question

Diuretics

answer

Drugs that act to increase the flow of urine

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Purpose of Diuretics

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To increase the net loss of water

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How is diuresis achieved?

answer

Acts on kidneys in different locations to enhance the excretion of sodium

question

What do Methylxanthines do?

answer

Increase glomerular filtration

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What does Spironolactone do?

answer

Inhibits tubular reabsorption of sodium by inhibiting Aldosterone

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What do Thiazide/Loop Diuretics do?

answer

Act directly on kidney tubules to inhibit the reabsorption of Na/Cl/H2O

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What happens to Na and Cl that are not reabsorbed ?

answer

They are excreted into the collecting ducts then into the urteres then to the bladder, taking large volumes of water to be excreted from the body through urination

question

Diuretics are used for?

answer

1) *Heart Failure (to removes excess na/h20 to relieve symptoms assoc. w/ pulmonary congestion and edema) 2) *Hypertension (can reduced the morbidity/mortality assoc. w/ hypertension) 3) Cerebral Edema 4) Intraoccular Pressure assoc. w/ Glaucoma 5) Ascites assoc. w/ Liver Disease 6) Hypercalcemia

question

When older adults are taking diuretics what should they be monitored for?

answer

Hydration Status Electrolyte Balance Response to the tx

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Patient taking Digoxin is at what risk?

answer

At an increased for developing digitalis toxicity due to electrolyte imbalance

question

What are some signs of dehydration?

answer

Inelastic skin turgor Sticky oral mucus membranes Shrunken/deeply furrowed tongue Crusted lips Wt loss Deteriorating vitals Soft/sunken eyeballs Weak pedal pulses Delayed capillary filling Excessive thirst High urine specific gravity No urine output Possible mental confusion

question

When patient is over hydrated what lab changes will be noticed?

answer

Hemodilution= values appear to drop

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When patients are dehydrated what lab changes will be noticed?

answer

Hemoconcentration= values appear higher

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Edema

answer

Excessive fluid accumulation in extracellular spaces (+1)-Slight (+4)-Deep Cool Tight Shiny Pale skin Crackles in the lung sounds (Excess fluid)

question

Signs and symptoms of electrolyte imbalance

answer

Mental Status (alertness, orientation, confusion) Muscle Strength Muscle Cramps Tremors Nausea General Apperance

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Susceptible people to Electrolyte Imbalance

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1) History of renal/cardiac disease 2) Hormonal Disorders 3) Massive Trauma 4) Burns 5) Receiving Diuretic/Steroid Tx

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Hypokalemia

answer

K+ levels <3.5 mEq/L Vomit Diarrhea Heavy Diuresis **All diuretics EXCEPT K-sparing can cause this

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Hyperkalemia

answer

K+ levels >5.5 mEq/L Excessive amounts of K supplements (IV/PO) Adverse effects of K-sparing diuretics or renal disease

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Hyponatremia

answer

Na levels <135 mEq/L **"Where sodium goes, water goes" Monitor for hyponatremia in patient during/after diuresis

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Hypernatremia

answer

Na levels >145 mEq/L When given IV fluids in excess of the fluid that has been excreted

question

What are the different areas that can be recorded for output?

answer

Mouth Urethra Rectum Wounds Tubes (catheters) Daily output= 1200-1500mL or 30-50mL/hr **Low urinary output can be a sign of dehydration, renal failure, or cardiac disease

question

Medication Considerations for Diuretics

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1) Taken Early morning-Mid Afternoon to avoid nocturia 2)Daily wt--same time, usually before breakfast **Gaining 2+ lbs in 2 days needs to be reported!!!!!

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***DO NOT ADMINISTER DIURETICS AFTER WHAT TIME

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NO LATER THAN MID AFTERNOON--TO PREVENT NOCTURIA!

