hey everyone it's Sarah with register nurse ran.com and in this video I'm going to be going over hyponatremia in my previous video I covered hyper nmia so be sure to check that out so in this video what I'm going to cover is I'm going to cover the types of hyponatremia the signs and symptoms the causes and the nursing interventions and with this I'm want to try to give you some clever pneumonics to help you remember this for your nursing lecture exams and for the inlex now after this video be sure to go to my website register nurse rn.com and take the free quiz that goes along with this video it's going to test you on hypernia and hyponatremia okay so let's get started let's talk about hyponatremia like I've said all the time anytime I have one of these huge words I like to break them down to know what type of electrolyte I'm dealing with because there's a lot of different electrolyte imbalances so first part of the word is hypo what does hypo mean it means underneath or beneath low a nutria part of that the n a part is a prefix for sodium so I automatically know that I am dealing with the electrolyte sodium and emia means blood so when you put all that together you get low sodium in the blood now what is a normal sodium level a normal sodium level is 135 to 145 mil equivalents per liter anything less than 135 is considered hyponic okay let's talk about the role of sodium in the body because in order to understand all those causes the signs and symptoms you have to know how sodium works in the body okay sodium is a very important electrolyte that helps regulate the water inside the cell intracellularly and extracellular outside the cell and water and sodium love each other water always wants to be where sodium's at so wherever sodium is more congregated at water H2O will run to where that's at and that's what's happening with hypona and I have a video on the tonicity where I covered hypertonic hypotonic and isotonic and showed you how in different situations the cells will swell or become dehydrated and what types of fluids are used to treat those conditions and if you're interested in that video a card should pop up so you can access that but what's happening with this little illustration here in hypon nmia you have low amounts of sodium in the blood extracellularly and according to osmosis remember the rule of Osmosis anything of a low concentration wants to move to a higher concentration where everything else is at so here you have low amounts of sodium and you have water and remember water loves sodium and there's more sod sodium inside the cell and that's where water wants to be it wants to be where sodium's at so what happens is that all that water rushes inside this cell expanding the cell which can cause it to burst and this is again caused by osmosis and this affects cells everywhere in your body and one of the cells that are really sensitive to this is brain cells whenever they swell you're going to probably see a patient get confused and that's why whenever this is happening the patient will have confusion because the cell is swelling now let's talk about the different types of hypon nutras because you have different types and the patients are going to present a little bit differently and they're caused by different things and then after that I'm going to give you a pneumonic on how to remember the different types so you can be prepared for your exam and help really simplify it for you okay first let's go over the first type which is juvo volic hyponatremia this is where the water in the body is increases but sodium stays the same so you're not going to see ad edema which is swelling and like the extremities or in the body on this patient like how you will will with hypo volumic hypon neutrum and sodium stays the same but what happens is because you have that increased water volume happening the sodium becomes diluted so whenever you go to measure the sodium level it's going to be diluted with all that water and it's going to be low so hypon netrate and there are some causes of this and I would remember this because this is usually a big test question um causes of this type of hyponatremia is What's called the SI ADH syndrome syndrome which is the syndrome of inappropriate antidiuretic hormone see why they have it short because it's a big long word and what happens is that ADH which is an anti-diuretic hormone is being increase in secretion in the body and whenever this happens the body starts to retain water and whenever it retains water in turn it dilutes sodium other causes are diabetes insipidus adrenal insufficiency like Addison's disease so that's the causes of that now the second type is hypo volic hyponatremia and this is where your patient becomes dehydrated um they have a loss of blood volume so you're seeing a decrease in sodium and a decrease in water and common causes of this are vomiting diarrhea NG suction your GI secretions are really rich in sodium so whenever you have continuous NG suction going out you're losing a lot of sodium diuretic therapy that waste sodium any type of Burns and excessive sweating so the patient is becoming dehydrated and they're just losing all of that next the third type is hyperic hyponatremia and this is where your water and your sodium both increase in the body and this leads to fluid volume overload so you're really going to see swelling on these patient however the sodium becomes diluted I know that's like a paradox even though they're both increasing doesn't it seem like the sodium should be increasing too however no because what happens is that your total body water and your sodium are regulated differently and they're regulated independently of each other so it actually cause the sodium to decrease now when are you going to see this you're going to see this in patients who have CHF which is congestive heart failure kidney failure excessive infusion of saline solution or liver failure so let's simplify this and put it in a pneumonic so you can remember it for exams okay remember the phrase no sodium the um symbol for sodium is na with a positive sign and here we have it laid out each letter will correlate with what it means in for sodium na uh sodium excretion is increased with renal problems like the NG suction the vomiting the diuretic therapy the sweating diabetes and citus and uh which