SlideShare ist ein Scribd-Unternehmen logo
1 von 10
WELCOME
HEAD INJURY
Head injury is also called traumatic brain
injury. It is an insult to the brain capable of
producing physical ,intellectual ,emotional ,
social and vocational changes and it produces
compromised neurological functions ,
resulting in diffuse symptoms.
ETIOLOGY AND RISK FACTORS
• Motor vehicle accident.
• Falls sports related injuries, workplace accidents,
assults or bullets.
• Gender : most males younger than 30
• A person who has had a head injury and if
experiencing the following symptoms should seek
immediate medical care
 Serious bleeding from head or face and clear fluid
drainage from the nose or ear.
 Loss of consciousness, however , brief , confusion
and lethargy.
 Lack of pulse or breathing.
PATHOPHYSIOLOGY
Cells within brain become anoxic and cannot
metabolize properly, producing ischemia,
infarction,irreversible brain damage and eventually
brain death.
Brain suffers traumatic injury
Brain swells or bleeds which increases intracranial
volume
Rigid cranium has no space to expansion of contents
Increased intracranial pressure
Pressure in the blood vessels within the brain causes
blood flow the brain to slow
Cerebral hypoxia and ischemia occur
ICP continue to rise , brain may herniated or cerebral
blood flow ceases
Altered level of conciousness
Coma and death
DIAGNOSTIC PROCEDURE
• History taking and physical examinations
• Blood test : CBC , coagulation profile,
• X-ray skull, MRI and CT scan
• Diagnostic burr hole
• Neuropsychological test : during rehabilitaion phase
to determine cognitive defects
TREATMENT AND MANAGEMENT
Treatment dependent on the site and severity of the
injury.
The management focuses on supporting all organ
system. The support includes:
• Ventilatory support
• Management of fluid balance and elimination
• Management of nutrition and gastro intestinal
function.
1. Patient with minor head injury with concussions,
the medical treatment includes
-keeping the patient in observation for 24hrs with
complete bed rest.
-symptomatic treatment and discharge.
2.If patients need further management and have
severe brsin injury he/she should be admitted in the
special unit and carried out following treatment.
-For all the patient with head injury , prophylactic
antibiotic are given to prevent potential CNS
infection
-Sedatives should be given if seizures
-Medical decompression is done to reduce edema.
NURSING MANAGEMENT
• Airway :
-patient airway should be assessed and maintained.
-incubate the patient who has GCS less than 8 score
-placement NG tube with intubation to prevent aspiration
• Breathing :
-all the intubated patient should have in ventilatory
support and provide oxygen as needed.
• Circulatory support and maintenance :
-prevent hypotension and maintain SBP above 110mmof
hg
-maintain normal fluid volume.
• Support care :
-nutritional support ,rehabilitaion support services and
skin care.
• Performed routine basic care :
-position change frequently,physiotherapy etc
-antibiotic to prevent infection with open skull
fracture.
-treatment of hyponatremia by fluid intake and output

Weitere ähnliche Inhalte

Ähnlich wie injuries that occur to the scalp, skull, brain, and underlying tissue and blood vessels in the head

Increased intracranial pressure
Increased intracranial pressureIncreased intracranial pressure
Increased intracranial pressuregslister
 
Care for head injury joanne (1)
Care for head injury  joanne (1)Care for head injury  joanne (1)
Care for head injury joanne (1)joanne khairuddin
 
Module 11 Updated Student Copy.pptx
Module 11 Updated Student Copy.pptxModule 11 Updated Student Copy.pptx
Module 11 Updated Student Copy.pptxErickaVargas24
 
Meningitis.pptx
Meningitis.pptxMeningitis.pptx
Meningitis.pptxMeerub Ali
 
2 raised-intracranial-pressure
2 raised-intracranial-pressure2 raised-intracranial-pressure
2 raised-intracranial-pressureChantal Settley
 
Encephalitis & brain abscess.pptx
Encephalitis & brain abscess.pptxEncephalitis & brain abscess.pptx
Encephalitis & brain abscess.pptxMeerub Ali
 
