[10] FINALS | RENAL DRUGS Flashcards
acts to increase flow of urine
DIURETICS
DIURETICS
Purpose:
* Decrease h____
* Decrease e____
Purpose:
* Decrease hypertension
* Decrease edema
DIURETICS
Drug Categories:
A. T____
B. L____
C. K____
D. C____
E. O____
Drug Categories:
A. Thiazides & Thiazide-like
B. Loop diuretics
C. K+ sparing diuretics
D. Carbonic Anhydrase inhibitor
E. Osmotic Diuretics
THIAZIDES & THIAZIDE-LIKE
EXAMPLES (2)
Chlorothiazide (Diuril), Hydrochlorothiazide (Hydrodiuril - most common)
THIAZIDES & THIAZIDE-LIKE
I: hypertension and p____
MOA: Acts on the ____ renal tubules to promote Na, Cl, and water excretion
S/E: h____ , hypomagnesemia, h____ , dizziness, headache, N&V, constipation, o____ , hyperglycemia, h____
I: hypertension and peripheral edema
MOA: Acts on the distal convoluted renal tubules to promote Na, Cl, and water excretion
S/E: Hypokalemia, hypomagnesemia, hypercalcemia, dizziness, headache, N&V, constipation, orthostatic hypotension, hyperglycemia, hyperuricemia
THIAZIDES
Nursing Considerations:
Assessment:
- VS, Weight, u____, e____
Check:
- Peripheral extremities – e____
- History of drugs and herbal supplements taken daily
- Review drug to drug interactions (d____, corticosteroids, antidiabetics, g____, l____)
Nursing Considerations:
Assessment:
- VS, Weight, Urine Output, Electrolyte values
Check:
- Peripheral extremities – Edema
- History of drugs and herbal supplements taken daily
- Review drug to drug interactions (digoxin, corticosteroids, antidiabetics, gingko, licorice)
THIAZIDES
Nursing Considerations:
✓Monitor VS (BP & Pulse) and s____ levels- report changes
✓Watch out for d____ and h____
❑ (muscle weakness, leg cramps, and cardiac
dysrhythmias)
✓Monitor daily weight- weight gain of ____ lbs. is equivalent to 1 L of body fluids
✓Note urine output (fluid loss or retention)
Nursing Considerations:
✓Monitor VS and serum electrolyte levels- report changes
✓Watch out for digitalis toxicity and hypokalemia
❑ (muscle weakness, leg cramps, and cardiac
dysrhythmias)
✓Monitor daily weight- weight gain of 2.2 lbs. is equivalent to 1 L of body fluids
✓Note urine output (fluid loss or retention)
THIAZIDES
Patient teaching:
- Emphasize adherence to the therapy plan
- Take drug e____
- Keep drugs out of reach of small children
- Inform – certain h____ may interact with
thiazide diuretics - Teach on how to take and record b____ (daily)
Patient teaching:
- Emphasize adherence to the therapy plan
- Take drug early in the morning
- Keep drugs out of reach of small children
- Inform – certain herbal products may interact with
thiazide diuretics - Teach on how to take and record BP (daily)
THIAZIDES
Patient teaching:
- Prevent o____ - by slowly changing position from lying to standing
- Use sunblock – to prevent p____
- Eat foods rich in p____ (e.g. avocado, banana) - supplements may be prescribed
- Taken with f____ - to avoid GI upset (diarrhea, N/V, anorexia)
Patient teaching:
- Prevent orthostatic hypotension - by slowly changing position from lying to standing
- Use sunblock – to prevent photosensitivity
- Eat foods rich in Potassium (e.g. avocado, banana) - supplements may be prescribed
- Taken with FOOD- to avoid GI upset (diarrhea, N/V, anorexia)
LOOP DIURETICS/ HIGH CEILING
EXAMPLES (2)
Furosemide (Lasix - most common), Bumetanide (Bumex)
LOOP DIURETICS/ HIGH CEILING
I: E____ and hypertension
MOA: Acts on the a____ by inhibiting Na reabsorption
S/E: H____, Na, Ca, Mg, Cl, dizziness, headache, N&V, o____
I: Edema and hypertension
MOA: Acts on the ascending loop of Henle by inhibiting Na reabsorption
