Hyponatremia Case Study

The patient is a 78-year-old female who had a recent fall. She fell on the left side. She has a very large left medial thigh hematoma. She continued to feel weak and unable to care for herself at home and presented to the ED. She is known to have hypertension, insulin dependent diabetes mellitus, a TIA in 1998 with some minimal left-sided weakness and she has had nephrolithiasis. In the ED she was found that her creatinine has gone from 1.2-1.82. Sodium on admission was 130 with a glucose of 360 which suggests that she has some hyponatremia not as profoundas the 130 would suggest. The patient has a complained of pain all over her body, her neck, her arms and her back. She is evaluated by physical therapy who feels that she is unsafe

Hypovolemic shock is an emergency condition caused by loss of whole blood (hemorrhage), plasma (burns), or interstitial fluid (diaphoresis, diabetes mellitus, diabetes insipidus, emesis, diuresis, and diarrhea) in large amounts. This makes the heart unable to pump enough blood to the body (Heller, 2014). The severe compromise in blood flow and therefore systemic perfusion contributes to cerebral, renal, or hepatic ischemia and possible organ failure. It is the most common type of shock in children with dehydration and trauma being the most common factors (McCance, 2010. pp 1703).

Shock is a life threatening medical condition where there is very low amount of blood flow through the human body. There are many different types of shocks:

Did you know that you can die from drinking too much water? Water intoxication can also be referred to as “water poisoning.” It can cause fatal disturbances in the brain functions. Meaning the normal balance of electrolytes in the body is pushed outside safe limits by overhydration. If your electrolytes drop too low too quickly, it can be fatal. Death by overhydration is rare, but it can still happen.

Describe complications that can occur as a result of dialysis and identify nursing measures that are designed to prevent these complications.

Shock is described as a state of hypoperfusion of the organs and tissues, which will result in cellular dysfunction and cell death. There are many varieties of shock, but for the purpose of this essay I will focus on hypovolemic shock. The term hypovolemic means low volume, this term in and of itself tells us what the root cause of this form of shock is, low blood volume. There are two different types of hypovolemic shock, hemorrhagic and non hemorrhagic, I will be discussing the possible causes, signs, symptoms, and treatment options for the hemorrhagic type. I will also explain what health care providers in the field should be looking for to determine whether their patient is in a state of compensated shock, where their body is doing everything it can to maintain perfusion, or if the patient is de-compensating and the body 's attempts at maintaining perfusion are failing.

The patient is 52-year-old female who presents with dyskinesias and dysarthrias in the setting of a migraine headache with photophobia. She has ongoing involuntary jerking and twitching movements symptoms present for the past 2 weeks. She has never had them before and they have become increasingly troublesome. She also presents with garbled speech along with the involuntary movements. Her medical history is significant for hypothyroidism, seizure disorder, hypotension, bipolar disorder, borderline personality disorder, schizoaffective disorder, schizophrenia and migraine. I concur with Dr. Lasheen and in view of this complicated history, as well as the multiplicity of comorbidities

Nursing care of hyponatremia require understanding of the relationship between sodium and fluid balance and the role of vasopressin, recognition of a patient’s volume status, onset of the of sodium deficit, severity of signs and symptoms, and degree of the sodium deficit. Depending on the severity (acute vs chronic) of the condition and the selected treatments, serum sodium levels should be measured every 1- 2 hours during initial treatment and at least every 4 hours until symptoms resolve. Oral care is important as patients to have a dry mouth due to fluid restrictions. According to hyponatremia treatment guidelines chronic hyponatremia must be corrected to less than 10 to 12 mEq/L over 24 hours and less than 18 mEq/L over 48 hours in order

The defining characteristics of the nursing diagnosis were dyspnea, along with an abnormal breathing pattern (Ackley & Ladwig, 2014). In order to alleviate symptoms of heart failure, Osborne et al., (2014) suggests use of loop diuretics to facilitate the removal of excess fluids which often accumulates in the lungs (Osborne et al., 2014). Therefore, patient C.Z. was educated on the importance of taking her medications as prescribed; she was also encouraged to ingest less than 2 grams of sodium on a daily basis coupled with a fluid restriction of 1500 milliliters (mLs) per day. An additional goal for patient C.Z. during her hospital stay was to maintain O2 saturations greater than 92% on room air, complete ten repetitions of incentive spirometry every hour while she was awake, reaching a level of at least 1500 mLs; and finally, ambulation as tolerated no less than three times per day prior to her

A 34-year-old previously healthy woman, transferred from another hospital presents for neck stiffness, lethargy and abnormal jerks of all four limbs.

[Name] returns today. She has seen Dr. [Name]. She has a history of an abnormal echocardiogram, and hypertension with hyponatremia.

I have selected case number 1. An 85 year old man came to the emergency room with palpitations for a few days. He states that he sometimes feels light headed and dizzy. The patient’s heart rate is elevated and irregular. As he goes from a sitting position to a standing position he becomes light headed and dizzy. In taking orthostatic blood pressure you notice that they are positive.

The patient is an 88-year-old female who presents with profound weakness, headache and abdominal pain. The patient is known also to have hypertension and Parkinson's disease. On presentation she presented with profound hyponatremia with a sodium of 124. She was also an acute kidney injury, as well as UTI. She grew an Escherichia coli. She is known to have chronic hyponatremia and it was felt to be secondary to Thiazide diuretics which have been changed. She has been treated with Frosemide and despite that presents with this profound hyponatremia. It is feeling of the nephrologist that this patient needs further work-up in order to determine the etiology of her hyponatremia. The hypernatremia places her in a very increased risk for falls.

There are good indicators for mortality ratio that help prediction of mortality in health care patients. Hyponatremia has strong association with all mortality causes in primary health care as well as pulmonary , head and neck cancers . [2] Red blood cell distribution width (RDW) is a good indicator for cardiovascular mortality as well as cardiovascular morbidity . [3] RDW is also associated with increased mortality in diseases rather than cardiovascular ones . [4] Preoperative routine blood tests are good predictor of the outcomes of the surgery , mortality ratio and length of stay in intensive care and hospital also laboratory results of albumin level have the upper hand in cardiovascular surgery . [5] plasma creatinine level is a good predictor

The patient is an 89-year-old female who presented to the ED after a fall down one flight of stairs at home. The patient initially stated that she remembers the entire event and was able to call her daughter who sent the ambulance to bring her to the hospital, however it is recorded that she lost consciousness in the ambulance. This elderly lady lives alone. She denied any blurred vision, nausea or vomiting, but she is known to have SIADH which is managed as an outpatient basis with fluid restriction to a liter a day. The ED notes also indicate that she vomited a small amount after she presented. She was nauseous, which improved with Zofran. She also had systolic blood pressure readings that went from a systolic 100s into the 90s and