improved QoL at 60 days after discharge.
-Accordingly, we suggest therapeutic goals of 6 to 8 mmol/L in 24 hours, 12 to 14 mmol/L in 48 hours, and 14 to 16 mmol/L in 72 hours. Inadvertent overcorrection owing to a water diuresis may complicate any form of therapy, including the newly available vasopressin antagonists. Frequent monitoring of the serum sodium concentration and urine output are mandatory. Administration of desmopressin to terminate an unwanted water diuresis is an effective strategy to avoid or reverse overcorrection.
-In patients with asymptomatic hyponatremia, slow correction is the appropriate approach. When patients are overtreated, neurologic damage can be prevented by relowering the serum sodium (SNa) so that the daily increase in SNa remains below 10 mmol/L/24 hours. Frequent measurements of SNa during the correction phase of SNa are mandatory to avoid overcorrection. The use of urea to treat hyponatremia represents an advantageous alternative to hypertonic saline.
Evaluation
Standards
Nursing Diagnosis:
Nursing Assessment:
Objective Cues:
Subjective Cues:
Goal: After 4 days of holistic nursing care, the client will be able to:
manifest no signs of dehydration as evidenced by maintained fluid volume.
Objective: After 8 hours of student - nurse client interaction, the client will be able to:
maintain fluid volume at a functional level as evidenced by stable vital signs, good skin turgor, good capillary refill, moist mucous membranes and adequate urinary output with normal specific gravity.
Nursing Actions: measures to promote balanced fluid volume
- Fluid replacement needs are based on the correction of current deficits and ongoing losses.
- Impaired gag and swallow reflexes, anorexia, oral discomfort, nausea, and changes in mentation are among factors that affect client’s ability to replace fluids orally.
- To prevent further dryness of the mucous membrane.
- Decreased cerebral perfusion frequently results in changes in mentation or altered thought process, requiring protective measures to prevent client injury
- helps restore water levels in the body, saline water helps in the treatment of symptoms such as lightheadedness and other dehydration related symptom
Priority Nursing Problem:
Goal: After 4 days of holistic nursing care, the client will be able to:
Normalize vital signs and laboratory results
Objective: After 8 hours of student nurse - client interaction, the client will be able to :
1. Achieve a heart rate within normal ranges
2. Attain normalized blood pressure
3. Display laboratory results within normal limits
4. Display absence of muscle weakness and neurological irritability
Nursing Actions:
- indicators of fluid balance are important because either fluid excess or deficit may occur with hyponatremia
- Sodium deficit may result in decreased mentation to the point of coma, as well as generalized muscle weakness, cramps, or convulsions.
- reduces CNS stimulation and risk of injury from neurological complications such as seizures
- Evaluates therapy needs and effectiveness
- effective in reducing fluid excess to correct sodium and water balance