S/E: Hypokalemia, Na, Ca, Mg, Cl, dizziness, headache, N&V, orthostatic hypotension
LOOP DIURETICS/ HIGH CEILING
Assessment:
- Check for drugs that may cause drug interaction (e.g. alcohol, a____, anticoagulants, corticosteroids, l____, a____, digitalis)
- VS, serum electrolytes, weight, and UO
- Note hypersensitivity to s____
Assessment:
- Check for drugs that may cause drug interaction (e.g. alcohol, aminoglycosides, anticoagulants, corticosteroids, lithium, amphotericin B, digitalis)
- VS, serum electrolytes, weight, and UO
- Note hypersensitivity to sulfonamides
LOOP DIURETICS/ HIGH CEILING
Nursing Considerations:
- Monitor VS (decrease B____) and UO (should be at least ____ mL/h or ____ mL/24 hr)
- Notify doctor – if UO does not increase (s____ may be present)
- Weigh the patient - A loss of ____ lbs is equivalent to a fluid loss of 1 L
Nursing Considerations:
- Monitor VS (decrease BP) and UO (should be at least 30 mL/h or 600 mL/24 hr)
- Notify doctor – if UO does not increase (severe renal disorder may be present)
- Weigh the patient - A loss of 2.2 lbs is equivalent to a fluid loss of 1 L
LOOP DIURETICS/ HIGH CEILING
Nursing Considerations:
- Administer IV f____ SLOWLY
- h____ may occur if it is rapidly injected
- Check for signs of h____ (< 3.5 mEq/L) - Muscles weakness, abdominal distention, leg cramps, or cardiac dysrhythmias
- Taken in the m____
- Rise slowly from lying to standing (dizziness resulting from fluid loss)
Nursing Considerations:
- Administer IV furosemide SLOWLY
- Hearing loss may occur if it is rapidly injected
- Check for signs of hypokalemia (< 3.5 mEq/L) - Muscles weakness, abdominal distention, leg cramps, or cardiac dysrhythmias
- Taken in the morning
- Rise slowly from lying to standing (dizziness resulting from fluid loss)
OSMOTIC DIURETIC
EXAMPLES (2)
Mannitol (Osmitrol - most common), Urea (Ureaphil)
OSMOTIC DIURETIC
I: Increased i____, i____ and prevent k____
MOA: Increases p____ and b____ concentration in renal tubules
S/E:
✓ F____ imbalance
✓ Pulmonary Edema
✓ N&V
✓ T____
✓ A____
I: Increased IOP, ICP and prevent kidney failure
MOA: Increases plasma and blood concentration in renal tubules
S/E:
✓ F&E imbalance
✓ Pulmonary Edema
✓ N&V
✓ Tachycardia
✓ Acidosis
OSMOTIC DIURETIC
Nursing Consideration for Mannitol
- Mannitol c____ at low temperature
-use i____
-may be warmed
-f____ drip
-give with extreme caution if with h____
Nursing Consideration for Mannitol
- Mannitol CRYSTALLIZES at low temperature
-use in-line filter
-may be warmed
-fast drip
-give with extreme caution if with heart condition/ heart failure
CARBONIC ANHYDRASE INHIBITORS
EXAMPLE (1)
Acetazolamide (Diamox)
CARBONIC ANHYDRASE INHIBITORS
I: increased IOP in o____ only, epilepsy, high altitude or a____; r____
MOA: Blocks the action of the enzyme c____ = increased NA, K, HCO3 excretion
S/E: f____ imbalance, Metabolic acidosis, c____, Orthostatic Hypotension, N/V, a____, confusion
I: increased IOP in open angle glaucoma only, epilepsy, high altitude or acute mountain sickness; respiratory acidosis
MOA: Blocks the action of the enzyme Carbonic Anhydrase = increased NA, K, HCO3 excretion
S/E: F&E imbalance, Metabolic acidosis, Crystalluria, Orthostatic Hypotension, N/V, anorexia, confusion
POTASSIUM- SPARING DIURETICS
EXAMPLES (2)
Spinorolactone (Aldactone)
Amiloride (Midamor)
POTASSIUM- SPARING DIURETICS
I: Edema and h____
MOA: Acts primarily in the c____ renal
tubules to promote Na, H2O excretion & K
retention
S/E:
* H____
* Caution with poor renal functioning
* A____, N/V, diarrhea
