Exam 1: Sodium Imbalances

Question 1

Most abundant electrolyte in ECF?

Answer 1

Na

Question 2

Concentration of Na?

Answer 2

135-145

Question 3

Primary role of Sodium?

Answer 3

Controlling water distribution throughout body, because it doesd not easily cross the cell wall membrane.

Question 4

What is Sodium regulated by?

Answer 4

ADH, Thirst, and RAAS

Question 5

Loss or gain or sodium is usually accompanied by?

Answer 5

Loss or gain of water

Question 6

SIADH may be associated with?

Answer 6

Sodium imbalance

Question 7

When is Arginine Vasopressin (AVP) released?

Answer 7

When there is a decrease in the circulating plasma osmolality, blood volume, or blood pressure

Question 8

What can oversecrection of AVP cause?

Answer 8

SIADH

Question 9

Sodium Deficit name?

Answer 9

Hyponatremia

Question 10

Sodium Excess Name?

Answer 10

Hypernatremia

Question 11

Hyponatremia Contributing Factors?

Answer 11

Loss of Sodium through diuretics, renal disease, gain of wwater, and disease states associated with SIADH

Question 12

Hyponatremia Signs/Symptoms

Answer 12

Anorexia, Nausea and Vomiting, Headache, Decreased BP/Pulse, Dry Skin, Weight Gain, Edema

Question 13

Hyponatremia Labs Indicate

Answer 13

Decreased Serum and Urine Sodium

Decreased Urine Specific Gravity and Osmolality

Question 14

Hypernatremia Contributing Factors

Answer 14

Fluid deprivation in patients who don’t respond to thirst.
Diabetes Insipidus
Watery Diarrhea

Question 15

Hypernatremia Signs/Symptoms

Answer 15

Thirst, Elevated Body Temperature, Seizures, Increased BP and Pulse

Question 16

Hypernatremia Labs Indicate

Answer 16

Increased Serum Sodium
Decreased Urine Sodium
Increased Urine Specific Gravity and Osmolality
Decreased Central Venous Pressure

Question 17

Hyponatremia refers to serum sodium level that is

Answer 17

less than 135 mEq / L

Question 18

Acute Hyponatremia is commonly the result of

Answer 18

a fluid overload in a surgical patient

Question 19

Chronic hyponatremia is more frequently

Answer 19

in patients outside a hospital setting, has longer duration

Question 20

Low Urine Sodium occurs as

Answer 20

the kidneys retains sodium to compensate for nonrenal fluid loss (vomiting, diarrhea, sweating)

Question 21

High Urine Sodium concentration is associated with

Answer 21

renal salt washing

Question 22

What medications increase the risk of hyponatremia?

Answer 22

Anticonvulsants, Oxcarbazepine, Levetiracetam, SSRIs, SErtraline, Paroxetine, or Desmopressin Acetate

Question 23

Neurologic changes of hyponatremia?

Answer 23

Altered mental status, status epilepticus and coma

Question 24

Hyponatremia: What happens as extracellular sodium level decreases?

Answer 24

The cellular fluid becomes relatively more concentrated and pulls water into the cells.

Question 25

Acute decreases in sodium may be associated with?

Answer 25

Brain herniation, and compression of midbrain strcutres

Question 26

What signs can ocur when Serum Sodium levels decreases to less than 115 mEq/L?

Answer 26

Signs of increasing intracranial pressure, such as lethargy, confusion, muscle twitching, focal weakness, hemiparesis, seizures, or death

Question 27

Sodium level in hyponatremia?

Answer 27

Less than 135 mEq/L

Question 28

Sodium level in SIADH?

Answer 28

May be lower than 100 mEq/L

Question 29

When hyponatremia is due primarily to sodium loss, the urinary sodium content is

Answer 29

less than 20 mEq/L, suggesting proximal reabsorption of sodium secondary to ECF volume depletion

Question 30

Hyponatremia SpG?

Answer 30

1.002 to 1.004

Question 31

Urinary Sodium Content and SpG when Hyponatremia due to SIADH?

Answer 31

Greater than 20 mEq.L and urine specific gravity is usually greater than 1.012

Question 32

Most common treatment for hyponatremia is?

Answer 32

Careful administration of sodium by mouth, nasogastric tube, or parenteral route

Question 33

Sodium replacement for patients who can eat and drink?

Answer 33

Sodium easily replaced because it is consumed abundantly in a normal diet

Question 34

Sodium replacement for those who cnanot consume sodium?

Answer 34

Lactated Ringer solution or isotonic saline (0.9% sodium chloride)

Question 35

usual daily sodium requirement in adults?

Answer 35

Approximately 100 mEq

Question 36

In patients with normal or excess fluid volume, hyponatremia is usually treated effectively by

Answer 36

restricting fluid

Question 37

Hyponatremia: Pharmacologic Therapy treatments?

Answer 37

AVP Receptor Antagonists Vaprisol Tolvaptan

Question 38

What do AVP Recceptor Antagonists do?

Answer 38

Pharmacologic agents that treat hyponatremia by stimulating free water excretion

Question 39

What does Vaprisol do?

Answer 39

Limited to hospitalized patients. May be useful therapy for those patients with moderate to severe symptomatic hyponatremia, but not those with seizures or in a coma

Question 40

What does Samsca do?

Answer 40

Oral medication for clinically significant hypervolemic and euvolemic hyponatremia

Question 41

Hyponatremia is a frequently overlooked cause of what?

Answer 41

Confusion in older patients who are at increased risk because of decreased renal function

Question 42

What should a nurse monitor?

Answer 42

I/O, Weight, and be alert for GI Manifestations

Question 43

Hypernatremia is

Answer 43

a serum sodium level higher than 145 mEq/L

Question 44

How is Hypernatremia caused?

Answer 44

By a gain of sodium in excess of water or by a loss of water in excess of sodium

Question 45

Hypernatremia can occur in patients with

Answer 45

normal fluid volume, or those with FVD or FVE

Question 46

Hypernatremia, what happens in water loss?

Answer 46

Patient loses more water than sodium, as a result, the sodium concentration icnreases and the increased concentration pulls fluid out of the cell

Question 47

Common cause of hypernatremia?

Answer 47

Fluid deprivation in patients who cannot respond to thirst.

Question 48

Less common causes of hypernatremia??

Answer 48

Heat Stroke, NEar Drowning in Sea Water, and Malfunction of hemodialysis or peritoneal dialysis systems

Question 49

Clinical manifestations of hypernatremia?

Answer 49

Are owing to increased plasma osmolality causedby an increase in plasma sodium concentration. Water moves out of the cell into the ECF

Question 50

Serum Sodium levels in hypernatremia?

Answer 50

> 145 mEq/L

Question 51

Serum Osmolality in Hypernatremia?

Answer 51

300 mOsm / kg

Question 52

Urine SpG and Urine Osmolality in hypernatremia?

Answer 52

Increased as kidneys attempt to converse water.

Question 53

Treatment of hypernatremia consists of

Answer 53

gradual lowering of the seurm sodium level by the infusion of a hypotonic electrolyte solution (0,3% sodium chloride) or an isotonic nonsaline solution (dextrose 5% in water).

Question 54

Why is Hypotonic thought to be safer than Isotonic?

Answer 54

Allows gradual reduction in the serum sodium level, thereby decreasing the risk of cerebral edema

Question 55

How should a nurse prevent hypernatremia?

Answer 55

By providing oral fluids at regular intervals

Question 56

How should a nurse prevent hypernatremia if patient unconscious?

Answer 56

By enteral feedings or by the parenteral route.