Diuretics Flashcards
diuretics promote the _______ of water
net loss
diuretics are the mainstays of treatment for _____ & ______
heart failure
&
hypertension
another use of diuretics is _______, but you must ensure vascular space is in a ________.
reducing edema
deficit state
stroke volume is directly affected by ________
diruetics
patient history assessments for patients on diuretics
renal/hepatic/heart failure
HTN (hypertnesion)
urniation pattern
current diuretic regimen, including dosages
patient physical assessments for patients on diuretics
same as ECV & electrolyte balance (hypokalemia for most diuretics)
daily weights
(2 pounds in 2 days is significant)
for potassium sparing diuretics, you must watch out for ________
hyperkalemia
(palpitations, numbness/tingling, dyspnea, nausea/vomiting)
Lab assessments for diuretics
RENAL!!! BUN, Creatinine (and Creatinine clearance)
Chest x-ray for pulmonary edema
Electrolyte panel (sodium/potassium)
Electrolyte panel consists of
sodium
potassium
chloride
CO2 (a good indication of acidosis)
basic metabolic panel has
BUN & Creatinine
as well as electrolytes
comprehensive metabolic panel has
BUN & Creatinine
electrolytes
and
liver function
Creatinine clearance indicates good ______ function
kidney
normal eGFR is
> 60 mL/min
normal creatinine
male 0.6-1.2 mg/dL
female 0.5-1.1 mg/dL
increased BUN/creatinine ratio may be due to conditions that ________ blood flow to the kidneys
decrease
(for example, dehyrdration)
not getting enough volume to nephrons to perfuse the nephrons properly
normal BUN/creatinine ratio
15:1
dehydrated BUN/creatinine ratio
30:1
normal potassium
3.5-5
normal sodium
135-145
nursing process implementation for diruetics
note potassium intake & type of diuretic prescribed
keep urinal and bedpan available
daily weights
fall risks (hypokalemia/muscle weakness, urgency, dcreased pre-load/orthostatic hypotension)
1 liter of urine weighs
1 kg
1 kg equals ____ pounds
2.2 pounds
take diuretic in the _____ to prevent nocturia
morning
furosemide is a
diuretic
if there’s a severe orthostatic vial sign change, do not administer ______
diruetics
that’s 20 systolic or 10 diastolic changes
if potassium is low do we still give diuretics?
yes, but after we fix the potassium. call HCP
too much diuretics could cause
hypotension
instruct patients to rise slowly so they don’t fall
sulfonamide
loop diuretics
uses: treatment for heart failure and hypertension
also used for treating edema (as long as no vascular volume deficit)
common adverse effects: dry mouth, orthostatic hypotension
metolazone / zaroxolyn
thiazide
helps with diuresis resistance
important in patients with renal dysfunction, remains effective for creatinine clearance as low as 10 mL/min
given sympotmatic (moderate to severe) heart failure
oral form only
most effective: give 30 minutes before IV loop diruetics
uses: treat edema, maybe first choice for hypertension
common adverse side effects: orthostatic hypotension (similar to loops : hypotension, hypokalemia, hyperglycemia, hyperuricemia, cholesterol)
interactions: digoxin, lithium, NSAIDs, hypertensive agents
spironolactone / Aldactone
triamterene / Dyrenium
potassium-sparing diuretics
actions: induce retention of potassium, and excrete sodium at distal tubules
uses: combo with thiazides to lessen hypokalemic effects, and for certai ntypes of edema, namely ascites
adverse effects: electrolyte imbalance, HYPTERKALEMIA
drug interactions: ACE inhibitors, ARBs my increase risk for HYPERKALEMIA
check for potassium supplements and salt substitutes
combination diuretics are usually
thiazides and potassium-sparing
acetazolamide / Diamox
carbonic anhydrase inhibitor
weak diuretic
used mostly for glaucoma (decreases intraocular pressure), but can also help excrete bicarb for alkalosis
salt substitutes often contain
potassium
ascites is a ______ spacing
third spacing
the accumulation of fluid in the peritoneal cavity
can’t escape
reduces the amount of fluid available for normal physiologic functions
cirrhosis is the most common cause, but has other causes: decreased synthesis of albumin by the liver and fluid retention
postural hyotension and reduced sesrum albumin levels cause capillary hydrostatic pressure to _______ capillary osmotic pressure
exceed
the imbalance pushes water into the peritoneal cavity
postural hypotension also increases the production of hepatic ______, which weeps into the peritoneal cavity
lymph
spironolactone/ hydrochlorothiazide (Aldactazide)
triamterene/ hydrochlorthiazide (Dyazide, Maxzide)
combination diuretics
action: same as potassium sparing diuretics/thiazide diuretics
use: promote diuresis & maintain normal potassium levels
common adverse effects: hyperkalemia, hyponatremia
for diuretics, make sure to pay attention to the vascular space, especially when there’s a _______ or a _______ problem
an albumin problem or a nutrition problem
hypouricemia is
low levels of uric acid in the blood / can lead to gout
a side effect of loop diuretics