I: Edema and HF
MOA: Acts primarily in the collecting duct renal
tubules to promote Na,H20 excretion & K
retention
S/E:
* Hyperkalemia
* Caution with poor renal functioning
* Anorexia, N/V, diarrhea
POTASSIUM- SPARING DIURETICS
Assessment:
- Check history of drugs taken daily
- VS, s____, weight, and UO
- UO should increase - report if UO is less than ____ mL/hr or less than ____ mL/day
- Check for ____ (>5.0 mEq/L; give potassium chloride) - Nausea, diarrhea, abdominal cramps, numbness and tingling of the hands and feet, leg cramps, tachycardia and later bradycardia, peaked narrow T wave on ECG, oliguria
Assessment:
- Check history of drugs taken daily
- VS, serum electrolytes, weight, and UO
- UO should increase - report if UO is less than 30 mL/hr or less than 600 mL/day
- Check for hyperkalemia (>5.0 mEq/L; give potassium chloride) - Nausea, diarrhea, abdominal cramps, numbness and tingling of the hands and feet, leg cramps, tachycardia and later bradycardia, peaked narrow T wave on ECG, oliguria
POTASSIUM- SPARING DIURETICS
Patient Teaching:
- Take s____ with or after meals
- Do not discontinue without consulting the Doctor
- Spironolactone- can cause p____ - Use sunblock
- Report r____, dizziness, w____ and GI upset
- Advise patients with hyperkalemia to avoid foods rich in p____ - when taking potassium-sparing diuretics
Patient Teaching:
- Take spironolactone with or after meals
- Do not discontinue without consulting the Doctor
- Spironolactone- can cause photosensitivity - Use sunblock
- Report rash, dizziness, weakness and GI upset
- Advise patients with hyperkalemia to avoid foods rich in potassium - when taking potassium-sparing diuretics
BODY FLUIDS
Osmolality of body fluids - concentration of body fluids
- Normal serum osmolality: ____ mOsm/kg
Osmolality of body fluids - concentration of body fluids
- Normal serum osmolality: 275 to 295 mOsm/kg
BODY FLUIDS
- Three (3) Types of fluid concentration (based on the osmolality of body fluids):
1. I____
2. H____
3. H____
- Three (3) Types of fluid concentration (based on the osmolality of body fluids):
1. Isoosmolar
2. Hypoosmolar
3. Hyperosmolar
TYPES OF INTRAVENOUS SOLUTIONS
A. C____
1. Isotonic
2. Hypotonic
3. Hypertonic
B. C____
C. B____
A. Crystalloids
1. Isotonic
2. Hypotonic
3. Hypertonic
B. Colloids
C. Blood and blood products
CRYSTALLOIDS - ISOTONIC SOLUTION
Example:
- LR, R____, 0____, 5____ in water
Uses:
- Corrects D____ and Na depletion
- Replace GI losses
- D____ provide some calories
Example:
- LR, Ringer’s solution, 0.9% NaCl, 5% Dextrose in water
Uses:
- Corrects DHN and Na depletion
- Replace GI losses
- Dextrose provide some calories
CRYSTALLOIDS - ISOTONIC SOLUTION
Cautions for use:
- LR should be used cautiously to patients with: r____ (contains K+), a____, l____
- Isotonic solutions should be used cautiously in
patients with: c____ or r____ disease (risk of FVE)
Note: DO NOT administer Isotonic solutions to patients with known or suspected I____
Cautions for use:
- LR should be used cautiously to patients with: renal failure (contains K+), alkalosis, liver disease
- Isotonic solutions should be used cautiously in
patients with: Cardiac or renal disease (risk of FVE)
Note: DO NOT administer Isotonic solutions to patients with known or suspected ICP
CRYSTALLOIDS - HYPOTONIC SOLUTION
Examples:
- ____% NaCl, ____% NaCl, ____% NaCl
Uses:
- Treats intracellular d____ (DKA - Diabetes TYPE 1, Hyperosmolar hyperglycemic State - Diabetes TYPE 2)
- Provides f____ to allow excretion of body wastes
- D____ provides some calories
