Hypernatremia

sodium above ___ indicates hypernatremia

145 mEq/L

what is the core fluid shift in hypernatremia?

water LEAVES the cell and moves into the bloodstream, cells SHRINK

• brain cells at risk for injury

what is the pattern behind most hypernatremia cases?

• sodium excess from diet or IV

• excess water loss

• not enough water intake

• heat stroke

• excessive sodium retention

• fluid losses through GI tract, kidneys, and skin

what can cause sodium retention?

kidney failure, cushing’s syndrome

physical cues for hypernatremia

edema, flushed dry skin, swollen dry tongue (late sign)

words to describe a hypernatremic person

“big and bloated”

“big and bloated” appearance in hypernatremia

edema and flushed skin from water following sodium into the ECF

oral signs in hypernatremia

• swollen, dry tongue (late)

dry mouth, sticky mucosa

neuro changes to monitor in hypernatremia

• restlessness, agitation

• confusion or disorientation

• fatigue

• seizures

how does hypernatremia impact energy levels?

it causes fatigue

how does hypernatremia impact thirst?

it causes polydipsia (increased thirst)

how does hypernatremia impact urination?

it causes oliguria (decreased urine output)

GI findings in hypernatremia

nausea; vomiting; hyperactive bowel sounds

bowel sounds in hypernatremia

hyperactive bowel sounds

• in both hypo and hyper

how does hypernatremia affect body temperature?

can be hyperthermic

first nursing priority for hypernatremia

identify and treat the underlying cause

due to sodium’s role in the neuro system, what should we be monitoring hypernatremia?

level of consciousness

comfort measures to take for hypernatremic patients

provide oral hygiene for very dry, sticky mouth

what should nurses be monitoring for hypernatremic patients?

intake and output with special focus on urine volume

what diet should be followed for hypernatremia?

low-sodium diet

foods to avoid in hypernatremia

eliminate table salt

• processed cheese

• lunch meats or cold cuts

• canned soups & vegetables

• salted snacks

• dill pickles

• frozen dinners

• restaurant foods

oral fluid advice in hypernatremia

encourage oral fluids as prescribed

what IV fluids would a patient with hypernatremia be put on?

hypotonic fluids or isotonic non-sodium fluids as prescribed

• draw fluids into the cells and out of ECF with sodium

what type of medication works in diluting sodium and may be prescribed?

loop diuretics

when may dialysis may be needed in hypernatremia?

if impaired kidney function is causing the issue

why is hypernatremia dangerous for the brain?

cells shrink from water loss and cause neurological impairment

• potential permanent brain damage