Hypertension Diuretics Flashcards
Actions of a Diuretic
Diuretics, sometimes called water pills, help rid your body of salt (sodium) and water. Most of these medicines help your kidneys release more sodium into your urine. The sodium helps remove water from your blood, decreasing the amount of fluid flowing through your veins and arteries. This reduces blood pressure.
Specifics with LOOP
Loop diuretics are medications used in the management and treatment of fluid overload conditions such as heart failure, nephrotic syndrome or cirrhosis, and hypertension, in addition to edema.
POTASSIUM SPARING
Potassium-sparing diuretics are one type of diuretic. They are weak diuretics usually prescribed in combination with other types of diuretics. They are used to increase the amount of fluid passed from the body in urine, whilst also preventing too much potassium being lost with it
Potassium Sparing Use
They are typically used as an adjunct in management of hypertension, cirrhosis, and congestive heart failure.
Potassium Sparing Medications
- Amiloride (Midamor)
* Triamterene (Dyrenium) - Spirolactones (Aldactone, Carospir)
- Eplerenone (Inspra)
Potassium Sparing Adverse reactions
Hyperkalemia (increased levels of potassium in the blood)
Nausea and vomiting.
Abdominal discomfort.
Headache.
Drowsiness.
Confusion.
Ataxia (loss of control on bodily movements due to lack of coordination between muscles and brain)
Kidney stones.
Low potassium (hypokalemia) refers to a lower than normal potassium level in your bloodstream. Potassium helps carry electrical signals to cells in your body.
HYPOKALEMIA
High potassium (called “hyperkalemia”) is a medical problem in which you have too much potassium in your blood.
HYPERKALEMIA
is an increase in the amount of breast gland tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone.
GYNECOMASTIA
Therapy can prevent additional clots from forming.
*group of drugs included warfarin and fractionated and unfractionated heparin
Anticoagulants
glycosides (used to treat heart failure)
*concurrently require frequent monitoring of the pulse rate and rhythm because of the possibility of cardiac arrhythmias
DIGITALIS
Insulin or oral antidiabetic drug dosages may require alterations because of hyperglycemia; therefore serum glucose concentrations are monitored periodically.
K sparing:
Antidiabetic drugs
Patients with Edema
Accumulation of excess water in the body
Many conditions or diseases, such as heart failure (HF), endocrine disturbances, and kidney and liver diseases, can cause fluid overload or edema.
Clinician may prescribe a diuretic to reduce the increased fluid
Clients with edema caused by HF or other conditions are weighed daily or as ordered by the health care provider.
Parenteral loop diuretics are typically used in the hospital for rapid fluid loss when it interferes with cardiac function. Weight loss of about (2 lbs) daily is desirable to manage fluid loss and prevent dehydration and electrolyte imbalance.
Every 8 hours, carefully measure and document the fluid intake and output. The critically ill client with renal disease may require more frequent measurements of urinary output.
The blood pressure, pulse, and respiratory rate are assessed every 4 hours or as ordered by the clinician. An acutely ill client may require more frequent monitoring of the vital signs.
Areas of edema are examined daily to evaluate the effectiveness of drug therapy. Note the client’s general appearance and condition daily or more often if the client is acutely ill.
Patients with HTN
Teach the hypertensive client how to monitor their blood pressure and pulse rate when receiving a diuretic or a diuretic along with an antihypertensive drug.
Clients can monitor their own vital signs easily when going to the grocery store or pharmacy; many of these places have access for free monitoring.
For those who wish to use technology, many devices will monitor pulse and blood pressure, as well as activity.
Vital signs, including respiratory rate, are more frequently monitored when the client is critically ill or the blood pressure is excessively high
Renal Compromise
When thiazide diuretics are administered, renal function should be monitored periodically. These drugs may cause azotemia (accumulation of nitrogenous waste in the blood). If nonprotein nitrogen (NPN) or (BUN) levels increases, the clinician may consider withholding the drug or discontinuing its use.
In addition, serum uric acid concentrations are monitored periodically during treatment with thiazide diuretics because these drugs may cause an acute attack of gout; therefore be alert to client complaints of joint pain or discomfort.
Insulin or oral antidiabetic drug dosages may require alterations because of hyperglycemia; therefore serum glucose concentrations are monitored periodically.
Electrolyte Imbalances
As fluid electrolytes shift in the body be alert for imbalances. One of the primary and balances to monitor is potassium. Clients who experience cardiac arrhythmias or who are being “digitalized” (initiating digoxin therapy) may be more susceptible to significant potassium loss when taking diuretics. The potassium-sparing diuretics are recommended for these clients.
When would a nurse administer a diuretic
Hypertension
Edema
Renal disease
Cerebral Edema
Seizures and altitude sickness
Impaired Urinary elimination
It’s good to explain to the client that eliminating fluids helps the heart and blood work efficiently.
Risk for FVD
Monitor the fluid intake and output so the client doesn’t become dehydrated.
List food sources for Potassium replacement
Fruits (10 highest): apricots, prunes, dried currants/raisins, dates, figs, dried coconut, avocado, bananas, oranges, nectarines, and peaches.
