NURS 317 my au Flashcards
chapter 52 Diuretic agents chapter 53Drugs Affecting the Urinary Tract and the Bladder
Most diuretics act in the body to cause
a.loss of calcium.
b.loss of sodium.
c.retention of potassium.
d.retention of chloride.
b
loss of sodium
Diuretics cause a loss of fluid volume in the body. The drop in volume activates compensatory mechanisms to restore the volume, including
a.suppression of ADH release and stimulation of the countercurrent mechanism.
b.suppression of aldosterone release and increased ADH release.
c.activation of the renin–angiotensin–aldosterone system with increased ADH and aldosterone.
d.stimulation of the countercurrent mechanism with reflex drop in renin release.
c
activation of the renin–angiotensin–aldosterone system with increased ADH and aldosterone.
Thiazide diuretics are considered mild diuretics because
a.they block the sodium pump in the loop of Henle.
b.they cause loss of sodium and chloride but little water.
c.they do not cause fluid rebound when they work in the kidneys.
d.they have little or no effect on electrolyte levels.
b
they cause loss of sodium and chloride but little water.
The nurse would anticipate an order for a loop diuretic as the drug of choice for a patient with
a.hypertension.
b.septic shock.
c.pulmonary edema.
d.fluid retention of pregnancy.
c
pulmonary edema
When providing care to a patient who is receiving a loop diuretic, the nurse would determine the need to regularly monitor which?
a. Sodium levels
b. Bone marrow function
c. Calcium levels
d. Potassium levels
d
potassium levels
When developing the plan of care for a patient with hyperaldosteronism, the nurse would expect the physician to prescribe which agent?
a. Spironolactone
b. Furosemide
c. Hydrochlorothiazide
d. Acetazolamide
a.
spironolactone
A patient with severe glaucoma who is about to undergo eye surgery would benefit from a decrease in intraocular fluid. This is often best accomplished by giving the patient
a. a loop diuretic.
b. a thiazide diuretic.
c. a carbonic anhydrase inhibitor.
d. an osmotic diuretic.
d
an osmotic diuretic
The nurse would instruct a patient receiving a loop diuretic to report
a. yellow vision.
b. weight loss of 1 lb/d.
c. muscle cramping.
d. increased urination.
c.
muscles cramps
Diuretics are currently recommended for the treatment of which conditions?
a.Hypertension
b.Renal disease
c.Obesity
d.Severe liver disease
e.Fluid retention of pregnancy
f.Heart failure
a, b, d, f
hypertension
renal disease
severe retention of pregnancy
HF
Which interventions would include the routine nursing care of a client receiving a diuretic?
a.Daily weighing
b.Tight fluid restrictions
c.Periodic electrolyte evaluations
d.Monitoring of urinary output
e.Regular IOP testing
f.Teaching the patient to report muscle cramping
a,c,d,f
daily weight
periodic electrolyte evaluations
monitoring of urinary output
teaching the pt. to report muscle cramping
A nursing student is preparing medication cards on diuretics for a clinical experience on a medical floor. The student has been assigned to two patients: a young adult and an older adult. The student has to do teaching with a client on furosemide (Lasix). The faculty member has requested that the student nurse do a 5-minute preconference presentation on the various types of diuretics.
What are the key therapeutic actions, indications, and most common adverse effects of diuretics?
- Diuretics increase the excretion of sodium, and therefore water, from the kidneys and are used in the treatment of edema associated with heart failure and pulmonary edema, liver failure and cirrhosis, and various types of renal disease. They are also used in the treatment of hypertension.
- Electrolyte imbalance (potassium, sodium, and chloride), hypotension and hypovolemia, hypoglycemia, and metabolic alkalosis are all potential adverse effects of diuretic therapy.
What are the key therapeutic actions and indications for the five types of diuretics?
- Thiazide and thiazide-like diuretics act to block the chloride pump. Chloride is actively pumped out of the tubule by cells lining the ascending limb of the loop of Henle and the distal tubule. Sodium passively moves with the chloride to maintain electrical neutrality. Blocking of the chloride pump keeps the chloride and the sodium in the tubule to be excreted in the urine, thus preventing the reabsorption of both chloride and sodium in the vascular system. Because these segments of the tubule are impermeable to water, there is little increase in the volume of urine produced, but it will be sodium rich, a saluretic effect. Thiazides are considered to be mild diuretics compared with the more potent loop diuretics. These drugs are the first-line drugs used to manage essential hypertension when drug therapy is needed.
- Loop diuretics block the chloride pump in the ascending loop of Henle, where normally 30% of all filtered sodium is reabsorbed. This action decreases the reabsorption of sodium and chloride. The loop diuretics have a similar effect in the descending loop of Henle and in the distal convoluted tubule, resulting in the production of a copious amount of sodium-rich urine. These drugs work even in the presence of acid–base disturbances, renal failure, electrolyte imbalances, or nitrogen retention. Loop diuretics are commonly indicated for the treatment of acute heart failure, acute pulmonary edema, and edema associated with heart failure or with renal or liver disease, and hypertension.
