diuretics remove sodium & water tx hypertension, chf, pulmonary edema, kidney disease nursing...
TRANSCRIPT
Diuretics
Remove sodium & water tx hypertension, CHF, pulmonary
edema, kidney disease nursing diagnosis - fluid volume
excess
Renal Physiology
Urine formation occurs in nephron where blood plasma is processed into urine
ADH – released when osmolality of extracellular fluid increases which increases water reabsoprtion
Acid-base regulation Usual urine production is less than 2L/day
Carbonic Anhydrase Inhibitor
Enzyme (carbonic anhydrase) acts to promote reabsorption of sodium and bicarbonate
Diamox (acetazolamide) Agents used more for glaucoma than as
diuretic may cause false positive urine protein test take with meals
Loop Diuretics
Inhibit reabsorption of sodium and chloride in the ascending loop of Henle
effective even with impaired GFR watch for hypokalemia Lasix (furosemide) - may raise glucose
level, push slowly with IV, store oral solution in refrigerator
Osmotic Diuretics
These agents are filtered by glomerulus but have limited capability of being reabsorbed
Used primarily with increased intracranial pressure but also may be used with ARF
mannitol (Osmitrol) - IV, if crystals form, warm sol. then cool to body temp., IV set must have filter, infiltration may result in tissue necrosis
Thiazide Diuretics
Safest diuretic Structurally related to antibacterial
sulfonamides inhibit sodium and chloride reabsorption in early
portion of distal tubule watch for hypokalmia adverse effects - hyperglycemia and
hyperuricemia) HydroDIURIL (hydrochlorothiazide)
Potassium-sparing Diuretics The drugs in this class have different modes
of action Dyrenium (triamterene) & Midamor (amloride)
blocks sodium reabsorption in distal tubule Aldactone (spironolactone) - inhibits action of
aldosterone, adverse effect is gynecomastia for male clients
Generally used with potassium-depleting diuretic
Combination Diuretics
Combines potassium sparing diuretic with hydrochlorothiazide (HCTZ) (thiazide diuretic)
Aldactozide (spirolactone & HCTZ)
Nursing Implications
Monitor I&O, weights Monitor potassium, chloride, glucose,
uric acid Give early in day Watch for Digoxin toxicity for clients on
Digoxin
Critical Thinking
Ms. Jones is admitted with CHF. She is started on HydroDIURIL. What type of diuretic is this?
What lab data would you check prior to giving this medication?
What are the adverse effects you will be monitoring for?
What do you expect to see if Ms. Jones has a therapeutic response?
Critical Thinking (cont)
Ms. Jones is having difficulty breathing. The physician orders Lasix IV.
Is impaired renal function a contraindication?
What primary electrolyte imbalance will you monitor for?
What precautions will you take when administering Lasix IV?