Kidney chapter 51 Flashcards by Shaniya Capre

What are functions of the kidney ?

Regulating fluid volume
Electrolyte control
Blood pressure
Red blood cells production
Acid-base balance
Excretion of medication

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What do diuretic agents help with

Promote renal excretion of sodium, water and other
electrolytes
decreases overall fluid volume
Indicated for HF, HTN, pulm edema, renal disease

Glaucoma management
* Decreases fluid pressure in the eye [intraocular pressure (IOP)]

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What are adverse affects of diruetics?

*General:
* Fluid imbalance
* Electrolyte imbalances
(potassium/ calcium)
* Hyperglycemia(Change the way glucose is metabolized)

GI:
* Upset/ decrease appetite due to fluid shift

CNS:
* Drowsiness
* Confusion

CV:
* Hypotension
* Arrhythmias

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What are classes of diuretics?

Thiazide diuretics and thiazide-like diuretics
Loop diuretics
Carbonic anhydrase inhibitors
Potassium sparing diuretics
Osmotic diuretics

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What is hydrochlorothiazide (HydroDiuril)?

Thiazide diuretics
Synthetic, related to sulfonamides*

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What are therapeutic actions of hydrochlorothiazide (HydroDiuril)?

Thiazide diuretics

Block chloride pump –> Inhibit resorption of Na, Cl, and KCL –> Results in water loss
Also cause relaxation of arterioles

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What are indications of hydrochlorothiazide (HydroDiuril)?

Thiazide diuretics

HF, HTN

Edema caused by renal dz, hf, liver

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What are adverse effects of hydrochlorothiazide (HydroDiuril)?

Thiazide diuretics

Electrolyte changes
GI upset
Hypotension
Photosensitivity (HCTZ)

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What are contra of hydrochlorothiazide (HydroDiuril)?

Thiazide diuretics

Allergy to sulfonamides
Severe renal disease
Hypotension

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What are cautions of hydrochlorothiazide (HydroDiuril)? ?

Thiazide diuretics

Systemic lupus erythematosus (SLE)
Diabetes
Pregnancy – use only if necessary
Gout

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What are drug to drug interactions with hydrochlorothiazide (HydroDiuril)?

Thiazide diuretics

Digoxin
Lithium
Diabetic agents

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What are nursing considerations with hydrochlorothiazide (HydroDiuril)?

Thiazide diuretics

Monitor for electrolyte
imbalance:
Hypokalemia
Hypercalcemia
Hyperuricemia

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What is furosemide (Lasix)?

Loop diuretic

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What are therapeutic actions of furosemide (Lasix)?

Loop diuretic
* Work in loop of Henle –> Block chloride and sodium resorption
* Also may have some vasodilating effect, reducing preload and afterload

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What are indications of furosemide (Lasix)?

Loop diuretic
CHF, peripheral edema associated with HF, acute pulmonary edema, HTN

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What are pharmacokinetics of furosemide (Lasix)?

Loop diuretic
Can be given IV (slow push) or PO

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What are adverse effects of furosemide (Lasix)?

Loop diuretic
* Hypokalemia
* Hypocalcemia
* Hypotension, dizziness
* Monitor for ototoxicity
* May be reversed if drug stopped early

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What are contras of furosemide (Lasix)?

Loop diuretic
* Severe renal failure
* Hypotension
* Pregnancy

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What are cautions of furosemide (Lasix)?

Loop diuretic
* Systemic lupus erythematosis
(SLE)
* Gout
* Diabetes

What are drug interactions with furosemide (Lasix)?

Loop diuretic
Monitor use with
aminoglycosides(Ototoxicity), NSAIDS,
diabetic agents

What are nursing considerations with furosemide (Lasix)?

Loop diuretic
Nutrition consult – dietary
potassium needs

Describe potassium sparing diruetics?