Examples:
- 0.45% NaCl, 0.33% NaCl, 0.225% NaCl
Uses:
- Treats intracellular dehydration (DKA - Diabetes TYPE 1, Hyperosmolar hyperglycemic State - Diabetes TYPE 2)
- Provides free water to allow excretion of body wastes
- Dextrose provides some calories
CRYSTALLOIDS - HYPOTONIC SOLUTION
Contraindications:
- Do not use in patients with: known or suspected
i____, l____, shock, trauma, b____
Considerations:
- Monitor for signs of F____ and worsening of
h____ (due to decrease in vascular volume)
Contraindications:
- Do not use in patients with: known or suspected
ICP, liver disease, shock, trauma, burns
Considerations:
- Monitor for signs of FVD and worsening of
hypovolemia (due to decrease in vascular volume)
CRYSTALLOIDS - HYPERTONIC SOLUTION
Example:
- ____% NaCl; 5% Dextrose and ____% NaCl; 5%
Dextrose and ____% NaCl; % Dextrose in LR; ____% Dextrose and water; ____% Dextrose and water
Uses:
- Corrects severe h____
- Decreases i____ (cerebral edema)
- Dextrose provides some calories
Example:
- 3% NaCl, 5% Dextrose and 0.45% NaCl, 5%
Dextrose and 0.9% NaCl, % Dextrose in LR, 10% Dextrose and water, 50% Dextrose and water
Uses:
- Corrects severe hyponatremia
- Decreases ICP (cerebral edema)
- Dextrose provides some calories
CRYSTALLOIDS - HYPERTONIC SOLUTION
Considerations:
- May cause i____ and pulmonary edema - Administer slowly and carefully with infusion control pump and constant monitoring
- Avoid p____ use
- Higher concentrations of dextrose (>____%) must be given through - Central venous access device
- May be added to amino acid solutions as T____
Contraindications:
- C____ or r____ disease
- D____ or D____
Considerations:
- May cause intravascular volume overload and pulmonary edema - Administer slowly and carefully with infusion control pump and constant monitoring
- Avoid prolonged use
- Higher concentrations of dextrose (>10%) must be given through - Central venous access device
- May be added to amino acid solutions as TPN (total parenteral nutrition)
Contraindications:
- Cardiac or renal disease
- DHN or DKA
used primarily as a measurement of the concentration of IV solutions compared with the osmolality of body fluids
TONICITY
TONICITY OF INTRAVENOUS SOLUTIONS
- Hypotonic: <____ mOsm/kg
- Isotonic: ____ mOsm/kg
-
Hypertonic: >____ mOsm/kg
* IV solutions are used to replace body fluid loss
- Hypotonic: <280 mOsm/kg
- Isotonic: 280–300 mOsm/kg
-
Hypertonic: >300 mOsm/kg
* IV solutions are used to replace body fluid loss
COLLOIDS
Volume expanders
- D____
- A____
- H____
- P____
- C____
Volume expanders
- Dextran solutions
- Amino acids
- Hetastarch
- Plasmanate
- Colloidal gelatin
BLOOD AND BLOOD PRODUCTS
EXAMPLES (4)
Packed RBCs (PRBC), plasma, platelets, cryoprecipitate
BLOOD AND BLOOD PRODUCTS
Considerations:
- Proper products-to- patient identification
- Maximum rate of infusion – ____ hours per unit
- Pre-medications (e.g. d____)
- Multiple Blood transfusions – check for serum ionized c____ levels
- Never add medications to the unit of blood
Considerations:
- Proper products-to- patient identification
- Maximum rate of infusion – 4 hours per unit
- Pre-medications (e.g. diphenhydramine)
- Multiple Blood transfusions – check for serum ionized calcium levels
- Never add medications to the unit of blood
BLOOD AND BLOOD PRODUCTS
- I____ - known as lipid emulsion
- Patient must have c____ or p____ inserted vascular access device
- N & V, elevated t____ - if given rapidly
- IV Fat Emulsion - known as lipid emulsion
- Patient must have centrally or peripherally inserted vascular access device
