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nursing > Drug Therapy for Fluid Volume Excess > Flashcards

Drug Therapy for Fluid Volume Excess Flashcards

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1
Q

Anasarca

A

generalized massive edema

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2
Q

Anuria

A

no urine output (don’t give this person a diuretic)

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3
Q

Ascites

A

fluid overload in the abdomen

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4
Q

Edema

A

General medical term for swelling

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5
Q

Dependent Edema

A

dependent on the lowest point in the body. Feet and fingers.

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6
Q

Extracellular Fluid

A

Fluid outside of the cells

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7
Q

Intracellular Fluid

A

Fluid inside the cell

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8
Q

Renal Physiology

A

Kidneys, Ureters, Bladder, Urethra

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9
Q

Primary Function of Kidneys

A

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

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10
Q

RAAS System

A

increases perfusion through the kidneys and makes red blood cells through erythropoietin production

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11
Q

RBC Production effect on BP

A

Increase

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12
Q

Vitamin D Conversion

A

maintain strong bones

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13
Q

Amount of Output the Kidney’s receive

A

receive 25% of cardiac output

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14
Q

Renal Capsule

A

the fibrous protection around the kidney to protect it because a bunch of blood is flowing through it

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15
Q

Regions of Kidney

A

Cortex, Medulla, Renal Pelvis

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16
Q

Cortex

A

we are going to see part of the nephron

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17
Q

Nephron

A

functional unit of the kidney. One million nephrons in each kidney

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18
Q

Medulla

A

middle layer that contains the loop of Henle and collecting ducts

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19
Q

Renal Pelvis

A

takes newly made urine and makes it ready to go to the bladder

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20
Q

Nephron Functions

A

Glomerular Filtration
Tubular Secretions
Tubular Reabsorption

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21
Q

Glomerular Filtration

A

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

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22
Q

Tubular Secretions

A

things that are secreted out with your urine

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23
Q

Tubular Reabsorption

A

things that your body is reabsorbing for you to use again

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24
Q

bowman’s capsule

A

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

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25
Q

Glomerular Filtration Rate:

A

How fast the glomerular is able to filter your blood! The faster the better

125 ml/min is normal

2L of secretion is normal

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26
Q

Conditions requiring Diuretic Agents:

A

Alterations in renal function (GFR)
Renal
Cardiovascular
Hepatic
Burns
Trauma
Allergies
Inflammatory Reactions

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27
Q

Reasons for Swelling

A

Increased Capule Permeability
Increased hydrostatic pressure
Decreased Plasma Oncotic Pressure

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28
Q

Decreased Plasma Oncotic Pressure

A

result from low plasma protein which are responsible for holding on to fluids and keeping them where they should be.

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29
Q

Increased hydrostatic pressure

A

increase blood volume causing high venous pressure. So much volume on the inside that the body tries to push it to the outside

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30
Q

Increased Capule Permeability

A

Part of the response to inflammatory or allergic reactions. Capillaries grow to allow for more blood to flow through

31
Q

Clinical manifestations

A

Edema
Alterations in fluid
Electrolyte Imbalance
Dependent Edema
Pulmonary Edema
Anasarca

32
Q

Diuretics

A

Treatment for Edema: increase urine output and increase urine formation

33
Q

Loop Diuretic Examples

A

Furosemide, Bumetanide, Torsemide

34
Q

Loop Diuretic: Pharmacokinetics

A

PO, IV, IM. This is the strongest diuretic. Not K+ sparing

35
Q

Loop Diuretic Action:

A

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!

36
Q

Loop Diuretic Use

A

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

37
Q

Loop Diuretics Adverse Effects

A

fluid and electrolyte imbalance
Hypokalemia
Fluid volume deficit
Ototoxicity

38
Q

Loop Diuretic Drug-Drug Interactions

A

Aminoglycosides
Cephalosporins
Corticosteroids
Digoxin

39
Q

Loop Diuretic Considerations

A

**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

40
Q

Loop Diuretic Diet

A

Low sodium
High K diet
Record daily weight

41
Q

Thiazide + Thiazide-like diuretics Examples

A

Hydrochlorothiazide (HCTZ)
Metolazone (thiazide-like)