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Things to remember about nutrition when taking diuretics

answer

Potassium Sparing: K foods/salts limited use or restricted Other Diuretics: Required to consume high K foods

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Names of Sulfonamide-Type Loop Diuretics

answer

Furosemide (Lasix) Torsemide (Demedex)

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MOA of Furosemide (Lasix)/Torsemide (Demedex)?

answer

1) Inhibits Na/Cl reabsorption in the ascending loop of Henle 2) Promotes excretion of Na, Cl, Mg, Phosphate, HCO3, Water 3) Increases Renal Blood Flow and GFR

question

Uses of Furosemide (Lasix)/Torsemide (Demedex)

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1) Hypertension 2) Edema from HF, Cirrhosis of Liver, Renal Disease 3) Hypercalcemia (Furosemide ONLY!) --promotes loss of Ca in urine

question

What needs to be assessed before the administration of Uses of Furosemide (Lasix)/Torsemide (Demedex)?

answer

Baseline VS Lung Sounds Wt Degree of Edema in Patient Lab Studies (electrolytes, renal/liver function) Mental Status Muscle Strength *Pt with DM--check blood glucose Check for Symptoms of Gout Any Reduction in Hearing

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** Patients that are allergic to Sulfonamides (sulfa) may be allergic to Sulfonamide-Type Loop Diuretics as well!!!

answer

...

question

Common Adverse Effects of Uses of Furosemide (Lasix)/Torsemide (Demedex)

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Oral Irritation, Dry Mouth (use h202 mouth wash) Orthostatic Hypotension

question

Serious Adverse Effects of Uses of Furosemide (Lasix)/Torsemide (Demedex)

answer

1) GI Irritation, Abd Pain 2) Electrolyte Imbalance, Dehydration (monitor mental status-*K loss! 3) Hyperuricemia (check labs and s/s of gout) 4) Hyperglycemia (glycosuria) 5) Hypersensitivity (sulfa allergy) 6) Hearing Loss

question

Drug Interactions with Uses of Furosemide (Lasix)/Torsemide (Demedex)

answer

1) Alcohol, Barbiturates, Narcotics= Additive Hypotension 2) Digoxin= Digitalis Toxicity (causes excessive K excretion) 3) NSAIDs= Decreases Loop Diuretic Activity 4) Steroids= Increases Risk of Hypokalemia

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Name of Non Sulfonamide Diuretics

answer

Ethacrynic Acid (Edecrin)

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MOA of Ethacrynic Acid (Edecrin)

answer

Inhibits NaCl absorption in the ascending loop of henle * Does not effect renal blood flow or glomerular filtration rate

question

Use of Ethacrynic Acid (Edecrin)

answer

1) Edema from HF, Cirrhosis of Liver, Renal Disease, Malignancy, Pediatric Patients 2) Hypercalcemia

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Assessments that should be done prior to the administration of Ethacrynic Acid (Edecrin)

answer

Baseline VS Lung Sounds Wt Degree of Edema in Patient Lab Studies (electrolytes, renal/liver function) Mental Status Muscle Strength *Pt with DM--check blood glucose Check for Symptoms of Gout Any Reduction in Hearing

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Common Adverse Effects of Ethacrynic Acid (Edecrin)

answer

Orthostatic Hypotension

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Serious Adverse Effects of Ethacrynic Acid (Edecrin)

answer

1) Electrolyte Imbalance, Dehydration 2) Dizzy, Deaf, Headache 3) GI Bleeding, Diarrhea 4) Hyperglycemia

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Drug Interactions for Ethacrynic Acid (Edecrin)

answer

NSAIDs Digoxin Steroids

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Name of Thiazide Diuretics

answer

Hydrochlorothiazide (HydroDIURIL)

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MOA of Hydrochlorothiazide (HydroDIURIL)

answer

Blocks NaCL reabsorption from the distal tubule **NaCl that's not reabsorbed are passed into the collecting ducts, taking molecules or water with them resulting in diuresis **Slower onset og action compared to the loop diuretics **Moderate fluid loss compared to the loss in loop diuretics

question

Use of Hydrochlorothiazide (HydroDIURIL)

answer

HTN Edema from HF, Renal/Liver Disease, Pregnancy, PMS

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What should be assessed prior to the administration of Hydrochlorothiazide (HydroDIURIL) ?

