Hypernatremia & Hyponatremia (Sodium Imbalances) Nursing Care Plans


This guide discusses the nursing care plans and nursing diagnosis for hypernatremia and hyponatremia. It provides essential information on the assessment, diagnosis, and management of these conditions.

Sodium (Na) Imbalances: Hypernatremia and Hyponatremia

Sodium (Na) is a major extracellular fluid cation. The balance of sodium is important for many physiologic functions that include facilitating impulse transmission in nerve and muscle fibers by participating in the sodium-potassium pump; assists in acid-base balance by combining with bicarbonate and chloride.

The normal serum sodium concentration ranges from 135 to 145 mEq/L.

  • Hypernatremia is defined as serum sodium levels above 145 mEq/L.
  • Hyponatremia is defined as serum sodium levels below 135 mEq/L.

Nursing Care Plans

Hypernatremia and hyponatremia are common electrolyte imbalances that can affect patients in various healthcare settings. These conditions require prompt recognition and appropriate interventions to prevent complications and improve patient outcomes.

Here are two nursing diagnosis for patients with sodium imbalances: hypernatremia and hyponatremia nursing care plans:

  1. Hypernatremia: Risk for Electrolyte Imbalance
  2. Hyponatremia: Risk for Electrolyte Imbalance

Hypernatremia: Risk For Electrolyte Imbalance

Hypernatremia, an elevated level of sodium in the blood, can occur due to various reasons such as diarrhea, vomiting, diabetes insipidus, renal disease, high protein diet, and side effects of osmotic diuresis. These conditions can lead to a loss of water from the body or an excess of sodium, leading to a risk of electrolyte imbalance. This can affect the normal functioning of cells, muscles, and organs, and may lead to symptoms such as confusion, seizures, and coma.

Nursing Diagnosis

  • Risk for Electrolyte Imbalance

May be related to

  • Diarrhea, vomiting
  • Diabetes insipidus, renal disease
  • Fever, profuse sweating
  • High-protein diet
  • Side effects of medication such as osmotic diuretics

Possibly evidenced by

  • Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

Nursing Assessment and Rationales

1. Monitor respiratory rate and depth.
Metabolic acidosis secondary to hyperchloremia may result in deep, labored breathing with air hunger, which can lead to a cardiopulmonary arrest if left untreated.

2. Monitor blood pressure.
Depending on the fluid status, hypertension or hypotension may be present. The presence of postural hypotension may affect activity tolerance.

3. Monitor the level of consciousness and muscular strength, tone, and movement.
Sodium imbalances may cause changes that vary from irritability and confusion to seizures and coma. In the presence of a water deficit, rapid rehydration may cause cerebral edema.

4. Monitor intake and output and specific gravity. Assess the presence and location of edema. Weigh clients daily.
These parameters are variable, depending on the fluid status, and are indicators of therapy needs and effectiveness.

5. Assess skin turgor, color, temperature, and mucous membrane moisture.
Water-deficit hyponatremia manifest by signs of dehydration.

6. Monitor serum electrolytes, osmolality, and arterial blood gasses, as indicated.
This will evaluate the therapy’s needs and effectiveness.

7. Identify the client at risk for hypernatremia and likely causes such as sodium excess or water deficit.
Early identification and intervention prevent serious complications associated with this problem.

Nursing Interventions and Rationales

1. Provide safety and seizure precautions as indicated such as using padded side rails and putting the bed in a low position.
Cerebral edema and sodium excess increase the risk of convulsions. Seizures and altered mental status are potential complications in patients with severe hypernatremia. Padded side rails and a low bed position can prevent falls and injury during a seizure. Bed alarms, bed pads or mats, and close supervision can also be utilized. Healthcare providers should follow guidelines to ensure patient safety and provide prompt intervention in case of a seizure.

2. Allow debilitated client fluids at regular intervals. Provide free water to a client receiving enteral feedings.
May prevent hypernatremia in a client who is unable to perceive or respond to thirst.

3. Encourage meticulous skin care and frequent repositioning.
Maintains the integrity of the skin. Encouraging meticulous skin care and frequent repositioning is vital for patients with hypernatremia to prevent skin breakdown, pressure ulcers, and complications. Hypernatremia can cause dehydration and increase the risk of skin damage, making it essential to promote optimal skin care and repositioning to prevent further harm.

4. Teach the client to avoid foods high in sodium such as regular canned vegetables and vegetable juices, processed foods, snack foods, and condiments.
Decreases the risk of sodium-associated complications such as stroke, heart disease, and heart failure.

5. Provide frequent oral care. Avoid the use of mouthwash containing alcohol.
Promotes comfort and prevents further drying of mucous membranes.

6. Encourage increased oral and IV fluid intake.
Replacement of total body water deficit will gradually restore sodium and water balance.

7. Restrict sodium intake and administer diuretics as indicated.
Sodium intake restriction while promoting renal clearance decreases serum sodium levels in the presence of extracellular fluid excess.


Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.

NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care 
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health 
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

See also

Other recommended site resources for this nursing care plan:

Other nursing care plans related to endocrine system and metabolism disorders:


Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers.

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