NSG 210 Test #4 (Final)
The client asks, "What is reduction?" How will the nurse respond?
"It refers to realigning the bone."
SIADH diagnostic criteria
-Hyponatremia (serum sodium <135 mEq/L). -Hypotonicity (plasma osmolality <280 mOsm/kg). -Decreased urine volume. -Highly concentrated urine with a high sodium content. -Absence of renal, adrenal, or thyroid abnormalities.
An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker?
24 hours
Bulimics have a minimum of ___ binge episodes per week for at least ___ months
2; 3
The nurse is caring for a patient with a total hip replacement. How should the nurse allow the patient to turn?
45 degrees onto the unoperated side if the affected hip is kept abducted
A client's blood test results reveal an elevated alkaline phosphatase. What might this indicate?
A bone tumor
A client has just undergone arthrography. What is the most important instruction for the nurse to include in the teaching plan?
A client has just undergone arthrography. What is the most important instruction for the nurse to include in the teaching plan?
DI results from the deficit of:
ADH
Hormone secreted by the posterior pituitary
ADH and oxytocin
Cushing syndrome pathology
Access glucocorticoid secreted from adrenal cortex Affects metabolic function, stress, response, inflammatory, and immune responses Causes: long-term administration of exogenous glucocorticoids; tumors of pituitary, adrenals, or distant sites
Delirium tremens
Acute complication of alcoholism Medical and nursing emergency Etiology: Sudden or decrease in alcohol following chronic intoxication; infections; metabolic disorders; anxiety Signs and symptoms: tremors, confusion, disorientation, fearfulness, tachycardia, fever, illusion, hallucinations (tactile & visual) nightmares, insomnia, psychomotor agitation Onset: maybe within 48 hours after withdrawal
What are some manifestations of fracture?
Acute pain Loss of function Deformity Shortening of the extremity Crepitus Local swelling and discoloration Diagnosis by symptoms and radiography
Nursing interventions for DI
Administer medications as ordered such as intronasal desmopressin acetate Initiate IV access Administer IV fluid replacement Encourage adequate fluid intake Obtain daily weights Assess for signs and symptoms of fluid overload Apply anti-embolism stockings
Diagnostic tests for adrenocortical insufficiency
Adrenocortical hormone levels ACTH levels ACTH stimulation test
When is it advisable for the nurse to apply heat to a sprain or a contusion?
After 2 days
Psychoactive substances
Alcohol Amphetamines, PCP Cannabis, cocaine, hallucinogens Inhalants Nicotine Opioids Sedatives, hypnotics, or anxiolytics
Primary effect of cortisol
Anti-inflammatory and decreases immune response; catabolic effect on tissues; stress response
What will decrease signs and symptoms and increase weight gain for those with bulimia?
Antidepressants
A patient sustains a fracture of the arm. When does the nurse anticipate pendulum exercise should begin?
As soon as tolerated, after a reasonable period of immobilization
Which action would be most important postoperatively for a client who has had a knee or hip replacement?
Assist in early ambulation
What are some complications of traction?
Atelectasis and pneumonia Constipation Anorexia Urinary stasis Infection VTE
A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect?
Avascular necrosis
Drugs for AWS
Benzodiazepines: reduce withdrawal symptoms of severity and incidents of delirium tremens and seizures; associated with with minimal respiratory and cardio depression Antidote: flumazenil/Romazicon + Haldol if hallucinating
What is the advantage of a plaster cast?
Better molding to the client
What signs/symptoms would you expect to see in a patient with fluid volume excess?
Bounding pulse, increased BP, weight gain, increased and dilute urine output , increased and shallow respirations. May see neck vein distention, pitting edema of lower extremities, crackles in the lungs
What food can the nurse suggest to the client at risk for osteoporosis?
Broccoli; it is high in calcium
CAGE assessment tool
C: have you ever felt you ought to cut down on drinking? A: have people annoyed you by criticizing your drinking? G: have you ever felt guilty about your drinking? E: have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? (eye opener)
Pharmacologic management of osteoporosis
Calcium and vitamin D Bisphosphonates Calcitonin Estrogen agonists/antagonists Parathyroid hormone Receptor activator of nuclear factor kappa-B ligand inhibitors
What are the symptoms of hyponatremia?
