Hypernatremia & Hyponatremia (Sodium Imbalances) Nursing Care Plans

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

• The client will display heart rate, blood pressure, and laboratory results within the normal limit and absence of neuromuscular irritability and cognitive impairment.

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.