(^424) Medical-Surgical Nursing Demystified
- Monitor for signs of dehydration: decreased skin turgor (elasticity), dry
mucous membranes, decreased sweating, neurologic changes. - Appropriate oral hygiene for dry mucous membranes.
- Proper skin care is especially important if the patient is experiencing diarrhea
or dehydration. - Explain to the patient fluid restriction and dietary modifications.
- Increase sodium in diet appropriately, considering comorbidities.
Hypernatremia
WHAT WENT WRONG?
Hypernatremia is an abnormally high amount of sodium in blood. Fluid volume
may be altered as a result of changes in the levels of sodium. A mild rise in sodium
levels causes tissue that is normally excitable to become more irritable—for exam-
ple, cardiac muscle. The osmolarity of extracellular fluid also increases as the
sodium level increases. This is in attempt to correct the sodium increase by bring-
ing more fluid from the cells into the extracellular area. These dehydrated, more
irritable cells have a decreased ability to respond to stimuli.
Causes may include insufficient water intake (patients who are NPO), insuffi-
cient sodium excretion due to hormone imbalance, renal failure, corticosteroids,
increased sodium intake or increased water loss due to fever, hyperventilation, in-
creased metabolism, and dehydration due to sweating, vomiting, or diarrhea.PROGNOSIS
Identification and correction of the cause is necessary to return the patient to a
normal fluid and electrolyte balance. IV fluids are carefully monitored during this
treatment period to avoid overcorrection of the sodium level, causing hyponatremia.
If the sodium level is severely elevated, the patient may need hemodialysis. Hyper-
volemia associated with hypernatremia in some patients may cause heart failure
and pulmonary edema.HALLMARK SIGNS AND SYMPTOMS
- Weight gain due to fluid retention
- Restlessness, irritability, and agitation due to increase in neural activity with
normal or low fluid volume
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