Nursing Care Plans for Hyponatremia – Best Nursing Care Plans (2022)

This article discusses Nursing Care Plans for Hyponatremia plus its causes, symptoms, preventions, treatments and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

Hyponatremia is a condition in which your blood contains insufficient sodium. You require sodium in your bloodstream to keep track of how much water is in and around your body’s cells.

It can occur due to medical issues, medications you may be on, or excessive water consumption.

The amount of water in your body grows due to the low sodium, causing your cells to inflate. This can cause a slew of issues. Some are minor, but others can be dangerous and even fatal.

 If your blood sodium level is between 135 and 145 milliequivalents per liter (mEq/L), it’s normal. It’s hyponatremia if it’s less than 135 mEq/L.

Symptoms of Hyponatremia

If your hyponatremia is minor, you may not have any symptoms. Symptoms usually arise when your sodium level rises or falls unexpectedly.

Hyponatremia symptoms include:

Vomiting and nausea

Fatigue

Confusion or a headache

Muscle cramps or spasms are common symptoms of menopause.

Irritability and agitation

Weakness

Severe Hyponatremia Symptoms

Nausea or vomiting

Confusion

Seizures

Coma or loss of awareness

Causes of Hyponatremia

Sodium is an essential nutrient in your body. It keeps your blood pressure in check, supports your nerves and muscles, and keeps your body’s fluid balance in check.

Sodium levels in the blood should be between 135 and 145 milliequivalents per liter (mEq/L). When the sodium level in your blood goes below 135 mEq/L, you have hyponatremia.

Hyponatremia can be caused by a variety of illnesses and lifestyle factors, including:

Medications in particular. Some medications, including diuretics, antidepressants, and pain relievers, can interfere with the normal hormonal and kidney processes that keep sodium levels in the healthy normal range.

Problems with the heart, kidneys, and liver. Fluid accumulation in the body can be caused by congestive heart failure and certain disorders of the kidneys or liver, which dilute the sodium in the body and lower the overall level.

Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH). High quantities of the anti-diuretic hormone (ADH) are produced in this disease, causing your body to retain water rather than excreting it regularly through your urine.

Dehydration is caused by chronic, severe vomiting or diarrhea and other factors. This causes your body to lose electrolytes like sodium while raising ADH levels.

Drinking an excessive amount of water. Excessive water consumption can induce low sodium levels by obstructing the kidneys’ capacity to eliminate water. Drinking too much water during endurance exercises like marathons and triathlons might dilute the sodium concentration of your blood because you lose sodium through sweat.

Hormonal shifts Adrenal gland insufficiency (Addison’s disease) impairs the ability of your adrenal glands to generate hormones that assist keep your body’s sodium, potassium, and water balance in check. Low thyroid hormone levels can also cause low blood sodium levels.

Ecstasy – recreational drug. This amphetamine raises the risk of hyponatremia, which can be severe and even fatal.

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.

Risk Factors of Hyponatremia

Factors that may increase the risk of hyponatremia include:

Age. Hyponatremia may be more common in older persons due to age-related changes, the use of certain drugs, and a higher risk of developing a chronic disease that disrupts the body’s sodium balance.

Certain medications. Thiazide diuretics, as well as several antidepressants and pain relievers, can make you more susceptible to hyponatremia. Ecstasy, a recreational drug, has also been connected to fatal hyponatremia cases.

Conditions that cause your body to excrete less water. Kidney disease, syndrome of inappropriate anti-diuretic hormone (SIADH), and heart failure, among other medical disorders, can raise your risk of hyponatremia.

Physical exertion at a high level. Hyponatremia is more likely in people who drink too much water when participating in marathons, ultramarathons, triathlons, and other long-distance, high-intensity events.

Diagnosis of Hyponatremia

1. History taking
2. Physical examination
3. Urinalysis – to check for urine concentration by means of measuring urine sodium and osmolality levels.
4. 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)

Complications of Hyponatremia

If you suffer hyponatremia regularly (chronic hyponatremia), your sodium levels will drop slowly over several days, and you will be less likely to develop issues. However, if you have acute hyponatremia, your sodium levels drop rapidly. This can lead to:

• Rapid enlargement of the brain
• Coma
• Death

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Treatment of Hyponatremia

The severity of your hyponatremia and the cause of your hyponatremia will determine how you are treated. If you have an excess of water in your body, you may need to reduce the amount of liquids you drink. Your healthcare professional may adjust your diuretic (water pill) use to raise blood sodium levels. One or more of the following may also be required:

Intravenous (IV) fluid – To raise the amount of sodium in your blood, sodium solutions may be delivered through your vein. In most cases, this is done in a hospital.

Sodium retentive drugs: These drugs assist your kidneys in excreting significant amounts of urine. This causes the excess water to leave your body while keeping the sodium inside.

Dialysis: If your kidneys aren’t functioning correctly, you may need dialysis to get rid of the excess water in your body.

