Long-Term Care

Trainer’s tip: Recognize the symptoms of hyponatremia and hypernatremia

LTC Nursing Assistant Trainer, December 3, 2009

Residents with hyponatremia may be asymptomatic until the sodium level is well below normal. An astute CNA may report an increase in the resident’s normal urinary output. Symptoms of moderate to severe hyponatremia, which develop as a result of water moving into brain cells causing swelling and disrupting normal function, include:

  • Apathy
  • Feeling tired
  • Weakness
  • Confusion
  • Disorientation
  • Headache
  • Muscle cramps
  • Nausea

The signs and symptoms of hypernatremia can be very subtle. Reduced urinary output is common. Urine may appear dark and concentrated. Residents who are hypernatremic commonly have a reduced level of consciousness. The signs and symptoms are usually neurologic, including delirium, irritability, restlessness, lethargy, muscular twitching, spasticity, seizures, and hyperreflexia. These are caused by decreased water content in the brain cells, which leads to shrinkage. If the condition persists over time, it can cause cerebral hemorrhage. Hypernatremic residents are often found to have an infection.

This is an excerpt from HCPro's book, The Long-Term Care Nursing Desk Reference, Second Edition, by Barbara Acello, MS, RN.

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