{
  "name": "Sodium Imbalances",
  "slug": "sodium-imbalances",
  "url": "https://nursingplex.com/care-plans/sodium-imbalances",
  "category": "Endocrine & Metabolic",
  "summary": "Hypernatremia and hyponatremia; correct slowly to avoid neurologic injury.",
  "nursing_diagnoses": [
    "Risk for electrolyte imbalance",
    "Acute confusion",
    "Deficient fluid volume"
  ],
  "overview": [
    "Sodium is the principal extracellular cation and the main determinant of serum osmolality, so sodium disorders are fundamentally water problems and their symptoms are largely neurologic.",
    "Hyponatremia (below 135 mEq/L) develops from SIADH, heart failure, cirrhosis, diuretics, excessive water intake or GI losses replaced with plain water. Water shifts into brain cells, producing headache, nausea, confusion, and with rapid falls, seizures and herniation.",
    "Hypernatremia (above 145 mEq/L) develops from water loss or restricted access to water — fever, diabetes insipidus, osmotic diuresis, tube feeding without free water. Cells shrink, causing thirst, restlessness, lethargy and seizures. Both must be corrected slowly, because rapid shifts cause osmotic demyelination or cerebral edema."
  ],
  "key_facts": [
    {
      "label": "Correction limit",
      "text": "Change serum sodium by no more than about 8–10 mEq/L in 24 hours in chronic imbalance."
    },
    {
      "label": "Hypertonic saline",
      "text": "3% saline is reserved for symptomatic severe hyponatremia and requires close monitoring."
    },
    {
      "label": "SIADH",
      "text": "Low sodium with concentrated urine and normal volume; treated with fluid restriction."
    },
    {
      "label": "Neuro checks",
      "text": "Level of consciousness is the most sensitive indicator of sodium-related brain effects."
    }
  ],
  "nursing_priorities": [
    "Determine volume status along with the sodium level.",
    "Correct sodium at a safe rate.",
    "Protect the patient during altered mental status and seizure risk.",
    "Treat the underlying cause.",
    "Monitor intake, output and daily weights closely."
  ],
  "assessment": {
    "subjective": [
      "Reports of headache, nausea, weakness or muscle cramps (low sodium)",
      "Reports of intense thirst, dry mouth or restlessness (high sodium)",
      "History of diuretics, water intake pattern, tube feeding or GI losses",
      "Family reports of confusion or personality change"
    ],
    "objective": [
      "Serum sodium, osmolality and urine sodium and osmolality",
      "Level of consciousness, orientation, seizures",
      "Volume status: edema and crackles versus dry mucosa and flat neck veins",
      "Daily weight, strict intake and output",
      "Hyperreflexia or muscle twitching in hypernatremia"
    ],
    "related_factors": [
      "SIADH, heart failure, cirrhosis or renal disease",
      "Diuretic therapy and GI losses",
      "Excess free water intake or hypotonic IV fluids",
      "Insensible losses, fever, diabetes insipidus, osmotic diuresis",
      "Impaired thirst or no access to water"
    ]
  },
  "goals": [
    "The client's serum sodium will return to normal at a safe rate.",
    "The client will remain alert and oriented at baseline.",
    "The client will remain free from seizures and injury.",
    "The client will maintain appropriate fluid balance and weight."
  ],
  "interventions": [
    {
      "title": "Monitor",
      "points": [
        "Perform neurologic checks at least every 4 hours, more often during active correction.",
        "Track sodium levels at the ordered intervals and verify the correction rate stays within limits.",
        "Record strict intake and output and daily weights.",
        "Assess volume status and urine specific gravity."
      ]
    },
    {
      "title": "Manage hyponatremia",
      "points": [
        "Restrict free water as ordered, typically 800–1,200 mL daily in SIADH.",
        "Administer hypertonic saline only per protocol with frequent sodium checks.",
        "Hold hypotonic fluids and review medications that cause SIADH.",
        "Provide oral care and hard candy for thirst during restriction."
      ]
    },
    {
      "title": "Manage hypernatremia",
      "points": [
        "Replace water gradually with hypotonic fluids or free water flushes as ordered.",
        "Offer fluids on a schedule to patients who cannot express thirst.",
        "Add free water to tube-feeding regimens as prescribed.",
        "Treat the cause: fever, hyperglycemia, diabetes insipidus."
      ]
    }
  ],
  "patient_teaching": [
    "Explain the prescribed fluid restriction or free-water goal in household measures.",
    "Teach caregivers to offer fluids regularly to older adults with blunted thirst.",
    "Advise reporting new confusion, severe headache or seizures immediately.",
    "Discuss sodium intake in relation to the underlying condition."
  ]
}