by: janel canty rns (osborn, 2010). objectives to understand hyponatremia to be able to recognize...
Post on 24-Dec-2015
216 Views
Preview:
TRANSCRIPT
ObjectivesTo understand HyponatremiaTo be able to recognize hyponatremia in a
clinical settingBe able to apply to identify what a medical
professionals would do with a patient with hyponatremia
(Osborn, 2010)
Pathophysiology of hyponatremia This is defined as sodium below the normal range that the human body requires for normal functioning. Sodium is the most numerous cation in the extracellular fluid, it maintains the volume through osmotic pressure, regulates acid-base balance, and conducts nerve impulses. When the sodium balance is off the exchange of electrons between molecules does not take place properly to conduct normal activities.
Most common CausesWater excess!Loss of sodium containing fluidsAce inhibitorsdiureticsvomitingdiarrheaRenal failure Syndrome of inappropriate
antidiuretic hormone
(Osborn, 2010)
Sign/SymptomsInitially
Headache, nausea, vomitingLater stages
Hyponatremic encephalopathy, cerebral edemaMay progress to
Hallucinations, lethargy, weakness, bradycardia, ataxia, respiratory depression, seizures, coma, or death
Patients may be asymptomatic
Haskal, 2007)
Prevalence30% of patients undergoing acute hospital
care15% of those patients have symptoms
One of the most common electrolyte disorders
(Haskal, 2007)
Laboratory test Urine osmolality
Determines if the kidneys are damaged and can’t dilute the urine Greater then 100 mOsm/kg
Serum osmolalityDetermines if it hyponatremia or another cause
that manifest the same as hyponatremiaUrinary sodium concentration
Determine if the hyponatremia is because of SIADH Greater then 20-40 mEq/l
(Osborn, 2010, medscape)
(Osborn, 2010)
What population is at risk?Everyone!
Affects all races the sameAffects both genders the sameHappens at any age
More likely in elderly because of decreased renal function
Prognosis In hospitalized patients
Increased association with adverse reactions Increased mortality
Severe hyponatremia (less than 105 mEq/L) High mortality rate
Over 50%
(Nursing central & medscape)
Interventions Immediately administer one boluses of
2ml/Kg of 3% NaCl IVConsider other conditions that can cause
hyponatremiaCorrect underlying cause
Assess for overcorrection of hyponatremia causing hypernatremia This could cause brain damage
A Bladder catheter should be inserted to monitor the water balance
(Overgaard-steensen, 2011)
Patient Scenario A 46 year old African American male arrived
at the emergency room on 9/15 complaining of vomiting for 1 week. Upon arrival the patient had a sodium level of 130 and was admitted for treatment of hyponatremia. Patient was tested and diagnosed with HIV after being admitted. Patient was given Amphotericin B from 9-16-2012 until 10-15-2012 to treat the HIV.
Interventions for the scenarioThe patient was given 3% NaCl IV 2ml/Kg
every 6 hours until Sodium levels were in normal range
Patient was started on Amphotericin B To treat underlying cause of HIV
Patient’s fluids were initially restricted to 1,000 Ml per day
Patient was on I&O’s
(Osborn, 2010)
Nursing DiagnosisRisk for life-threatening cerebral edema R/T
fluid retention or low sodium AEB serum sodium of less than 135 mEq/L
(Osborn, 2010)
NCLEX!John came to the ED with a sodium level of
122 mEq/L and was treated with 3% NaCl IV. When you come to assess John you notice that his level of consciousness has declined. What is this most likely from?
A. Drug useB. Increasing the sodium levels too quicklyC. hypokalemiaD. infusing the NaCl too slowly
(Osborn, 2010)
Answer!John came to the ED with a sodium level of
125 mEq/L and was treated with 3% NaCl IV. When you come to assess John you notice that his level of consciousness has declined. What is this most likely from?
A. Drug useB. Increasing the sodium levels too
quicklyC. hypokalemiaD. infusing the NaCl too slowly
(Osborn, 2010)
Nclex The nurse is caring for a patient and has just
received the laboratory data report. Which of the following results cause the most concern?
A. Na+:115 mEq/LB. K+:4.0 mEq/LC.Ca+: 9 mg/dLD.Mg+: 2.0 mg/dL
Answer The nurse is caring for a patient and has just
received the laboratory data report. Which of the following results cause the most concern?
A. Na+:115 mEq/LB. K+:4.0 mEq/LC.Ca+: 9 mg/dLD.Mg+: 2.0 mg/dL
(Osborn, 2010)
(Osborn, 2010)
Work citedHaskal, R. (2007). Current issues of nurse
practitioners: hyponatremia , 563-576.Overgaard-steensen, C. (2011). Inital
approach to the hyponatremic patient , 139-145.
Osborn, W. W. (2010). Medical Surgical Nursing . New Jersey: Pearson.
Jensen, S. (2011). Nursing Health Assessment. Philadeplphia: Lippincott Williams and Wilkins. Nusing Central. (2012,05).
top related