answer

Baseline VS Lung Sounds Wt Degree of Edema in Patient Lab Studies (electrolytes, renal/liver function) Mental Status Muscle Strength *Pt with DM--check blood glucose Check for Symptoms of Gout Any Reduction in Hearing

question

Common Adverse Effects of Hydrochlorothiazide (HydroDIURIL)

answer

Orthostatic Hypotension

question

Serious Adverse Effects of Hydrochlorothiazide (HydroDIURIL)

answer

GI Irritation, N/V, Constipation Electrolyte Imbalance Dehydration Hyperuricemia Hyperglycemia Hypersensitivity

question

Drug interactions with Hydrochlorothiazide (HydroDIURIL)

answer

NSAIDs Steroids Lithium Digoxin

question

Names of the Potassium Sparing Diuretics

answer

Amiloride (Midamor) Spironolactone (Aldactone) Trianlterene (Dyrenium)

question

MOA for Amiloride (Midamor), Spironolactone (Aldactone), Trianlterene (Dyrenium)

answer

Induces retention of K Excretion of Na at distal tubules

question

Uses of Amiloride (Midamor), Spironolactone (Aldactone), Trianlterene (Dyrenium)

answer

1) *In combo with other diuretics to tx HTN 2) To relieve edema related to HF and liver disease 3) To prevent hypokalemia in patient taking loop or thiazide diuretics

question

Assessments that must be made prior to the administration of Amiloride (Midamor), Spironolactone (Aldactone), Trianlterene (Dyrenium)

answer

Baseline VS Lung Sounds Wt Degree of Edema Present Lab Studies Mental Status *Libido (Spironolactone ONLY!)

question

Common Adverse Effects of Amiloride (Midamor), Spironolactone (Aldactone), Trianlterene (Dyrenium)

answer

Anorexia Nausea Vomiting Flatulence Headache

question

Serious Adverse Effects of Amiloride (Midamor), Spironolactone (Aldactone), Trianlterene (Dyrenium)

answer

1) *Electrolyte Imbalance: Hyperkalemia (K sparing) 2) Dehydration 3) Gynecomastia, Reduced Libido (Spironolactone ONLY) 4) Hypersensitivity (Triamterene ONLY)

question

Drug Interactions with Amiloride (Midamor), Spironolactone (Aldactone), Trianlterene (Dyrenium)

answer

1) *ACEI, ARBs, Aldosterone Blockers= Increase risk for hyperkalemia 2) *K Supplements/ K Salts= Increased risk for hyperkalemia 3) NSAIDs= diminished diuretic effect

question

Names of The Combination Diuretic Products

answer

Spironolactone/Hydrochlorothiazide (Aldactazide) Triamterene/Hydrochlorothiazide (Dyazide, Maxzide) Amiloride/Hydrochlorothiazide (Moduretic)

question

Goal of The Combination Diuretic Products

answer

To promote diuresis and antihypertenisive effect through different mechanisms of action while maintaining normal serum potassium levels

question

Common Adverse Effects of The Combination Diuretic Products

answer

Hyperkalemia Hyponatremia

question

A patient has been placed on a loop diuretic to reduce the fluid that has been accumulating in the lungs. A statement made by the patient that would indicate further teaching is?

answer

I'll be sure to take my medication with supper

question

A patient with a history of heart failure is prescribed Furosemide (Lasix). Several days after the aggressive diuretic therapy started, the patient began to exhibit confusion, tremors, muscle cramps, and nausea. What does the nurse suspect?

answer

Hypokalemia

question

A patient reviewing Furosemide (Lasix) for a month reports experiencing pain in the toes. The patient states it has been years since having that type of pain. What does the nurse suspect?

answer

Gout

question

Which is a common finding with combination diuretic products?

answer

They increase the risk of hyperkalemia and hyponatremia

question

The nurse is reviewing what is meant by hyperkalemia. What is a correct statement?

answer

Occurs most frequently with potassium-sparing diuretics

question

Which diagnostic tests would be ordered to determine renal function?

answer

Serum Creatinine BUN

question

Which condition may thiazide diuretic therapy cause?

answer

Hyperuricemia

question

NSAIDs taken concurrently with certain diuretics (Bumetanide, Furosemide, and Ethacrynic Acid) can have which result?

answer

Decreased Diuresis

question

Potassium supplements and salt substitues should not be give with which class of diuretic?

answer

Potassium-Sparing

question

What is the main purpose of using diuretics for treating heart failure?

answer

Relieve symptoms associated with pulmonary congestion and edema

question

Which are methods for assessing for hydration?

answer

Skin turgor Oral mucus membranes Vital signs Weight changes

question

Why are diuretics usually not administered after mid noon?

answer

To prevent nocturia

question

When assessing a patient who is overhydrated, which assessment finding does the nurse expect to see?

