Week 6 Diuretics_UTI_Bladder Flashcards
Loop Diuretic
-decrease fluid volume
Furosemide (Lasix)
Torsemide -more modern
-emide
Furosemide and torsemide MOA
Block the chloride pump in the ascending loop of Henle.
This causes reabsorption of sodium and chloride.
Decreased fluid volume
what is the indication for the loop diuretics furosemide and torsemide
Edema, Hypertension, acute pulmonary edema
Getting rid of extra fluid
Extra fluid= HTN
are loop diuretics given to treat HTN alone?
no they work adjacently with other meds
What are the side effects/ adverse effects of loop diuretics furosemide and torsemide?
Reabsorbs the sodium,
hypokalemia-potassium loss is a high risk of losing too much K+
Hyperglycemic
*Hyperuricemia-getting rid of extra fluid causes a higher concentration of uric acid
Dizziness nausea and vomiting due to decreased fluid volume: aka symptoms of dehydration
What meds and conditions would interact/contraindication?
loop diuretic
NSAIDs,
Salicylates (asprin)
*Contraindication: Gout- causes concentration so antigout treatment will be given
nursing implications for loop diuretics surrounding the patients consumption?
-furosemide and torsemide
- Drink with milk to decrease gastric irritation
- Increase K-rich foods-
Oranges, dates, apricots, raisins, broccoli, green beans, potatoes, meats, fish legumes, salt substitutes
-due to drug-releasing so much K+ its important to restore through diet
What would a nurse assess for a patient on a loop diuretic?
- Daily weights, (nurse monitor I & O)
- Muscle weakness, constipation, irregular pulse, and lethargy are all signs of hypokalemia*
-Uric acid levels as well! - potassium levels!
- blood glucose levels if the pt is diabetic (hyperglycemic affect)
What should a pt report immediately if they are on a loop diuretic?
- Muscle weakness, constipation, irregular pulse and lethargy are all signs of hypokalemia (potential medical emergency)
- Report immediately N/V, or diarrhea ( creates fluid and electrolyte imbalances)
thiazide diuretic example
Hydrochlorothiazide- HCTZ
MOA of HCTZ
Inhibit tubular resorption of sodium, chloride, and potassium ions
in the distal convoluted tubule
Result: water, sodium, and chloride are excreted
what is the indication for hydrochlorothiazide
Edema, monotherapy or adjunct for treatment of hypertension
what are the side effects of hydrochlorothiazide? what do they relate to?
Dizziness, orthostatic hypotension, dehydration,
hypokalemia- (all pertain to fluid loss symptoms)
Hyperglycemia, hyperuricemia, (caution with gout and diabetes )
Photosensitivity,
what would contraindicate hydrochlorothiazide diuretic
Caution with Diabetes
Gout- can cause flare-up
what would a nurse want to be aware of when giving hydrochlorothiazide
may need increased dose of insulin
-Wearing sunscreen/limit sun
-be aware of hypokalemia
- monitor uric acid
osmotic diuretic example
mannitol
mannitol MOA
Pull water into the renal tubule without sodium loss
Inhibit tubular resorption of water and solutes, thus producing rapid diuresis
Indication for mannitol osmotic diuretic
: Reduces Intracranial pressure or cerebral edema associated with head trauma
-lowers head swelling fluid
what is the SE AE of manitol
Relate to the sudden drop in fluid levels:
if someone is dehydrated….
They will have nausea and vomiting,
hypotension,
light-headed,
dizzy, confusion, headache,
dryness, temp
what is the SE AE of mannitol
Relate to the sudden drop in fluid levels:
if someone is dehydrated….
They will have nausea and vomiting,
hypotension,
light-headed,
dizzy, confusion, headache,
dryness, temp
what are the potential serious adverse effects of osmotic diuretics mannitol
Convulsions and pulmonary edema
nursing implications for a patient on an osmotic diuretic mannitol
Nursing Implications: Assess:
* IV only and must use a filter*
* LS- Osmotic diuretic can precipitate heart failure and pulmonary edema
IV for mannitol must have a what?
filter!
why should the nurse assess for lung sounds on a pt on an osmotic diuretic? what noises would a nurse find?