Syncope medical emergency
Syncope medical emergencySyncope medical emergency
Syncope medical emergencyKrutika Mistry
 
surgery.Head injury.(dr.ari)
surgery.Head injury.(dr.ari)surgery.Head injury.(dr.ari)
surgery.Head injury.(dr.ari)student
 
Head injury and nursing management
Head injury and nursing managementHead injury and nursing management
Head injury and nursing managementRakhiYadav53
 
Managing clients with neurologic dysfunction
Managing clients with neurologic dysfunctionManaging clients with neurologic dysfunction
Managing clients with neurologic dysfunctionTosca Torres
 
Unconciousness and head injuries by katunga charles rphn at lawanika college ...
Unconciousness and head injuries by katunga charles rphn at lawanika college ...Unconciousness and head injuries by katunga charles rphn at lawanika college ...
Unconciousness and head injuries by katunga charles rphn at lawanika college ...lewanika
 
CENTRAL NERVOUS SYSTEM (1) (1).pptx
CENTRAL NERVOUS SYSTEM (1) (1).pptxCENTRAL NERVOUS SYSTEM (1) (1).pptx
CENTRAL NERVOUS SYSTEM (1) (1).pptxSujoy Tontubay
 
What you should know about Intracranial pressure
 What you should know about Intracranial pressure What you should know about Intracranial pressure
What you should know about Intracranial pressureNapoleon Abonales
 
Surgery 5th year, 2nd/part two, 3rd & 4th lectures (Dr. Ari Sami)
Surgery 5th year, 2nd/part two, 3rd & 4th lectures (Dr. Ari Sami)Surgery 5th year, 2nd/part two, 3rd & 4th lectures (Dr. Ari Sami)
Surgery 5th year, 2nd/part two, 3rd & 4th lectures (Dr. Ari Sami)College of Medicine, Sulaymaniyah
 

Ähnlich wie injuries that occur to the scalp, skull, brain, and underlying tissue and blood vessels in the head (20)

Hydrocephalus
HydrocephalusHydrocephalus
Hydrocephalus
 
Increased intracranial pressure
Increased intracranial pressureIncreased intracranial pressure
Increased intracranial pressure
 
Care for head injury joanne (1)
Care for head injury  joanne (1)Care for head injury  joanne (1)
Care for head injury joanne (1)
 
Module 11 Updated Student Copy.pptx
Module 11 Updated Student Copy.pptxModule 11 Updated Student Copy.pptx
Module 11 Updated Student Copy.pptx
 
neurological disorders
 neurological  disorders neurological  disorders
neurological disorders
 
Cerebro vascular accident
Cerebro vascular accidentCerebro vascular accident
Cerebro vascular accident
 
Meningitis.pptx
Meningitis.pptxMeningitis.pptx
Meningitis.pptx
 
2 raised-intracranial-pressure
2 raised-intracranial-pressure2 raised-intracranial-pressure
2 raised-intracranial-pressure
 
Encephalitis & brain abscess.pptx
Encephalitis & brain abscess.pptxEncephalitis & brain abscess.pptx
Encephalitis & brain abscess.pptx
 
Syncope medical emergency
Syncope medical emergencySyncope medical emergency
Syncope medical emergency
 
surgery.Head injury.(dr.ari)
surgery.Head injury.(dr.ari)surgery.Head injury.(dr.ari)
surgery.Head injury.(dr.ari)
 
Head injury and nursing management
Head injury and nursing managementHead injury and nursing management
Head injury and nursing management
 
Managing clients with neurologic dysfunction
Managing clients with neurologic dysfunctionManaging clients with neurologic dysfunction
Managing clients with neurologic dysfunction
 
Unconciousness and head injuries by katunga charles rphn at lawanika college ...
Unconciousness and head injuries by katunga charles rphn at lawanika college ...Unconciousness and head injuries by katunga charles rphn at lawanika college ...
Unconciousness and head injuries by katunga charles rphn at lawanika college ...
 