Slow acting, weak diuretic, often used in combo with other diuretics

What is spironolactone (Aldactone)?

potassium sparing diruetics
Most frequently used, aldosterone antagonist – blocks action of aldosterone

What are therapeutic actions of spironolactone (Aldactone)?

potassium sparing diruetics

Loss of sodium, retain potassium

What are indications of spironolactone (Aldactone)?

potassium sparing diruetics spironolactone --> used to treat hyperaldosteronism – often seen with liver cirrhosis and nephrotic syndrome

What are adverse affects spironolactone (Aldactone)?

potassium sparing diruetics Hyperkalemia

What are contras of spironolactone (Aldactone)?

potassium sparing diruetics Renal dz due to risk of hyperkalemia * Pregnancy

What are cautions of spironolactone (Aldactone)?

potassium sparing diruetics * Use of other diuretics – dehydration * Cardiac disease – arrhythmias with hypo/hyperkalemia

What are nursing considerations of spironolactone (Aldactone)?

potassium sparing diruetics * Monitor for effects of hyperkalemia  lethargy confusion, muscle cramps, cardiac arrhythmias * Educate to avoid foods high in potassium

What is mannitol (Osmitrol)?

Osmotic diuretic

what are therapeutic actions of mannitol (Osmitrol)?

Osmotic diuretic * Pulls fluid into vasculature from extra vascular spaces – including aqueous humor

What are indications of mannitol (Osmitrol)?

Osmotic diuretic * Used for rapid and/or emergent diuresis * Useful for ICP, intraocular pressure, urinary excretion of toxic substances

What are pharmacokinetics of mannitol (Osmitrol)?

Osmotic diuretic IV only – rapid acting

What are adverse effects of mannitol (Osmitrol)?

Osmotic diuretic * r/t large, sudden volume loss  hypotension, shock, fluid & electrolyte imbalance

What are contras of mannitol (Osmitrol)?

Osmotic diuretic * Renal failure * Dehydration * Cranial bleeds

What is acetazolamide (Diamox)?

Carbonic Anhydrase Inhibitors Mild diuretic

What are therapeutic actions of acetazolamide (Diamox)?

Carbonic Anhydrase Inhibitors * Inhibits enzyme needed for sodium, bicarbonate and water resorption. more sodium and bicarbonate being excreted

What are indications of acetazolamide (Diamox)?

Carbonic Anhydrase Inhibitors Glaucoma * Process especially useful to reduce aqueous humor in eye * Used in conjunction with other diuretic

What are contras acetazolamide (Diamox)?

Carbonic Anhydrase Inhibitors * Pregnancy * Allergy to sulfa/thiazides * Some glaucoma

What are cautions ofacetazolamide (Diamox)?

Carbonic Anhydrase Inhibitors Electrolyte imbalance, renal/hepatic disease

What are drug interaction with acetazolamide (Diamox)?

Carbonic Anhydrase Inhibitors Increases excretion of lithium

What are nursing considerations with diuretics? children

HCTZ, lasix, spironolactone used in children * Monitor for rapid metabolism and effect * Follow weights, assess for ototoxicity

What are nursing considerations with diuretics? adults

* Teach to monitor weights, activity levels, dietary guidelines * Careful assessment of renal function, syncope, drug-drug interactions * AM dosing!

What to assess with diuretics?

* VS, Allergies * Wt, I&O * Physical assessment * Past medical history * Labs * Electrolytes, Renal function * Pregnancy status

What are nsg diagnosis with diuretics?

Risk for deficient fluid volume r/t drug effect * Impaired urinary elimination r/t drug effect

What are implementation of diuretics?

* Monitor I&Os, weight, edema * Administer in am * Check potassium levels prior to administering each dose * Educate pt: * Adverse effects to monitor * s/s of dehydration * Daily weight  when to call PCP (3+ lbs in 1 day) * Dietary sources of potassium  encourage intake (or need to avoid with potassium-sparing) * Safety measures

What to evaluate with a patient on diuretics?

Monitor patient response to medication (wt, urinary output, edema changes, blood pressure)