Can be vague and depends on if has a fluid imbalance as well. Severe hyponatremia presents with weakness, N/V/D and mental status changes such as confusion, disorientation and personality changes due to low sodium and osmolarity which causes more water to collect in and around the brain
Signs of cocaine overdose
Cardiac dysrhythmia or arrest Increased or lowered blood pressure Chest pain Vomiting Seizures Psychosis Confusion Dyskinesia Dystonias Coma
What are the expected outcomes for increased nutrition in bulimics?
Client sets appropriate target weight Client gains 1 to 2 pounds per week Client will not artificially increase weight Client eats at least 50% of each meal Abide by limits Identifies trigger foods Differentiates emotions from hunger Identifies stressful situations Keeps daily log
A client was playing softball and dislocated four fingers when diving for a ball. The physician manipulated the fingers into alignment and applied a splint to maintain alignment. What type of procedure does the nurse document this as?
Closed reduction
Lab results in the patient with DI
Colorless urine with low osmolality and low specific gravity Sodium level is greater than 145 Osmolality increases Serum vasopressin level is decreased BUN and creatinine are elevated ADH test shows absent or below normal levels
Hypersecretion in the anterior pituitary can lead to:
Cushing disease, gigantism, acromegaly
Hypo secretion of the posterior pituitary can lead to:
DI
Addison's disease
Darker pigmentation of skin -high ACTH Glucocorticoid deficiency -Hypoglycemia, weakness, poor stress, response, fatigue, anorexia, nausea, vomiting, weight loss, personality changes Mineralcorticoid deficiency -dehydration, hyponatremia, hyperkalemia, hypotension, weakness, fatigue, shock
Primary effect of calcitonin
Decreases release of calcium from the bone to lower blood calcium level
What are some late fracture complications?
Delayed union, malunion, and nonunion Avascular necrosis of bone Complex regional pain syndrome (CRPS) Heterotrophic ossification
Alcohol withdrawal syndrome signs and symptoms
Diaphoresis Tachycardia Hypertension Tremors Restlessness Nausea and vomiting Anorexia Hallucination Convulsions DTs
Evidence of moderate withdrawal from opioids
Dilated pupils; bone and muscle aches, sensation of goosebumps; hot and cold flashes
Nursing orders for ED behavior
Discuss clients perception of body image Do not argue with perceptions Point out your perceptions and objective data Discuss cultural stereotypes of appearance Discuss clients perception of others bodies Minimize comments about actual weight gain Help identify positive attributes Help patient identify their own interests
Medical management of multiple sclerosis
Disease-modifying therapy; interferon beta-1a and interferon beta-1b, glatiramer acetate, and IV methylprednisolone Symptom management of muscle spasms, fatigue, ataxia, bowel and bladder control
The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication?
Dislocation of the hip
What is considered binge drinking?
Drinking five or more drinks on same occasion at least once in past month
Disulfiram (Antabuse)
Drug given to alcoholics as a deterrent; inhibits enzyme aldehyde dehydrogenase thereby blocking the oxidation of alcohol; if person drinks 3 to 7 drinks while on med they can become sick and possibly die; they must be off 12 hours before starting med
Hypo secretion in the anterior pituitary can lead to:
Dwarfism, panhypopituitarism
Symptoms of alcohol withdrawal can begin how many hours after the last drink
Eight; symptoms usually begin 4 to 12 hours after cessation or marked reduction of alcohol intake
Medical complications of eating disorders
Electrolyte imbalances, dehydration Cardiac: bradycardia, arrhythmias, hypotension, failure, anemia Severe dental problems Gastrointestinal: constipation, abdominal pain Endocrine: menstrual irregularities, bone density, hormonal imbalances Renal: potassium deficiency, increased or decreased urination
Which group is at the greatest risk for osteoporosis?
European American women
Hormone secreted by the anterior pituitary
FSH, LH, prolactin, ACTH, TSH, GH
What is considered heavy drinking?
