sodium Flashcards
Sodium is
main cation of ECF
Function of sodium
generation and transmission of nerve impulse, muscle contractility, and regulation of acid base balance
how does sodium leave the body?
urine, sweat, and feces
what is the primary regulator of sodium balance
kidneys
how does the kidneys regulate the ECF concentration of sodium
by excreting/retaining water under the influence of ADH
What does Aldosterone do?
regulates sodium by promoting sodium reabsorption from renal tubule
serum sodium levels reflect
ratio of sodium to water
change in serum sodium levels can reflect
water and sodium imbalance
Sodium Labs
135-145 mEq/L
Hypernatremia- Pts who are at risk
(high sodium)
water loss/sodium gain
causes hyperosmolality
what is hyperosmolality?
shift of water out of the cells (cellular dehydration)
Hypernatremia- what does sodium retention cause?
RF
Hypernatremia- how to get sodium
OTC meds, dietary sodium, corticosteroids
Hypernatremia- water loss
water deprivation: cognitive impairment= pt cant communicate their needs
diabetes insipidus: problems with ADH (synthesis/release); causes diuresis (inc urine)
Hypernatremia- CNS
early: restless, agitation, muscle twitch, dec alertness
later/severe: lethargy, weakness, dec DTRs (assess pt’s level of skeletal muscle strength)
as sodium inc (muscle and nerve controlled by sodium) less likely to respond to stimulus (severe)
Hypernatremia- CV
dec contractility
hypernatremia- ECF volume deficit
postural hypotension weakness
dec skin turgor
Hyponatremia- Pts who are at risk
low serum sodium
water excess in relation to amount of sodium (dilutional hyponatremia)
What causes hyponatremia?
diaphoresis (sweating), draining wounds, excessive D/V and trauma with significant blood loss
What does hyponatremia cause?
hypoosmolality with shift of water into the cell
hyponatremia- increase water (FVE)
excessive ADH
SIADH (result in dilutional hyponatremia caused by abnormal water retention)
CHF/HF- heart isnt pumping; body retaining fluid
hyponatremia- inc excretion(fluid and sodium loss)
renal loss
GI loss- sodium, potassium, chloride (lose electrolytes- diarrhea)
hormonal- lack of aldosterone
What is due to hyponatremia?
cellular swelling
first manifested in CNS
what does excess water for hyponatremia do?
lowers plasma osmolality, shifting fluids into brain cells;
causing: irritability, headache, confusion, seizures, and coma
hyponatremia- neurological
cerebral edema (inc ICP); confusion, HA
Hyponatremia- CV
hypervolemia (too much fluid volume in blood)
hypovolemia
hyponatremia- musculoskeletal
dec DTR (patellar & achillies)
hyponatremia- respiratory
skeletal muscle weakness can affect respiratory
hyponatremia- GI
smooth muscle- inc motility
cramping, N/V
hypernatremia- nursing Dx- risk
risk for injury: alt sensorium and seizure; FVD related to excessive intake of sodium and/or water loss; electrolyte imbalance
impaired memory
hypernatremia- nur Dx- potential complications
seizure and coma leading to irreversible brain damage
hypernatremia- nur Dx-Dec CO
dec contractility
hypernatremia- nur Dx-falls
skeletal muscle weakness
hyponatremia- nur Dx-risk for:
acute confusion
alt sensorium and dec LOC
electrolyte imbalance- excessive loss of sodium and/or excessive intake or retention of water
hypernatremia- nur Dx-potential complications
severe neurologic changes
hypernatremia- nur Dx
nausea, acute confusion, fatigue (skeletal muscle weakness), falls, alt nutrition, knowledge deficit, activity intolerance, imbalance fluid volume, dec CO
hypernatremia- Goals: treat-
treat primary water deficit, fluid replacement (orally/IV) with isotonic/hypotonic fluids (5DW)
dilute sodium concentration with sodium free IV fluids
hypernatremia- Goals: monitor-
I&O: losing/gaining fluids(weight)
LOC
sodium levels: if you reduce serum sodium levels, it can cause a rapid shift of water back into the cell (cerebral edema and neurologic complications)
restrict sodium intake
hyponatremia- Goals: treat-
fluid is often only treatment
if seizure; small amounts of IV hypertonic solution
abnormal fluid loss: fluid replacement with sodium-containing solutions
hyponatremia- Goals/treat- administer
administer: saline IVF osmotic diuretics(mannitol- osmitrol)