Vegetables (10 highest): sun-dried tomatoes, spinach, Swiss chard, mushrooms, sweet potato, kale, brussels sprouts, zucchini, green beans, and asparagus.
Other sources: chocolate, molasses, nuts, and nut butters
What is the brand name for bumetanide?
Bumex
Edecrine
Same as bumetanide plus ascites caused by malignancy, idiopathic, edema, lymphedema
Lasix
Furosemide
Spironolactone
Aldactone
Diuril
Htn, edema caused by HF, Cirrhosis, corticosteroid, and estrogen therapy,
Diamox is used to treat what?
Altitude sickness (acute), edema caused by HF, drug-induced edema, centrencephalic epilepsy
Cardiotonics
is a class of drugs used to increase the efficiency and improve the contraction of the heart muscle, which leads to improve blood flow to all tissues of the body.
What are Cardiotonics primarily used for
Used to treat heart failure and atrial fibrillation
Which type of client us cardiotonics
Treats patients that are in Heart Failure
Describe Left sided heart failure
Causes a backup of fluid in the lungs and leads to pulmonary symptoms, such as dyspnea and moist cough with the production of frothy pink sputum.
Describe Right sided heart failure
Causes a backup in the peripheral venous system and leads to neck vein distention, peripheral edema, weight gain, and hepatic engorgement.
Most common s/s of Heart Failure are
Left ventricular dysfunction
Shortness of breath with exercise
Dry, hacking cough or wheezing
Orthopnea
Restlessness and anxiety
Right ventricular dysfunction
Swollen ankles, leg, or abdomen
Anorexia
Nausea
Nocturia
Weakness
Weight gain as a result of fluid retention
Other symptoms include palpitations, fatigue, or pain when performing normal activities
Tachycardia or irregular heart rate
Dizziness or confusion
What is the most common form of heart failure
Left ventricular dysfunction aka left ventricular systolic dysfunction
Left Ventricular dysfunction It results in
Decreased Cardio output
Digoxin or lanoxin is the most commonly used
Cardiotonic
Digoxin is derived from the leaves of the
foxglove plant.
The cardiotonics are used to treat the following
HF (Heart Failure)
AF (Atrial Fibrillation)
Cardiotonics Adv reactions
GI nausea and anorexia
What would you recommend for a client with nausea and anorexia fo cardiotonics
That is should be taken with food.
Describe Digitalis Toxicity
Toxic drug effects that occur when digoxin is administered.
Cardiotonics are given cautiously to clients with ?
Electrolyte imbalance
Thyroid disorders
Severe carditis
Heart Block
Myocardial Infarction
Severe Pulmonary disease
Acute Glomerulonephritis
Impaired renal or hepatic function
Why do we minimize fiber with a client’s diet?
Because it decreases the absorption of the cardiotonic
How does St John”s Wort effect digitalis levels?
It causes a decrease in serum digitalis levels
before administering digoxin
History of cardiac episodes, pain assessment if experiencing pain.
Medical/family history
Drug therapy (list of all current drugs and supplements taken)
What do you assess? (Digoxin)
Before administering each dose take the apical pulse rate for 60 seconds. If the pulse rate is below 60 bpm is adults or greater then 100bpm, withhold the drug and notify the primary health care provider,
What do you monitor? (digoxin)
You need to monitor the intake and output and measure it if the client has edema or HF or is also receiving a diuretic.
Name some nursing interventions for a client on Digoxin:
Monitor blood pressure in patients receiving IV digoxin
Monitor ECG during IV administration and 6 hr after each dose
Notify health care professional if bradycardia or new arrhythmias occur
Explain Dig levels, therapeutic and toxic
Serum digoxin levels are monitored closely. Blood for serum level measurements should be drawn immediately before the next dose or 6-8 hr after the last dose regardless of the administration route. Therapeutic drug levels are between 0.8 and 2ng/ml serum digoxin levels >2 ng /ml are considered toxic and are reported to the primary health provider
How does hypokalemia affect a client taking Digoxin?
Hypokalemia makes the heart muscle more sensitive to digitalis, thereby increasing the possibility of digitalis toxicity.
Signs of Digoxin toxicity
Anorexia, nausea, and vomiting. Other signs of digitalis toxicity include abdominal pain, visual disturbances (blurred vision, or green vision and white halos, borders around dark objects) and arrhythmias (any type)
Who are prone to Digoxin toxicity?
Clients with hypomagnesemia (low serum magnesium levels)
What should you monitor as a nurse with a client taking Digoxin?
When a cardiotonic drug is given IV, it is administered slowly (over at least 5 min), and the administration site is assessed for redness or infiltration
Malnutrition risk related to anorexia, nausea, and vomiting
Activity intolerance related to weakness and drowsiness
Injury risk related to dizziness and lightheadedness
Pulse rate is monitored, and the drug held if the clients heart rate is less the 60 bpm
Monitor for toxicity to the drug, which can appear as GI distress, changes in vison, or muscle weakness
