Page 247 - Saunders Comprehensive Review For NCLEX-RN

sodium absorption and potassium excretion.
5. Prepare the client for dialysis if potassium levels are
critically high.
6. Prepare for the administration of IV calcium if
hyperkalemia is severe, to avert myocardial
excitability.
7. Prepare for the IV administration of hypertonic
glucose with regular insulin to move excess
potassium into the cells.
8. When blood transfusions are prescribed for a client
with a potassium imbalance, the client should receive
fresh blood, if possible; transfusions of stored blood
may elevate the potassium level because the
breakdown of older blood cells releases potassium.
9. Teach the client to avoid foods high in potassium (see
Box 11-2).
10. Instruct the client to avoid the use of salt substitutes or
other potassium-containing substances.
11. Monitor the serum potassium level closely when a
client is receiving a potassium-sparing (retaining)
diuretic.
VII. Hyponatremia

The normal sodium level is 135 to 145 mEq/L (135 to 145 mmol/L)

A. Description
1. Hyponatremia is a serum sodium level lower than
135 mEq/L (135 mmol/L).
2. Sodium imbalances usually are associated with fluid
volume imbalances.

B. Causes

1. Increased sodium excretion
a. Excessive diaphoresis
b. Diuretics
c. Vomiting
d. Diarrhea
e. Wound drainage, especially
gastrointestinal
f. Kidney disease
g. Decreased secretion of aldosterone
2. Inadequate sodium intake
a. Fasting; nothing by mouth status
b. Low-salt diet
3. Dilution of serum sodium
a. Excessive ingestion of hypotonic fluids
or irrigation with hypotonic fluids

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