Five or more drinks on the same occasion on at least five different days in past month
Treatment for Addison disease
Fluid replacement Hydrocortisone Oral glucocorticoid and mineralcorticoid replacement Increase sodium intake due to excess sodium losses
Primary effect of norepinephrine
General vasoconstriction
Primary effect of glucagon
Glycogenolysis in liver; increases blood glucose level
What would be a nursing action for a patient experiencing a severe anxiety episode and respiratory alkalosis and why?
Have the patient breathe into a paper bag. Patient is hyperventilating causing patient to lose CO2 resulting in respiratory alkalosis. Rebreathing the air in the paper bag provides more CO2 to correct the respiratory alkalosis.
Physical manifestations and complications of bulimia
Headache, fatigue, muscle cramps Swollen knuckles from induced vomiting Chipmunk cheeks, swollen uvula Polyuria, polydipsia Irregular menses Cardiovascular problems Gastric dilatation, ruptured esophagus Profound constipation, cathartic colon Loss of tooth enamel Fluid and electrolyte imbalance
DI diagnostic criteria
History and physical examination Laboratory tests -Serum osmolality -ADH levels -Urine specific gravity <1.005 -Urine osmolality
What should the nurse prepare the client for that promotes bone growth?
Hypovolemic shock; because the loss of 1,000 mL of blood into the tissues is common with fractures of the femoral shaft
Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture?
Impacted
What are the signs and symptoms of hypercalcemia?
Increased BP and pulse, skeletal muscle weakness, decreased GI motility including diarrhea, severe fatigue, confusion
What labs and signs/symptoms would you expect to see in a patient with dehydration?
Increased Hct and BUN, increased urine specific gravity, low BP, rapid pulse, increased temperature, decreased urine output, skin tenting, dry skin and mucous membranes
Physiological effects of cannabis use
Increased appetite Bloodshot eyes Tachycardia Hypotension
Primary effect of parathyroid hormone
Increases blood calcium level by stimulating bone demineralization and increasing absorption of calcium in the digestive tract and kidneys
Primary effect of aldosterone
Increases sodium and water reabsorption in the kidney
Diabetes insipidus pathophysiology
Insufficient ADH Inability to concentrate or retain water Causes: -Adenoma -Insufficient ADH production or secretion Inadequate kidney response to ADH Water intoxication
Open fracture management
Internal fixation devices hold bone fragment in position(metallic pins, wires, screws, plates)
After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?
Leg on the affected side abducted
A client informs the nurse that he feels as though he has a kidney stone again. The client is on a diet for weight loss and feels as though this may be a contributing factor as it never occurred before going on the diet. Which diet does the nurse suspect the client may be on?
Low carbohydrate/high protein
Acamprosate calcium
MOA: thought to restore chemical, balance and brain; reduces physical distress and emotional discomfort experience when client quit drinking; reduces, sweating, anxiety, and sleep disturbances Adverse rxns: , dry mouth, headache, dizziness
Imaging studies to diagnose altered hormone function
MRI - hypothalamus/pituitary
When should the person with an eating disorder be hospitalized?
Medically unstable (heart rate in the 40s, orthostatic pressure changes; blood pressure less than 80/50, hypokalemia or hypophosphatemia) Suicidality Weight less than 75% No motivation to recover Need supervision during all meals Complete role impairment; can't feed self Severe family conflict Treatment not available near home
Cushing Syndrome
Metabolic alterations Obesity of trunk, face, and upper back Glucose intolerance Suppression of inflammation/immunity Behavioral changes Impaired stress response
What occurs in skeletal traction?
Metal pins go through skin to the bone
Wernicke's encephalopathy
Mild to severe decrease in mental functioning: ataxia, nystagmus, and mental status changes
Nursing care for DI
Monitor fluids Replace fluids Check Neuro status Check vital signs Check mucous membranes
What are the interventions for hypernatremia?
Monitor weight, monitor I & O, administer diuretics, restrict dietary sodium
What are the sign/symptoms of hypokalemia?
Muscle fatigue and cramping, mental status changes, shallow ineffective respirations due to diminished skeletal muscle activity, irregular and weak/thready pulse, dysrhythmias
What are the signs/symptoms of hyperkalemia?
Muscle twitching and cramps with muscle weakness, hypotension, slow and irregular heart rate with possible dysrhythmias and cardiac arrest
When is skeletal traction interrupted?
