Last updated on May 18th, 2022 at 09:01 am
Hyponatremia and Hypernatremia Nursing Care Plans Diagnosis and Interventions
Hyponatremia and Hypernatremia NCLEX Review and Nursing Care Plans
Hyponatremia and hypernatremia are conditions that refer to the concentration of sodium in the blood.
Hyponatremia denotes abnormally low levels of sodium, while hypernatremia means high levels of sodium.
Sodium is an essential extracellular electrolyte. It helps maintain fluid balance and it also plays a key role in nerve and muscle function.
The body’s normal sodium level is between 135-145 milliequivalents per liter. Any level outside of this range can cause dysfunction in fluid balance and nerve and muscle function.
Signs and Symptoms of Hyponatremia and Hypernatremia
Hyponatremia
When sodium levels fall below 135 mEq/L, the water in the blood stream moves into the cells causing them to swell.
This swelling can cause many health concerns and can be life-threatening. The signs and symptoms of hyponatremia rely on how fast the sodium level drops.
When hyponatremia occurs, the following signs and symptoms are observed:
- Nausea and vomiting
- Headache- one of the initial symptoms noted in patients with hyponatremia.
- Confusion -the brain is sensitive to sodium levels in the blood. Confusion and lethargy are commonly the first symptoms of hyponatremia.
- Loss of energy, drowsiness, fatigue- these happen due to the osmotic changes affecting the cells in the body including the brain.
- Restlessness and irritability – these may happen together with confusion when changes in the osmotic functions affecting the brain cells.
- Muscle weakness, spasms or cramps – increased sodium levels can affect muscle and nerve function.
- Seizure -when sodium levels drop, the fluid moves to intracellular compartments leading to cellular swelling. This can happen in the brain cells causing seizure.
- Coma- brain cells swelling can cause coma and permanent brain damage.
Hypernatremia
Similar to hyponatremia, the signs and symptoms of hypernatremia rely on how fast the sodium level rises. The symptoms may include the following:
- Thirst – in hypernatremia, fluid loss in the body exceeds sodium loss. This triggers the thirst response in the body as a coping mechanism to try to replenish the lost fluid.
- Confusion -hypernatremia is related to dehydration, which in turn causes confusion.
- Muscle twitching – sodium is partly responsible for nerve and muscle functions. Changes in the normal levels of sodium can cause alteration in the functions of nerves and muscles.
- Seizure -disruptions in sodium levels affect the osmotic shift of water in the brain cells causing seizures in some cases.
- Coma -if the rise in sodium levels happens quickly, the changes in the osmotic movement in the brain can cause coma.
Causes of Hyponatremia and Hyponatremia
Hyponatremia and hypernatremia result from changes in the body’s fluid balance. Many factors can cause these to occur such as the following:
- Medications. There are certain drugs that affect the body’s fluid balance. Diuretics, antidepressants, and pain killers all have effects in the hormonal and kidney processes that help maintain normal body fluid level.
- Conditions of the heart, kidney, and liver. These three organs all have functions in the body’s fluid balance. Congestive heart failure, kidney failure, and liver diseases can cause fluid to accumulate in the body.
- Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH). This condition refers to the increased body production of anti-diuretic hormone causing the body to retain water instead of it being excreted through the kidneys.
- Diarrhea and vomiting that cause severe dehydration. Dehydration triggers the body to increase anti-diuretic hormone level hence causing fluid retention.
- Too much oral fluid intake. Excessive water or fluid intake can overwhelm kidneys to excrete fluid.
- Adrenal gland disorders. Conditions related to the adrenal gland can cause either inadequate or too much production of hormones that help regulate sodium, potassium, and water levels.
Complications of Hyponatremia and Hypernatremia
Changes in sodium levels commonly occur gradually. However, when the drop or rise in sodium level is rapid, swelling of the brain cells can happen immediately causing coma and, in some cases, brain damage.
This also applies to the rapid correction of sodium imbalance.
Diagnosis of Hyponatremia and Hypernatremia
- History taking
- Physical examination
- Urinalysis – to check for urine concentration by means of measuring urine sodium and osmolality levels
- Blood test – Biochemistry to check for the level of sodium (normal serum sodium level is 135-145mEq/L); ADH test – to measure the level of circulating ADH in the body (normal ADH range is 0-5 picograms/mL)
Treatment of Hyponatremia and Hypernatremia
The treatment of altered serum sodium levels focuses on addressing the underlying cause. Treatment also includes addressing the symptoms.
Hyponatremia
- Fluid restriction. In some cases of mild hyponatremia, fluid restriction usually solves the condition. The aim is to prevent dilution of sodium caused by too much intravascular fluid.
