Ch 19 Urinary Output

Question 1

What is the expected pharmalogical action of loop diuretics

Answer 1

They work in the ascending loop of henle
Blocks reabsorption of sodium and chloride to prevent reabsorption of water.
Causes extensive diuresis even with severe renal impairment

Question 2

What are the therapeutic uses of loop diuretics

Answer 2

They are used when there is need for the rapid administration of fluid
They are used for pulmonary edema caused by HF
They are used in conditions not responsive to other diuretics, such as edema caused by liver, cardiac, or kidney disease or HTN

THESE MEDS MAY ALSO BE USED TO TREAT HYPERCALCEMIA R/T KINDNEY STONE FORMATION

Question 3

What are adverse effects of loop diuretics

Answer 3

Dehydration
Hyponatremia
Hypochloremia
Hypotension
Hypokalemia
Decrease in calcium and magnesium levels
Ototoxicity ( transient with furosemide and irreversible with Ethacrynic acid)

Question 4

What are high potassium foods

Answer 4

Bananas, potatoes, Dried fruits, nuts, spinach, citrus fruit

Question 5

What are signs of hypokalemia

Answer 5

Nausea/ vomiting

General weakness

Question 6

What is a medication interaction of loop diuretics

Answer 6

Digoxin
Ventricular dysrhythmias can occur in the presence of HYPOKALEMIA
Concurrent use with antihypertensives can cause additive hypotensive effect.
Lithium serum levels can be increased which leads to toxicity
NSAIDS decrease blood flow to kidneys which reduces the diuretic effect

Question 7

What are signs of low magnesium

Answer 7

Weakness

Muscle twitching

Question 8

How can a nurse recognize that the loop diuretics worked

Answer 8

Decrease in pulmonary or peripheral edema
Weight loss
Decrease in BP
increase in urinary output

Question 9

Thiazide diuretics select prototype drug

Answer 9

Hydrochlorothiazide ( Hydrodiuril)

Other drugs; chlorothiazide ( Diuril)
methyclothiazide ( Enduron)

Thiazides type diuretics-
Indapamidem( Lozide, Lozol)
Chlorthalidone ( Hygroton)
Metolazone ( Zaroxolyn)

Question 10

How do Thorazine diuretics work

Answer 10

They work in the early distal convoluted tubule
Blocks the reabsorption of sodium and chloride, and prevents the reabsorption of water at this site
Promotes diuresis when renal function is not impaired

They are often the 1st med of choice for essential HTN
these meds may be used for edema to mild to moderate HF and liver and kidney disease.

Question 11

What are adverse effects of thiazides diuretics

Answer 11

Dehydration
Hypokalemia
Hyperglycemia

Question 12

What are pre assessments of the drug thiazides diuretics

Answer 12

Obtain clients baseline data including 
Orthostatic BP
weight
Electrolytes
And location and extent of edema

Question 13

Potassium sparing diuretics

Answer 13

Prototype drug; spironolactone ( Aldactone)

Other drugs; triamterene ( Dyrenium) amiloride ( Midamor)

Question 14

What is the expected pharmalogical action of potassium sparing diuretics

Answer 14

Blocks the action of aldosterone ( sodium and water rentention) which results in potassium rentention and the excretion of sodium and water

Question 15

What are the therapeutic uses of potassium sparing diuretics

Answer 15

Oral administration
Used for HF
May take 12-48 hours for effect

Question 16

What are the side effects of potassium sparing diuretics

Answer 16

Hyperkalemia

Endocrine effects..impotence in men, irregularities in menstrual cycle for woman.

Question 17

What are med interactions of potassium sparing diuretics

Answer 17

ACE INHIBITORS increase the risk of hyperkalemia

Question 18

Triamterene may turn the urine what color

Answer 18

A bluish color

Question 19

What are osmotic diuretics

Answer 19

Osmotic diuretics reduce intracranial pressure and intraocular pressure by raising serum osmolality and drawing fluid back into the vascular and exteavascular space.

Question 20

What are the therapeutic uses for osmotic diuretics

Answer 20

Prevent kidney failure in specific situations such as hypocovolemic shock and severe hypotension
Decreases intracranial pressure caused by cerebral edema by drawing off fluid from the brain Into the bloodstream
It is administered for oliguria phase of acute kidney failure

Question 21

What are adverse effects of osmotic diuretics

Answer 21

HF
pulmonary edema
Fluid and electrolyte imbalances

Question 22

What is an extreme caution of osmotic diuretics

Answer 22

HF

Question 23

What are med interactions of osmotic diuretics

Answer 23

Lithium excretion through the kidneys is increased

Monitor lithium levels

Question 24

What are nursing considerations for diuretics

Answer 24

Administer mannitol by continuous IV infusion

Question 25

High ceiling loop diuretics

Answer 25

Prototype: furosemide (Lasix)

Other drugs: Ethacrynic ( Edecrin)
Bumetanide ( Bumex)
Torsemide ( Demadex)