Never
What are the normal values for pH, PCO2 and HCO3-?
Normal pH = 7.35 to 7.45 Normal PCO2 = 35 to 45 Normal HCO3- = 22-26
Naltrexone
Opioid receptor antagonist; reduces craving for EtOH and blocks feeling of pleasure when opioids are taken; MOA: some believe drug effects neural pathways in brain where NT dopamine is found
Assessing for neurovascular changes using the 5 Ps
Pain Pallor Pulselessness Paresthesia Paralysis
A nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan?
Perform neurovascular assessment every hour
How to treat infant drug withdrawal
Phenobarbital for hyperactivity and seizures Paregoric to decrease G.I. motility Promazine for vomiting and sedation Minimize stimulation, dim lights, soft music, massage, swaddling, rocking
Wernicke-Korsakoff syndrome
Physical complication of ETOH Organic mental disorder due to: poor nutrition, thiamine deficiency, and neurotoxic effects of EtOH
What kind of cast can be dented while it's damp?
Plaster
Clinical manifestations of diabetes insipidus
Polyuria Excessive thirst Dehydration Shock Death (if untreated)
What are food sources of potassium?
Potatoes, sweet potatoes, soybeans, banannas, tomato juice, dried apricots, kidney beans, orange juice, spinach
Manifestations of fetal alcohol syndrome
Prenatal and postnatal growth deficiency Facial malformations CNS dysfunction Varying degrees of major organs system malfunction
A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?
Prevent internal rotation of the affected leg.
A client presents to the clinic with severe edema. Which type of deficiency should be suspected in this client?
Protein
Purpose of traction
Reduce muscle spasms Reduce, align, and immobilize fractures Reduce deformity Increase space between opposing forces *Used as short-term intervention until other modalities are possible
Purpose of naltrexone in alcoholism
Reduces cravings Helps maintain abstinence Interferes with the tendency to want to drink more
Physical manifestations and complications of anorexia nervosa
Related to starvation Sleep problems Bloating, early satiety, constipation Amenorrhea Hypotension, bradycardia, hypothermia Loss of scalp hair Lanugo
After a fracture, during which stage or phase of bone healing is devitalized tissue removed and new bone reorganized into its former structural arrangement?
Remodeling
Which of the following is the final stage of fracture repair?
Remodeling
SIADH treatment
Remove the cause Water restriction Isotonic or hypertonic IV fluid replacement Pharmacologic treatment
Nursing interventions for SIADH
Restrict fluids to 500 to 1500 mL per day Provide sodium replacement orally or IV Obtain lab specimens for testing Insert dwelling urinary catheter Strict I&O Daily weights Reduce unnecessary environmental stimuli Apply anti-embolism stockings Provide a safe environment Institute seizure precautions Frequently auscultate heart and lung for changes Administer loop diuretics for acute management
Evidence of mild withdrawal from opioids
Rhinorrhea, lacrimation, dysphoria
Hyper secretion of the posterior pituitary can lead to:
SIADH
What are the signs/symptoms of hypomagnesemia? What population is especially vulnerable to this?
Same as hypocalcemia: Positive Trousseau's sign and Chvostek's sign, increased and irregular heart rate, mental status changes, diarrhea and abdominal cramping, hyperactive deep tendon reflexes Alcoholics
What laboratory tests are used to diagnose altered hormone function
Serum and urine hormone levels -Cortisol -Prolactin -thyroxine and TSH -estrogen, testosterone, LH/FSH -GH, somatomedin (insulin-like growth factor-1) Hormone suppression and stimulation test Serum electrolyte, glucose, and calcium levels
What are some early fracture complications?
Shock Fat embolism Compartment syndrome VTE, PE
What are the signs and symptoms of hypocalcemia?
Spasms of face, lips, larynx (can cause stridor) tingling sensation around mouth, mental status changes, increased and irregular heart rate which can lead to cardiac arrest, Trousseau's sign, Chvostek's sign
A client sustains an injury to the ligaments surrounding a joint. What will the nurse identify this injury as?
