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Pharm Diuretics

QuestionAnswer
Edema excess fluid in tissues
Hydorstatic Pressure Created by fluid in closed space
Oncotic Pressure Created by plasma proteins
Polyuria large urine output
Oliguria small unrine output
Anuria No urine output
Diuretics are agents that increase renal excretion of water,sodium,and other electrolytes thereby increasing urine formation and output.
Goals of Diuretic Therapy Most common reason for giving diuretics is to eliminate excess fluid, electrolytes, and/or wastes.
General Actions They commonly increase urine formation by: 1) increasing the glomerular filtration rate 2) decreasing reabsorption from renal tubules
Who would need a diuretic? Person who is retaining fluid. (edema)
Some causes of edema are 1) heart failure2) Poor circulation3)Renal failure4) HypertensionDiuretics might be used for all these problems
When might you want to reduce intraocular pressure? When IOL is abnormally elevated and to soften the eye for ophthalmic surgery
Common Adverse Effects Fluid/electrolyte imbalanceHypokalemia(most diuretics)Fluid volume deficit/hypotensionHyponatremia (sodium)Hyperglycemia
Thiazide Diuretics (Hydrochlorozide [HCTZ]) Act on renal tubuals to: decrease reabsorption of Na, Cl, &, K, Mg,bicarbonate, water
Features of Thiazide Diuretics (Hydrochlorozide [HCTZ]) Not strong diuretic slow onset of action(2 hours)Useful in treating elevated urine calcium(Hypercalciuria)b/c it cuases tubules to reasorb calcuim Poor choice w/diabetes b/c it increases serum glucose and lipids risk of allergy (allergic to sulfonamides)
High Ceiling (loop) Diurectics (furosemide [Lasix]) These drugs act by decreasing the reabsorption of Na, Cl, and Ca
High Ceiling (loop) Diurectics (furosemide [Lasix]) stronger, faster onset of action than thiazides. Na restriction often is needed b/c of post-diuretic rebound effect. Treats hypercalcemia: unlike thiazides,these drugs increase Ca in the unrins. Ototoxic so assess hearing and balance
Potassium-Sparing Diuretics (Spironolactone [Aldactone]) Action:Aldosterone Antagonist, drug prevents Na retention. K is not excreated in exchange for Na so excess K is not lost
Aldosterone normally promotes Na retention
Features of Potassium Sparing Diuretics (Spironolactone [Aldactone]) Potential for hyperkalemia exists. Potassium supplements are not needed. Monitor HR and rhythm b/c abnormal K affects conduction of cardiac nerve impulses & myocardial contraction.
Osmotic Diuretics (Mannitol [Osmitrol]) Increasing Osmotic pressure in blood & in glomerular filtrate. Considerations: uses: anuria(absence of urine production), increased IOP, cerebral edema, Risk of hypervolemia, then hypovolemia
Features of Osmotic Diuretics (Mannitol [Osmitrol]) given by IV only, it is used to treat: anuria cerebral edema, IOP. As excess fluid is drawn from the tissues into bloodstream, hypervolemia can occur. As kidneys excrete mannitol fluid is excreted possibly in excess resulting in hypovolemia.
Mannitol which has a high molecular weight, is delivered to the bloodstream where it increases osmotic pressure.Large molecules do not pass out of blood into body tissues. by osmosis mannitol causes water to move out of edematous tissue into the bloodstream.
Carbonic Anhydrase Inhibitors (Acetazolamide [Diamox]) Act by inhibiting HCO3 reabsorption, production of aqueous humor and cerebrospinal fluid (CSF)
Features of Carbonic Anhydrease Inhibitors (Acetazolamide [Diamox]) Durg reduces IOP and ICO(Intracranial Pressure) By preventing bicarbinate reabsorption, it decreases blood pH.
Diuretics: Nursing Assessment What of the following data are needed when patients are taking diuretics? I&O, Daily weights, Edema, Serum electrolytes, neuromuscular status, serum glucose, mental status.
Assessment for Diuretics I&O will help determine whether pt is elimination excess fluid. you would expect output to exceed intake during diuresis. this will be most apparent when pts are retaining alot of fluid.When pt take diuretics long-term,fluid I&O may remain about equal.