Head injury dkg
Head injury dkgHead injury dkg
Head injury dkg
 
CENTRAL NERVOUS SYSTEM (1) (1).pptx
CENTRAL NERVOUS SYSTEM (1) (1).pptxCENTRAL NERVOUS SYSTEM (1) (1).pptx
CENTRAL NERVOUS SYSTEM (1) (1).pptx
 
What you should know about Intracranial pressure
 What you should know about Intracranial pressure What you should know about Intracranial pressure
What you should know about Intracranial pressure
 
Surgery 5th year, 2nd/part two, 3rd & 4th lectures (Dr. Ari Sami)
Surgery 5th year, 2nd/part two, 3rd & 4th lectures (Dr. Ari Sami)Surgery 5th year, 2nd/part two, 3rd & 4th lectures (Dr. Ari Sami)
Surgery 5th year, 2nd/part two, 3rd & 4th lectures (Dr. Ari Sami)
 
Cva slides
Cva slidesCva slides
Cva slides
 
Increased icp
Increased icpIncreased icp
Increased icp
 

Kürzlich hochgeladen

Colonoscopy Screening And Age: Adapting Guidelines For Different Life Stages
Colonoscopy Screening And Age: Adapting Guidelines For Different Life StagesColonoscopy Screening And Age: Adapting Guidelines For Different Life Stages
Colonoscopy Screening And Age: Adapting Guidelines For Different Life StagesCanadian Place Endoscopy
 
Renal Replacement Therapy - ICU Guidlines
Renal Replacement  Therapy - ICU GuidlinesRenal Replacement  Therapy - ICU Guidlines
Renal Replacement Therapy - ICU GuidlinesLikhithaNalluru
 
Jaipur #ℂall #gIRLS Oyo Hotel 89O1183OO2 #ℂall #gIRL in Jaipur
Jaipur #ℂall #gIRLS Oyo Hotel 89O1183OO2 #ℂall #gIRL in Jaipur Jaipur #ℂall #gIRLS Oyo Hotel 89O1183OO2 #ℂall #gIRL in Jaipur
Jaipur #ℂall #gIRLS Oyo Hotel 89O1183OO2 #ℂall #gIRL in Jaipur aunty1x1
 
Importance of Diet on Dental Health.docx
Importance of Diet on Dental Health.docxImportance of Diet on Dental Health.docx
Importance of Diet on Dental Health.docxSachin Mittal
 
#cALL# #gIRLS# In Chhattisgarh ꧁❤8901183002❤꧂#cALL# #gIRLS# Service In Chhatt...
#cALL# #gIRLS# In Chhattisgarh ꧁❤8901183002❤꧂#cALL# #gIRLS# Service In Chhatt...#cALL# #gIRLS# In Chhattisgarh ꧁❤8901183002❤꧂#cALL# #gIRLS# Service In Chhatt...
#cALL# #gIRLS# In Chhattisgarh ꧁❤8901183002❤꧂#cALL# #gIRLS# Service In Chhatt...aunty1x1
 
Improve Patient Care with Medical Record Abstraction
Improve Patient Care with Medical Record AbstractionImprove Patient Care with Medical Record Abstraction
Improve Patient Care with Medical Record AbstractionCardiac Registry Support
 
Leaukemia and it cause sign and symptoms
Leaukemia and it cause sign and symptomsLeaukemia and it cause sign and symptoms
Leaukemia and it cause sign and symptomswajidullah9551
 
CHAPTER- 1 SEMESTER - V NATIONAL HEALTH PROGRAMME RELATED TO CHILD.pdf
CHAPTER- 1 SEMESTER - V NATIONAL HEALTH PROGRAMME RELATED TO CHILD.pdfCHAPTER- 1 SEMESTER - V NATIONAL HEALTH PROGRAMME RELATED TO CHILD.pdf
CHAPTER- 1 SEMESTER - V NATIONAL HEALTH PROGRAMME RELATED TO CHILD.pdfSachin Sharma
 
2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdf
2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdf2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdf
2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdfRobert Cole
 
ASSISTING WITH THE USE OF BED PAN BY ANUSHRI SRIVASTAVA.pptx
ASSISTING WITH THE USE OF BED PAN BY ANUSHRI SRIVASTAVA.pptxASSISTING WITH THE USE OF BED PAN BY ANUSHRI SRIVASTAVA.pptx
ASSISTING WITH THE USE OF BED PAN BY ANUSHRI SRIVASTAVA.pptxAnushriSrivastav
 