- Intravenous fluids. The use of intravenous fluids is common in hospital settings. A slow intravenous sodium solution is given to raise the sodium level in the blood stream. It is noted, however, that rapid correction can result to dangerous side effects or complications.
- Medications. Certain drugs may be stopped by the doctor if they are causing the problem. However, the doctor can also prescribe other medications to treat the symptoms related to hyponatremia.
- Intravenous sodium. In severe cases of hyponatremia, sodium can be given intravenously with close monitoring. A diuretic is usually given in conjunction with IV sodium.
Hypernatremia
- Fluid replacement. In hypernatremia, there is less fluid for the amount of sodium in the blood stream. Replacing fluid either orally or intravenously is used to treat hypernatremia. Its correction should be done slowly and carefully to prevent complications from rapid osmotic changes.
Nursing Diagnosis for Hyponatremia and Hypernatremia
Hyponatremia and Hypernatremia Nursing Care Plan 1
Nursing Diagnosis: Electrolyte Imbalance related to hyponatremia as evidenced by nausea, vomiting, serum sodium level of 100 mEq/L, irritability, and fatigue
Desired Outcome: Patient will be able to re-establish a normal electrolyte and fluid balance.
| Hyponatremia and Hypernatremia Nursing Interventions | Rationale |
| Obtain a urine sample and blood samples from the patient. | Urinalysis – to check for urine concentration by means of measuring urine sodium and osmolality levels. Blood test – Biochemistry to check for the level of sodium (normal serum sodium level is 135-145mEq/L); ADH test – to measure the level of circulating ADH in the body (normal ADH range is 0-5 picograms/mL) |
| Place the patient on fluid restriction as per the physician’s order. | Fluid restriction helps to prevent more buildup of fluid in the body. |
| Administer a slow intravenous sodium solution as prescribed. | A slow intravenous sodium solution is given to raise the sodium level in the blood stream. |
| Start a strict input and output monitoring. | To accurately measure the input and output of the patient and to ensure that fluid restriction is performed. |
| In case of SIADH-induced hyponatremia, administer vasopressin antagonists as prescribed. | To block the action of the vasopressin ADH. |
Hyponatremia and Hypernatremia Nursing Care Plan 2
Nursing Diagnosis: Imbalanced Nutrition Less than Body requirments related to nausea, vomiting, weakness, loss of appetite, and verbalization of decreased energy levels
Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.
| Hyponatremia and Hypernatremia Nursing Interventions | Rationale |
| Explain to the patient the relation of altered sodium levels to nausea and vomiting and loss of appetite. | To help the patient understand why nausea and vomiting associated with loss of appetite is one of the signs of hyponatremia. |
| Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term goals of weight loss. | To effectively monitory the patient’s daily nutritional intake and progress in weight loss goals. |
| Help the patient to select appropriate dietary choices to follow a high caloric diet. | To increases the caloric intake of the patient that can be used by the body to increase energy levels and be able to perform ADLs. |
| Refer the patient to the dietitian. | To provide a more specialized care for the patient in terms of nutrition and diet in relation to hyponatremia/ hypernatremia. |
Hyponatremia and Hypernatremia Nursing Care Plan 3
Nursing Diagnosis: Deficient Knowledge related to new diagnosis of hypernatremia as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”
Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of hypernatremia and its management.
| Hyponatremia and Hypernatremia Nursing Interventions | Rationales |
| Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits)To address the patient’s cognition and mental status towards the new diagnosis of hypernatremia and to help the patient overcome blocks to learning. | |
| Explain what hypernatremia is, and how it affects the vital organs such as the kidneys, brain, and heart. Avoid using medical jargons and explain in layman’s terms. | To provide information on hypernatremia and its pathophysiology in the simplest way possible. |
| Educate the patient about hypernatremia. Inform him/her the target range for serum sodium levels. | To give the patient enough information on hypernatremia and its effects to the body. The normal serum sodium level is 135-145mEq/L. |
| Teach the patient on how to perform oral fluid replacement. | In hypernatremia, there is less fluid for the amount of sodium in the blood stream. Replacing fluid either orally or intravenously is used to treat hypernatremia. Its correction should be done slowly and carefully to prevent complications from rapid osmotic changes. |
| Teach the patient and caregiver on how to perform strict intake and output monitoring, and educate them on the need for oral and intravenous fluid replacement to treat hypernatremia. | To accurately measure the input and output of the patient and to ensure that proper fluid replacement is performed. |
More Hyponatremia and Hypernatremia Nursing Diagnosis
- Risk for: Excess Fluid Volume (Hyponatremia) or Deficient Fluid Volume (Hypernatremia)
- Elimination disorders related to a decrease in urine volume
- Disturbed Thought Processes
- Risk for Injury related to seizures
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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