Sodium (Regular, Hypo, & Hypernatremia)

Question 1

What are the functions of sodium (5)

Answer 1

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

Question 2

Sodium makes a big impact on the body’s what

Answer 2

fluid balance

Question 3

sodium is a major electrolyte in which cellular fluid

Answer 3

extracellular fluid

Question 4

what does sodium control the balance of in the body

Answer 4

controls water balance

Question 5

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

Answer 5

ADH & aldosterone hormones
Na+ & K+ pump

Question 6

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

Answer 6

brain
do neuro checks
safety

Question 7

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

Answer 7

less than 135

Question 8

what are the causes of hyponatremia (7)

Answer 8

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

Question 9

how does SIADH cause hyponatremia

Answer 9

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

Question 10

how does water intoxication cause hyponatremia

Answer 10

retaining fluid & sodium causing hemodilution of sodium

Question 11

how does psychogenic polydipsia cause hyponatremia

Answer 11

when there is excessive fluid intake w/out psychological stimuli

Question 12

how do hypotonic fluids cause hyponatremia

Answer 12

shift solutes into the cell

Question 13

how does inadequate sodium intake cause hyponatremia

Answer 13

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

Question 14

what factors increase Na+ excretion (4)

Answer 14

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

Question 15

there are three types of hyponatremia, what are they

Answer 15

euvolemic
hypovolemic
hypervolemic

Question 16

what does euvolemic mean

Answer 16

low sodium with (ECF) voulme normal

Question 17

what does hypovolemic mean

Answer 17

sodium loss with ECF volume depletion

Question 18

what does hypervolemic mean

Answer 18

sodium loss with increased ECF volume

Question 19

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

Answer 19

seizures
brainstem herniation
respiratory arrest
death

Question 20

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

Answer 20

lethargy
weakness
altered LOC

Question 21

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

Answer 21

headache
nausea/vomiting
fatigue

Question 22

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

Answer 22

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

Question 23

what should we avoid when replacing sodium

Answer 23

avoid fluid overload

Question 24

why do we avoid fluid overload when replacing sodium

Answer 24

this is due to fluid shifting with the sodium

Question 25

what can happen if we replace sodium too fast

Answer 25

can cause neuro damage

Question 26

how much MAXIMUM sodium are we allowed to give a pt

Answer 26

0.5 mEq/L per hr

Question 27

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

Answer 27

6-12 pts

Question 28

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

Answer 28

every 2-4 hours

Question 29

what sodium wasting loop diuretics do we need to stop

Answer 29

thiazides

Question 30

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

Answer 30

spironolactone

Question 31

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

Answer 31

0.9% NS

Question 32

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

Answer 32

3% NS

Question 33

what line do we give 3% NS in

Answer 33

a central line

Question 34

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

Answer 34

give osmotic diuretics (mannitol) and fluid restrictions

Question 35

when a pt is euvolemic, what syndrome do they have

Answer 35

SIADH

Question 36

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

Answer 36

3% NS and less than 120 mEq/L

Question 37

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

Answer 37

no more than 6-12 in first 24 hours

Question 38

what should we insert for strict I&O

Answer 38

a foley cath

Question 39

what checks should we perform in a sever hypnatremic pt

Answer 39

neuro checks

Question 40

how often should we perform nero checks for the hyponatremic pt

Answer 40

every 2-4 hrs

Question 41

what type of rest should the hyponatremic pt be placed on

Answer 41

pt should be on bedrest

Question 42

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

Answer 42

safety

Question 43

what happens is sodium is overcorrected too quickly (2)

Answer 43

damage to nerve cells in the brain locked-in syndrome

Question 44

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

Answer 44

ADH and retain water

Question 45

SIADH upsets the electrolytes but which electrolyte is especially upset

Answer 45

Sodium

Question 46

In SIADH what retention is increased

Answer 46

water retention

Question 47

Is sodium increased or decreased in SIADH

Answer 47

decreased

Question 48

SIADH means the pt is what inside

Answer 48

soaked inside

Question 49

SIADH causes what 3 diseases

Answer 49

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

Question 50

do SIADH pt's pee a lot of very little

Answer 50

very little to none at all

Question 51

where is ADH created

Answer 51

in the pituitary gland

Question 52

what does ADH do

Answer 52

adds the h20

Question 53

what meds are synthetic ADH

Answer 53

desmopressin vasopressin

Question 54

does ADH increase or decrease urine output

Answer 54

decreases urine output

Question 55

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

Answer 55

the bp goes up

Question 56

what symptom should we watch for in SIADH

Answer 56

headaches

Question 57

what low sodium cause neurologically (2)

Answer 57

seizures death

Question 58

what are the treatments for SIADH (5)

Answer 58

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

Question 59

how much fluid are SIADH pt's allowed to have

Answer 59

800-1000mL/day

Question 60

what does demeclocycline block the affect of

Answer 60

blocks effect of ADH

Question 61

what does the affect of demeclocycline result in SIADH

Answer 61

results in more dilute urine

Question 62

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

Answer 62

salt tabs bacon processed foods

Question 63

how can we treat SIADH

Answer 63

with hypertonic saline

Question 64

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

Answer 64

greater than 145

Question 65

what causes hypernatremia (8)

Answer 65

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

Question 66

how do corticosteroids cause hyponatremia

Answer 66

causes kidneys to retain sodium

Question 67

how does Cushing's syndrome occur

Answer 67

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

Question 68

what can cushing's cause

Answer 68

hyperaldosteronism

Question 69

hyperaldosrteronism causes the body to have high what and retain what

Answer 69

have high sodium and retain water

Question 70

What level is severe hypernatremia defined as

Answer 70

greater than 160

Question 71

what increases the oral sodium intake (3)

Answer 71

eating too much sodium or processed foods alka seltzer asprin

Question 72

what can increase your sodium intake via IV

Answer 72

hypertonic solutions: 3% or 5% NS

Question 73

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

Answer 73

they are fasting diet order NPO

Question 74

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

Answer 74

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

Question 75

what interventions will we perform for hypernatremia (10)

Answer 75

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

Question 76

what happens if we bring down sodium too quickly

Answer 76

rapid correction can lead to seizures due to quick fluid shift

Question 77

what fluids should we admin for hypernatremia

Answer 77

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

Question 78

why should we admin diuretics for hypernatremia?

Answer 78

due to inadequate renal excretion

Question 79

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

Answer 79

loop diuretics; thiazides

Question 80

What are mild symps of hypernatremia (3)

Answer 80

faint feeling muslce fatigue weakness

Question 81

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

Answer 81

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

Question 82

what are the severe symps of hypernatremia (4)

Answer 82

nausea & vomiting increased muscle tone seizures coma

Question 83

When you have diabetes insipidus what hormone is being insufficiently produced

Answer 83

ADH

Question 84

Insufficient ADH being produced causes what to happen with the kidneys

Answer 84

the kidneys produced a lot of urine

Question 85

what does diabetes insipidus equal

Answer 85

hyeprnatremia

Question 86

DI means what inside

Answer 86

dry inside

Question 87

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

Answer 87

increased sodium & diluted urine

Question 88

what can DI cause in the body (3)

Answer 88

damage to brain tumors trauma

Question 89

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

Answer 89

polydipsia polyuria

Question 90

how much urine can a DI pt excrete per hour

Answer 90

greater than 200mL/hr

Question 91

how can we treat DI

Answer 91

with DDAVP (ADH)