- Carbonic anhydrase inhibitors: The enzyme carbonic anhydrase is a catalyst for the formation of sodium bicarbonate, which is stored as the alkaline reserve in the renal tubule, and for the excretion of hydrogen, which results in a slightly acidic urine. Diuretics that block the effects of carbonic anhydrase slow down the movement of hydrogen ions; as a result, more sodium and bicarbonate are lost in the urine. These drugs are used as adjuncts to other diuretics when a more intense diuresis is needed. Most often, carbonic anhydrase inhibitors are used to treat glaucoma because the inhibition of carbonic anhydrase results in decreased secretion of aqueous humor of the eye.
- Potassium-sparing diuretics are not as powerful as the loop diuretics, but they retain potassium instead of wasting it. These diuretics are used for patients who are at high risk for hypokalemia associated with diuretic use.
- Osmotic diuretics use hypertonic pull to remove fluid from the intravascular spaces and to deliver large amounts of water into the renal tubule. There is a danger of sudden change of fluid volume and massive fluid loss with some of these drugs. These drugs are used to decrease intracranial pressure, to treat glaucoma, and to help push toxic substances through the kidney.
What is the use of diuretic agents across the lifespan?
- Diuretics are often used in children to treat edema associated with heart defects, to control hypertension, and to treat edema associated with renal and pulmonary disorders. Because of the size and rapid metabolism of children, the effects of diuretics may be rapid and adverse effects may occur suddenly. The child receiving a diuretic should be monitored for serum electrolyte changes; for evidence of fluid volume changes; for rapid weight gain or loss, which could reflect fluid volume; and for signs of ototoxicity.
- Adults may be taking diuretics for prolonged periods and need to be aware of the signs and symptoms of fluid imbalance to report to their health care provider. Adults receiving chronic diuretic therapy should weigh themselves on the same scale, in the same clothes, and at the same time each day to monitor for fluid retention or sudden fluid loss. They should be alerted to situations that could aggravate fluid loss, such as diarrhea, vomiting, or excessive heat and sweating, which could change their need for the diuretic. They should also be urged to maintain their fluid intake to help balance their body’s compensatory mechanisms and to prevent fluid rebound.
- Older adults often have conditions that are treated with diuretics. They are also more likely to have renal or hepatic impairment, which requires cautious use of these drugs. Older adults should be started on the lowest possible dose of the drug, and the dose should be titrated slowly based on patient response. Frequent serum electrolyte measurements should be done to monitor for adverse reactions. The intake and activity level of the patient can alter the effectiveness and need for the diuretic. High-salt diets and inactivity can aggravate conditions that lead to edema, and patients should be encouraged to follow activity and dietary guidelines if possible.
What are the most important teaching points for a patient receiving furosemide (Lasix)?
- A diuretic, or “water pill,” such as furosemide (Lasix) will help to reduce the amount of fluid in your body by causing the kidneys to pass larger amounts of water and salt into your urine. By removing this fluid, the diuretic helps to decrease the work of the heart, lower blood pressure, and get rid of edema, or swelling, in your tissues.
- This drug can be taken with food, which may eliminate possible stomach upset. When taking a diuretic, you should maintain your usual fluid intake and try to avoid excessive intake of salt.
- Furosemide is a diuretic that causes potassium loss, so you should eat foods that are high in potassium (e.g., orange juice, raisins, and bananas).
- Weigh yourself each day, at the same time of day and in the same clothing. Record these weights on a calendar. Report any loss or gain of 3 pounds or more in 1 day.
- Common effects of this drug include the following:
o Increased volume and frequency of urination: Have ready access to bathroom facilities. Once you are used to the drug, you will know how long the effects last for you.
o Dizziness, feeling faint on arising, drowsiness: Loss of fluid can lower blood pressure and cause these feelings. Change positions slowly; if you feel drowsy, avoid driving or other dangerous activities. Often these feelings are increased if alcohol is consumed; avoid this combination or take special precautions if you combine them.
o Increased thirst: As fluid is lost, you may experience a feeling of thirst. Sucking on sugarless lozenges and frequent mouth care might help alleviate this feeling. Do not drink an excessive amount of fluid while taking a diuretic. Try to maintain your usual fluid intake. - Report any of the following to your health care provider: muscle cramps or pain, loss or gain of more than 3 pounds in 1 day, swelling in your fingers or ankles, nausea or vomiting, unusual bleeding or bruising, trembling, or weakness.
- Avoid the use of any over-the-counter (OTC) medication without first checking with your health care provider. Several OTC medications can interfere with the effectiveness of this drug.
- Tell any doctor, nurse, or other health care provider involved in your care that you are taking this drug.
- Keep this drug, and all medications, out of the reach of children.
