Sodium (Regular, Hypo, & Hypernatremia) Flashcards
What are the functions of sodium (5)
maintain bp
blood volume
pH balance (acid-base)
controlling nerve impulses
stimulating muscle contractions
Sodium makes a big impact on the body’s what
fluid balance
sodium is a major electrolyte in which cellular fluid
extracellular fluid
what does sodium control the balance of in the body
controls water balance
sodium is regulated by which hormones and what pump in the body
ADH & aldosterone hormones
Na+ & K+ pump
what should we be most concerned about when we are looking at sodium (3)
brain
do neuro checks
safety
what level does it need to be for a pt to be hyponatremic
less than 135
what are the causes of hyponatremia (7)
dilution of sodium
SIADH
Water intoxication
psychogenic polydipsia
hypotonic fluids
inadequate sodium intake
increased sodium secretion
how does SIADH cause hyponatremia
the impaired water excretion caused by the inability to suppress secretion of ADH; water retention causes dilutional hyponatremia
how does water intoxication cause hyponatremia
retaining fluid & sodium causing hemodilution of sodium
how does psychogenic polydipsia cause hyponatremia
when there is excessive fluid intake w/out psychological stimuli
how do hypotonic fluids cause hyponatremia
shift solutes into the cell
how does inadequate sodium intake cause hyponatremia
if the pt is fasting/NPO
if the pt intakes a low amount of sodium
what factors increase Na+ excretion (4)
4 D’s: diarrhea, diuretics, drainage, diaphoresis
Vomiting
Kidney disease
Hypoaldosteronism (Addison’s)
-sodium loss & water retention
there are three types of hyponatremia, what are they
euvolemic
hypovolemic
hypervolemic
what does euvolemic mean
low sodium with (ECF) voulme normal
what does hypovolemic mean
sodium loss with ECF volume depletion
what does hypervolemic mean
sodium loss with increased ECF volume
how will a patient present if they have severe hyponatremia (4)
seizures
brainstem herniation
respiratory arrest
death
how will a pt present if they have moderate hyponatremia (3)
lethargy
weakness
altered LOC
how will a pt present if they have mild hyponatremia (3)
headache
nausea/vomiting
fatigue
how do we intervene when a pt has hyponatremia (3)
replace sodium slowly
stop sodium wasting diuretics
provide IV fluids/meds
what should we avoid when replacing sodium
avoid fluid overload
why do we avoid fluid overload when replacing sodium
this is due to fluid shifting with the sodium
what can happen if we replace sodium too fast
can cause neuro damage
how much MAXIMUM sodium are we allowed to give a pt
0.5 mEq/L per hr
how many pints of sodium can we give in a 24 hr period
6-12 pts
how often do we check Na+ levels when replacing the sodium
every 2-4 hours
what sodium wasting loop diuretics do we need to stop
thiazides
what diuretic may we need to start in a pt w/ hyponatremia
spironolactone
when a pt is a hypovolemic what fluid can we give to correct fluid volume status and Na+
0.9% NS
when a pt is a hypovolemic what fluid do we give when a pt is severely hypovolemic
3% NS
what line do we give 3% NS in
a central line
When a pt is hypervolemic what med should we give and what should we restrict
give osmotic diuretics (mannitol) and fluid restrictions
when a pt is euvolemic, what syndrome do they have
SIADH
what type of fluid do we admin and how much per liter should we admin when a pt is a severe hyponatremic
3% NS and less than 120 mEq/L
how many liters of 3% NS should we give in a 24 hour period
no more than 6-12 in first 24 hours
what should we insert for strict I&O
a foley cath
what checks should we perform in a sever hypnatremic pt
neuro checks
how often should we perform nero checks for the hyponatremic pt
every 2-4 hrs
what type of rest should the hyponatremic pt be placed on
pt should be on bedrest
what is a key component in the care of a hyponatremic pt
safety
what happens is sodium is overcorrected too quickly (2)
damage to nerve cells in the brain
locked-in syndrome
when a pt has SIADH they have high levels of what hormone which causes the body to retain what
