drug therapy for fluid volume excess Flashcards
anasarca
generalized massive edema; entire body completely swollen
anuria
no urine output
ascites
fluid volume overload in the abdomen (distention looking/ beer belly)
edema
general swelling/ excess fluid buildup in the body
extracellular fluid
fluid outside the cell, not circulating through the cells
dependent edema
dependent on the lowest point of the body; if sitting, you might see feet and ankles swelling; if arm is dangling, you might see the hand start to swell
intracellular fluid
fluid inside the cells, going to be circulating around
renal physiology composed of
kidneys, ureters, bladder, urethra
primary function of kidneys
regulate volume, composition of urine, regulate pH, eliminating waste, BP regulation, RBC production, vitamin D conversion
kidneys receive what % of cardiac output (CO)
25%
erythropoietin is responsible for
stimulating the production of new RBCs, which will increase volume
25% of CO enter the kidneys through
the afferent arteriole right of the aorta
the blood will exit from the kidneys through
efferent arteriole
renal capsule
the three layers of kidneys
outer cortex, inner medulla, renal pelvis
outer cortex you see
part of the nephron
inner medulla you can see
loop of henle and collecting ducts
renal pelvis, the most inner part of the kidney you
take newly made urine and get ready to enter the utters and bladder
nephron functions
glomerular filtration, tubular secretions, tubular reabsorption
glomerular filtration is what
the passage of components of blood and fluid thru glomerulus (Na, K, protein; stay in blood/ extra meds, electrolytes will get filtered out)
tubular secretions is what
active movement of substances from blood thru renal tubule
tubular reabsorption is what
movement of substances from renal tubule back to vascular system
glomerular filtration in detail
arterial blood enters glomerulus via afferent arteriole; blood is coming in in high pressure pushing water, electrolytes and other solutes out -> bowmans capsule -> proximal tubule; GFR 125 ml/min; blood leaves the glomerulus via efferent arteriole
glomerular filtration rate (GFR)
125 ml/min = end product about 2 L of urine/ day
nephron
kidneys has millions
filtrate composition
h2o, NaCl, HCO3, H, urea, glucose, amino acids, some drugs
Whereis the loop of henle found
nephron; the nephron is the functional unit of the kidney. each nephron contains a tubule and a glamorous. there are about 1 millions nephrons in the kidney
conditions requiring diuretic agents/ alters in renal function
cardiovascular, renal, hepatic, burns, trauma, allergies, inflammatory reactions
clinical manifestions/ symptoms
edema, alterations in fluid or electrolyte balance (kidneys unable to control volume, composition, and pH of body)
types of edema
dependent edema, pulmonary edema (in the lungs), anasarca (massive generalized edema)
T or F. Edema occurs only when the heart no longer functions efficiently
false; edema is the excessive accumulation of fluid in body tissues. it is the symptom of many disease processes and may occur in any part of the body
diuretics do what
increase renal secretion of water, sodium, and other electrolytes (increase urine formation and output)
5 classes of diuretics
loop, thiazide, potassium sparing, osmotic, carbonic anhydrase
example of loop diuretic
furosemide (act in loop of henle)
example of thiazide/ thiazide like diuretic
hydrochlorothiazide (HCTZ)/ metolazone (act in distal convoluted tubule)
example of potassium sparing diuretic
spironolactone/ act in collecting duct
example of osmotic diuretic
mannitol
example of carbonic anhydrase inhibitor
acetazolamide (act in proximal convoluted tubule)
principles of therapy diuretics
drug selection and dosing depend on the patients condition; loop diuretic is preferred when rapid diuretic effect is necessary or when renal impairment is present; potassium sparing diuretic may be used concurrently to prevent or manage hypokalemia
pharmacokinetics of loop diuretic
PO/ IV/ IM
mechanism of action of loop diuretic
inhibit Na+/ Cl- reabsorption, work in ascending loop of henle, produce significant fluid loss
uses of loop diuretics
management of pulmonary edema, CHF, hepatic and renal disease/ combination for tx of HTN/ pts with renal impairment and hepatic impairment/ critically ill pts
adverse effects of loop diuretics
fluid and electrolyte imbalances (you’ll see hyponatremia, hypokalemia, fluid volume deficit/ low BP), ototoxicity (ringing of the ears, permanent hearing loss)
contraindications of loop diuretics
anuria, allergy to sulfonamides
drug-drug interactions of loop diuretics
ahminoglycosides, cephalosporins, corticosteroids, digoxin
drug-drug interactions of loop diuretics
ahminoglycosides, cephalosporins, corticosteroids, digoxin
nursing implications of loop diuretics
**slow push 20mg/min, check labs: Na, K, baseline/ daily weight, accurate I & Os, monitor vitals (watch for hypotension)
patient teaching about loop diuretics
low Na diet, high K diet, record daily weight, change position slowly, take in morning
thiazide & thiazide like diuretics pharmacokinetics
PO
mechanism of action of thiazide & thiazide like diuretics
decreases reabsorption of Na, Cl, H2O, HCO3, in the distal convoluted tubule
uses of thiazide & thiazide like diuretics
first line tx of HTN, edema associated with CHF or nephrotic syndrome, or pts with renal impairment
adverse effects of thiazide & thiazide like diuretics
hypotension, dizzy, hypokalemia, hyperglycemia, diarrhea, weakness
contraindications for thiazide & thiazide like diuretics
allergy to sulfonamides and renal failure/ anuria
nursing implications of thiazide & thiazide like diuretics
checks labs: Na, K, glucose, renal function/ baseline & daily weights, I & Os, vitals, given in AM
patient teaching for thiazide & thiazide like diuretics
low Na diet, high K diet, daily weights, change positions slowly, take in the morning
prevent and management of potassium imbalances: hypokalemia
low dosing of diuretics, using supplemental potassium, use potassium- sparing almond with potassium losing medication, increase food intake of potassium, restrict dietary sodium intake
s/sx of hypokalemia
confusion ,weakness, heart palpatations (dysrhythmias), GI upset, SOB
what assessment finding in a patient with heart failure receiving furosemide would indicate an improvement in fluid volume status?
