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IM2 > Sodium (Regular, Hypo, & Hypernatremia) > Flashcards

Sodium (Regular, Hypo, & Hypernatremia) Flashcards

1
Q

What are the functions of sodium (5)

A

maintain bp
blood volume
pH balance (acid-base)
controlling nerve impulses
stimulating muscle contractions

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2
Q

Sodium makes a big impact on the body’s what

A

fluid balance

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3
Q

sodium is a major electrolyte in which cellular fluid

A

extracellular fluid

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4
Q

what does sodium control the balance of in the body

A

controls water balance

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5
Q

sodium is regulated by which hormones and what pump in the body

A

ADH & aldosterone hormones
Na+ & K+ pump

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6
Q

what should we be most concerned about when we are looking at sodium (3)

A

brain
do neuro checks
safety

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7
Q

what level does it need to be for a pt to be hyponatremic

A

less than 135

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8
Q

what are the causes of hyponatremia (7)

A

dilution of sodium
SIADH
Water intoxication
psychogenic polydipsia
hypotonic fluids
inadequate sodium intake
increased sodium secretion

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9
Q

how does SIADH cause hyponatremia

A

the impaired water excretion caused by the inability to suppress secretion of ADH; water retention causes dilutional hyponatremia

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10
Q

how does water intoxication cause hyponatremia

A

retaining fluid & sodium causing hemodilution of sodium

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11
Q

how does psychogenic polydipsia cause hyponatremia

A

when there is excessive fluid intake w/out psychological stimuli

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12
Q

how do hypotonic fluids cause hyponatremia

A

shift solutes into the cell

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13
Q

how does inadequate sodium intake cause hyponatremia

A

if the pt is fasting/NPO
if the pt intakes a low amount of sodium

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14
Q

what factors increase Na+ excretion (4)

A

4 D’s: diarrhea, diuretics, drainage, diaphoresis
Vomiting
Kidney disease
Hypoaldosteronism (Addison’s)
-sodium loss & water retention

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15
Q

there are three types of hyponatremia, what are they

A

euvolemic
hypovolemic
hypervolemic

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16
Q

what does euvolemic mean

A

low sodium with (ECF) voulme normal

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17
Q

what does hypovolemic mean

A

sodium loss with ECF volume depletion

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18
Q

what does hypervolemic mean

A

sodium loss with increased ECF volume

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19
Q

how will a patient present if they have severe hyponatremia (4)

A

seizures
brainstem herniation
respiratory arrest
death

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20
Q

how will a pt present if they have moderate hyponatremia (3)

A

lethargy
weakness
altered LOC

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21
Q

how will a pt present if they have mild hyponatremia (3)

A

headache
nausea/vomiting
fatigue

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22
Q

how do we intervene when a pt has hyponatremia (3)

A

replace sodium slowly
stop sodium wasting diuretics
provide IV fluids/meds

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23
Q

what should we avoid when replacing sodium

A

avoid fluid overload

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24
Q

why do we avoid fluid overload when replacing sodium

A

this is due to fluid shifting with the sodium

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25
Q

what can happen if we replace sodium too fast

A

can cause neuro damage

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26
Q

how much MAXIMUM sodium are we allowed to give a pt

A

0.5 mEq/L per hr

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27
Q

how many pints of sodium can we give in a 24 hr period

A

6-12 pts

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28
Q

how often do we check Na+ levels when replacing the sodium

A

every 2-4 hours

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29
Q

what sodium wasting loop diuretics do we need to stop

A

thiazides

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30
Q

what diuretic may we need to start in a pt w/ hyponatremia

A

spironolactone

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31
Q

when a pt is a hypovolemic what fluid can we give to correct fluid volume status and Na+

A

0.9% NS

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32
Q

when a pt is a hypovolemic what fluid do we give when a pt is severely hypovolemic

A

3% NS

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33
Q

what line do we give 3% NS in

A

a central line

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34
Q

When a pt is hypervolemic what med should we give and what should we restrict

A

give osmotic diuretics (mannitol) and fluid restrictions

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35
Q

when a pt is euvolemic, what syndrome do they have

A

SIADH

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36
Q

what type of fluid do we admin and how much per liter should we admin when a pt is a severe hyponatremic

A

3% NS and less than 120 mEq/L

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37
Q

how many liters of 3% NS should we give in a 24 hour period

A

no more than 6-12 in first 24 hours

38
Q

what should we insert for strict I&O

A

a foley cath

39
Q

what checks should we perform in a sever hypnatremic pt

A

neuro checks

40
Q

how often should we perform nero checks for the hyponatremic pt

A

every 2-4 hrs

41
Q

what type of rest should the hyponatremic pt be placed on

A

pt should be on bedrest

42
Q

what is a key component in the care of a hyponatremic pt

A

safety

43
Q

what happens is sodium is overcorrected too quickly (2)