For Better Jaipur #ℂall #Girl Service ❤89011-83002❤ Jaipur #ℂall #Girls
For Better Jaipur #ℂall #Girl Service ❤89011-83002❤ Jaipur #ℂall #Girls For Better Jaipur #ℂall #Girl Service ❤89011-83002❤ Jaipur #ℂall #Girls
For Better Jaipur #ℂall #Girl Service ❤89011-83002❤ Jaipur #ℂall #Girls aunty1x1
 
PT MANAGEMENT OF URINARY INCONTINENCE.pptx
PT MANAGEMENT OF URINARY INCONTINENCE.pptxPT MANAGEMENT OF URINARY INCONTINENCE.pptx
PT MANAGEMENT OF URINARY INCONTINENCE.pptxdrtabassum4
 
Management of Colorectal Cancer for the Trainee Surgeon
Management of Colorectal Cancer for the Trainee SurgeonManagement of Colorectal Cancer for the Trainee Surgeon
Management of Colorectal Cancer for the Trainee SurgeonMinistry of Health, Sri Lanka
 
Chris Shade BS MEd MS LPC-Associate "Presume" (What Do I Do?)
Chris Shade BS MEd MS LPC-Associate "Presume" (What Do I Do?)Chris Shade BS MEd MS LPC-Associate "Presume" (What Do I Do?)
Chris Shade BS MEd MS LPC-Associate "Presume" (What Do I Do?)Chris Shade
 
Master the Art of Yoga with Joga Yoga Training
Master the Art of Yoga with Joga Yoga TrainingMaster the Art of Yoga with Joga Yoga Training
Master the Art of Yoga with Joga Yoga TrainingJoga Yoga Training
 
ASSISTING WITH THE USE OF URINAL BY ANUSHRI SRIVASTAVA.pptx
ASSISTING WITH THE USE OF URINAL BY ANUSHRI SRIVASTAVA.pptxASSISTING WITH THE USE OF URINAL BY ANUSHRI SRIVASTAVA.pptx
ASSISTING WITH THE USE OF URINAL BY ANUSHRI SRIVASTAVA.pptxAnushriSrivastav
 
Storage_of _Bariquin_Components_in_Storage_Boxes.pptx
Storage_of _Bariquin_Components_in_Storage_Boxes.pptxStorage_of _Bariquin_Components_in_Storage_Boxes.pptx
Storage_of _Bariquin_Components_in_Storage_Boxes.pptxBariquins
 
Homeopathy Medicine for Diabetes_ Balancing Blood Sugar .pdf
Homeopathy Medicine for Diabetes_ Balancing Blood Sugar .pdfHomeopathy Medicine for Diabetes_ Balancing Blood Sugar .pdf
Homeopathy Medicine for Diabetes_ Balancing Blood Sugar .pdfDharma Homoeopathy
 
Nose-Nasal Cavity & Paranasal Sinuses BY Dr.Rabia Inam Gandapore.pptx
Nose-Nasal Cavity & Paranasal Sinuses BY Dr.Rabia Inam Gandapore.pptxNose-Nasal Cavity & Paranasal Sinuses BY Dr.Rabia Inam Gandapore.pptx
Nose-Nasal Cavity & Paranasal Sinuses BY Dr.Rabia Inam Gandapore.pptxDr. Rabia Inam Gandapore
 

Kürzlich hochgeladen (20)

Colonoscopy Screening And Age: Adapting Guidelines For Different Life Stages
Colonoscopy Screening And Age: Adapting Guidelines For Different Life StagesColonoscopy Screening And Age: Adapting Guidelines For Different Life Stages
Colonoscopy Screening And Age: Adapting Guidelines For Different Life Stages
 
Renal Replacement Therapy - ICU Guidlines
Renal Replacement  Therapy - ICU GuidlinesRenal Replacement  Therapy - ICU Guidlines
Renal Replacement Therapy - ICU Guidlines
 
Jaipur #ℂall #gIRLS Oyo Hotel 89O1183OO2 #ℂall #gIRL in Jaipur
Jaipur #ℂall #gIRLS Oyo Hotel 89O1183OO2 #ℂall #gIRL in Jaipur Jaipur #ℂall #gIRLS Oyo Hotel 89O1183OO2 #ℂall #gIRL in Jaipur
Jaipur #ℂall #gIRLS Oyo Hotel 89O1183OO2 #ℂall #gIRL in Jaipur
 
