NCLEX - Hyponatremia Management

Here are key facts for NCLEX from the Acute Hyponatremia Management tutorial, as well as points of interest at the end of this document that are not directly addressed in this tutorial but should help you prepare for the boards. See the tutorial notes for further details and relevant links.

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1. Time frame classification: From the time of development section, distinguish between acute hyponatremia (within last 48 hours) and chronic hyponatremia (longer than 48 hours). 2. Critical assessment findings: From the key symptoms section, monitor for GI symptoms (nausea, vomiting), motor symptoms (ataxia, tremor), and cognitive symptoms (confusion, seizures, coma). 3. Physical examination: From the key physical exam findings section, assess for peripheral edema indicating volume overload and neurological signs that may indicate cerebral edema. 4. Severity classification: From the severity section, identify hyponatremia as severe (<120 mEq/L), moderate (120-130 mEq/L), or mild (130-135 mEq/L). 1. Emergency management: From the symptomatic section, prepare for administration of rapid 100 mL 3% hypertonic saline infusion (over 10 minutes) for symptomatic patients with cerebral edema concerns. 2. Treatment administration: From the asymptomatic section, prepare to administer 50 mL of 3% saline for asymptomatic patients when ordered. 3. Fluid management: From the additional management section, implement ordered restrictions of IV fluids and electrolyte-free water intake. 4. Monitoring protocol: From the general goal section, prepare for hourly sodium level monitoring to track correction rates and prevent complications.

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1. High-risk patient identification: From the common acute causes section, be particularly vigilant with post-surgical patients receiving IV fluids and patients with potential water intoxication (marathon runners, psychiatric patients with polydipsia). 2. Medication review: From the additional management section, assess medication regimen for potential contributors to hyponatremia, particularly thiazide diuretics. 3. Risk factor assessment: From the additional management section, identify recent surgery, pain, and certain medications as possible SIADH triggers. 4. Self-correction monitoring: From the autocorrecting section, assess for signs of spontaneous correction through water diuresis. 1. Treatment protocol implementation: From the treatment indication section, prepare for treatment initiation when sodium is <130 mEq/L in acute cases. 2. Fluid restriction enforcement: From the additional management section, implement and monitor adherence to electrolyte-free water restriction. 3. IV therapy management: From the additional management section, discontinue other IV fluids as ordered to prevent worsening hyponatremia. 4. Symptomatic patient care: From the symptomatic section, prioritize care for patients with neurological symptoms due to risk of increased intracranial pressure. 1. Laboratory monitoring: From multiple sections, prepare for and assist with hourly sodium level monitoring during treatment. 2. Correction rate tracking: From the general goal section, monitor for targeted 5 mEq/L increase over first few hours without over-correction over 24 hours. 3. Neurological assessment: From the key symptoms section, perform frequent neurological checks for changes in cognitive status, motor function, and consciousness. 4. Self-correction surveillance: From the autocorrecting section, if the condition is autocorrecting, closely monitor without additional intervention unless sodium drops instead of rises. 5. Complication prevention: From the general goal section, monitor to avoid osmotic demyelination by preventing overly rapid correction.

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Below is information not explicitly contained within the tutorial but important for NCLEX. 1. Documentation requirements: Precise intake/output measurements, vital signs, neurological assessments, and response to treatment. 2. Patient and family education: Teaching about sodium restrictions, fluid limitations, and symptoms requiring immediate reporting. 3. IV hypertonic saline administration: Special considerations for administration rate, concentration verification, and site monitoring. 1. Fall prevention: Implementing safety measures for patients with neurological symptoms. 2. Emergency response preparation: Equipment and medications to have available for patients at risk of seizures. 3. Communication protocols: When and how to notify providers about changes in patient status or laboratory values. 4. Ethical considerations: Managing fluid restrictions in confused patients who request water.