Diuretics (VN16) Flashcards
Common Conditions That Cause Edema
-Heart failure
-Endocrine disturbances
- Kidney and liver diseases
-Fluid overload from other causes
Causes of Excess fluid volume
-Heart and blood vessel failure- Heart fails to
pump all the blood coming into it, so blood backs
up into the vessels- (like a traffic jam due to
construction)
• Renal failure- kidneys fail to remove enough
waste and fluid, so fluid accumulates
• Liver failure- liver fails to filter blood coming to
it, so a backlog develops
• Pulmonary failure- lungs are not able to handle
the blood volume, so patient starts to “drown
Diuretic Drugs (classified based on where they work within the nephron, chemical structure, & diuretic potency)
group of drugs that inhibit sodium and water
reabsorption by the kidney – the more they inhibit
reabsorption, the greater the amount of diuresis and
the greater amount of water and sodium loss
Diuretics Drugs five classifications
- Osmotic diuretics
Drug: mannitol (Osmitrol) - Carbonic Anhydrase Inhibitors (CAI)
Drug: acetazolamide (Diamox - Loop diuretics
Drugs: (furosemide) Lasix, (Bumetonide) Bumex - Thiazide diuretics
Drugs: hydrochlorothiazide (HCTZ) - Potassium sparing diuretics-
Drugs: spironolactone (Aldactone)
Potassium wasting diuretic (k-wasting)
EXAMPLES
-furosem-ide
-bumetam-ide
USE
-HF, HTN, Ascites
K,H,K
1.hypokalemia (will see low/slow, bradycardia, fatigue, muscle twitching) increase k and monitor labs (potassium normal range 3.5-5.0)
2.toxicity (tinnitus, dizzy, hearing changes)
Monitor sx
3.hyperglycemia (increased BS labs) monitor BS
4.photosensitivity (skin changes) avoid sun, use sunscreen
Potassium wasting diuretics (k-wasting)
Increase urine output
Is to be taken in the am
Always check vitals
Isosorbide is not a potassium wasting diuretic***
Thiazides (k-wasting)
(usually the first line of tx for htn)
USE:
HTN, HF, Edema
I
EXAMPLES:
HCTZ
Hydrochlorothiazide
K,H,K
1. Hypokalemia (will see low/slow, bradycardia, fatigue, muscle twitching) decrease k and monitor labs (potassium normal range 3.5-5.0)
2.chemically similar to sulfonamides (not a good choice for someone that has allergy to sulfa drugs)
Potassium sparing diuretics
EXAMPLE
Spirol-actone
USE
HF ,HTN, Edema
K,H,K
1.hyperkalemia (increase in k)
(potassium normal range 3.5-5.0)
Seen on ekg:
Tall T waves, dysthymias, increase BS, muscle cramps, numbness/tingling in extremities
2. Gynecomasia (breast growth in males)
3.menstural problems
4.dysfunction
**use 12 lead ecg
**Avoid k foods (salt sub.)
If serum levels exceed 5.3 stop med
Diuretics—Uses
o edema
o hypertension
o renal disease
o cerebral edema
o seizures and altitude sickness
o acute glaucoma; increased intraocular pressure
o short term management of ascites
o premenstrual bloating or weight loss (nonprescription)
Educating the Client and Family
▫ Explain the importance of taking the drug at prescribed time
intervals and as directed
▫ Advise about the importance of completing the entire course
of treatment
▫ Emphasize the importance of taking the drug with food or
milk if GI upset occurs
▫ Advise the client to take the drug early in the morning unless
the provider directed otherwise
Educating the Client and Family
▫ Do not reduce fluid intake to reduce the need to urinate
▫ Instruct client to avoid alcohol and nonprescription drugs
▫ Emphasize observing caution while driving or performing
hazardous tasks
▫ Explain necessary interventions if dizziness or weakness or
signs of dehydration or electrolyte imbalance occurs; notify
provider: slow position changes
Educating the client
▫ Instruct client to weigh themselves daily and track their weight; notify
provider if weight loss or gain exceeds 2 to 3 pounds in a week.
▫ If foods or fluids high in potassium are recommended by the provider,
educate the client about potassium-rich food and fluid sources; caution
client not to exceed daily recommended amount
▫ Explain the importance of avoiding exposure to sunlight or ultraviolet light
▫ Explain to clients with diabetes mellitus and who take loop or thiazide
diuretics to contact health care provider if increase in blood glucose
level
▫ Clients on potassium-sparing diuretics: teach clients to avoid eating
foods or drinking fluids high in potassium
NURSING MANAGEMENT OF PATIENTS ON DIURETICS
• Monitor fluid and electrolytes –
• Monitor postural blood pressures
• Use diuretics with caution for people who have –
hypokalemia, disease, hepatic disease, lupus,
diabetes, COPD, gout.
• Monitor lab values (K, Na, Ca, Cl, Mg, uric acid,
creatinine),
• Monitor intake and output, mucous membranes,
skin turgor, urine concentration, capillary refill
