Unit 7.2 Diuretics PDF

Diuretics NUR 210/BSL 101 Unit 7  Thiazide and thiazide-like Types of Diuretics Loop or high-ceiling Osmotic Potassium-sparing  Action Thiazide Diuretics - Action is in the kidneys h...

Diuretics NUR 210/BSL 101 Unit 7  Thiazide and thiazide-like Types of Diuretics Loop or high-ceiling Osmotic Potassium-sparing  Action Thiazide Diuretics - Action is in the kidneys hydrochlorothiazide ◦ Promotes NA, K, and water excretion ◦ Act on distal convoluted renal tubule Uses Treat hypertension Edema from heart failure  Side effects and adverse reactions Dizziness, headache, weakness Thiazide Diuretics - GI distress hydrochlorothiazide Photosensitivity Fluid and Electrolyte imbalances Hypotension, orthostatic hypotension Hyperglycemia Hypokalemia, dysrhythmias  Contraindications Renal failure Electrolyte depletion Thiazide Diuretics - Caution hydrochlorothiazide ◦ Hepatic dysfunction ◦ Diabetes mellitus Interactions Increased digoxin toxicity with hypokalemia Anti-diabetic drugs Steroids  Action ◦ Inhibits water and sodium reabsorption, potassium, magnesium and calcium are also excreted Loop Diuretics - ◦ Act on ascending loop of Henle Furosemide Uses ◦ Treat fluid retention caused by heart failure ◦ Renal dysfunction ◦ Cirrhosis ◦ Hypertension ◦ Pulmonary edema  Side effects and adverse reactions GI distress Dizziness Loop Diuretics - Weakness Furosemide Photosensitivity Fluid and electrolyte imbalances Orthostatic hypotension, hypotension Hyperglycemia Hearing loss – when iv pushing too fast  Contraindications Severe electrolyte imbalance Hypovolemia Allergy to sulfa drugs Caution Loop Diuretics - ◦ Heart failure Furosemide ◦ Diabetes Interactions Anticoagulants (increased bleeding) Steroids (increased K loss) Digoxin if hypokalemia is present  Serum chemistry abnormalities with k wasting diuretics K wasting Hypokalemia Diuretics lab Hypomagnesemia abnormalities Hypochloremia 1 Hyponatremia Hyperglycemia hypocalcemia in loop Hypercalcemia in thiazides  Action ◦ Causes water, sodium, chloride, potassium to be excreted through Osmotic Diuretics - the kidneys Mannitol Use: ◦ decrease Intracranial pressure ◦ decrease intraocular pressure ◦ Promote excretion of toxic substances ◦ Usually used in an emergency situation  Side effects/adverse reactions: ◦ GI upset Osmotic Diuretics - ◦ Fluid and electrolyte imbalance Mannitol ◦ Pulmonary edema from rapid shift of fluids ◦ Tachycardia from rapid fluid loss ◦ Rapid fluid loss, acidosis Extreme caution ◦ Heart disease and heart failure ◦ Renal failure  Action Blocks action of aldosterone Potassium-Sparing Because of blocking aldosterone, the Diuretics renal tubules promote sodium and water excretion and potassium retention Spironolactone Also excretes magnesium, calcium – can increase blood glucose Uses Heart failure Hepatic cirrhosis  Side effects/adverse reactions Potassium-Sparing Diuretics GI distress, dizziness, weakness Spironolactone Erectile dysfunction Orthostatic hypotension, Hypotension Fluid and Electrolyte imbalance Hyperkalemia  Contraindications Potassium-Sparing Severe kidney/renal disease Hyperkalemia Diuretics Spironolactone Interactions Potassium supplements ACE inhibitors and angiotensin 2 receptor blockers Salt substitutes containing potassium  Assessment Nursing Process: Medication/medical history Diuretics Vital signs Fluid and electrolyte levels, weight Renal/hepatic function Allergies  Interventions Monitor I & O, daily weight Nursing Process: Notify hcp if urine output does not increase Diuretics Monitor vs, watching blood pressure Administer IV furosemide slowly For k wasting watch for s/s of hypokalemia For k sparing watch for s/s of hyperkalemia Monitor electrolyte levels Monitor glucose periodically  Teaching Take bp before dose Weigh self daily – report gain of 2 # overnight or 5 # in week Take medication in the morning Ok to take