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Pathopharmacology > Diuretics and Electrolytes > Flashcards

Diuretics and Electrolytes Flashcards

1
Q

What is the function of the kidneys?

A
  1. regulating fluid balance, electrolyte balance, and acid-base balance
  2. Regulates blood pressure through the RAAS
  3. Regulates RBC production
  4. Filtrates, Reabsorbs, and Excretes into Nephron*
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2
Q

What substances are secreted by the kidneys?

A
  1. Renin
  2. Erythropoietin
  3. Calcitriol
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3
Q

Function of the Nephron

A

filters fluid and makes urine

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4
Q

Function of Bowman’s Capsule

A

filter that allows fluid in, but keeps large particles out (protein)

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5
Q

Function of Glomerulus

A

Group of blood vessels that allow fluid and waste passage

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6
Q

Describe the flow of Filtrate through the body

A

Kidneys –> Nephron –> Glomerulus –> Proximal Tubule –> Loop of Henley –> Distal Tubule –> Collecting duct –> out of body

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7
Q

What is a diuretic?

A

drug that reduces fluid volume in the body and increases urine output.

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8
Q

Uses of diuretics include

A
  1. Hypertension**
  2. CHF
  3. Cirrhosis or liver failure
  4. Renal disease
  5. Increased intracranial pressure
  6. Pulmonary edema
  7. Glaucoma
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9
Q

What is the pharmodynamics of diuretics?

A
  1. Block sodium and water reabsorption in the nephron, sending more sodium into the urine to be excreted
  2. Increases urine output (diuresis)
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10
Q

What does the effectiveness of a diuretic depend on?

A
  1. The part of the tubule affected by the drug

2. The potency of the drug

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11
Q

What should the nurse assess prior to administering diuretics and why?

A
  1. Complete Health Hx
  2. Electrolytes (lose fluid=lose electrolytes)
  3. CBC (diuretics may cause agranulocytosis)
  4. Liver/Renal fx (risk for toxicity)
  5. Weight (daily, same time and scale, consistency is key)
  6. Blood Pressure (fluid loss=hypotension)
  7. Breath sounds (crackles = diuretics may be ineffective)
  8. Cardiac Monitoring (hand in hand with electrolytes)
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12
Q

What should the nurse monitor after administering diuretics?

A
  1. VS/Electrolytes/BUN&Creatinine

2. Signs of gout (certain diuretics may cause hyperuricemia leading to gout flare ups)

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13
Q

What are the normal BUN and Creatinine levels?

A

BUN: 10-20
Creatinine: 0.5-1.2

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14
Q

Normal Electrolyte Balances? (K, Na, Mg, Ca)

A

K: 3.5-5
Na: 135-145
Mg: 1.5-2.5
Ca: 9-10.5

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15
Q

What is the relationship between Na and Water?

A

Where Na goes, Water follows

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16
Q

How is Hypernatremia Treated?

A

Depends on underlying cause

  1. Hypotonic Fluids
  2. Na restricted diet
  3. Diuretics (not common)
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17
Q

How is Hyponatremia Treated?

A

Na replacement

  • oral Na/isotonic fluid if asymptomatic
  • IV for neuro decline or very severe
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18
Q

S/S of Hypernatremia

A
  1. Dehydrated/Thirsty
  2. Tachycardia
  3. Irritable/Restlessness
  4. Altered LOC
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19
Q

S/S of Hyponatremia

A
  1. Lethargy
  2. Headache
  3. Confusion
  4. Seizure
  5. Coma
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20
Q

What causes hypermagnesemia?

A
  1. Abuse of antacids
  2. Laxatives
  3. Renal failure
21
Q

What causes hypomagnesemia?

A
  1. Use of diuretics

2. Alcoholism

22
Q

S/S of Hyperkalemia

A
  1. Muscle fatigue
  2. Weakness
  3. Paralysis
  4. Abnormal heart rhythms (arrhythmias)
  5. Nausea
23
Q

S/S of Hypokalemia

A
  1. Severe V/D
  2. Metabolic Alkalosis
  3. Respiratory Alkolosis
24
Q

What does Furosemide do?

A
  1. Blocks the chloride pump in the ascending loop of Henle
  2. Decreases reabsorption of sodium and chloride
  3. Causes diuresis even with severe renal impairment

Blocks sodium reabsorption which means Na stays as well as Cl & waste leading to diuresis

25
Q

Why would you administer furosemide?