Importance of Diet on Dental Health.docx
Importance of Diet on Dental Health.docxImportance of Diet on Dental Health.docx
Importance of Diet on Dental Health.docx
 
#cALL# #gIRLS# In Chhattisgarh ꧁❤8901183002❤꧂#cALL# #gIRLS# Service In Chhatt...
#cALL# #gIRLS# In Chhattisgarh ꧁❤8901183002❤꧂#cALL# #gIRLS# Service In Chhatt...#cALL# #gIRLS# In Chhattisgarh ꧁❤8901183002❤꧂#cALL# #gIRLS# Service In Chhatt...
#cALL# #gIRLS# In Chhattisgarh ꧁❤8901183002❤꧂#cALL# #gIRLS# Service In Chhatt...
 
Improve Patient Care with Medical Record Abstraction
Improve Patient Care with Medical Record AbstractionImprove Patient Care with Medical Record Abstraction
Improve Patient Care with Medical Record Abstraction
 
Leaukemia and it cause sign and symptoms
Leaukemia and it cause sign and symptomsLeaukemia and it cause sign and symptoms
Leaukemia and it cause sign and symptoms
 
CHAPTER- 1 SEMESTER - V NATIONAL HEALTH PROGRAMME RELATED TO CHILD.pdf
CHAPTER- 1 SEMESTER - V NATIONAL HEALTH PROGRAMME RELATED TO CHILD.pdfCHAPTER- 1 SEMESTER - V NATIONAL HEALTH PROGRAMME RELATED TO CHILD.pdf
CHAPTER- 1 SEMESTER - V NATIONAL HEALTH PROGRAMME RELATED TO CHILD.pdf
 
2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdf
2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdf2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdf
2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdf
 
ASSISTING WITH THE USE OF BED PAN BY ANUSHRI SRIVASTAVA.pptx
ASSISTING WITH THE USE OF BED PAN BY ANUSHRI SRIVASTAVA.pptxASSISTING WITH THE USE OF BED PAN BY ANUSHRI SRIVASTAVA.pptx
ASSISTING WITH THE USE OF BED PAN BY ANUSHRI SRIVASTAVA.pptx
 
For Better Jaipur #ℂall #Girl Service ❤89011-83002❤ Jaipur #ℂall #Girls
For Better Jaipur #ℂall #Girl Service ❤89011-83002❤ Jaipur #ℂall #Girls For Better Jaipur #ℂall #Girl Service ❤89011-83002❤ Jaipur #ℂall #Girls
For Better Jaipur #ℂall #Girl Service ❤89011-83002❤ Jaipur #ℂall #Girls
 
PT MANAGEMENT OF URINARY INCONTINENCE.pptx
PT MANAGEMENT OF URINARY INCONTINENCE.pptxPT MANAGEMENT OF URINARY INCONTINENCE.pptx
PT MANAGEMENT OF URINARY INCONTINENCE.pptx
 
Importance-of-Protein-During-Pregnancy Time
Importance-of-Protein-During-Pregnancy TimeImportance-of-Protein-During-Pregnancy Time
Importance-of-Protein-During-Pregnancy Time
 
Management of Colorectal Cancer for the Trainee Surgeon
Management of Colorectal Cancer for the Trainee SurgeonManagement of Colorectal Cancer for the Trainee Surgeon
Management of Colorectal Cancer for the Trainee Surgeon
 
Chris Shade BS MEd MS LPC-Associate "Presume" (What Do I Do?)
Chris Shade BS MEd MS LPC-Associate "Presume" (What Do I Do?)Chris Shade BS MEd MS LPC-Associate "Presume" (What Do I Do?)
Chris Shade BS MEd MS LPC-Associate "Presume" (What Do I Do?)
 
