Sodium - Electrolytes

Question 1

Sodium is the major electrolyte of what?
what is the range?

Answer 1

Major electrolyte of the ECF
135-145
*ECF sodium levels effect ICF:

Question 2

Serum Sodium (blood Na) = Dilute ECF, does what?

Answer 2

H20 drawn into the cell

Question 3

Serum Sodium (blood Na) = Concentrated, does what?

Answer 3

H20 pulled out of the cell

Question 4

If sodium is in the cell, where is potassium?

Answer 4

moves outside of the cell

Question 5

where is sodium obtained? and where is it excreted?

Answer 5

obtained through the diet and excreted from the kidneys

Question 6

what are the 3 major functions of sodium?

Answer 6

1. BP
2. Blood Volume
3. PH balance

Question 7

What regulates sodium?

Answer 7

ADH (anti-diuretic hormone)
Aldosterone (holds sodium inside the body by blocking it at the kidneys)
Sodium- potassium pump (moves sodium out of the cell by ATP)

Question 8

what are some causes of HYPOnatremia?
“NONA”

Answer 8

“N”a+ excretion increase w/renal problems, NG suction, vomiting, diuretics, sweating, diarrhea, decreased secretion of aldosterone (DI)
“O”verload of fluid (CHF, RF, hypotonic fluids infusion)
“N”a+ intake low (low salt diet, NPO)
A”ntidiuretic hormone oversecretion (SIADH)

Question 9

S/S of HYPOnatremia:
“SALT LOSS”

Answer 9

“S”eizures & Stupor
“A”bdominal cramping, attitude changes (confusion)
“L”ethargic
“T”endon reflexes diminished, trouble concentrating (confused)
L”oss of urine & appetite
“O”rthostatic hypotension, overactive bowel sounds
“S”hallow respirations (happens late due to skeletal muscle weakness)
“S”pasms of muscles

Question 10

HYPOnatremia Lab Values:
4

Answer 10

1. Serum Na+ < 135 mEq/L
2. Serum osmolality < 280 mOsm/kg
3. Urinary Na+ < 20 mEq/L
4. Urine specific gravity < 1.010

Question 11

Medical Treatment for HYPOnatremia:

Answer 11

1. Na replacement by mouth, IV, or NGT
   2.Can use LR, NS
   When replacing Na, watch for signs of fluid overload or pulmonary edema

Question 12

what is the rule of thumb when replacing sodium?

Answer 12

Rule of thumb: serum Na must not be increased > 12 mEq/L in 24 hours.

Question 13

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Answer 13

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Question 14

Nursing interventions for HYPOnatremia?

Answer 14

1. Identify pt. at risk
2. Monitor labs, I&O, daily weight
3. Review medications: lithium w low sodium which can cause lithium toxicity it can affect the electrolytes
4. GI manifestations
5. Monitor for S/S of hyponatremia
6. Monitor for neurological changes
7. Oral hygiene

Question 15

what are the causes of HYPERnatremia ?
think “HIGH SALT”

Answer 15

“H”ypercortisolism (Cushing’s Syndrome, hyperventilation)
“I”ncreased intake of sodium (oral or IV route)
“G”I feeding (tube) without adequate water supplements
“H”ypertonic solutions
“S”odium excretion decreased and corticosteroids
“A”ldosteronism (hyper)
“L”oss of fluids (infection, sweating, diarrhea, DI
“T”hirst impairment

Question 16

S/S of HYPERnatremia:
think * no FRIED food*

Answer 16

1. F”ever, flushed skin
2. “R”estless, really agitated
3. “I”ncreased fluid retention
4. “E”dema, extremely confused
5. “D”ecreased urine output, dry mouth/skin

Question 17

HYPERnatremia Lab Values:

Answer 17

Serum Na+ > 145 mEq/L
Serum osmolality > 300 mOsm/L
Urine specific gravity > 1.015

Question 18

HYPERnatremia medical treatment includes what? 5

Answer 18

1. serum Na+ level gradually
2. approx. 0.5-1mEq/L/hr over 48 hrs
3. Monitor for neuro changes & cerebral edema
4. Hypotonic solution D5W or 0.45% NS
5. Desmopressin (DDAVP)

Question 19

HYPERnatremia nursing interventions include what?

Answer 19

1. Identify pt at risk
2. Monitor fluid loss / gain
   Labs and ORAL Na Intake
3. Neuro precautions and behavior changes
4. Offer fluids
5. Note medication with Na+ content