ADH and retain water
SIADH upsets the electrolytes but which electrolyte is especially upset
Sodium
In SIADH what retention is increased
water retention
Is sodium increased or decreased in SIADH
decreased
SIADH means the pt is what inside
soaked inside
SIADH causes what 3 diseases
Small cell lung cancer
Severe brain trauma
Sepsis infections of the brain
do SIADH pt’s pee a lot of very little
very little to none at all
where is ADH created
in the pituitary gland
what does ADH do
adds the h20
what meds are synthetic ADH
desmopressin
vasopressin
does ADH increase or decrease urine output
decreases urine output
how is the bp affected when there is ADH in the body
the bp goes up
what symptom should we watch for in SIADH
headaches
what low sodium cause neurologically (2)
seizures
death
what are the treatments for SIADH (5)
fluid restriction
demeclocycline
diuretics
increase oral sodium intake
Daily wt & I&Os
how much fluid are SIADH pt’s allowed to have
800-1000mL/day
what does demeclocycline block the affect of
blocks effect of ADH
what does the affect of demeclocycline result in SIADH
results in more dilute urine
how can we increase oral sodium intake for SIADH (3)
salt tabs
bacon
processed foods
how can we treat SIADH
with hypertonic saline
what level does it have to be for a pt to be hypernatremic
greater than 145
what causes hypernatremia (8)
decreased sodium excretion
corticosteroids
cushing’s syndrome
hyperaldosteronism
kidney disease
increased sodium intake
decreased water intake
increased water loss (hemoconcentration)
how do corticosteroids cause hyponatremia
causes kidneys to retain sodium
how does Cushing’s syndrome occur
occurs due to prolonged exposure to glucocorticoids (prednisone) or a tumor producing excessive cortisol adrenals
what can cushing’s cause
hyperaldosteronism
hyperaldosrteronism causes the body to have high what and retain what
have high sodium and retain water
What level is severe hypernatremia defined as
greater than 160
what increases the oral sodium intake (3)
eating too much sodium or processed foods
alka seltzer
asprin
what can increase your sodium intake via IV
hypertonic solutions: 3% or 5% NS
what is the pt doing/what diet order do the have if their water intake is decreased
they are fasting
diet order NPO
what can cause increased water loss (hemoconcentration) (3)
dehydration: too much water loss and sodium gain
infection
diabetes insipidus
what interventions will we perform for hypernatremia (10)
bring sodium levels down slowly
provide IV fluids/meds
Diuretics
Avoid meds that cause hypernatremia
Restrict sodium & fluid intake as prescribed
Free water intake to help hemodilution
Pt safety
daily wt
I&O
Neuro checks
what happens if we bring down sodium too quickly
rapid correction can lead to seizures due to quick fluid shift
what fluids should we admin for hypernatremia
admin IV fluids infusion in case pt have fluid loss
hypotonic solutions: 1/2 NS & D5W
why should we admin diuretics for hypernatremia?
due to inadequate renal excretion
what diuretics should we admin for pt’s that have hypernatremia
loop diuretics; thiazides
What are mild symps of hypernatremia (3)
faint feeling
muslce fatigue
weakness
what are the moderate symps of hypernatremia (monitor closely) (7)
confusion
irritability
swollen & dry red tongue
hyperflexia
muscle twitching
edema
thirst
what are the severe symps of hypernatremia (4)
nausea & vomiting
increased muscle tone
seizures
coma
When you have diabetes insipidus what hormone is being insufficiently produced
ADH
Insufficient ADH being produced causes what to happen with the kidneys
the kidneys produced a lot of urine
what does diabetes insipidus equal
hyeprnatremia
DI means what inside
dry inside
DI means that there is increased what in the body and diluted what coming out of the body
increased sodium & diluted urine
what can DI cause in the body (3)
damage to brain
tumors
trauma
When a pt has DI what two symps will they likely have (2)
polydipsia
polyuria
how much urine can a DI pt excrete per hour
greater than 200mL/hr
how can we treat DI
with DDAVP (ADH)