A

damage to nerve cells in the brain
locked-in syndrome

44
Q

when a pt has SIADH they have high levels of what hormone which causes the body to retain what

A

ADH and retain water

45
Q

SIADH upsets the electrolytes but which electrolyte is especially upset

A

Sodium

46
Q

In SIADH what retention is increased

A

water retention

47
Q

Is sodium increased or decreased in SIADH

A

decreased

48
Q

SIADH means the pt is what inside

A

soaked inside

49
Q

SIADH causes what 3 diseases

A

Small cell lung cancer
Severe brain trauma
Sepsis infections of the brain

50
Q

do SIADH pt’s pee a lot of very little

A

very little to none at all

51
Q

where is ADH created

A

in the pituitary gland

52
Q

what does ADH do

A

adds the h20

53
Q

what meds are synthetic ADH

A

desmopressin
vasopressin

54
Q

does ADH increase or decrease urine output

A

decreases urine output

55
Q

how is the bp affected when there is ADH in the body

A

the bp goes up

56
Q

what symptom should we watch for in SIADH

A

headaches

57
Q

what low sodium cause neurologically (2)

A

seizures
death

58
Q

what are the treatments for SIADH (5)

A

fluid restriction
demeclocycline
diuretics
increase oral sodium intake
Daily wt & I&Os

59
Q

how much fluid are SIADH pt’s allowed to have

A

800-1000mL/day

60
Q

what does demeclocycline block the affect of

A

blocks effect of ADH

61
Q

what does the affect of demeclocycline result in SIADH

A

results in more dilute urine

62
Q

how can we increase oral sodium intake for SIADH (3)

A

salt tabs
bacon
processed foods

63
Q

how can we treat SIADH

A

with hypertonic saline

64
Q

what level does it have to be for a pt to be hypernatremic

A

greater than 145

65
Q

what causes hypernatremia (8)

A

decreased sodium excretion
corticosteroids
cushing’s syndrome
hyperaldosteronism
kidney disease
increased sodium intake
decreased water intake
increased water loss (hemoconcentration)

66
Q

how do corticosteroids cause hyponatremia

A

causes kidneys to retain sodium

67
Q

how does Cushing’s syndrome occur

A

occurs due to prolonged exposure to glucocorticoids (prednisone) or a tumor producing excessive cortisol adrenals

68
Q

what can cushing’s cause

A

hyperaldosteronism

69
Q

hyperaldosrteronism causes the body to have high what and retain what

A

have high sodium and retain water

70
Q

What level is severe hypernatremia defined as

A

greater than 160

71
Q

what increases the oral sodium intake (3)

A

eating too much sodium or processed foods
alka seltzer
asprin

72
Q

what can increase your sodium intake via IV

A

hypertonic solutions: 3% or 5% NS

73
Q

what is the pt doing/what diet order do the have if their water intake is decreased

A

they are fasting
diet order NPO

74
Q

what can cause increased water loss (hemoconcentration) (3)

A

dehydration: too much water loss and sodium gain
infection
diabetes insipidus

75
Q

what interventions will we perform for hypernatremia (10)

A

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

76
Q

what happens if we bring down sodium too quickly

A

rapid correction can lead to seizures due to quick fluid shift

77
Q

what fluids should we admin for hypernatremia

A

admin IV fluids infusion in case pt have fluid loss
hypotonic solutions: 1/2 NS & D5W

78
Q

why should we admin diuretics for hypernatremia?

A

due to inadequate renal excretion

79
Q

what diuretics should we admin for pt’s that have hypernatremia

A

loop diuretics; thiazides

80
Q

What are mild symps of hypernatremia (3)

A

faint feeling
muslce fatigue
weakness

81
Q

what are the moderate symps of hypernatremia (monitor closely) (7)

A

confusion
irritability
swollen & dry red tongue
hyperflexia
muscle twitching
edema
thirst

82
Q

what are the severe symps of hypernatremia (4)

A

nausea & vomiting
increased muscle tone
seizures
coma

83
Q

When you have diabetes insipidus what hormone is being insufficiently produced

A

ADH

84
Q

Insufficient ADH being produced causes what to happen with the kidneys

A

the kidneys produced a lot of urine

85
Q

what does diabetes insipidus equal

A

hyeprnatremia

86
Q

DI means what inside

A

dry inside

87
Q

DI means that there is increased what in the body and diluted what coming out of the body

A

increased sodium & diluted urine

88
Q

what can DI cause in the body (3)

A

damage to brain
tumors
trauma

89
Q

When a pt has DI what two symps will they likely have (2)

A

polydipsia
polyuria

90
Q

how much urine can a DI pt excrete per hour

A

greater than 200mL/hr

91
Q

how can we treat DI

A

with DDAVP (ADH)

IM2 (17 decks)

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