Master the Art of Yoga with Joga Yoga Training
Master the Art of Yoga with Joga Yoga TrainingMaster the Art of Yoga with Joga Yoga Training
Master the Art of Yoga with Joga Yoga Training
 
ASSISTING WITH THE USE OF URINAL BY ANUSHRI SRIVASTAVA.pptx
ASSISTING WITH THE USE OF URINAL BY ANUSHRI SRIVASTAVA.pptxASSISTING WITH THE USE OF URINAL BY ANUSHRI SRIVASTAVA.pptx
ASSISTING WITH THE USE OF URINAL BY ANUSHRI SRIVASTAVA.pptx
 
Storage_of _Bariquin_Components_in_Storage_Boxes.pptx
Storage_of _Bariquin_Components_in_Storage_Boxes.pptxStorage_of _Bariquin_Components_in_Storage_Boxes.pptx
Storage_of _Bariquin_Components_in_Storage_Boxes.pptx
 
Homeopathy Medicine for Diabetes_ Balancing Blood Sugar .pdf
Homeopathy Medicine for Diabetes_ Balancing Blood Sugar .pdfHomeopathy Medicine for Diabetes_ Balancing Blood Sugar .pdf
Homeopathy Medicine for Diabetes_ Balancing Blood Sugar .pdf
 
Nose-Nasal Cavity & Paranasal Sinuses BY Dr.Rabia Inam Gandapore.pptx
Nose-Nasal Cavity & Paranasal Sinuses BY Dr.Rabia Inam Gandapore.pptxNose-Nasal Cavity & Paranasal Sinuses BY Dr.Rabia Inam Gandapore.pptx
Nose-Nasal Cavity & Paranasal Sinuses BY Dr.Rabia Inam Gandapore.pptx
 

injuries that occur to the scalp, skull, brain, and underlying tissue and blood vessels in the head

  • 2. HEAD INJURY Head injury is also called traumatic brain injury. It is an insult to the brain capable of producing physical ,intellectual ,emotional , social and vocational changes and it produces compromised neurological functions , resulting in diffuse symptoms.
  • 3. ETIOLOGY AND RISK FACTORS • Motor vehicle accident. • Falls sports related injuries, workplace accidents, assults or bullets. • Gender : most males younger than 30 • A person who has had a head injury and if experiencing the following symptoms should seek immediate medical care  Serious bleeding from head or face and clear fluid drainage from the nose or ear.  Loss of consciousness, however , brief , confusion and lethargy.  Lack of pulse or breathing.
  • 4. PATHOPHYSIOLOGY Cells within brain become anoxic and cannot metabolize properly, producing ischemia, infarction,irreversible brain damage and eventually brain death. Brain suffers traumatic injury Brain swells or bleeds which increases intracranial volume Rigid cranium has no space to expansion of contents
  • 5. Increased intracranial pressure Pressure in the blood vessels within the brain causes blood flow the brain to slow Cerebral hypoxia and ischemia occur ICP continue to rise , brain may herniated or cerebral blood flow ceases Altered level of conciousness Coma and death
  • 6. DIAGNOSTIC PROCEDURE • History taking and physical examinations • Blood test : CBC , coagulation profile, • X-ray skull, MRI and CT scan • Diagnostic burr hole • Neuropsychological test : during rehabilitaion phase to determine cognitive defects
  • 7. TREATMENT AND MANAGEMENT Treatment dependent on the site and severity of the injury. The management focuses on supporting all organ system. The support includes: • Ventilatory support • Management of fluid balance and elimination • Management of nutrition and gastro intestinal function. 1. Patient with minor head injury with concussions, the medical treatment includes -keeping the patient in observation for 24hrs with complete bed rest. -symptomatic treatment and discharge.
  • 8. 2.If patients need further management and have severe brsin injury he/she should be admitted in the special unit and carried out following treatment. -For all the patient with head injury , prophylactic antibiotic are given to prevent potential CNS infection -Sedatives should be given if seizures -Medical decompression is done to reduce edema.
  • 9. NURSING MANAGEMENT • Airway : -patient airway should be assessed and maintained. -incubate the patient who has GCS less than 8 score -placement NG tube with intubation to prevent aspiration • Breathing : -all the intubated patient should have in ventilatory support and provide oxygen as needed. • Circulatory support and maintenance : -prevent hypotension and maintain SBP above 110mmof hg -maintain normal fluid volume.
  • 10. • Support care : -nutritional support ,rehabilitaion support services and skin care. • Performed routine basic care : -position change frequently,physiotherapy etc -antibiotic to prevent infection with open skull fracture. -treatment of hyponatremia by fluid intake and output