Study Guide 8

Question 1

List of Loop Diuretics

Answer 1

• Bumetanide (Bumex)
• Ethacrynic acid (Edecrin)
• Furosemide (Lasix)
• Torsemide (Soaanz)

Question 2

Specifics with POTASSIUM SPARING

Answer 2

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

Question 3

Potassium sparing drug

Answer 3

Spirolactones (Aldactone, Carospir)
Can cause hyoperkalemia above 5.0 meq

Question 4

Hypokalemia

Answer 4

Low potassium (hypokalemia) refers to a lower than normal potassium level in your bloodstream. Potassium helps carry electrical signals to cells in your body.

Question 5

Hyperkalemia

Answer 5

High potassium (called “hyperkalemia”) is a medical problem in which you have too much potassium in your blood.

Question 6

Gynecomastia

Answer 6

is an increase in the amount of breast gland tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone.

Question 7

Dry mouth is caused by what medication

Answer 7

Diuretics

Question 8

Loop Diuretic contraindications

Answer 8

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

Question 9

Precautions with Loop Diuretics

Answer 9

Strenuous activity (anything that increases blood pressure) should be avoided for the first two weeks after surgery.

Question 10

Loop

Answer 10

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.

Question 11

K sparing:
Antidiabetic drugs

Answer 11

Insulin or oral antidiabetic drug dosages may require alterations because of hyperglycemia; therefore serum glucose concentrations are monitored periodically.

Question 12

Nursing process: steps to building clinical judgment client receiving a diuretic
Preadministration:

Answer 12

• Weight (best method to measure water loss).

• Laboratory tests—serum electrolytes and hepatic and renal function tests (blood urea nitrogen [BUN] and creatinine clearance).

Question 13

Ongoing Assessments to report fluid loss or gain

Answer 13

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.

Question 14

Nursing Diagnosis diuretics

Answer 14

• 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

Question 15

Patients with HTN

Answer 15

• 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

Question 16

Renal compromise

Answer 16

• 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.

Question 17

Electrolyte Imbalances

Answer 17

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.

Question 18

Nursing Alert: Hyperkalemia

Answer 18

• 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

Question 19

List food sources for Potassium replacement

Answer 19

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!!!

Question 20

Education recommendations for clients taking diuretics

Answer 20

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.

Question 21

Generic Name of Lasix

Answer 21

Furosemide

Question 22

Describe the actions of cardiotonics

Answer 22

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.

Question 23

what are Cardiotonics primarily used for

Answer 23

Used to treat heart failure and atrial fibrillation

Question 24

Left sided heart failure

Answer 24

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.

Question 25

Right sided heart failure

Answer 25

Causes a backup in the peripheral venous system and leads to neck vein distention, peripheral edema, weight gain, and hepatic engorgement.

Question 26

Digoxin or Lanoxin is most commonly used????

Answer 26

cardiotonics

Question 27

What kind of plant digoxin come from

Answer 27

Foxglove plant

Question 28

Adverse reactions of digoxin

Answer 28

GI nausea and anorexia

Question 29

What would you recommend for a client with nausea and anorexia

Answer 29

Small frequent meals

Question 30

Digitalis toxicity described

Answer 30

Toxic drug effects that occur when digoxin is administered

Question 31

Cardiotonics are given cautiously to clients with?

Answer 31

Electrolyte imbalance

• Thyroid disorders
• Severe carditis
• Heart Block
• Myocardial Infarction
• Severe Pulmonary disease
• Acute Glomerulonephritis
• Impaired renal or hepatic function

Question 32

Why do we minimize fiber with a client’s diet?

Answer 32

Because it decreases the absorption of the cardiotonic

Question 33

How does St John”s Wort effect digitalis levels?

Answer 33

It causes a decrease in serum digitalis levels

Question 34

Before administering digoxin

Answer 34

• Inspect sputum raised( if any), noting the appearance ( e.g frothy, pink tinged, clear, yellow)

Question 35

Labs to check before administering digoxin

Answer 35

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

Question 36

Nursing interventions for a client on digoxin

Answer 36

• Notify health care professional if bradycardia or new arrhythmias occur

Question 37

Digoxin therapeutic and toxic

Answer 37

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

Question 38

How does hypokalemia affect a client taking Digoxin?

Answer 38

Hypokalemia makes the heart muscle more sensitive to digitalis, thereby increasing the possibility of digitalis toxicity.

Question 39

Signs of digoxin toxicity

Answer 39

visual disturbances (blurred vision, or green vision and white halos, borders around dark objects) and arrhythmias (any type)

Question 40

Cardiotonics drugs

Answer 40

Improves contractility and efficiency

Question 41

Education to patient taking digoxin

Answer 41

Take medication every day don’t miss a dose

Question 42

Dixon in level 0.25ng/ml

Answer 42

Increase the dose

Question 43

Best time to give a diuretic

Answer 43

8 am and 2 pm

Question 44

Digoxin toxicity

Answer 44

Halos
Nausea
Vomiting
Serum potassium less than 2.8

Question 45

Digitalis monitoring

Answer 45

Monitor electrolytes
Atypical pulse