absence of crackles on auscultation of Lungs; crackles usually indicate fluid in the alveoli, hearing no crackles would indicate there is no excess fluid remaining in the lungs
pharmacokinetics of potassium sparing diuretics
slow onset and peak 24-48 hrs/ 6 weeks for maximum effect
mechanism of action for potassium sparing diuretics
blocks effects of aldosterone, weak diuretic effect, use in combination with other diuretics
uses for potassium sparing diuretics
tx of heart failure, ascites in liver disease, hypokalemia, mild-moderate HTN, hyperaldosteronism
adverse effects of potassium sparing diuretics
dizziness, diarrhea, androgen like effects, increase risk of GI bleed, BLACK BOX warning for tumorigenic with chronic toxicity
contraindications for potassium sparing diuretics
renal insufficiency, hyperkalemia
drug-drug interactions for potassium sparing diuretics
ACE inhibitors, ARBs, K+ containing drugs
nursing implications of potassium sparing diuretics
check labs: K, renal function, daily weights, I & Os
patient teaching of potassium sparing diuretics
low salt, low K diet, daily weight, monitor abd girth (liver disease), take in morning with food
prevention and management of potassium imbalances: hyperkalemia
potassium sparing along with potassium wasting medications, avoid potassium supplements, avoid salt substitutes, maintain urine output
s/sx of hyperkalmeia
muscle cramps, EKG changes, low BP, diarrhea, death, weakness, dysrhythmias
osmotic diuretics pharmacokinetics
IV- in glass bottle
mechanism of action of osmotic diuretics
increases solute load (osmotic pressure) of glomerular filtrate, pulls from extracellular into blood, decreases reabsorption of H2O and electrolytes
uses of osmotic diuretics
reduction of intracranial pressure, reduction of intraocular pressure, effective in decreased renal circulation and GFR
adverse effects for osmotic diuretics
hyperosmolar non-ketotic coma, confusion, HA, cardiac dysrhythmias, severe dehydration
contraindications of osmotic diuretics
severe dehydration, pulmonary edema, older adults, abdominal pain
nursing implications of osmotic diuretics
baseline physical exam of vitals, I & Os, monitor vitals
antidote for mannitol (osmotic diuretic)
hyaluronidase
pharmacokinetics of carbonic anhydrase inhibitors
IV/ eye gtt (eye drop)
mechanism of action of carbonic anhydrase inhibitors
inhibits carbonic anhydrase to reduce formation of aqueous humor and lower IOP
uses of carbonic anhydrase inhibitors
open angle glaucoma, secondary glaucoma
adverse effects of carbonic anhydrase inhibitors
**metabolic acidosis, Stephen Johnson syndrome, flaccid paralysis, blood dycrasias
contraindications of carbonic anhydrase inhibitors
renal/ hepatic disease, Addisons disease, chronic non-congestive angle closure glaucoma
nursing implications for carbonic anhydrase inhibitors
baseline vision exam, eye drop administration
how to give eye drops
head back and look up, pull lower eyelid down and squeeze prescribed number of drops in the pocket (lower conjuctiva)
a nurse is instructing a pt on dietary considerations while taking spironolactone. which of the following statements made by the patient indicates further teaching is necessary ?
I should use salt substitutes instead of regular salt; most sale substitutes use potassium chloride as it tastes like salt. foods high in potassium should be avoided with spironolactone which is a potassium sparing diuretic
