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HYPERNATREMIAHYPERNATREMIA

andandHYPONATREMIAHYPONATREMIA

(Sodium)(Sodium)Submitted by:

Ayes, FedelaineAyes, FedelaineLongcanaya, ReymondLongcanaya, Reymond

Piano, MenissaPiano, MenissaSacay, Shiela MaeSacay, Shiela MaeCorregidor, Maria LeofeCorregidor, Maria Leofe

Submitted to:

Mrs. Rowena AngMrs. Rowena AngClinical Instructor

SodiumSodium

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- A cation which is the most abundant electrolyte in theextracellular fluid

- Normal count ranges 135-145 mEq/L

Functions of SodiumFunctions of Sodium Maintaining the tonicity and concentration of extracellular

fluid

Acid-base line (reabsorption of sodium ions and excretion ofhydrogen ions)

Nerve conduction

Neuromuscular function

Glandular secretion

Water balance

Sources of SodiumSources of Sodium Table salt Baking soda Condiments Monosodium glutamate Additives Food seasonings Meat Fish Poultry Eggs Pickled foods Olives

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Sodium Electrolyte ImbalancesSodium Electrolyte Imbalances

HYPERNATREMIAHYPERNATREMIA- Excessive serum levels of the sodium cation relative to body

water

PathophysiologyPathophysiology

Increased sodium intake

Sodium levels increase

Water shift from cells to the ECF

Cellular dehydration

Decreased myocardial contractility

Aldosterone and ADH are suppressed

Signs and SymptomsSigns and Symptoms Dry, swollen tongue

Flushed skin

Hypertension, dyspnea (with hypervolemia)

Low-grade fever

Orthostatic hypotension and oliguria

Sticky mucous mebrane

Twitching

Nursing DiagnosisNursing Diagnosis Deficient knowledge

Disturbed thought process

Ineffective tissue perfusion: cardiopulmonary

Risk for deficient fluid volume

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Risk for injury

Management:Management:

MedicalMedical

Activity, as tolerated Administration of salt-free solutions (such as dextrose in

water) followed by infusion of half-normal saline solution toprevent hyponatremia

Discontinuation of drugs that promote sodium retention Sodium-restricted diet

NursingNursing Obtain a drug history to check for drugs that promote

sodium retention.

Assist with oral hygiene.

Watch for signs of cerebral edema during fluid replacementtherapy.

PharmacologicPharmacologic Diuretics

Vasopressin if the patient has diabetes insipidus

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HYPONATREMIAHYPONATREMIA- Serum sodium level less than 135 mEq/L

PathophysiologyPathophysiology

Excessive water intake

Sodium level decreases

Intracellular edema

Brain herniation

Brain cells compensate by;Reducing cerebral blood flow

Shifting CSFDecreasing brains osmolality

Signs and SymptomsSigns and Symptoms Dry mucous membrane

Orthostatic hypotension

Poor skin turgor

Rales or crackles

Rapid, bounding pulse

Nursing DiagnosisNursing Diagnosis Acute confusion

Decreased cardiac output

Impaired oral mucous membrane

Ineffective breathing pattern

Nausea

Risk for injury

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Management:Management:

MedicalMedical Activity, as tolerated High-sodium diet Restricted fluid intake

NursingNursing Restrict fluid intake

Give prescribed I.V. fluids.

Provide a safe environment.

Institute seizure precautions, if needed.

PharmacologicPharmacologic Demeclocycline or lithium

Hypertonic (3% or 5%) saline solution (with serum sodiumlevels below 110mEq/L)

Normal saline solution

Oral sodium supplements