- N & V, elevated temperature- if given rapidly
BLOOD AND BLOOD PRODUCTS
Cautions for use:
- At risk for fat e____ (fractured femur)
- With allergy to e____ or soybeans
- P____
- Bleeding disorders
- L____ failure
- R____ disease
Cautions for use:
- At risk for fat embolism (fractured femur)
- With allergy to eggs or soybeans
- Pancreatitis
- Bleeding disorders
- Liver failure
- Respiratory disease
FLUID IMBALANCE
Fluid Volume Deficit
- Strict I and O h____
- O____ Care
- Encourage increase O____
- Monitor for s____ and pressure
- Monitor for s/sx of F____ due to h____ - thirst, restlessness, HA, inability to concentrate, dry mucous membranes, poor skin turgor, tachycardia, changes in mental status, slightly decrease BP
Fluid Volume Deficit
- Strict I and O hourly
- Oral Care
- Encourage increase OFI
- Monitor for skin breakdown and pressure
- Monitor for s/sx of FVD due to hypovolemia - thirst, restlessness, HA, inability to concentrate, dry mucous membranes, poor skin turgor, tachycardia, changes in mental status, slightly decrease BP
FLUID IMBALANCE
Fluid Volume Deficit
- Recognize late symptoms of hypovolemia: c____, cold clammy skins, w____, confusion and o____
- Assess for o____ - safety in transferring and changing of positions
- Monitor lab results: H____ and H____, urine s____; increase NA, BUN, crea, electrolyte levels & serum osmolality
Fluid Volume Deficit
- Recognize late symptoms of hypovolemia: Cyanosis, cold clammy skins, weak thread pulse, confusion and oliguria
- Assess for orthostatic hypotension- safety in transferring and changing of positions
- Monitor lab results: Hgb and Hct, urine specific gravity (increased - concentrated urine); increase NA, BUN, crea, electrolyte levels & serum osmolality
FLUID IMBALANCE
Fluid Volume Excess
- Monitor for F____
- T____, bounding pulse, t____, increase BP and pulse pressure
- Altered m____, generalized edema, a____,
- Constant, irritated cough; dyspnea, o____, crackles, pulmonary congestion, muffled heart sounds
- F____
- Increased ICP, j____ vein distention; increased UO
- Monitor lab results - elevated BUN, Hgb and Hct, Na, Serum osmolality, urine specific gravity)
Fluid Volume Excess
- Monitor for FVE
- Tachycardia, bounding pulse, tachypnea, increase BP and pulse pressure
- Altered mental status, generalized edema, anasarca,
- Constant, irritated cough; dyspnea, orthopnea, crackles, pulmonary congestion, muffled heart sounds
- Fatigue
- Increased ICP, jugular vein distention; increased UO
- Monitor lab results - elevated BUN, Hgb and Hct, Na, Serum osmolality, urine specific gravity)
FLUID IMBALANCE
Fluid Volume Excess
- Daily weight- sudden ____
- Administer d____ as ordered
- Fluid and s____ restrictions
- Head of the bed elevated ____ to ____ degrees - facilitate respiration
Fluid Volume Excess
- Daily weight- sudden increases
- Administer diuretics as ordered
- Fluid and sodium restrictions
- Head of the bed elevated 30 to 40 degrees - facilitate respiration
FLUID IMBALANCE
Fluid Volume Excess
- Monitor e____ areas for signs of pressure and altered skin integrity
- Meticulous s____
- R____
Fluid Volume Excess
- Monitor edematous areas for signs of pressure and altered skin integrity
- Meticulous skin care
- Repositioning
ELECTROLYTES
A. P____
B. S____
C. C____
D. M____
E. C____
F. P____
A. Potassium
B. Sodium
C. Calcium
D. Magnesium
E. Chloride
F. Phosphorus (phosphate
Transmission and conduction of nerve impulses and for the contraction of skeletal, cardiac and smooth muscles
POTASSIUM (3.5-5.0 mEq/L)
POTASSIUM (3.5-5.0 mEq/L)
