Primary Nursing Diagnosis

Altered thought processes related to neurological dysfunction

OUTCOMES. Electrolyte and acid-base balance; Cognitive ability; Concentration; Neurological status: Consciousness; Fluid balance; Respiratory status: Gas exchange; Safety behavior

INTERVENTIONS. Electrolyte management: Hyponatremia; Cerebral perfusion promotion; Surveillance: Safety; Intravenous therapy; Fluid management; Fluid monitoring; Seizure precautions


The course of treatment depends on the cause; the goal is to correct the TBW-to-sodium ratio. Hypovolemic hyponatremic patients should be treated with isotonic saline to correct the volume deficit. If hyponatremia is severe (serum sodium >115 mEq/L), an infusion of 3% to 5% sodium chloride solution may be administered slowly in small volumes. Monitor the patient carefully for signs and symptoms of circulatory overload (dyspnea, crackles, engorged veins). Fluid administration should be regulated with an intravenous (IV) controller to decrease the possibility of fluid overload. A diuretic may be given concurrently to avoid the occurrence of circulatory overload. Because IV hypertonic solutions are irritating to the vein, monitor the IV site closely. Monitor the effectiveness of fluid administration by following the serum sodium and osmolality levels, as well as daily weights and intake and output.

Hypervolemic or edematous patients are treated with a fluid restriction: 800 to 1000 mL of fluid is allowed per day. Euvolemic patients need only a water restriction without a sodium restriction. Endocrine abnormalities should be specifically addressed and treated, such as the syndrome of inappropriate antidiuretic hormone (SIADH), which is treated with a water restriction.

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