Mr. MB was admitted to room 103. She is a 98-year-old woman, a client of Dr. Mandeep. She was hospitalized on March 11 after steady deterioration at home. She is weak, tired, more confused and suffers from back pain. She was diagnosed with hyponatremia. Ms. MB is a DNR. She is allergic to chloromycetin, Darvon, influenza vaccine, penicillins, sulfonamides, and tetracyclines. Hyponatremia Hyponatremia is a deficit of sodium in the body (Gould & Dyer, 2011, p. 125). This can result from loss of sodium-containing fluids, excess water, or a combination of the two (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011, p.313). One of the most common causes of hyponatremia is the inappropriate use of sodium-free or hypotonic IV fluids (Lewis, 2011, p.313). This situation can occur after surgery, severe trauma, or with the administration of fluids in patients with renal failure (Lewis, 2011, p.313). Other common causes include excessive sweating, vomiting, and diarrhea; use of diuretic drugs; insufficient aldosterone, adrenal insufficiency and excessive secretion of antidiuretic hormone (ADH); early chronic renal failure; or excessive water intake (Gould & Dyer, 2011, p. 125). The first effects of hyponatremia will appear in the central nervous system (CNS). The extra amount of water will reduce the osmolality of the plasma, causing fluid to shift in the brain cells (Lewis, 2011, p.313). This fluid shift will cause irritability, apprehension, confusion, seizures, and possibly coma (Lewis, 2011, p.313). Severe, untreated hyponatremia can cause irreversible neurological damage or death (Lewis, 2011, p.313). Clinical manifestations include anorexia, nausea, cramps, fatigue, lethargy, muscle weakness, headache, confusion, seizures... middle of paper... drastic changes can be fatal for patients who are unable to compensate for the sudden increase in blood return to the heart (Lewis, 2011, p. 1012). When caring for a patient with constipation, a nurse should monitor for lethargy, hemorrhoids, abscesses, abdominal distension, hypoactive bowel sounds, fecal impaction, and hard bloody stools (Lewis, 2011, p. 1012). Many cases of constipation can be treated with adequate dietary fiber, fluids, and exercise (Lewis, 2011, p. 1012). Stool softeners such as milk of magnesia and suppositories can also be used to prevent constipation (Lewis, 2011, p. 1012). Patient teaching should include the importance of activity, adequate fiber intake, and adequate hydration (Lewis, 2011, p. 1012). Exercise will promote gastrointestinal movement; fiber and hydration will prevent the stool from becoming hard and impacted (Lewis, 2011, p. 1012).