Sprain
Detox for substance-abuse
Stabilize physical condition Private room by nurses station Decrease stimuli Administer anti-anxiety meds Administer anti-emetic meds Vitamins Benzodiazepines if DTs Increase fluid intake Sometimes restraints are used Monitor vital signs often
Stages of alcoholic liver disease
Stage one: acute fatty liver disease, or chronic liver enlargement - recovery favorable Stage two: alcoholic hepatitis - decreased metabolism Stage three: cirrhosis - portal, hypertension, ascites, hepatic, encephalopathy, bleeding disorders, renal failure
Primary effect of adrenocorticotropic hormone
Stimulates adrenal cortex to secrete primarily cortisol
Primary effect of prolactin
Stimulates breastmilk production during lactation
Primary effect of oxytocin
Stimulates contraction of uterus after delivery; stimulates ejection of breastmilk during lactation
Primary effect of growth hormone
Stimulates protein synthesis
What causes release of catecholamine hormones?
Stimulation of preganglionic sympathetic nerve fibers
Primary effect of epinephrine
Stress response; visceral and cutaneous vasoconstriction; vasodilation in skeletal muscles; increases rate and force of heart contractions; broncodilation
Hypernatremia: SALT LOSS
Stupor/coma Anorexia, n/v Lethargy Tendon reflexes decreased Limp muscles (weakness) Orthostatic hypotension Seizures/headache Stomach cramping
What are interventions for hypercalcemia?
Telemetry monitoring, IV fluids, medications including the diuretic Lasix, and meds that slow calcium movement from bones to the blood such as Aredia, Zometa, calcitonin
A client presents to the clinic with severe edema. Which type of deficiency should be suspected in this client?
The fat-soluble vitamins are stored in adipose tissue and may reach toxic levels.
Why don't you want the person with an eating disorder to gain weight too fast?
They can get fatty liver or CHF
Korsakoff's psychosis
Thiamine deficiency; gate disturbance, disorientation, short-term memory, loss, delirium, fabrication/confabulation, neuropathy
What are the signs/symptoms of hypernatremia?
Thirst, mental status changes due to too little water in and around the brain, tremors, seizures, muscle weakness
Primary effect of insulin
Transport of glucose and other substances into cells; lowers blood glucose level
A client experiencing alcohol withdrawal may exhibit:
Tremors; seizures; increased temperature, pulse and blood pressure; delirium tremors
Diagnostic criteria for Cushing syndrome
Two out of three confirm the diagnosis: Serum cortisol Urine cortisol Dexamethasone suppression test Imaging studies to detect tumors Other indicators: Hypernatremia Hyperglycemia Low eosinophils Decreased lymphoid tissue
Signs and symptoms of DI
Up to 20 L of urine per day Decrease specific gravity Decreased osmolarity Hypovolemia Increased thirst Tachycardia Decreased blood pressure
External fixator devices
Used to manage open fractures with soft tissue damage Provide support for complicated or comminuted fractures Patient requires reassurance because of appearance of device Discomfort is usually minimal, and early mobility may be anticipated with these devices Elevate to reduce edema Monitor for signs and symptoms of complications, including infection Pin care Patient education
Closed fracture management
Uses manipulation and manual traction Traction may be used (skin or skeletal)
Patients having orthopedic surgery are particularly at risk for:
Venous thromboembolism, including DVT and PE
What does the nurse know is the most serious complication of a supracondylar fracture of the humerus?
Volkmann's ischemic contracture
Signs and symptoms of infant drug withdrawal
Within 24 hours of birth: high-pitched cry, jitteriness, clonus, tremors, increased muscle tone, sleep, disturbance, seizures, hyperthermia, nasal stuffiness, nasal flaring, vomiting, and diarrhea, excessive sweating
Primary effect of luteinizing hormone
Women: stimulates maturation of ovum and ovulation; men: stimulates secretion of testosterone
A client returns to the doctor's office for evaluation 6 weeks after a tibial fracture. Which assessment indicates the potential for nonunion?
X-ray shows minimal calcification at the fracture.