42
Q

Thiazide Route and Class

A

Given PO. Not as strong so it is good for home management. Works in distal convoluted tube

43
Q

Thiazide Action

A

Decreases reabsorption of Na+, H2O, Cl-, HCO3

44
Q

Thiazide Use

A

First line of treatment for mild-moderate HTN
Edema associated with CHF or nephrotic syndrome
Patients with renal impairment

45
Q

Thiazide Adverse Side Effects:

A

+Hypotension
Weakness
+Dizziness
Diarrhea/constipation
Hypokalemia
*Hyperglycemia

46
Q

Thiazide Considerations

A

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

47
Q

Thiazide Patient Teaching

A

Low sodium diet
High k+ diet
Record daily weight
Change position slowly
Take in the morning

48
Q

Hypokalemia

A

below 3.5

49
Q

Hypokalemia S/SX

A

Confusion
GI upset
Heart arrhythmias
Death

50
Q

Potassium Sparing Diuretics Example

A

Spironolactone

51
Q

Potassium Sparing Diuretics Pharmacokinetics

A

Slow onset and peak 24-48 hours
6 week for maximum effect
Long term treatment

52
Q

Potassium Sparing Diuretics Action

A

Block effects of aldosterone (in the RAAS system)
Weak diuretic effect
Use in combination with other diuretics

53
Q

Potassium Sparing Diuretics Use

A

*treatment of heart failure
*ascites in liver disease
Hypokalemia
Mild-moderate HTN
*hyperaldosteronism (high aldosterone)

54
Q

Potassium Sparing Diuretics Adverse Effects

A

Adregen (having to do with the male sex hormone) like effects
Alginomastia: breast tissue growth in males
Irregular periods in women

55
Q

Potassium Sparing Diuretics Black Box Warning:

A

Increased risk of tumors if built up in the body

56
Q

Potassium Sparing Diuretics Contraindications:

A

Renal insufficiency
Hyperkalemia
Drug interactions:
ACE-1, ARBs, K+ containing drugs

57
Q

Spironolactone Nursing implications

A

Check K+ levels
Check Kidney levels
Accurate I+O
Monitor for safety and dizziness

58
Q

Spironolactone Teaching

A

Avoid salt substitutes
Low K Diet
Record daily weight
Monitor abd girth
Change positions slowly
Take with morning food

59
Q

Hyperkalemia

A

K+ level above 5

60
Q

Hyperkalemia S/sx

A

Muscle cramps
EKG changes
Heart arrhythmias
Death

61
Q

Osmotic Diuretics Example

A

Mannitol (Emergency Med)

62
Q

Osmotic Action

A

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

63
Q

Osmotic Use

A

Reduction of intracranial pressure
Reduction of intraocular pressure
Effective in decreased renal circulation and GFR

64
Q

Osmotic Adverse Effect

A

Hyperosmolar nonketotic coma
Confusion
Headache
Syncope
Cardiac dysrhythmias
Severe dehydration

65
Q

Osmotic Contraindications

A

Severe dehydration
Abdominal pain
Appendicitis
Pulmonary edema
Severe cardiac decompensation
Older adults

66
Q

Osmotic Nursing Implications

A

Comes in a glass bottle and is given IV
Baseline vitals and physical examination
Accurate I+O
Closely monitor vitals

67
Q

Osmotic Antidote

A

Hyaluronidase

*Osmotic Diuretics are toxic if they infiltrate

68
Q

Carbonic Anhydrase Inhibitors Examples

A

Acetazolamide

69
Q

Carbonic Anhydrase Inhibitors Action

A

Inhibits carbonic anhydrase to reduce formation of aqueous humor and lower IOP

70
Q

Carbonic Anhydrase Inhibitor Uses

A

Open-angle glaucoma
Secondary glaucoma

71
Q

Carbonic Anhydrase Adverse Effects

A

Metabolic Acidosis
Stephen johnson syndrome
Flaccid paralysis
Blood dyscrasias

72
Q

Carbonic Anhydrase COntraindicated

A

Non-congested angle-glaucoma (getting rid of fluid wont help non-congested…)
Addison’s disease
Electrolyte imbalance

73
Q

Carbonic Anhydrase Nursing implications

A

Baseline vision exam
Eye gtts administration
IV or Eye drops

nursing (17 decks)

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