sodium

Question 1

What maintains osmotic pressure

Answer 1

Sodium

Question 2

When ingesting Na→ what happens

Answer 2

↑ serum osmolality→ thirst and release of ADH→ the kidneys retain water

Question 3

Sodium maintains

Answer 3

blood volume and blood pressure

Question 4

Water follows sodium and sodium also travels with what

Answer 4

Chloride

Question 5

Hyponatremia <133

Answer 5

Excess water accumulates and dilutes the normal Na concentration

Question 6

specific gravity for someone with hyponatremia

Answer 6

<1.008

Question 7

Two different volume issues can cause hyponatremia

Answer 7

hypervolemia and hypovolemia Hypovolemic hyponatremia is the most common

Question 8

what causes hyponatremia

Answer 8

*Diarrhea, Vomiting, Burns, Sweating (Insensible fluid loss)
*GI suctioning
*Drugs – more commonly seen with thiazide diuretics

Question 9

Signs and Symptoms (Think Neuro!)

Answer 9

*Neuro in type: Lethargy, Headache, Confusion, Apprehension, Seizures, Coma
*N/V, muscular weakness, & diminished reflexes
* Severe hyponatremia (<115) can lead to permanent neurological damage r/t cerebral edema

Question 10

Low volume (_____________) hyponatremia is the most common. It occurs when the plasma osmolality and volume is ______. Volume depletion causes release of ______, which causes ___________ of water and Na (but to a lesser degree – resulting in hyponatremia).

Answer 10

hypovolemia
low
ADH
retention

Question 11

what kind of assessment would you preform on a patient with hyponatremia

Answer 11

Focused Neuro Assessment

Question 12

Treat this with what IV solutions

Answer 12

NS or D5NS to slow the increase of Na

Question 13

While treating hyponatremia slow increases in serum Na is important to avoid

Answer 13

Neurological damage

Question 14

Another way to treat hyponatremia

Answer 14

increase Na in diet

Question 15

Extra water, retention of fluids (H2O) creates a

Answer 15

dilution effect

Question 16

Excess Volume (______________) hyponatremia

Answer 16

hypervolemic

Question 17

causes of hypervolemic hyponatremia

Answer 17

*Hypervolemia [Heart Failure (retention of fluids)]
*Continuous hypotonic solutions (D5W & D5.45NS or .45NS) – in critical care
*Malnutrition
*Addison’s disease (K retention and Na excretion because of inadequate release of aldosterone and cortisol)

Question 18

Treatment would include

Answer 18

*Fluid/water restriction
*Daily weights (#1 indicator of fluid imbalance)
*I & O
*Administer steroids (in case of Addison’s disease)
*Neuro Assessments

Question 19

Hypernatremia (>145) occurs when

Answer 19

too much water is lost or too much Na is consumed

Question 20

The most common cause of hypernatremia is

Answer 20

inadequate water intake (elderly), excess excretion of urine due to meds

Question 21

Other causes include

Answer 21

*Severe vomiting and diarrhea
*Steroids or Cushing Syndrome (promotes Na retention and K excretion because of additional release of aldosterone and cortisol)
*Stress cause release of cortical, which promotes Na retention and K excretion

Question 22

Signs and Symptoms of hyernatremia

Answer 22

*Thirst
*S/Sx of dehydration (fever, flushed skin, dry mucous membranes, tachycardia, decreased urine output, orthostatic hypotension)
*N/V & anorexia
*Severe Na levels – restlessness, irritability, cerebral edema (seizures and coma)

Question 23

Hypernatremia Treatment

Answer 23

Administering sodium free fluids (oral or IV). Infuse NS and free water (D5W) slowly.
*Daily Weight & I & O
*Sodium restriction

Question 24

Fast infusions may cause a sudden increase in serum Na, which may move fluids from the intravascular space into the cells and this can cause

Answer 24

(brain swelling being most dangerous) the pt. at risk for neurological damage