Question | Answer |
What are the mechanisms and adverse effects of: High Ceiling Loop Diuretics? | blocks reabsorption of Na, Cl and H2O in ALOH
assess pt for dehydration/hyponatremia/ hypochloremia/hypotension/hypokelmia/hypocalcemia in DM pts/ Digoxin and Lithium toxicity, ototoxicity |
If a pt taking Diuretic has low output what should you do? | Report it to the physician |
What should you teach a pt with Hypotension who is taking a High Ceiling Loop Diuretic? | to rise slowly, monitor bp and orthostatic hypotension. |
What should you be monitoring when assessing a pt taking a High Ceiling Loop Directive for hypokalemia? | Cardiac status and potassium levels |
At what rate should you push potassium and why? | 10MEQ/hr or less because it can cause death. |
At what rate should you push a High Ceiling Loop Diuretic and why? | 10-20mg/ min because it can cause hearing loss |
What could be a sign of ototoxicity in a patient taking a Diuretic? | Tinnitus |
What are two important things to monitor with a pt. taking a High Ceiling Loop Diuretic? | Daily weights and I/O |
What are some key teaching points for pts. taking High Ceiling Loop Diuretics? | Avoid in pregnancy
sit up slowly
eat foods high in potassium
monitor blood glucose/ bp/ daily weight/ I&O
Do not stop taking med w/o doctor approval
take in the morning |
Why is it recommended that patients take their diuretic in the morning? | To avoid having to urinate during sleeping hours. |
What is the prototype of High Ceiling Loop Diuretics? | Furosemide (Lasix) |
What is the prototype of Thiazide Diuretics? | Hydrochlorothiazide (hydrodiuril) |
What is the Mechanism and adverse side effects of Thiazide Diuretics? | blocks absorption of sodium and chloride and prevents reabsorption of water at early distal convoluted tubule
Dehydration/hyponatremia/hypochloremia/ hypokalemia/hypocalcemia/ototoxicity |
What diuretic is usually the first choice? | Thiazide Diuretic |
What is a pt taking a Thiazide diuretic at lower or no risk for than a pt taking a Loop Diuretic? | hypotension and hearing loss |
What are some key teaching points for pts. taking Thiazide Diuretics? | Eat a diet high in potassium
take in the morning |
What is the prototype of Potassium-Sparing Diuretics? | Spironolactone (Aldactone) |
What is the mechanism and adverse side effects of Potassium-Sparing Diuretic? | blocks action of aldersterone resulting in potassium retention and secretion of sodium and water.
avoid pts with kidney failure and anuria
hyperkalemia
endocrine dysfunction |
Which diuretic takes a longer time for therapeutic effect? | Potassium-Sparing Diuretics |
Which pts never get potassium supplements? | Pts experiencing hyperkalemia |
When should you monitor potassium levels with pts taking potassium-sparing diuretics? | When given with ACE inhibitors, angiotension receptor blockers, and direct renin inhibitors. |
What are effects of endocrine dysfunction in pts taking potassium-sparing diuretics? | impotence
irregular menstrual cycles |
What are some key teaching points for pts taking Potassium- Sparing Diuretics? | avoid salt substitutes because they contain potassium
triamterene may turn urine blue |
What is the prototype of Osmotic Diuretics? | Mannitol (Osmitrol) |
What is the mechanism of Osmotic Diuretics? | Draws fluid back to vascular space by raising serum osmolality to reduce intracranial and intraoccular pressure and to prevent kidney failure and hypovolemic shock.
Usually only given in the ICU or ED with close monitoring
Use cautiously in pts with HF |
What are adverse effects of Osmotic Diuretics? | kidney failure-nephrotoxicitiy- monitor kidneys
hypernatremia-monitor eletrodes
fluid overload- edema, respiratory and cardiac
lithium levels- may decrease with hyponatremia
monitor therapeutic effect
monitor I/O, bp, serum electrolytes and kidneys |
How do you administer Osmotic Diuretics? | intravenously with continuous infusion through a filter needle |