Diuretics PDF | GALEN COLLEGE OF NURSING

Diuretics NUR 210/BSL 101 Unit 7  Thiazide and thiazide-like Hydrochloro- thisnide Types of Diuretics Loop or high-ceiling Feurosemide Osmotic Mannitol...

Diuretics NUR 210/BSL 101 Unit 7  Thiazide and thiazide-like Hydrochloro- thisnide Types of Diuretics Loop or high-ceiling Feurosemide Osmotic Mannitol Potassium-sparing spirnolactone  Action Action is in the kidneys Thiazide Diuretics - ◦ Promotes NA, K, and water excretion I hydrochlorothiazide "Water Removing : Loading… Uses ◦ Act on distal convoluted renal tubule Treat hypertension Edema from heart failure  Side effects and adverse reactions Dizziness, headache, weakness GI distress Thiazide Diuretics - Photosensitivity hydrochlorothiazide Fluid and Electrolyte imbalances Hypotension, orthostatic hypotension Hyperglycemia Hypokalemia, dysrhythmias  Contraindications Renal failure Electrolyte depletion Thiazide Diuretics - Caution hydrochlorothiazide ◦ Hepatic dysfunction Loading… ◦ 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 ◦ Act on ascending loop of Henle Loop Diuretics - 2 Furosemide Uses ◦ Treat fluid retention caused by heart failure ◦ Renal dysfunction ◦ Cirrhosis ◦ Hypertension ◦ Pulmonary edema legs/arms in. swelling "Mide Sounds like Ride" - Going for a ride in a loop (PMC 90)  Side effects and adverse reactions GI distress Dizziness Weakness Loop Diuretics - Photosensitivity Furosemide med High-ceiling = Orthostatic Hypotension 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 Hypokalemia Hypomagnesemia K wasting Diuretics Hypochloremia lab abnormalities Hyponatremia 1 Hyperglycemia hypocalcemia in loop Hypercalcemia in thiazides  Action ◦ Causes water, sodium, chloride, potassium to be excreted through the kidneys Osmotic Diuretics - Use: 3 Mannitol ◦ decrease Intracranial edema pressure "Man I have a headache" excerebral - Get's rid of 10pEICP ◦ 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 Loading… ◦ 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 renal tubules promote sodium and water Diuretics excretion and potassium retention 4. 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 (Too much potassium)  Contraindications D Severe kidney/renal disease Potassium-Sparing Hyperkalemia - Diuretics Spironolactone Interactions Potato Ching" 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 D Renal/hepatic function Allergies  Interventions Monitor I & O, daily weight Notify hcp if urine output does not increase Nursing Process: Monitor vs, watching blood pressure Diuretics 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. O 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? furosemide Practice Question #2 A. Take the medication at bedtime. 1 B. Take the medication on an empty stomach. O 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 prevent sleep disturbances and nocturia; Practice Question #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 edema) (cerebral pressure. The nurse would anticipate administering Practice Question #3 1 A. furosemide (Lasix). O B. mannitol (Osmitrol). C. triamterene (Dyrenium). D. spironolactone (Aldactone).  Answer: B Rationale: Osmotic diuretics such as mannitol (Osmitrol) increase the osmolality and sodium reabsorption in the proximal tubule and loop of Henle. Sodium, chloride, potassium, and water are excreted. This Practice Question #3 group of drugs is used to prevent kidney 1 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 client for the development of Practice Question #4 1 A. hyperkalemia. ⑧ B. hypokalemia. C. hyponatremia. D. hypernatremia.  Answer: B Practice Question #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 indicates a fluid weight gain of Practice Question #5 1 A. ½ L. B. 1 L. O 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 is also receiving Practice Question #6 1 A. digoxin (Lanoxin). ⑧ B. potassium chloride (K-Dur). C. acetaminophen (Tylenol). D. doxazosin (Cardura).  Answer: B Rationale: spironolactone is a potassium- Practice Question #6 sparing diuretic. Potassium 1 Loading… 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 A. retention promotes sodium excretion. 1 - O B. is a mineralocorticoid hormone. sodium C. promotes potassium retention. - D. is secreted by the pancreas.  Answer: B Practice Question #7 Rationale: Aldosterone is a mineralocorticoid 1 hormone that promotes sodium retention, and potassium excretion is not secreted by the pancreas