Renal Medications

Question 1

Loop Diuretics

Answer 1

• act on the ascending loop of Henle
• primary use is to treat hypertension and edema
• second use is to treat CHF and renal insufficiency
• may treat hypercalcemia
• effective for clients with impaired kidney function

Question 2

Loop Diuretics:

side/adverse effects

Answer 2

1) diuresis can lead to electrolyte imbalance
- hyponatremia
- hypokalemia
- hypmagnesemia
- hypocalcemia
2) dehydration
3) hypotension and postural hypotension, syncope
4) ototoxicity
5) may also precipitate renal failure in clients taking an NSAID and an ACE inhibitor

Question 3

Loop Diuretics:

nursing interventions/client education

Answer 3

1) monitor electrolytes, especially potassium levels
2) if potassium level drops below 3.5 mEq/L, the client will need potassium supplements
3) teach client to eat a diet high in potassium
4) monitor client’s BP and I&O
5) teach the client to self-monitor BP
6) teach client to rise slowly

Question 4

Thiazide Diuretics: diuril (Chlorothiazide)
primary side effects
interactions
client teaching

Answer 4

1) -hypokalemia
- dehydration
- hyperglycemia
2) taking digoxin (Lanoxin) in combination can increase a client’s risk of hypokalemia
3) -eat a diet high in potassium
- take diuretics first thing in the morning
- observe for signs of hypokalmia

Question 5

Potassium-Sparing Diuretics: aldactone
primary side effects
interactions
client teaching

Answer 5

1) -hyperkalemia
- impotence and menstrual irregularities
2) ACE inhibitors and Lisinopril increase risk of hyperkalemia
3) avoid potassium containing salt substitutes

Question 6

Osmotic Diuretics: Mannitol/Osmitrol
therapeutic uses
primary side effects

Answer 6

1) -prevent renal failure during hypovolemic shock
- decrease ICP
- promote sodium retention
2) heart and renal failure

Question 7

Osmotic Diuretics: Mannitol/Osmitrol

therapeutic interventions

Answer 7

1) give as a bolus
2) administer w/ filtered needle
3) monitor client’s electrolytes every 6 hr as needed
4) monitor I&O

Question 8

Diuretic Do’s and Don’ts

Answer 8

1) diuretics (except osmotics) do not pull fluid from tissues
2) diuretics are not appropriate for edema caused by inflammation or any other condition where normal blood-tissue barriers have broken down
3) diuretics are not appropriate for edema associated w/ hypoproteinemia. You cannot replace the osmotic contribution of albumin w/ elevated electrolyte concentrations
4) diuretics do not increase GFR. Osmotics are a subtle exception if they expand blood volume and enhance renal flow. That’s only if it was already below normal.
5) thiazide diuretics produce a gentle and sustained diuresis. Loop diuretics produce aggressive and short-lived diuresis.