Prevention of Hyponatremia

Hyponatremia can be avoided by taking the following steps:

1. Treat any problems that are present. Treatment for hyponatremia-causing illnesses, such as adrenal gland insufficiency can help prevent low blood sodium levels.
2. Make an effort to educate oneself. Be mindful of the signs and symptoms of low blood sodium if you have a medical condition that puts you at risk for hyponatremia or if you take diuretic drugs. Always discuss the dangers of a new drug with your doctor.
3. When participating in high-intensity activities, take care. Athletes should only drink as much water as they lose during a race via sweating. Thirst is a valuable indicator of how much water or other fluids you require.
4. During strenuous activity, consider drinking sports beverages. When participating in endurance events such as marathons, triathlons, and other strenuous exercises, see your doctor about replacing water with sports beverages containing electrolytes.
5. Water should be consumed in moderation. Water is essential for good health, so make sure you drink plenty of it. But don’t go overboard. Thirst and urine color are typically the best indicators of how much water you require. You’re probably receiving enough water if you’re not thirsty and your pee is pale yellow.

Nursing Care Plans for Hyponatremia Based on Diagnosis

Nursing Care Plan 1: Imbalanced Nutrition

Evidenced by nausea, vomiting, weakness, loss of appetite,

and verbalization of decreased energy levels

Desired Outcome

The patient will be able to achieve weight within their normal BMI range, demonstrating healthy eating patterns and choices.

Intervention	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 are 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 monitor the patient’s daily nutritional intake and progress in weight loss goals.
Help the patient, select appropriate dietary choices to follow a high caloric diet.	To increase 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 more specialized care for the patient in terms of nutrition and diet in relation to hyponatremia.

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Nursing Care Plan 2: Electrolyte Imbalance related to hyponatremia

 It is evidenced by nausea, vomiting, serum sodium level of 100 mEq/L, irritability, and fatigue.

Desired Outcome

The patient will be able to re-establish a normal electrolyte and fluid balance.

Intervention	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 bloodstream.
Start a strict input and output monitoring.	To accurately measure the patient’s input and output and 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 Nursing Intervention

• There are several different forms of nursing interventions for hyponatremia patients, as listed below:
• Maintain the patient’s fluid intake and output on an hourly basis.
• Every day, weigh yourself to keep track of your fluid volume.
• To detect dehydration and correctly record the state of hydration, monitor and evaluate skin turgor.
• To detect pulmonary edema, closely monitor vital signs and take note of breathing rate and depth.
• Check for indications of edema and hypertension in the hyponatremia patient.
• As advised, keep an eye out for signs of circulatory excess.
• Foods high in sodium, such as milk, meat, eggs, carrots, beets, and celery, should be consumed.
• Ensure that the patient consumes 90 to 250 mEq of sodium every day.
• Neuromuscular changes, such as dwindling consciousness, weariness, and muscular weakness, should be monitored and observed.
• As needed, give supplemental oxygen to a drowsy or unconscious patient.
• Patients with sodium imbalances are frequently perplexed and act erratically. As a result, take precautions.
• Maintain a calm atmosphere.

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• Maintain a low, locked position for the bed.
• To avoid falling, keep the side rails up.
• Keep a nurse’s phone nearby and instruct the patient to call a nurse if they need help.
• Keep a close eye on hyponatremia patients for any signs of convulsions and call a doctor.
• As directed, use seizure precautions.
• To measure the efficiency of IV fluids, keep track of serum sodium levels in the lab.
• Administer the prescribed medication.
• Use an infusion pump to carefully give the 3 percent or 5% sodium-containing solution as directed.
• Check for symptoms of infiltration, such as redness or irritation, at the IV site.
• Determine the etiology of hyponatremia, such as sodium loss or fluid overload.
• As a result of the dry mouth and decreased saliva production, give mouth care regularly.
• Instead of simple water, rinse the nasogastric tube with regular saline.
• As directed, prepare the patient for dialysis.
• Acute life-threatening conditions should be addressed immediately, and supportive treatment should be initiated.

Related FAQs

1. What is a nursing diagnosis for hyponatremia?

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.

2. What nursing interventions for a patient with hyponatremia include?

Options include:

• Intravenous fluids. Your doctor may recommend IV sodium solution to slowly raise the sodium levels in your blood. …
• Medications. You may take medications to manage the signs and symptoms of hyponatremia, such as headaches, nausea and seizures.

3. What nursing interventions will you provide for a patient with fluid imbalance?

There are specific nursing interventions for fluid and electrolyte imbalances that can aid in alleviating the patient’s condition.

• Monitor turgor.
• Urine concentration.
• Oral and parenteral fluids.
• Oral rehydration solutions.
• Central nervous system changes.
• Diet.

4. What is the management of hyponatremia?

In general, hyponatremia is treated with fluid restriction (in the setting of euvolemia), isotonic saline (in hypovolemia), and diuresis (in hypervolemia). A combination of these therapies may be needed based on the presentation. Hypertonic saline is used to treat severe symptomatic hyponatremia.

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