answer

Neck Vein Engorgement

question

What are the classic signs of dehydration that the nurse will assess for and report?

answer

Shrunken or deeply furrowed tongue Delayed capillary filling Soft or sunken eyeballs Weak pedal pulses

question

A patient who has received IV fluids in excess of fluids excreted is likely to develop which electrolyte imbalance?

answer

Hypernatremia

question

When taking a history of a patient with fluid volume excess, the nurse should ask the patient questions that contribute to fluid volume excess such as?

answer

Dysrhythmias Heart Failure MI

question

Patients with which conditions are prone to developing fluid volume excess?

answer

Hypertension Heart Failure Renal Disease (renal failure) Ascites

question

The nurse should be aware of factor that may predispose a patient to the development of fluid volume excess such as?

answer

Immobility Corticosteroid Agents Hypertension Pregnancy

question

What lab test should be performed to determine if the patient has impaired kidney function?

answer

BUN Serum creatinine

question

What lab studies should be performed whenever a diuretic is prescribed?

answer

Potassium Sodium Hematocrit Blood Glucose BUN Creatinine

question

The nurse will assess which lab results for a patient with UTI, had hyponatremia, with acute kidney injury and a history of hypertension and heart failure?

answer

BUN Creatinine

question

The therapeutic outcomes associated with diuretic therapy include?

answer

Improvement in the symptoms of fluid volume excess Reduced edema Reduced blood pressure

question

A patient is concurrently taking Digoxin (Lanoxin), aminoglycosides, NSAIDs, and corticosteroids for multiple medical problems. Which principle does the nurse consider in monitoring this patient when Bumetanide (Bumex) has now been prescribed?

answer

The potential for ototoxicity from the aminoglycosides is increased

question

A patient with type 2 diabetes mellitus and congestive heart failure is being treated with Metformin (Glucophage), Warfarin (Coumadin), and Digitalis. The patient has a new order for Bumetanide (Bumex). Upon review of the chart, the nurse learns that the patient is allergic to Furosemide (Lasix). What does the nurse do next?

answer

Increase citrus fruits, tomatoes, bananas, dates, and apricots in the patients diet Assess blood sugar because Bumetanide (Bumex) may decrease the hypoglycemic effects of Metformin

question

The patient who has experienced vomiting and diarrhea is likely to develop what?

answer

Hypokalemia

question

When monitoring the lab values of potassium in patients taking diuretics the nurse knows the normal values for potassium is:

answer

3.5-5.2 mEq/L

question

Thiazides may cause or aggravate which electrolyte imbalance?

answer

Chloride (Cl-) Potassium (K+) Sodium (Na+)

question

When thiazide diuretics such as Chlorothiazide (Diuril) are administered, the drug is acting primarily on the?

answer

Distal tubules of the loop of henle

question

Potent diuretics that act primarily by inhibiting sodium and chloride reabsorption from the ascending loop of henle in the kidneys include?

answer

Bumetanide (Bumex) Furosemide (Lasix) Torsemide (Demedex)

question

When administering thiazide and loop diuretics to a diabetic patient, the nurse will need to monitor what labs to prevent an adverse reaction?

answer

Potassium Blood Sugar

question

A patient taking Ethacrynic Acid (Edecrin) is most at risk for developing dizziness, deafness, and tinnitus when he or she also has which condition?

answer

Impaired Renal Function

question

The patient with glaucoma who is receiving Acetazolamide (Diamox) can expect which effects?

answer

Increased urine output

question

Diuretic therapy has been shown to be effective in reducing edema and improving symptoms of what?

answer

Heart failure

question

Which statements does the nurse include when teach a patient about diuretic therapy?

answer

If you are taking Aldactone avoid the use of salt substitutes in your diet You should rise slowly from a lying or sitting position and lie down if you feel faint because some diuretics cause you to develop low blood pressure in certain positions The purpose of diuretics is to increase the net loss of water

question

The nurse gives which instructions to a patient who is on Hydrocholorothiazide (HydroDIURIL) on how to reduce indigestion that the patient is experiencing?

answer

Take this medication with food or milk to reduce gastric irritation

question

If patients take salt substitutes while in Spironolactone (Aldactone), the patients lab results mat include?

answer

Hyperkalemia

question

What patient assessment should be performed on a regular basis when diuretics are being administered?

