Sodium

Sodium

  • Plays a major role in
    • ECF volume and concentration
    • Generation and transmission of nerve impulses
    • Muscle contractility
    • Acid-base balance
  • Hypernatremia
    • Elevated serum sodium occurring with inadequate water intake, excess water loss or sodium gain
      • Causes hyperosmolality leading to cellular dehydration
      • Manifestations
        • Thirst
        • Alterations in mental status, ranging from agitation, restlessness, confusion and lethargy to seizures and coma
        • Symptoms of fluid volume deficit
    • Nursing diagnosis
      • Risk for electrolyte imbalance related to inadequate water intake, excess sodium intake and/or water loss injury related to altered sensorium and seizures
      • Risk for fluid volume deficit related to inadequate water intake and/or water loss
      • Risk for injury related to altered sensorium and seizures
      • Potential complication: Seizures and coma
    • Nursing implementation
      • Treat underlying cause
      • Primary water deficit—replace fluid orally or IV with isotonic or hypotonic fluids
      • Excess sodium—dilute with sodium-free IV fluids and promote excretion with diuretics
  • Hyponatremia
    • Results from loss of sodium-containing fluids and/or from water excess
      • Manifestations
        • Mild- headache, irritability, difficulty concentrating. 
        • More severe- confusion, vomiting, seizures, coma
    • Nursing diagnosis
      • Risk for electrolyte imbalance related to excess sodium loss and/or excess water intake or retention
      • Risk for injury related to altered sensorium and decreased level of consciousness
      • Risk for acute confusion related to electrolyte imbalance
      • Potential complication: Severe neurologic changes
    • Nursing implementation – Cause is water excess
      • Fluid restriction is needed
      • Loop diuretics
      • Severe symptoms (seizures)
        • Give small amount of IV hypertonic saline solution (3% NaCl)
      • Fluid replacement with sodium-containing solution
      • Increase oral intake
      • Withholding diuretics
      • Drugs that block vasopressin (ADH)