A
  1. Pulmonary edema
  2. Edema caused by liver, cardiac, or kidney disease or HTN
  3. To treat hypercalcemia related to kidney stone formation
26
Q

Adverse effects of Furosemide

A
  1. Dehydration
  2. Hypotension
  3. Electrolyte imbalance
  4. Ototoxicity
27
Q

S/S of Hypermagnesemia

A
  1. N/V
  2. Muscle Weakness
  3. Hypotension
  4. Bradycardia
  5. Respiratory Depression
28
Q

S/S of Hypomagnesemia

A
  1. Tetany/Tremors
  2. Confusion/Depression/Irritability
  3. Nystagmus
  4. Malnutrition/Malabsorption
29
Q

Nursing Interventions for Diuretics

A
  1. Monitor Daily Weights
  2. Strict I&Os
  3. Monitor BP
  4. Monitor Electrolytes
30
Q

Nursing Interventions/Pt Education for Furosemide

A
  1. Eat High K foods
  2. Monitore glucose and uric acid levels
  3. Use cautiously in diabetic/gout patients
  4. Dont give in evening/night
31
Q

What diuretic is first choice for hypertension?

A

Hydrochlorothiazide

32
Q

How does hydrochlorothiazide work?

A
  1. Block the chloride pump to keep chloride and sodium in the tubule (to be excreted in urine).
  2. Promotes diuresis in healthy kidneys
33
Q

What is hydrochlorothiazide used for?

A
  1. Hypertension

2. Treatment of mild-mod edema r/t heart failure or liver or kidney disease

34
Q

When should hydrochlorothiazide be administered?

A

Early in day

35
Q

Hydrochlorothiazide causes what electrolyte imbalances?

A
  1. Hypokalemia
  2. Hyperglycemia
  3. Hypercalcemia
  4. Hyperuricemia
36
Q

Nursing Interventions/Patient Education for Hydrochlorothiazide

A
  1. Educate clients to consume diets high in potassium
  2. Do not give during pregnancy
  3. Take early in the day
  4. Increased risk for lithium or digoxin toxicity
  5. Check skin turgor for hydration status
37
Q

How does spironolactone work?

A
  1. Blocks the action of aldosterone, causing excretion of sodium and water
  2. Promotes retention of potassium (which decreases risk for arrhythmias)
38
Q

What are the therapeutic uses for Spironolactone?

A
  1. Usually combined with other diuretics

2. Heart failure patients or high risk for hypokalemia

39
Q

Adverse Effects of Spironolactone

A
  1. Hyperkalemia / arrythmias

2. Endocrine effects such as hirsutism, gynecomastia, irregular menses

40
Q

Nursing Interventions/ Patient Education for Spironolactone

A
  1. Monitor potassium levels
  2. Never administer potassium supplements with this drug
  3. Regular insulin to tx hyperkalemia
  4. Do not give to clients with renal failure
  5. Do not give with ACE inhibitors
  6. Avoid salt substitutes that contain potassium
41
Q

How does mannitol work?

A
  1. Pull large amounts of fluid into the urine through osmotic pull
  2. Pulls water into the renal tubule without sodium loss
42
Q

Therapeutic Uses for Mannitol

A
  1. Acute renal failure (severe hypotension/shock)
  2. Decrease intracranial pressure
  3. Decrease intraocular pressure (glaucoma)
  4. Drug overdose (pushes toxic substances through kidneys)
43
Q

Adverse effects of Mannitol

A
  1. Heart failure / pulmonary edema
  2. Kidney failure
  3. Severe fluid and electrolyte imbalances
44
Q

Nursing Interventions/Pt Education for Mannitol

A
  1. Monitor for signs of heart failure
  2. Monitor lung sounds
  3. Monitor BUN & Crt levels
  4. Monitor daily weight/ I&O/ electrolyte levels
  5. Administer via IV
  6. Must use filter needle and filter IV tubing
45
Q

How does acetazolamide work?

A
  1. block the effects of the carbonic anhydrase enzyme, slowing down the movement of hydrogen ions
  2. causes loss of sodium and bicarbonate in the urine
46
Q

Therapeutic Uses for Acetazolamide?

A
  1. used as adjunct to other diuretics
  2. treatment of glaucoma
  3. acute heart failure - edema
47
Q

Adverse Effects of Acetazolamide

A
  1. Metabolic acidosis
  2. Hypokalemia
  3. Paresthesias
  4. Confusion/drowsiness
  5. Urinary frequency
  6. Renal calculi
  7. Bone marrow suppression
48
Q

Nursing Interventions/Patient Education for Acetazolamide

A
  1. Use cautiously in patients with fluid/electrolyte imbalances, renal/liver disease, or COPD
  2. Monitor for adverse effects and report to HCP
  3. Increase potassium in diet/ potassium supplements
  4. Monitor CBC

Pathopharmacology (6 decks)

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