with food if GI upset occurs Nursing Process: Stay out of sun with photosensitivity Diuretics Teach to get up slowly Reinforce need for medication and to compliance Diet – k wasting – increase potassium, potassium supplement, if client on digoxin, especially important Diet – k sparing – decrease potassium Teach that drugs can increase glucose so hcp will monitor blood glucose  A client is taking furosemide (Lasix) 40 mg daily for heart failure and hypertension. It is most important for the nurse to assess the client for the development of Practice Question #1 A. low serum potassium, sodium, and 1 magnesium, and elevated calcium. B. low serum potassium and sodium and elevated magnesium and calcium. C. low serum potassium, sodium, magnesium, and calcium. D. low serum potassium and sodium, with magnesium and calcium remaining normal. Practice Question #1 Answer: C 1 Rationale: Loop diuretics cause a loss of potassium, sodium, magnesium, and calcium.  Which statement will the nurse include when teaching a client about loop (high-ceiling) diuretics? Practice Question #2 A. Take the medication at bedtime. 1 B. Take the medication on an empty stomach. C. Rise slowly from a lying or sitting to standing position to prevent dizziness. D. Avoid fruit and vegetables in the diet.  Answer: C Rationale: The medication should be taken in the morning, not at bedtime, to Practice Question prevent sleep disturbances and nocturia; #2 taking the medication at mealtime or with 1 a snack, not on an empty stomach, can prevent nausea from developing, and clients receiving this medication should eat a diet high in fruits and vegetables to prevent hypokalemia.  A client is admitted to the intensive care unit with increased intracranial pressure. The nurse Practice Question would anticipate administering #3 1 A. furosemide (Lasix). B. mannitol (Osmitrol). C. triamterene (Dyrenium). D. spironolactone (Aldactone).  Answer: B Rationale: Osmotic diuretics such as mannitol (Osmitrol) increase the osmolality and sodium Practice Question reabsorption in the proximal tubule and loop of #3 Henle. Sodium, chloride, potassium, and water 1 are excreted. This group of drugs is used to prevent kidney failure, to decrease intracranial pressure, and to decrease intraocular pressure. Mannitol is a potent osmotic potassium-wasting diuretic frequently used in emergency situations such as ICP and IOP.  A client is receiving furosemide (Lasix). It is most important for the nurse to monitor the Practice Question client for the development of #4 1 A. hyperkalemia. B. hypokalemia. C. hyponatremia. D. hypernatremia. Practice Question Answer: B #4 Rationale: Hypokalemia is the most common 1 electrolyte balance associated with furosemide (Lasix) therapy.  A client with congestive heart failure gains 5 pounds in 1 week. This most likely Practice Question indicates a fluid weight gain of #5 1 A. ½ L. B. 1 L. C. 2 L. D. 3 L. Practice Question #5 Answer: C 1 Rationale: Weight gain of 2.2 pounds is equivalent to an excess liter of body fluids.  Before administering Spironolactone, it is most important for the nurse to determine if the client Practice Question is also receiving #6 1 A. digoxin (Lanoxin). B. potassium chloride (K-Dur). C. acetaminophen (Tylenol). D. doxazosin (Cardura).  Answer: B Practice Question Rationale: spironolactone is a potassium- #6 sparing diuretic. Potassium 1 supplementation is not indicated unless the client’s serum potassium level is very low.  Which statement about aldosterone does the nurse identify as being true? Aldosterone Practice Question #7 1 A. promotes sodium excretion. B. is a mineralocorticoid hormone. C. promotes potassium retention. D. is secreted by the pancreas. Practice Question Answer: B #7 Rationale: Aldosterone is a 1 mineralocorticoid hormone that promotes sodium retention, and potassium excretion is not secreted by the pancreas