Drug Therapy for Fluid Volume Excess Flashcards
Anasarca
generalized massive edema
Anuria
no urine output (don’t give this person a diuretic)
Ascites
fluid overload in the abdomen
Edema
General medical term for swelling
Dependent Edema
dependent on the lowest point in the body. Feet and fingers.
Extracellular Fluid
Fluid outside of the cells
Intracellular Fluid
Fluid inside the cell
Renal Physiology
Kidneys, Ureters, Bladder, Urethra
Primary Function of Kidneys
Regulate Volume (how much fluid to get rid of)
Composition of Urine (how many electrolytes we are going to keep)
Regulate pH (How many H+ ions we are going to eliminate)
Eliminating Wastes (medications, diet)
BP Regulation
RAAS System
increases perfusion through the kidneys and makes red blood cells through erythropoietin production
RBC Production effect on BP
Increase
Vitamin D Conversion
maintain strong bones
Amount of Output the Kidney’s receive
receive 25% of cardiac output
Renal Capsule
the fibrous protection around the kidney to protect it because a bunch of blood is flowing through it
Regions of Kidney
Cortex, Medulla, Renal Pelvis
Cortex
we are going to see part of the nephron
Nephron
functional unit of the kidney. One million nephrons in each kidney
Medulla
middle layer that contains the loop of Henle and collecting ducts
Renal Pelvis
takes newly made urine and makes it ready to go to the bladder
Nephron Functions
Glomerular Filtration
Tubular Secretions
Tubular Reabsorption
Glomerular Filtration
filters out things that are good and need to stay in the body (protein, Na, K)
First stop of the blood coming into the kidney
Tubular Secretions
things that are secreted out with your urine
Tubular Reabsorption
things that your body is reabsorbing for you to use again
bowman’s capsule
Blood comes in from the aorta into the glomerulus under high pressure
Under the high pressure, it pushes water, electrolytes, and other solutes out into bowman’s capsule which is like a catchers mitt
Bowman’s capsule pushes it down through the tubules where the urine is made
Glomerular Filtration Rate:
How fast the glomerular is able to filter your blood! The faster the better
125 ml/min is normal
2L of secretion is normal
Conditions requiring Diuretic Agents:
Alterations in renal function (GFR)
Renal
Cardiovascular
Hepatic
Burns
Trauma
Allergies
Inflammatory Reactions
Reasons for Swelling
Increased Capule Permeability
Increased hydrostatic pressure
Decreased Plasma Oncotic Pressure
Decreased Plasma Oncotic Pressure
result from low plasma protein which are responsible for holding on to fluids and keeping them where they should be.
Increased hydrostatic pressure
increase blood volume causing high venous pressure. So much volume on the inside that the body tries to push it to the outside
Increased Capule Permeability
Part of the response to inflammatory or allergic reactions. Capillaries grow to allow for more blood to flow through
Clinical manifestations
Edema
Alterations in fluid
Electrolyte Imbalance
Dependent Edema
Pulmonary Edema
Anasarca
Diuretics
Treatment for Edema: increase urine output and increase urine formation
Loop Diuretic Examples
Furosemide, Bumetanide, Torsemide
Loop Diuretic: Pharmacokinetics
PO, IV, IM. This is the strongest diuretic. Not K+ sparing
Loop Diuretic Action:
Inhibit the Na+ and the Cl- reabsorption. Work in the ascending loop of Henle
If we stop the Na+ from going back into the body, we are going to stop the H2O from going back into the body as well!