is where you have decreased aldosterone secretion and you're wasting sodium so remember that all those problems right there are where you're having um sodium in excretion increased okay oh for overload of fluids again remember this this is where we're going back to the hyper volic and you have congestive heart failure you have the hypotonic Solutions and liver failure and that will dilute your sodium in for sodium na again um your intake of sodium is low this could either be through a lows salt diet or no status they're just not getting enough salt intake a lot of your elderly patients may suffer from that and the last part the a for the anti-diuretic hormone is over secreted remember in the SI ADH and adrenal insufficiency and all that can cause hyponatremia now let's go over the signs and symptoms and the nursing interventions to help you remember the signs and symptoms of hyponatremia remember the phrase salt loss because here you have low salt okay so the first s of the word salt remember seizures and stuper the patient's probably going to have this if it's really low next for a abdominal cream camping or attitude changes meaning confusion they may have came in alert and oriented their sodium level dropped out and now they're confused next L lethargic they're going to be tired they're not going to want to get up and move they're just going to want to sleep t for tendon reflexes diminished and trouble concentrating again that's back to the confusion and remember salt has a plays a role in your muscles and your nerve conduction and lo L loss of urine and appetite o orthostatic hypotension and overactive bowel sounds s shallow respirations and this happens late and this will be due to the weakness of the skeletal muscle so that will be a late sign you're not going to see that at first and then the other s last s is spasms of the muscles okay now nursing interventions this is definitely the thing you want to pay attention to because your professors are going to hit on this and inlex is going to hit on this so I've HIIT the highlights of things that will probably come from a test okay first intervention of course is you want to watch your cardiac status your respiratory status neuro renal and GI status all these systems are going to be affected next now if the patient is having hypovolemic hyponatremia this is what usually you'll do remember this is where the patient has probably had diarrhea vomiting and they've just lost all that water and all that sodium and we've got to get them better so usually usually what you're going to do is you'll administer an IV solution Sodium IV solution to restore that balance of fluids and sodiums typically what is given is 3% saline this is a hypertonic solution so commit that to memory and this solution is really hard on the veins it's typically given in a central line usually and they like to give it in a area where you can really monitor that patient the nurse doesn't have a lot of other patients like the ICU because since it's a hypertonic solution it works by shrinking the cell down it pulls all that fluid out the cell because remember before the cell was swollen and whenever you do this you if you do it too fast you can cause the patient to go into fluid volume overload and you want to watch them and you want to give that that slowly so make sure you commit that to memory now if the patient is hyperic which is the opposite of the hypovolemic this means that they have two too much fluid they've retained too much fluid in the body and too much sodium but the sodium's become diluted um what will you'll do with that is you'll restrict their fluid intake we don't want them to have any more fluids on board some cases some doctors May order diuretics to excrete that extra fluid on the body but conserve the sodium and if the patient has renal failure they're not a candidate for a diuretic therapy so they may be prescribed to go get some dialysis to suck that fluid off okay next if the patient is having sadh that was that anti-diuretic hormone insufficiency you're going to restrict the fluids you don't want them to have any more fluids and this is usually treated with an anti-diuretic hormone antagonist so it goes against the anti-diuretic hormone and Commit This drug to memory um a lot of Physicians like to prescribe deyin um you may be familiar with this if you've taken pharmacology this is part of your tetra cycling family so as the nurse you need to know how to administer this typically you do not give this with any food um especially Dairy and ant acids because this binds to the catons and it affects absorption so you won't be absorbing all the declomycin um next another big thing you want to remember is lithium if you have a patient who's taking the drug lithium a lot of mental health patients already prescribed this medicine you're going to want to check your lithium drug levels because the body is going to conserve lithium and it's not going to be excreted as much whenever your sodium levels get out of whack that's why whenever you're teaching your patients whenever they're going home on lithium to make sure they consume enough salt and whenever you don't have enough salt it throws off the lithium so that's another big you want to remember and last but not least you want to instruct the patient to consume sodium rich foods that's usually not a problem here especially in our society in America um this is really a no-brainer with what foods are rich in salt but remember there things your professions may want to throw some tricky ones out there um first thing is bacon of course butter canned foods that's a big one a lot of people don't think of Cann Foods having a lot of salt in them they think oh I'm buying some vegetables canned corn so that's healthy no has a lot of salt in it and test questions like to throw that in out there it'll say the patient says which statement to you they're um they have a high sodium level what would you not let them eat and canned food might be an option cheese Hot Dogs lunch meat processed food and table salt so that is about hyponatremia now be sure to check out my other videos on electrolyte imbalances and be sure to take that quiz on the differences between hyper nutria and hypon nutria and thank you so much for watching and please consider subscribing to this YouTube channel