QUIZ 2 ELECTROLYTE IMBALANCES Flashcards
Sodium imbalances:
Hypernatremia & Hyponatremia
IMPORTANCE of NA in many physiologic functions
- facilitating impulse transmission in nerve muscle fibers by participating in the sodium-potassium pump.
- assists in acid-base balance by combining bicarbonate and chloride.
↑ serum Na+ >145 mEq/L
urine specific gravity >1.025
Hypernatremia
Signs and Symptoms
FRIED
Fever-low grade , Flushed skin
Restless (irritable)
Increased fluid retention
EDema ( peripheral and pitting)
Decrease urine output, Dry mouth
Signs and Symptoms (too much salt)
SALT
Skin flushed
Agitation
Low grade fever
Thirst
Nursing Management
Restrict Na+ (butter, bacon, canned, processed food, pizza, chips
Encourage to eat banana, oranges, apples, fresh fruits and vegetables
Refrain from using condiments.
Daily weight & vital signs monitoring
Monitor & record 24 hr Intake & output
Documentation
With bipedal pitting edema grade ++ . Kept elevated and supported with a pillow.
Grading of edema: 6mm deep pit 10-12 sec to rebound
3+
Grading of edema: 4mm a few sec to rebound
2+
Grading of edema: 2 mm depression immediate rebound
1+
Grading of edema: 8 mm very deep pit > 20 sec to rebound
4+
AVPU
Awake
Verbal
Pain
Unresponsive
↓ serum Na+ <135 mEq/L
Urine specific gravity <1.005
Hyponatremia
Signs and Symptoms: HYPONATREMIA
SALT
Stupor/Coma
Anorexia
Lethargy
Tendon reflexes ↓↓ - Depressed DTR
DEEP TENDON REFLEXES: GRADING
Brisker than average, slightly hyperreflexic
3+
very brisk, hyperactive, with clonus
4+
Somewhat diminished, low normal
1+
Average, expected response; normal
2+
No response, absent
0+
Signs and Symptoms (Loss)
Limp muscles
Orthostatic hypotension
Seizures
Stomach cramping
For Hypovolemic Hyponatremia
Hypertonic 0.3% NS - slow IV infusion via central line.
***Watch out for fluid overload!
. For Hypervolemic Hyponatremia
Restrict fluid intake and in some cases administer diuretics to excretion the extra water rather than sodium to help concentrate the sodium.
***If the patient has renal impairment they may need dialysis.
Euvolemic Hyponatremia
Caused by SIADH antidiuretic hormone problems: fluid restriction or treated with antidiuretic hormone antagonists called Declomycin (don’t give with food especially dairy or antacids…bind to cations and this affect absorption).
Common Nursing Management in Sodium Imbalance
Weigh daily.
Accurately document intake and output.
Watch for signs and symptoms of fluid overload or dehydration.
Monitor serial serum electrolyte levels.
Nutrition interventions (optimizing the patient’s oral intake, providing oral nutrition supplements, and administering enteral and parenteral nutrition.)