Loop Diuretic Use
Acute conditions of Renal Failure
Management of pulmonary edema, CHF, Hepatic and Renal Disease
Given alone or in combination with HTN
Patients w/ renal impairment
Patients with hepatic impairment
Critically ill patients
Home care patients
Loop Diuretics Adverse Effects
fluid and electrolyte imbalance
Hypokalemia
Fluid volume deficit
Ototoxicity
Loop Diuretic Drug-Drug Interactions
Aminoglycosides
Cephalosporins
Corticosteroids
Digoxin
Loop Diuretic Considerations
**Slow push: 20mg/min
Check Labs
Baseline weight and daily weight
Accurate I+O
Closely monitor Vitals, watch for hypotension
GIve PO in AM
Monitor safety r/t dizziness
Loop Diuretic Diet
Low sodium
High K diet
Record daily weight
Thiazide + Thiazide-like diuretics Examples
Hydrochlorothiazide (HCTZ)
Metolazone (thiazide-like)
Thiazide Route and Class
Given PO. Not as strong so it is good for home management. Works in distal convoluted tube
Thiazide Action
Decreases reabsorption of Na+, H2O, Cl-, HCO3
Thiazide Use
First line of treatment for mild-moderate HTN
Edema associated with CHF or nephrotic syndrome
Patients with renal impairment
Thiazide Adverse Side Effects:
+Hypotension
Weakness
+Dizziness
Diarrhea/constipation
Hypokalemia
*Hyperglycemia
Thiazide Considerations
Check labs for electrolytes and glucose
Baseline weight and daily weight
Accurate I+O
Closely monitor vitals and watch for hypotension
Give in the AM
Monitor safety r/t dizziness
Thiazide Patient Teaching
Low sodium diet
High k+ diet
Record daily weight
Change position slowly
Take in the morning
Hypokalemia
below 3.5
Hypokalemia S/SX
Confusion
GI upset
Heart arrhythmias
Death
Potassium Sparing Diuretics Example
Spironolactone
Potassium Sparing Diuretics Pharmacokinetics
Slow onset and peak 24-48 hours
6 week for maximum effect
Long term treatment
Potassium Sparing Diuretics Action
Block effects of aldosterone (in the RAAS system)
Weak diuretic effect
Use in combination with other diuretics
Potassium Sparing Diuretics Use
*treatment of heart failure
*ascites in liver disease
Hypokalemia
Mild-moderate HTN
*hyperaldosteronism (high aldosterone)
Potassium Sparing Diuretics Adverse Effects
Adregen (having to do with the male sex hormone) like effects
Alginomastia: breast tissue growth in males
Irregular periods in women
Potassium Sparing Diuretics Black Box Warning:
Increased risk of tumors if built up in the body
Potassium Sparing Diuretics Contraindications:
Renal insufficiency
Hyperkalemia
Drug interactions:
ACE-1, ARBs, K+ containing drugs
Spironolactone Nursing implications
Check K+ levels
Check Kidney levels
Accurate I+O
Monitor for safety and dizziness
Spironolactone Teaching
Avoid salt substitutes
Low K Diet
Record daily weight
Monitor abd girth
Change positions slowly
Take with morning food
Hyperkalemia
K+ level above 5
Hyperkalemia S/sx
Muscle cramps
EKG changes
Heart arrhythmias
Death
Osmotic Diuretics Example
Mannitol (Emergency Med)
Osmotic Action
Increases solute load (osmotic pressure) of glomerular filtrate
Pulls fluid into the blood stream and blocks reabsorption
Pulls from extravascular into blood
Decreases reabsorption of H2O and electrolytes
Osmotic Use
Reduction of intracranial pressure
Reduction of intraocular pressure
Effective in decreased renal circulation and GFR
Osmotic Adverse Effect
Hyperosmolar nonketotic coma
Confusion
Headache
Syncope
Cardiac dysrhythmias
Severe dehydration
Osmotic Contraindications
Severe dehydration
Abdominal pain
Appendicitis
Pulmonary edema
Severe cardiac decompensation
Older adults
Osmotic Nursing Implications
Comes in a glass bottle and is given IV
Baseline vitals and physical examination
Accurate I+O
Closely monitor vitals
Osmotic Antidote
Hyaluronidase
*Osmotic Diuretics are toxic if they infiltrate
Carbonic Anhydrase Inhibitors Examples
Acetazolamide
Carbonic Anhydrase Inhibitors Action
Inhibits carbonic anhydrase to reduce formation of aqueous humor and lower IOP
Carbonic Anhydrase Inhibitor Uses
Open-angle glaucoma
Secondary glaucoma
Carbonic Anhydrase Adverse Effects
Metabolic Acidosis
Stephen johnson syndrome
Flaccid paralysis
Blood dyscrasias
Carbonic Anhydrase COntraindicated
Non-congested angle-glaucoma (getting rid of fluid wont help non-congested…)
Addison’s disease
Electrolyte imbalance
Carbonic Anhydrase Nursing implications
Baseline vision exam
Eye gtts administration
IV or Eye drops