Crackles:
Pt with heart failure or pulmonary edema will have crackles
-mannitol pulls off fluid but, pulmonary edema has a build-up in the lungs causing crackles
potassium-sparing Diuretics examples
Spironolactone
Triamterene
MOA for K sparring diuretic spironolactone and triamterene
Cause a loss of sodium while retaining potassium
* Prevent potassium from being pumped into the tubule, thus preventing its secretion
* Block the actions of aldosterone in the distal tubule
Indication for potassium sparing diuretics
Hypertension, Edema in patients who are at risk for hypokalemia
K sparring diuretic spironolactone and triamterene SEAE
SE/AE: Dizziness, Cramps, nausea, vomiting, hyperkalemia, hyponatremia
what would you monitor for on a patient with K sparring diuretic
Monitor for hyperkalemia
pt education for those on a k sparring diuretic spironolactone and triamterene
Salt substitutes make sure to educate on the use of salt-substitutes like K
Mrs dash is an example
Nursing considerations for all Diuretics
Assessment
Fluid or electrolyte disturbances,
gout,
glucose levels,
edema,
weight, I&O, K levels
Nursing considerations for all Diuretics
Assessment
Fluid or electrolyte disturbances,
gout,
glucose levels,
edema,
weight, I&O, K levels
Nursing considerations for all Diuretics
Pt ed:
Weigh daily, same scale and time
Report significant weight gain
(A couple pounds a day or 5 a week)
Do not take dose at night
(The latest does should be given no later than 4PM)
Change positions slowly
Notify provider immediately for rapid heart rate and syncope
-because of hypotension and fluid loss
therapeutic effects a nurse should monitor for all diuretics
Monitor for therapeutic effects:
* Reduction of edema
* Reduction of fluid volume overload
* Improvement in manifestations of HF
* Reduction of hypertension
* Return to normal intraocular pressures
Anti-invectives for UTI’s
Norfloxacin
Nitrofurantoin
Trimethoprim-
Norfloxacin
Nitrofurantoin
MOA
Act specifically within the urinary tract to destroy bacteria
Anti-invectives for UTI’s indication
Norfloxacin
Nitrofurantoin
: Chronic UTI, Prophylaxis
Norfloxacin
Nitrofurantoin SEAE
nervousness, confusion, Nitrofurantoin- dyspnea, chest pain, chills, fever, & cough
what should a nurse assess for a pt on norfloxacin and nitrofurantoin
Assess-
Urinary elimination patterns
-how much are they voiding, how often, frequency urgency and pain or difficult voiding
If they have symptoms of a UTI is the UTI effective?
Trimethoprim- Sulfonamide (Septra DS) indication
UTI’s with E.Coli
what are the SE AE of trimethoprim
Kidney stones, Stevens-Johnson syndrome
-blistering of the skin red and raw
Nsg implications for trimethoprim
-Take on empty stomach with 8oz H2O,
- Complete course of therapy,
-Use additional contraception, Important—
-number one risk of UTI is female, remember the best way to prevent recurrence is preforming proper peri care front to back.
Antispasmodics
(anticholinergics)
examples
Oxybutynin (Ditropan XL)
Tolterodine (Detrol)
Oxybutynin (Ditropan XL)
Tolterodine (Detrol)
MOA
Block the spasms of urinary tract muscles
Oxybutynin (Ditropan XL) and Tolterodine (Detrol) indication
Urinary frequency, urgency & urge incontinence caused by Bladder spasm and overactive bladder
antispasmodic SE AE
SE/AE:
Dry mouth blurred vision constipation anything drying
antispasmodic interactions
Haloperidol
-anticholinergic increasing risk of side effects of haloperidol
Contraindication: Obstructive urinary tract problems
What should a pt on antispasmodic drugs report to physician
should report the following symptoms to their physician:
-urinary hesitancy or retention,
- constipation,
- tachycardia, palpitations,
- tremors,
- confusion, sedation, hallucinations
- decreased sweating (leading to hot, dry skin
Phenazopyridine (Pyridium) MOA
When phenazopyridine is excreted in urine, it exerts a direct topical analgesic effect on the urinary mucosa
Urinary tract analgesia ex,
Phenazopyridine (Pyridium)
indication for urinary tract analgesia
dye that is used to relieve urinary tract pain and urgency.
Pain can be related to infection, trauma, or surgery
SE of urinary tract analgesia phenazopyridine
nsg implication related to SE
Urinary discoloration
-reddish orange color looks like bleeding but the dye will discolor the urine
Nursing Implications:
Edu on urinary discoloration is normal and expected
doxazosin
finasteride
tamsulosin
terazosin
are what
Alpha1-andrenergic blockers
alpha1 -adrenergic blockers indication
SE AE
Interactions
loss libido
ED
dizzy
hypotension
interact with alpha blockers because they increase antihypertensive effects
alpha1 - adrenergic blockers nsg implications
assess renal and liver function
PSA
intraocular pressure
and BP