Assessment for Diuretics Daily Weight this a simple, useful way to detect fluid loss or gain b/c body mass changes very little from day to day. Must be done on the same scale, under the same conditions each day inorder to be useful
Assessment of Diuretics Edema b/c water tends to flow downhill edema is most apparent in dependent body areas.Check ankles of ambulatory pts& backs of bed pts. Auscultation of lungs reveal pulmonary edema.Effective diuretic therapy should cause edema to decrease
Assessment for Diuretics Serum Electrolyte Reports reveal actual blood levels and enable you to detect abnormalities such as low K. Notify physician if values are significantly abnormal
Assessment for Diuretics Neruomuscualr Status Impulses conduction& muscle activity depend on specific concentrations of electrolytes,especially K & Ca.Assessment of Reflexes& muscle tone may yield indicators of electrolyte imbalance
Assessment for Diuretics Serum Glucose is most likely to be affected by the thiazides. this is not usually significant unless a pt has diabetes.
Assessment for Diuretics mental Status is affected by fluid & electrolyte balance. fluid excess can include cerebral edema causes confusion or decreased alertness.A fluid deficit dehydration decreases blood flow & also can cause mental changes
Nursing Diagnosis and Interventions for Pt on Diuretics Therapy Risk for deficient fluid volume r/t excess diuresis(hypervolemia). Monitor for hypervolemia indicators include hypotension, tachycardia, dry mucous membranes, concentrated urine. Administer fluid replacement oral or parenteral routes
Deficient knowledgeof diuretic therapy. The pt teaching plan should include: take diuretics in morning to avoid nighttime voiding.Report weakness,palpitations,muscle cramps,confusion.Reduce Na intake if ordered,elderly pt are at risk for Na depletion.Ask doctor before using Na substitutes. they contain K
Diuretcis are used for thier ability to promote the excretion of water and ____ Sodium
The most serious adverse effects of most diuretics is ________which can cause fatal alterations in cardiac rhythm. fluid and electrolyte imbalance
____diuretics are weak,slow, and are not advised with diabetes becasue they increase serum glucose and lipids Thiazide (Hydrochlorozide)
High ceiling diuretics promote calcium excretion whereas ____promote calcium retention Thiazide (Hydrochlorozide)
Patients taking ____diuretics may also require sodium restriction because of post diuretic rebound effect High Ceiling Diuretics (furosemide[Lasix])
Only Potassium sparing diuretics place the pt at risk for ___which also can cause fatal cardiac disturbances hyperkalemia
_____diuretics can cause fluid excess initially Osmotic Diuretics (Mannitol [osmitrol)
The type of diuretic used to lower increased Intraocular pressure is ______. Osmotic Diuretics (Mannitol [Osmitrol])
Signs and symptoms of _____ include hypotension, tachycardia, dry mucous membranes, and concentrated urine Diuretic therapy
When a pt on diuretic therapy has an irregular pulse, weakness, and abdominal distention you should suspect ________ Hypokalemia
Potass
Deficient knowledgeof diuretic therapy. The pt teaching plan should include: take diuretics in morning to avoid nighttime voiding.Report weakness,palpitations,muscle cramps,confusion.Reduce Na intake if ordered,elderly pt are at risk for Na depletion.Ask doctor before using Na substitutes. they contain K
Diuretcis are used for thier ability to promote the excretion of water and ____ Sodium
The most serious adverse effects of most diuretics is ________which can cause fatal alterations in cardiac rhythm. fluid and electrolyte imbalance
____diuretics are weak,slow, and are not advised with diabetes becasue they increase serum glucose and lipids Thiazide (Hydrochlorozide)
High ceiling diuretics promote calcium excretion whereas ____promote calcium retention Thiazide (Hydrochlorozide)
Patients taking ____diuretics may also require sodium restriction because of post diuretic rebound effect High Ceiling Diuretics (furosemide[Lasix])
Only Potassium sparing diuretics place the pt at risk for ___which also can cause fatal cardiac disturbances hyperkalemia
_____diuretics can cause fluid excess initially Osmotic Diuretics (Mannitol [osmitrol)
The type of diuretic used to lower increased Intraocular pressure is ______. Osmotic Diuretics (Mannitol [Osmitrol])
Signs and symptoms of _____ include hypotension, tachycardia, dry mucous membranes, and concentrated urine Diuretic therapy
When a pt on diuretic therapy has an irregular pulse, weakness, and abdominal distention you should suspect ________ Hypokalemia
Potassium that is administered too rapidly or in concentrated form can cause _________. Hyperkalemia
Diuretics are usually give in the morning to prevent _____. Avoid nighttime voiding
A pt on a potassium sparing diuretic who uses salt substitutes is at risk for ________ Hyperkalemia
Hypocalcemia assess for neuromuscular irritability. Provide calcium replacement as ordered
Hypercalcemia Assess for depressed neuromuscular function. Enocurage fluids to prevent unrinary calculi(stones). Administer high ceiling diuretics as ordered.
Created by: jessg445