answer

Presence of edema Intake and Output Blood Pressure Daily Weight

question

The nurse observed the patient for signs of adverse effects from diuretic therapy mainly from electrolyte imbalance, which will be in the form of ?

answer

Tremors Muscle Cramps Nausea Altered Mental Status

question

A male patient with hypertension is prescribed Spironolactone (Aldactone) therapy. Which instruction does the nurse include when teaching the patient about this therapy?

answer

Avoid salt in your diet as well as salt substitutes

question

A patient who is being treated for ascites resulting from liver disease is admitted. Which medication does the nurse anticipate will be ordered for this patient?

answer

Spironolactone (Aldactone)

question

When planning the administration of ethacrynic acid (Edecrin), which factor must the nurse consider?

answer

During IV administration, narrowed pulse pressure must be reported.

question

What is an advantage of using ethacrynic acid (Edecrin) over furosemide (Lasix) in patients with significant renal failure?

answer

Ethacrynic acid inhibits the reabsorption of sodium to a greater degree than furosemide.

question

What does the nurse suggest to a patient taking diuretics to decrease the effects of dry mouth?

answer

Suck on hard candy or ice chips

question

For which adverse effects does the nurse monitor in a patient taking bumetanide (Bumex) and an aminoglycoside?

answer

Hearing loss

question

What concerns the nurse about a patient taking a nonsteroidal anti inflammatory drug (NSAID) concurrently with a diuretic?

answer

Higher doses of the diuretic will be required to be effective

question

The nurse teaches a patient taking a potassium sparing diuretic to avoid ingesting which item?

answer

Salt substitute

question

A patient is ordered IV furosemide (Lasix). The nurse administers this drug over how many minutes?

answer

2 to 4

question

A patient is prescribed amiloride (Midamor). The nurse monitors the patient for which adverse effect?

answer

Hyperkalemia

question

For what therapeutic effect does the nurse assess in a patient taking acetazolamide (Diamox)?

answer

Decreased intraocular pressure

question

The nurse administering IV furosemide (Lasix) to a patient anticipates that diuresis will occur in how many minutes?

answer

5-10 minutes

question

Which nursing orders are found in the care plan for a patient receiving furosemide (Lasix)

answer

Suck on hard candy or ice to prevent dry mouth. Monitor for signs of hypokalemia Rise slowly from a sitting or supine position

question

Diuretics are the mainstays in the symptomatic treatment of?

answer

Heart Failure Hypertension Renal Disease

question

Diuretics also have a variety of other medical uses such as reducing?

answer

Cerebral Edema Intraocular Pressure Ascites Hypercalcemia

question

A drug from which class will most likely help a patient reporting insomnia as a result of a persistent cough?

answer

Antitussive --drug that suppresses cough

question

Which information does the nurse include in the teaching plan for a patient starting on antihistamine therapy for seasonal allergies?

answer

Take medication 45 to 60 minutes before going outdoors during pollen season

question

What is the primary reason for instructing patients to avoid overuse of nasal decongestant sprays?

answer

Rebound swelling of the nasal passages can occur.

question

Which patient must avoid taking alpha adrenergic decongestants?

answer

A 45 year old with hyperthyroidism

question

How long does it take for a patient to achieve the maximal effect of intranasal corticosteroids after beginning therapy?

answer

2 weeks

question

A patient has just been prescribed diphenhydramine hydrochloride (Benadryl) for a dermatologic reaction. The nurse questions the order after finding that the patient currently has which condition?

answer

Glaucoma

question

A patient is prescribed promethazine hydrochloride (Phenergan). For which anticholinergic effect does the nurse monitor the patient?

answer

Blurred vision

question

A patient is taking cromolyn sodium (Nasalcrom) for prophylactic management of asthma. Which adverse effect does the nurse instruct the patient to report to the health care provider immediately?

answer

Coughing

question

A patient is prescribed ephedrine (Ephedrine) for nasal congestion. The nurse questions the order after finding that the patient is also taking which medication?

answer

Methyldopa (Aldomet)

question

Which information does the nurse include when teaching a patient with asthma how to administer cromolyn sodium (Nasalcrom)?

answer

Continue therapy even if symptom free. A maximum of six sprays in each nostril may be used daily.

Drugs used for Diuresis (Ch.29) – Flashcards

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