Ch. 43 - Diuretics

Question 1

Diuretics:

Answer 1

Remove sodium & water from the body

For clients with:

- Edema
- HTN

Question 2

Regulation of Sodium Balance by Kidney:

Answer 2

Determined by:
-Glomerular Filtration Rate (GFR)
+Aldosterone
+Baroreceptors

Question 3

5 Categories of Diuretics:

Answer 3

1. ) Thiazide & thiazide-like
2. ) Loop
3. ) Osmotic
4. ) Carbonic anhydrase inhibitor
5. ) Potassium - sparing

Question 4

Thiazide & thiazide-like Diuretics:

Answer 4

Promotes sodium, chloride, & water excretion in distal convoluted renal tubule

For clients with normal renal function

Question 5

Thiazide Diuretics — Adverse Effects (1):

Answer 5

Hypokalemia:
1.) Large concentration of sodium reaches the distal tubules —>

2.) Greater sodium-potassium exchange occurring = Potassium depletion

Question 6

Thiazide Diuretics — Adverse Effects (2):

Answer 6

Large Amt of chloride excreted —>

 1. ) Chloride depletion 
 2. ) Metabolic alkalosis

Question 7

Thiazide Diuretics — Adverse Effects (3):

Answer 7

Hypercalcemia —- d/t loss of:

 1. ) Sodium, Potassium, & Magnesium 
 2. ) Promotes calcium reabsorption

Question 8

Prolonged tx of Thiazide Diuretics:

Answer 8

Potassium & chloride supplements

Question 9

Thiazide Diuretics — Other Adverse Effect:

Answer 9

Hyperglycemia

Hyperuricemia sensitivity

Question 10

Nursing Diagnoses — Thiazide Diuretics

Answer 10

1. ) Excess fluid volume r/t body fluid retention

2. ) Risk for deficient fluid volume r/t use of thiazides

Question 11

Nursing Interventions (1) – Thiazide Diuretics :

Answer 11

Monitor:

1. ) Vital signs 
2. ) Serum electrolytes:
      - Potassium = (3.5-5m Eq/l)
      - Glucose = (70-100 mg/dl)
      - Uric Acid = (3-7 mg/dl)

Question 12

Nursing Interventions (2) – Thiazide Diuretics :

Answer 12

3. ) Observe for s/s hypokalemia:
   
   • muscle weakness, leg cramps
   • cardiac dysrhythmias
4. ) Weigh daily –> 2.2 lbs = 1L fluid
5. ) Urine output

Question 13

Thiazide Diuretics — Teaching:

Answer 13

1. ) Take drug early in the morning
2. ) Orthostatic hypotension = change positions slowly
3. ) Potassium rich foods
4. ) GI upset = take with food

Question 14

Loop Diuretics (1):

Answer 14

1. ) Inhibit reabsorption of sodium & chloride in ascending Loop of Henle
2. ) Reduces kidney’s ability to concentrate urine

Question 15

Loop Diuretics (2):

Answer 15

3. ) More potent than thiazide diuretics
4. ) Less effective as an antihypertensive
5. ) Clients with impaired GFR

Question 16

Loop Diuretics (3) – Adverse Effects:

Answer 16

• Electrolyte imbalance
• Orthostatic Hypotension
• Ototoxicity w/ aminoglycosides

Question 17

Loop Diuretics – Examples::

Answer 17

Furosemide (Lasix)

Question 18

Loop Diuretics — Nursing Diagnoses:

Answer 18

1. ) Risk for deficient fluid volume r/t fluid loss with excessive use of loop diuretics
2. ) Risk for potassium deficit r/t excessive use of loop diuretics

Question 19

Loop Diuretics – Nursing Interventions (1):

Answer 19

Note onset of drug action:

1. ) Increased urine output
2. ) Oral = within 1 hour
3. ) IV = 5-20 mins
   
   • If not –> notify health care provider

Question 20

Loop Diuretics – Nursing Interventions (2):

Answer 20

4. ) Weight I & O
5. ) Vital signs
6. ) Adm IV furosemide slowly

Question 21

Loop Diuretics – Nursing Interventions (3):

Answer 21

S/S hypokalemia = (

Question 22

Loop Diuretics — Teach:

Answer 22

1. ) Take Loop diuretic in am
2. ) Take w/ food
3. ) Change positions slowly

Question 23

Osmotic Diuretics:

Answer 23

Mainly used to tx:

• Inc intracranial pressure
• Inc Intraocular pressure

Prevent acute renal failure

Question 24

Osmotic Diuretics – Example:

Answer 24

mannitol (Osmitrol)

1. ) IV
2. ) powerful diuretic
3. ) K+ depleting antidiuretic

Question 25

Potassium-Sparing Diuretics (1):

Answer 25

1. ) NOT as strong as thiazide or loop diuretics | 2. ) Combine with another diuretic or antihypertensive drug

Question 26

Potassium-Sparing Diuretics (2):

Answer 26

3. ) Aldosterone mineralcorticoid hormone = | - Promotes Na+ retention & K+ excretion

Question 27

Potassium-Sparing Diuretics (3):

Answer 27

4.) Blocks action of aldosterone 5. ) Inhibit K+ excretion --> - Combined with potassium-depleting diuretic to decrease occurrence of hypokalemia

Question 28

Potassium-Sparing Diuretics (4) -- Adverse Effects:

Answer 28

Hyperkalemia = DO NOT use K+ supplement with K+ sparing diuretic

Question 29

Potassium-Sparing Diuretics -- Example:

Answer 29

spironolactone (Aldactone): -Inhibits action of aldosterone --> by causing the kidneys to excrete salt and fluid in the urine while retaining potassium

Question 30

Potassium-Sparing Diuretics Nursing Interventions (1):

Answer 30

1. ) Monitor urinary output 2. ) Report: - Less than 30ml/hour - Less than 600 ml/24 hrs

Question 31

Potassium-Sparing Diuretics Nursing Interventions (2):

Answer 31

3. ) Observe for s/s hyperkalemia: - Nausea, diarrhea, abd cramps - Numbness, tingling - Tachycardia

Question 32

Potassium-Sparing Diuretics --- Teach:

Answer 32

1. ) Take with / after meals 2. ) Do not d/c w/o consulting health care provider 3. ) Avoid exposure to direct sunlight

Question 33

Potassium-Sparing Diuretics -- Diet:

Answer 33

Avoid foods high in K+