Nursing Care of Individuals with Hyponatremia

Nursing care for hyponatremia, an electrolyte imbalance of sodium in the body is a lot trickier than one may think. "How may that be so?  Just pump some sodium or normal saline into their body!" Well, it can be just as easy as that, depending on the type of hyponatremia one presents with. Also, there is another very important factor that one must consider.  Many times, there are other underlying causes of hyponatremia, such as congestive heart failure, diarrhea, liver failure, etc.  Management of the serum sodium level is still very much a very important part of the treatment of hyponatremia of course.  Nursing care for patients are focused on safe serum sodium levels, which are evidenced by: absence of n/v and cramps, no altered mental status, usual muscle strength, absence of seizures, and serum sodium levels within the normal range (1).  In order to detect any changes in the patient's normals, however, part of the nursing care involves assessments of signs and symptoms of hyponatremia.  These signs and symptoms include: nausea, vomiting, abdominal cramps, lethargy, confusion, weakness, seizures,and low serum sodium levels) (1). Nursing interventions to treat hyponatremia include: maintaining fluid restrictions (if ordered) and consulting physician about changes in dose of diuretic and temporary discontinuation of dietary sodium restriction if sodium level is significantly reduced (1). For hypovelemic hyponatremia, isotonic saline should be administered in order to replace the contracted intravascular volume (2).  For nursing care, many times, for hyponatremia, it is just managing the symptoms of hyponatremia while treating the low sodium in the blood.  The following tables and charts will make it easier to understand what is being done for hyponatremia:

  

Medical Management / Nursing Interventions:
- Electrolyte management: Hyponatremia
- Cerebral edema management
- Delirium management
- Fluid monitoring
- Fluid management
- Seizure precautions
- Monitor level of consciousness
- Institute safety measures for seizures
- Administer IV isotonic solution (e.g. 0.9% NaCl) as ordered
- Restrict free water intake (e.g. 1.2 L/24 hr)
- Monitor vital signs hourly and I&O (ECF excess, restrict fluids and  administer diuretics)
- Monitor serum sodium levels. Teach patient about adequate intake of sodium, side effects of diuretics and other causes for hyponatremia.

Works Cited:

1)  EHS: Nursing Care Planning Guides - Care Planner: Diagnosis: Altered fluid and electrolyte balance. (2012). Retrieved May 14, 2015, from http://www1.us.elsevierhealth.com/SIMON/Ulrich/Constructor/diagnoses.cfm?did=131|132|

2)  Simon, E. (2015, March 1). Hyponatremia Treatment & Management. Retrieved May 14, 2015, from http://emedicine.medscape.com/article/242166-treatment

3)  Sarikonda, K., & Watson, R. (2009, October 11). Hyponatremia. Retrieved May 14, 2015, from http://nihlibrary.ors.nih.gov/jw/POC/eepHyponatremia.htm

4) Nursing-Nurse.Com. (2007). Retrieved May 14, 2015, from http://www.nursing-nurse.com/medical-and-nursing-management-of-sodium-deficit-hyponatremia-serum-sodium-466/