BSN Notes: Common Signs And Symptoms: Hypernatremia

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HYPERNATREMIA 
·         Plasma sodium level greater than 145mEq/L.
·         Associated with water loss or sodium gain
ETIOLOGY
1.Excess sodium intake
·         Excessive or rapid IV administration
·         Hypertonic tube feedings
2.Inadequate water intake
3.Excessive water loss:
·         Increased insensible loss, osmotic diuretics, Diarrhea, severe diaphoresis
4.Disease conditions: Diabetic insipidus, primary hyperaldosteronism, Cushing syndrome, uncontrolled DM
CLINICAL MANIFESTATIONS:
Early C/F –
·         polyuria, oliguria, anorexia, nausea and vomiting, weakness and restlessness.
·         CNS - restlessness, agitation, irritability and muscle weakness.
·         Skin - dry and flushed, the mucous membrane becomes dry and sticky.
·         Pulmonary - crackles, dyspnoea and pulmonary edema.
CVS
In hypovolemic hypernatremia - hypotension with tachycardia.
In hypervolemic hypernatremia - Peripheral and Pulmonary edema, Hypertension

MEDICAL MANAGEMENT
·         Treat the underlying cause.
·         Prevent water loss in primary water deficit.
·         Intravenous 5% dextrose in water (D5W), hypo-osmolar electrolyte solution (0.45%NaCl).
·         Rapid correction of hypernatremia results in cerebral edema
Nursing Interventions
·         Asses for clinical features, diet and medication history.
·         Vital signs, intake and output, body weight monitoring.
·         Monitor for changes in plasma sodium level and plasma osmolality.

·         Report early signs of altered mental status.


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