EBP Paper Medical Surgical II

Robert M. Williams

University of South Florida













Hyponatremia
The purpose of the Evidence Based Practice (EBP) paper is to take a disease and
break it down by that diseases pathophysiology, the medical and nursing interventions
used for that disease and the application of the disease from a clinical standpoint. The
disease process that will be discussed for this paper is that of hyponatremia.
Hyponatremia simply put, is a condition where the sodium (salt) in the blood is
abnormally low (Dugdale, 2013). Hyponatremia is also the most common occurring
electrolyte disorder among the general hospital population Peralta, 2013). It occurs
equally in both men and women and can occur in any aged patient. Elderly patients
generally have a lower total body volume of water and also may have impaired kidney
function, which can increase the risk for hyponatremia (Peralta, 2013).
In the body, low sodium in the blood creates an osmotic gradient between plasma
and cells (Peralta, 2013). Thus resulting in a fluid shift into the cells, which causes edema
and increased intracranial pressure (Peralta, 2013). Hypotnatremia is generally caused by
large burns, diarrhea, diuretic medications, heart failure, kidney disease, liver cirrhosis,
syndrome of inappropriate antidiuretic hormone secretion (SIADH), sweating and
vomiting (Dugdale, 2013). Common symptoms seen in hyponatremia include confusion,
convulsions, fatigue, headaches, irritability, muscle spasms, muscle cramps, muscle
weakness, loss of appetite, nausea, restlessness and vomiting (Dugdale, 2013). The
prognosis for hyponatremia depends on the acuity of the situation. Acute hyponatremia,
which happens in less than 48 hours, is a more dangerous scenario than if it develops
over three days to a week. The slower occurring process allows more time for the brain to
adjust and decreases the amount of swelling that occurs (Dugdale, 2013).
Medical and nursing interventions or treatments for hyponatremia differ based on
the diagnosis of the hyponatremia. If the hyponatremia is a result of cancer, radiation,
chemotherapy or surgery to remove the tumor can correct the imbalance of sodium
(Dugdale, 2013). Other treatments for hyponatremia include
IV fluids, medications and fluid restriction. Underlying causes and conditions that can
result in hyponatremia, such as heart failure or cirrhosis, need to be treated as well
(Peralta, 2013).
In the patient scenario I experienced at Sarasota, the patient presented with
hyponatremia and renal insufficiency. This patient also had a history of urethral, bladder
and liver cancer. This patient had signs and symptoms of hyponatremia, specifically
confusion, edema and muscle spasms at the time I was seeing the patient. At Sarasota, the
patient was placed on a fluid restriction and his labs were being monitored very closely.
The patient was also medicated to relieve his other symptoms, including pain. These
interventions used are standard practice for the patient scenario.










References
Dugdale, D. C. (2013, October 31). Hyponatremia. Medline Plus. Retrieved from
http://www.nlm.nih.gov/medlineplus/ency/article/000394.htm
Peralta, R. (2013). Hyponatremia 5-Minute Clinical Consult. Nursing Central from
Unbound Medicine.