Study Guide 8 Flashcards
List of Loop Diuretics
• Bumetanide (Bumex)
• Ethacrynic acid (Edecrin)
• Furosemide (Lasix)
• Torsemide (Soaanz)
Specifics with 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 drug
Spirolactones (Aldactone, Carospir)
Can cause hyoperkalemia above 5.0 meq
Hypokalemia
Low potassium (hypokalemia) refers to a lower than normal potassium level in your bloodstream. Potassium helps carry electrical signals to cells in your body.
Hyperkalemia
High potassium (called “hyperkalemia”) is a medical problem in which you have too much potassium in your blood.
Gynecomastia
is an increase in the amount of breast gland tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone.
Dry mouth is caused by what medication
Diuretics
Loop Diuretic contraindications
Common complications include bruising, bleeding, fluid collections, contour irregularities, loss of nipple skin, visible scarring, and numbness of the nipples, inverted nipples, loose breast skin and asymmetries
Precautions with Loop Diuretics
Strenuous activity (anything that increases blood pressure) should be avoided for the first two weeks after surgery.
Loop
Loop diuretics are a class of medications used to cause diuresis, or increased urine flow. They differ from other types of diuretics in how they increase urine production.
K sparing:
Antidiabetic drugs
Insulin or oral antidiabetic drug dosages may require alterations because of hyperglycemia; therefore serum glucose concentrations are monitored periodically.
Nursing process: steps to building clinical judgment client receiving a diuretic
Preadministration:
• Weight (best method to measure water loss).
• Laboratory tests—serum electrolytes and hepatic and renal function tests (blood urea nitrogen [BUN] and creatinine clearance).
Ongoing Assessments to report fluid loss or gain
Weighing the client at the same time daily
Depending on the specific diarrhetic, frequent serum electrolyte, uric acid, and liver and kidney function test results may be performed during the first few months of therapy and periodically thereafter.
Nursing Diagnosis diuretics
- Increased urinary frequency: related to action of the diuretics causing increased bladder filling
- Hypovolemia/dehydration: related to excessive diuresis secondary to administration of a diuretic
- Injury risk: related to lightheadedness, dizziness, or cardiac arrhythmias
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.
Nursing Alert: Hyperkalemia
- Monitor clients taking potassium-sparing diuretics because they are at risk for hyperkalemia. If the serum potassium levels exceed 5.3 mEq/mL, the diuretics stopped in the clinician is notified immediately
List food sources for Potassium replacement
Top 10 foods with the highest amount of potassium per serving: white beans, dark leafy greens, baked potatoes with skin on, dried apricots, acorn squash, plain low-fat yogurt, salmon, avocado, mushrooms, and bananas.
Remember APRICOT!!!
Education recommendations for clients taking diuretics
Take the drug early in the morning (once-a-day dosage) unless directed otherwise to minimize the effects on nighttime sleep. Twice-a-day dosing should be administered early in the morning (e.g., 7 a.m.) and early afternoon (e.g., 2 p.m.) or as directed by the PHCP.
rise slowly from a sitting or lying position, and avoid standing in one place for an extended time.
Weigh yourself weekly or as recommended by the PHCP. Keep a record of these weekly weights and contact the PHCP if weight loss or gain exceeds 1.3–2.2 kg (3–5 lb) a week.
If foods or fluids high in potassium are recommended by the PHCP, then eat the amount recommended. Do not exceed this amount or eliminate these foods from the diet for more than 1 day, except when told to do so by the PHCP (see Client Teaching for Improved Outcomes: Preventing Potassium Imbalances).
For clients who have diabetes mellitus and who take loop or thiazide diuretics know that blood glucometer test results for glucose may be elevated. Contact the PHCP if home-tested blood glucose levels increase.
For clients who take potassium-sparing diuretics avoid eating foods high in potassium and avoid the use of salt substitutes containing potassium. Read food labels carefully. Do not use a salt substitute unless a particular brand has been approved by the PHCP. Also avoid the use of potassium supplements. Male clients who take spironolactone may experience gynecomastia. This is usually reversible when therapy is discontinued.
Generic Name of Lasix
Furosemide
Describe the actions of cardiotonics
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
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.
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.
Digoxin or Lanoxin is most commonly used????
cardiotonics
What kind of plant digoxin come from
Foxglove plant
Adverse reactions of digoxin
GI nausea and anorexia
What would you recommend for a client with nausea and anorexia
Small frequent meals
Digitalis toxicity described
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
• Inspect sputum raised( if any), noting the appearance ( e.g frothy, pink tinged, clear, yellow)
Labs to check before administering digoxin
renal and hepatic function tests complete blood count, and serum enzyme and electrolyte levels. Renal function is particularly important because diminished renal function could affect the prescribed drug
Nursing interventions for a client on digoxin
• Notify health care professional if bradycardia or new arrhythmias occur
Digoxin therapeutic and toxic
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
visual disturbances (blurred vision, or green vision and white halos, borders around dark objects) and arrhythmias (any type)
Cardiotonics drugs
Improves contractility and efficiency
Education to patient taking digoxin
Take medication every day don’t miss a dose
Dixon in level 0.25ng/ml
Increase the dose
Best time to give a diuretic
8 am and 2 pm
Digoxin toxicity
Halos
Nausea
Vomiting
Serum potassium less than 2.8
Digitalis monitoring
Monitor electrolytes
Atypical pulse
