Hyponatremia

 Serum sodium level lower than 135 mEq/L.

 Sodium imbalances are mostly associate with fluid volume imbalances.
Causes
 Loss of Sodium
 Excessive Diaphoresis
 Diuretics
 Serum Dilution
 Diarrhea
 Kidney Problems
 Hypoaldosteronism
 Lack of Sodium
 Fasting
 NPO
 Low Sodium Diet
 Serum Dilution
 Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)
 Overhydration
 Hyperglycemia
 Fresh Water Drowning
Assessments
 Increased Heart Rate
 Shallow Breathing (Weak Respiratory Muscles)
 Generalized Body Weakness
 Negative Deep Tendon Reflex
 Headache
 Confusion, Seizures, Coma
 Increased Motility
 Diarrhea
 Polyuria
 Dry Mucous Membrane
Interventions
 Monitor Vital Signs
 If hyponatremia is accompanied by Fluid Volume Deficit:
 Start IV Sodium Chloride Infusion (PNSS)
 If hyponatremia is accompanied by Fluid Volume Excess:
 Give Osmotic Diuretics (Mannitol IV)
  If hyponatremia is accompanied by SIADH
 Give ADH Antagonizers (Tolvaptan or Conivaptan)
 High Sodium Diet
 Processed Food
 Bacon
 Milk
 Snacks
 Cheese
Special Nursing Considerations
 If the client is taking Lithium, monitor the Lithium Level.
 Hyponatremia can cause Diminished Lithium Excretion.
 Hence, Hyponatremia causes Lithium Toxicity.
Hypernatremia
 Serum sodium level higher than 145 mEq/L.
Causes
 Decreased Sodium Excretion
 Corticosteroids
 Cushing’s Syndrome
 Kidney Disease
 Hyperaldosteronism
 Increased Sodium Intake
 Excessive Oral Sodium Intake
 Excessive Administration of Sodium-Containing IV Fluids
 Decreased Water Intake
 Fasting
 NPO
 Increased Water Loss
Assessments
 Increased Blood Pressure
 Tachycardia
 Pulmonary Edema (If hypervolemia is present)
 Twitches (Early)
 Weakness (Late)
 Altered Cerebral Function (Most Common)
 Extreme Thirst
 Dry Skin, Mucous Membranes, Sticky Tongue
Interventions
 Monitor Vital Signs
 If has fluid loss: Prepare IV Infusions
 If caused by inadequate renal excretion: Administer Diuretics
 Restrict sodium and fluid intake
Hypocalcemia
 Serum calcium level lower than 9.0 mg/dL
Causes
 Low calcium absorption in GI Tract
 Calcium is absorbed in the GI Tract
 Low Calcium Intake
 Lactose Intolerance
o Milk is rich source of calcium
 Malabsorption Syndromes:
o Celiac Disease
 Lack of villous area in GI Tract
o Crohn Disease
 Inflamed lower GI Tract
 Inadequate intake of Vitamin D (Calciferol)
o Vitamin D increases absorption of calcium in GI Tract
 End-Stage Kidney Disease
o CKD causes Hyperphosphatemia and decreased production of
Vitamin D
 Increased Calcium Excretion
 Polyuric Phase of Kidney Disease
 Diarrhea
 Steatorrhea
o Depletion of fat-soluble vitamin D may cause calcium deficiency
 Wound Drainage
 Decreased Ionized Fraction of Calcium
 Ionized fraction of calcium is those that freely circulating the body.
 Hyperproteinemia
 Alkalosis
o It promotes the binding of calcium to albumin, which reduce the
fraction of ionized calcium in the blood.
 Steatorrhea
 Calcium Binders
  Acute Pancreatitis
o Calcium is saponified by release of pancreatic lipase.
 Hyperphosphatemia
o Inversely proportional with Calcium
 Removal of Parathyroid Gland
o This gland regulates calcium levels in the blood.
Assessment
 Bradycardia
 Hypotension
 Bradypnea
 Twitches (Part of Triple T)
 Tetany (Part of Triple T)
 Watch out for signs of respiratory arrest.
 + Trousseau’s Sign (Part of Triple T)
 Taas ng Kamay
 + Chvostek’s Sign
 Cheeks
 Hyperactive Bowl & Diarrhea
Interventions
 Monitor Vital Signs
 Place the patient on a Cardiac Monitor
 Administer Calcium: Oral or Intravenous
 For IV Administration, warm the injection solution to body temperature.
 Administer slowly
 Monitor ECG Changes
 Monitor for Hypercalcemia
 Administer medications that increase Calcium absorption
 Aluminum Hydroxide
o Reduces Phosphorus Levels
o Increases Calcium Levels
 Vitamin D (Calciferol)
o Aids in absorption of Calcium in the GI Tract
 Provide a quiet environment
 Initiate seizure precautions
 Be careful when moving the patient
 At risk for Pathologic Fracture
 Standby Calcium Gluconate
 Increase calcium in the diet
  Dairy Products
 Milk
 Green Leafy Vegetables
Hypercalcemia
 Serum calcium level higher than 10.5 mEq/L
Causes
 Increased Calcium Absorption in GI Tract
 Excessive Oral Intake of Calcium
 Excessive Oral Intake of Vitamin D
 Decreased Calcium Excretion
 Kidney Disease
 Use of Thiazide Diuretics
o It increases renal reabsorption of Calcium
 Increased Bone Resorption of Calcium
 Hyperparathyroidism
 Hyperthyroidism
 Malignancy
o Bone Destruction from Metastatic Tumor
 Immobility
 Glucocorticoids
 Hemoconcentration
 Dehydration
 Use of Lithium
o It causes Hyperplasia of Parathyroid Gland
 Increases Parathyroid Hormone
 PTH increases Calcium
 Adrenal Insufficiency
o Reduced Calcium Excretion by the Kidney
 This increases calcium entry into the circulation.
Assessments
 Tachycardia
 Hypertension
 Bradypnea
 Due to Skeletal Muscle Weakness
 PROFOUND MUSCLE WEAKNESS
 Lethargy, Coma, Death
ECG Changes
 Shortened ST Interval
 Widened T Wave
Interventions
 Monitor Vital Signs
 Place the patient on a Cardiac Monitor
 Discontinue IVF/Meds containing Calcium and Vitamin D
 Discontinue Thiazide Diuretics
 It can be replaced with Loop Diuretics
*At risk for Pathologic Fracture*
o Bumetanide (Bumex)
o Furosemide (Lasix)
o Ethacrynic Acid (Edecrin) If all fails to
 Administer drugs that inhibit calcium resorption: lower down
 Phosphorus calcium, prepare
 Calcitonin (Miacalcin) the patient for
 Biphosphonates Dialysis.
o Alendronate (Fosamax)
o Residronate (Actonel)
 Prostaglandin Synthesis Inhibitor (Acetylsalicylic acid)
 NSAID’s
 Monitor the patient for Flank Pain
 To check for presence of Urinary Stones
 Monitor for signs of Pathologic Fracture