What is the first action for a nurse if a patient presents with hypernatremia?

First Action for a Nurse When Patient Presents with Hypernatremia

The first action a nurse should take when a patient presents with hypernatremia is to assess the patient's fluid status, including clinical signs of dehydration, and obtain baseline vital signs while simultaneously initiating intravenous fluid therapy with hypotonic solutions (preferably 5% dextrose in water) to begin correcting the sodium imbalance. 1, 2

Initial Assessment and Monitoring

• Immediately check vital signs, including blood pressure (both supine and standing to assess for orthostatic changes), heart rate, respiratory rate, temperature, and oxygen saturation 1
• Assess mental status and neurological condition, as hypernatremia can cause confusion, altered consciousness, and seizures 1, 3
• Obtain weight measurement as a baseline for monitoring fluid balance 1
• Assess for clinical signs of dehydration: dry mucous membranes, decreased skin turgor, sunken eyes, and reduced urine output 3, 4
• Initiate close monitoring of fluid balance with accurate intake and output documentation 1

Immediate Interventions

• Start intravenous fluid therapy with hypotonic solutions, preferably 5% dextrose in water 1, 5
• Calculate the initial rate of fluid administration to avoid decreasing serum sodium too rapidly (not more than 8 mmol/L/day for chronic hypernatremia) 1, 5
• Obtain STAT laboratory tests including serum electrolytes, blood glucose, blood urea nitrogen, creatinine, and osmolality 1, 3
• Collect urine sample for urinalysis and measurement of urine electrolytes and osmolality to help determine the cause of hypernatremia 1, 3
• Contact the physician to report findings and discuss treatment plan 1

Cautions in Management

• Avoid overly rapid correction of hypernatremia, as this can lead to cerebral edema and neurological complications 1, 5
• For chronic hypernatremia (present >48 hours), correction should not exceed 8-10 mmol/L/day 5, 3
• Monitor serum sodium levels frequently during treatment to guide the rate of correction 1, 3
• Be particularly vigilant with elderly patients and those with impaired thirst mechanisms who are at higher risk for hypernatremia 2, 4

Special Considerations

• For patients with heart failure and hypernatremia, fluid management must be carefully balanced to avoid worsening congestion while correcting sodium levels 1
• In patients with diabetes insipidus, notify the physician about potential need for desmopressin administration 5
• For patients with severe hypernatremia and neurological symptoms, prepare for possible administration of carefully calculated hypertonic saline under close monitoring 1, 2

Documentation and Communication

• Document all assessments, interventions, and patient responses 1
• Communicate findings and interventions to the healthcare team 1
• Ensure an emergency plan is in place for patients with known conditions predisposing to hypernatremia 1

Remember that hypernatremia reflects an imbalance in water homeostasis and can lead to serious neurological complications if not addressed promptly and correctly. The nurse's immediate actions focus on assessment, initiating appropriate fluid therapy, and close monitoring while avoiding too-rapid correction.