Ch 27 Urinary Output Flashcards
What is a creatinine lab
Diagnostic test that truly tells how well the kidney are functioning
How much urine does the kidney need to produce before they start to shut down
At least 30 ml hour
What is osmolality
The strength or concentration of the urine produced
What does the renal system consist of
Kidneys
Ureter and bladder
What is one reason for kidney failure
Long standing diabetes
What drugs are used in treating fluid overload or edema
Diuretics
What conditions does diuretics treat
Chronic heart failure Pulmonary edema HTN Cirrhosis ( liver failure) Nephrotic syndrome Kidney failure
What is the prototype drug of thiazide diuretics
Hydorchlorothiazide ( HydroDIURIL)
What are thiazide diuretics used for
In the treatment of hypertension
Where does thiazide diuretics work
In the distal tubule
What are contraindications and precautions of thiazide diuretics
Severe renal impairment
Anuria
Hepatic coma
Hypersensitivity
What are adverse effects of thiazide diuretics
Hypokalemia Hyponatremia Hypochloremia Hypomagnesemia HYPERCALCEMIA
What drug does thiazide diuretics interact with
Digoxin
With any diuretic what should you monitor for
Hypokalemia
What is a contraindication to thiazide diuretics
Sulfa
What are signs and symptoms of hypokalemia
Arrhythmias
What is a sign of hyponatremia
The body craving salt
Hydrochlorothiazide is more effect in what ethnic group
African Americans
What is a loop diuretic
They excerpt a powerful effect on fluid and electrolyte balance
They work in the loop of henle to inhibit sodium and chloride
What are loop diuretic used for
Pulmonary edema
CHF
Peripheral edema
it depletes K+ very fast
What is the prototype drug of loop diuretics
Furosemide ( lasix)
How are loop diuretics administered
IV or oral
Excreted in the kidneys
What are adverse effects of loop diuretics
Electrolyte imbalance
Ototoxicity if pushed too fast
Alteration in blood glucose levels
Alecia man
What 2 drugs shouldn’t be given concurrently with loop diuretics
Digoxin
Aminoglycosides
How long should one push furosemide
20-40 mg over 1-2 minutes
Closely monitor potassium levels
What labs should be monitored with furosemide
CBC
SERUM ELECTROLYTE
URIC ACID LEVELS
Wh would a pt who is malnourished be at greater risk for toxicity from furosemide
Because the malnourished pt has less protein in the body which will result in more free drug. Furosemide is a highly protein bound drug
Potassium sparing diuretics prototype drug
Triamterene ( Dyremium)
What are potassium sparing diuretics used for
It is used as an adjunct to manage edema and HTN
What is indomethacin used for
It is an anti inflammatory that treats gout
What are adverse effects of triamterene ( Dyrenium)
Potassium sparing diuretic
Hyperkalemia Nephrotoxic it's Thrombocytopenia Elevated liver enzymes Headache Photosensitivity
What lab level indicates thrombocytopenia
Platelet count less than 50,000
What are normal platelet counts
150,000-450,000
What are osmotic diuretics used for
They are used for intracranial pressure
& pushes fluid back into vascular space
Cerebral edema
And reduces intraocular pressure
It causes a severe electrolyte imbalance it is a very strong diuretic
What is the only way that mannitol is administered
IV
What is a test to determine how well the renal system is functioning
GFR
The bigger the dilation of a persons pupils are a indicator of what
You are going to die!
Coma is occurring
What are contraindications and precautions of mAnnitol (osmotic diuretic)
Severe renal disease
Pulmonary congestion
Active intracranial bleeding
What are adverse effects of osmotic diuretics ( mannitol)
Fluid or electrolyte imbalances
Hypotension
Tachycardia
What are major drug interactions of mannitol ( osmotic diuretic)
NONE
How can one maximize the therapeutic effects of mannitol
Know than concentrations that exceed 15% have a tendency to crystallize.
An inline filter should be used for the infusion
How can one minimize the adverse effects of mannitol( osmotic diuretic)
Monitor hourly output 30-50 ml/ hr at least Monitor BP pulse rate Electrocardiographic tracings Intake to output ratios Renal function test results Serum electrolyte levels
How should mannitol be administered
Parenterally
.2g over 3-5 min in 2 doses
What is mannitol administered for
Cerebral edema
Increase intraocular pressure
Sodium bicarbonate
ABGs
Base
