tremia. However, a patient whose consciousness is impaired or who cannot
swallow, such as a frail elderly patient, is at risk for hypernatremia.
Hypernatremia is caused by:
- Inadequate water intake.
- Inability of the hypothalamus gland to synthesize anti-diuretic hormone
(ADH) (which the kidneys require to regulate sodium). - Inability of the pituitary gland to release ADH.
- Inability of the kidneys to respond to ADH.
- Excess sodium (such as from a hypertonic IV solution).
- Inappropriate use of sodium-containing drugs.
- Ingestion of excessive amounts of sodium such as seawater.
The nurse can intervene by:- Replacing water using an IV of 5% dextrose in water or a hypotonic saline
solution as ordered. - Loweringthe serum sodium level slowly to avoid the risk of cerebral
edema(brain swelling). - Restricting sodium intake.
- Monitoring patient’s weight.
- Assessing extremities for edema (swelling).
- Monitoring breath sounds and respiratory effort for signs of heart failure.
The nurse must be alert to recognize the signs and symptoms of hyperna-
tremia. These are:
- Agitation
- Restlessness
- Weakness
- Seizures
- Twitching
- Coma
- Intense thirst
- Dry swollen tongue
- Edematous (swollen) extremities
The nurse should educate the patient to:- Avoid foods rich in sodium such as canned foods, lunch meats, ham, pork,
pickles, potato chips, and pretzels. Do not add salt to foods when cooking
or at the table.
CHAPTER 10 Fluid and Electrolyte Therapy^169