A child is admitted to the pediatric unit with a serum sodium level of 118 mEq/L.. Instituting seizure precautions

A child is admitted to the pediatric unit with a serum sodium level of 118 mEq/L. Which nursing action takes highest priority at this time?

• a. Replacing fluids slowly as ordered.
• b. Instituting seizure precautions.
• c. Administering diuretic therapy as prescribed.
• d. Administering sodium bicarbonate as prescribed.

Answer B.

A serum sodium level of 118 mEq/L indicates severe hyponatremia, which places the client at risk for seizures. Therefore, instituting seizure precautions takes highest priority. Fluid and sodium replacement should be done rapidly. Diuretic therapy isn’t indicated because it may cause additional sodium loss. In a child with hyperkalemia, administering sodium bicarbonate would be appropriate because it promotes movement of potassium into the intracellular spaces.

Out of the listed options, the nursing action that takes the highest priority for a child with a serum sodium level of 118 mEq/L is: a. Replacing fluids slowly as ordered.

Here's why:

• Hyponatremia, defined as a serum sodium level below 135 mEq/L, can be a life-threatening condition in children, especially when severe (less than 125 mEq/L). It can lead to seizures, coma, and even death.

• Rapid correction of hyponatremia can be dangerous and lead to potentially fatal complications like cerebral edema. Therefore, slow and controlled fluid replacement is crucial.

• The specific rate of fluid replacement will depend on the severity of hyponatremia, the underlying cause, and the child's individual circumstances. It's important to follow the doctor's orders and closely monitor the child's response to treatment.

Other Options:

While the other options might be part of the overall treatment plan, they are not as urgent as immediate fluid replacement in this critical situation:

- Instituting seizure precautions:

While seizures are a potential risk in severe hyponatremia, the immediate priority is to prevent further deterioration by correcting the electrolyte imbalance. Once the sodium level starts rising, the risk of seizures will decrease.

- Administering diuretic therapy:

Diuretics are typically used to remove excess fluid from the body, which can worsen hyponatremia. They are not indicated in this case as the child needs fluid replacement, not removal.

- Administering sodium bicarbonate:

While sodium bicarbonate can be used in some cases of hyponatremia associated with metabolic acidosis, it's not the first-line treatment and should only be administered under the doctor's supervision.

Remember, hyponatremia is a serious medical condition requiring prompt and careful management. If you encounter a child with hyponatremia, prioritize slow and controlled fluid replacement as per the doctor's orders and monitor the child closely for any signs of worsening.