Addisonian crisis
acute adrenocortical insufficiency; characterized by hypotension, cyanosis, fever, nausea/vomiting, and signs of shock
pheochryocytoma
adrenal medulla tumor
An important nursing assessment, post fracture, is to evaluate neurovascular status. Therefore, the nurse should check for:
capillary refill
Trousseau's sign
carpopedal spasm induced when blood flow to the arm is occluded using a blood pressure cuff or tourniquet, causing ischemia to the distal nerves; suggestive sign for latent tetany in hypocalcemia
hormones
chemical transmitter substances produced in one organ or part of the body and carried by the bloodstream to other cells or organs on which they have a specific regulatory effect
Addison's disease
chronic adrenocortical insufficiency due to inadequate adrenal cortex function
diabetes insipidus
condition in which abnormally large volumes of dilute urine are excreted as a result of deficient production of vasopressin
thyrotoxicosis
condition produced by excessive endogenous or exogenous thyroid hormone
Clinical manifestations of compartment syndrome
dusky, pale appearance of the exposed extremity; cool skin temperature; delayed capillary refill; paresthesia; and unrelenting pain not relieved by position changes, ice, or analgesia; hallmark sign is pain that occurs or intensifies with passive range of motion; patient may complain that the cast, brace, or splint is too tight
What should the nurse prepare the client for that promotes bone growth?
electrical stimulation
syndrome of inappropriate antidiuretic hormone (SIADH)
excessive secretion of antidiuretic hormone from the pituitary gland despite low serum osmolality level
The femur fracture that commonly leads to avascular necrosis or nonunion because of an abundant supply of blood vessels in the area is a fracture of the:
femoral neck
How does fever with osteomyelitis present?
fever may be lowgrade and occur in the afternoon or evening
Cushing's syndrome
group of symptoms produced by an oversecretion of adrenocorticotropic hormone; characterized by truncal obesity, "moon face," acne, abdominal striae, and hypertension
Triad of symptoms for pheochryocytoma
headache, diaphoresis, and palpitations in the patient with hypertension
Which type of cast encloses the trunk and a lower extremity?
hip spica
adrenocorticotropic hormone (ACTH)
hormone secreted by the anterior pituitary, essential for growth and development
calcitonin
hormone secreted by the thyroid gland; participates in calcium regulation
corticosteroids
hormones produced by the adrenal cortex or their synthetic equivalents
What is the primary treatment for musculoskeletal trauma?
immobilization
thyroiditis
inflammation of the thyroid gland; may lead to chronic hypothyroidism or may resolve spontaneously
A nurse would most likely expect the need for open reduction for a client with:
joint fracture
thyroid storm
life-threatening condition of the thyroid due to untreated hyperthyroidism
subluxation
partial or incomplete dislocation
acromegaly
progressive enlargement of peripheral body parts resulting from excessive secretion of growth hormone
thyroid stimulating hormone
released from the pituitary gland; causes stimulation of the thyroid, resulting in release of T3 and T4
Traction is used to:
relieve muscle spasm, align bones, and maintain immobilization when used properly
The client with a fractured clavicle has:
restricted motion, and the affected shoulder appears to slope downward and droop inward; the client will have pain
An open reduction is required when:
soft tissue is caught between the ends of the broken pieces of bone, the bone has a wide separation, open fractures are evident, comminuted fractures are present, and the patella or other joints are fractured; it is also done when wound debridement or internal fixation is needed.
Chvostek's sign
spasm of the facial muscles produced by sharply tapping over the facial nerve in front of the parotid gland and anterior to the ear; suggestive of latent tetany in patients with hypocalcemia
mineralcorticoids
steroid hormones secreted by the adrenal cortex
glucocorticoids
steroid hormones secreted by the adrenal cortex in response to adrenocorticotropic hormone; produce a rise of liver glycogen and blood glucose
Clinical manifestations of SIADH
•Decreased urine output (concentrated) •Severity of symptoms depends on serum sodium levels -Anorexia, nausea, vomiting, headache -Irritability, disorientation, cramps, weakness -Psychosis, gait disturbances, seizures, coma
SIADH Pathophysiology
•Excess production and release of ADH •Most common cause: tumor secreting ectopic ADH •ADH promotes water retention intracellularly •Water accumulates in cells, altering function •Sodium is diluted in extracellular space •Result: hypotonic hyponatremia