Question | Answer |
Common sites to check skin turgor
Weight gain that alerts the patient or nurse to increasing edema is generally 2 lbs in 2 days | Over the sternum, on the forehead, and on the forearm. |
Weight gain that alerts the patient or nurse to increasing edema | Generally 2 lbs in 2 days |
Required Evaluations in diuretic therapy | dehydration: skin turgor, oral mucous membranes; location of edema, signs of reduction |
Monitor laboratory values for changes. T or F | True |
Obtain daily weights
Measure intake and output | Assessment for Hydration |
Restricted sodium diet
Potassium intake depends on type of diuretic prescribed | Nursing Process Implementation with Diuretics |
Keep urinal or bedpan available | Nursing Process Implementation with Diuretics |
Heart failure
Edema, adventitious lung sounds, dyspnea, change in mental status | Conditions Contributing to Excess Fluid |
Liver disease
Ascites, cirrhosis, cancer | Conditions Contributing to Excess Fluid |
Renal disease
Renal failure | Conditions Contributing to Excess Fluid |
History of related causative disorders/factors
History of current symptoms
Pattern of urination
Medication history
Hydration status
Electrolyte imbalance | Renal Function: Assessment |
Often subtle changes, such as in mental status, muscle strength/cramps, tremors, nausea, general appearance | Electrolyte imbalance |
Used to increase flow of urine to reduce excess water in the body
Primarily used to treat heart failure, hypertension | Diuretics |
Other uses: liver disease, renal disease, cerebral edema, increased intraocular pressure, treat hypercalcemia | Diuretics |
reduce edema, improve symptoms of excess fluid | Therapeutic outcomes of diuretics |
Act on the kidneys to decrease reabsorption of sodium, chloride, and water. | Diuretics |
the sites of action for thiazide and potassium-sparing drugs. | The distal tubules |
the site of action for loop diuretics. | The loop of Henle |
indicates volume depletion; potassium level shows diuresis is occurring too rapidly | orthostatic blood pressure |
Take in the morning to prevent nocturia
Report gain of 2 lbs in 2 days | Medication considerations for diuretics |
Accurate measurement of fluid intake and output
Purpose of diuresis
Medication considerations
Nutrition
Health maintenance
Written record/patient self-assessment form | Patient Education Considerations |
Can cause weakness of cardiovascular, respiratory, digestive, and skeletal muscles | Potassium depletion |
Susceptible people: history of renal or cardiac disease, hormonal disorders, massive trauma or burns | Electrolyte Imbalance |
Electrolyte Imbalance values Serum potassium | < 3.5 mEq/L (hypokalemia), > 5.5 mEq/L (hyperkalemia) |
Required assessments for Electrolyte Imbalance | Assess mental status, muscle strength and cramps, tremors, nausea, general appearance |
Electrolyte Imbalance values Serum sodium) | < 135 mEq/L (hyponatremia), > 145 mEq/L (hypernatremia |
Drug: acetazolamide (Diamox) | Carbonic Anhydrase Inhibitor |
Weak diuretic; inhibit the enzyme carbonic anhydrase in kidney, brain, eye | Actions of acetazolamide (Diamox) |
Reduce intraocular pressure with glaucoma; reduce seizure activity with certain types of epilepsy | Uses ofacetazolamide (Diamox) |
bumetanide (Bumex), furosemide (Lasix), ethacrynic acid (Edecrin), torsemide (Demadex). | Sulfonamide-Type Loop Diuretics |
Loop Diuretic used to treat hypertension. | Furosemide |
More effective than other loop diuretics in patients with significant renal failure. | Ethacrynic acid |
Inhibit sodium and chloride reabsorption in ascending limb of the loop of Henle | Actions of Sulfonamide-Type Loop Diuretics |
Treat conditions such as edema resulting from heart failure, cirrhosis of the liver, renal disease | Uses of Sulfonamide-Type Loop Diuretics |
Oral irritation, dry mouth; orthostatic hypotension | Common adverse effects of Sulfonamide-Type Loop Diuretics |
Serious adverse effects of Sulfonamide-Type Loop Diuretics | GI: gastric irritation, abdominal pain
Electrolyte imbalance: dehydration, hypokalemia, hyperglycemia
Hypersensitivity: hives, rash, pruritus |
Drug interactions of Sulfonamide-Type Loop Diuretics | Alcohol, barbiturates, narcotics: orthostatic hypotension aggravated
Digoxin: may cause excessive potassium excretion, hypokalemia, digitalis toxicity |
Used for more long-term management of heart failure and hypertension. | Thiazide Diuretics |
Not strong diuretics; have a slow onset of action. | Thiazide Diuretics |
Treat edema associated with heart failure, renal disease, hepatic disease, pregnancy, obesity, premenstrual syndrome | Uses of Thiazide Diuretics |
Block reabsorption of sodium and chloride ions from the tubule | Actions of Thiazide Diuretics |
Common adverse effects of Thiazide Diuretics | Orthostatic hypotension |
Serious adverse effects of Thiazide Diuretics | GI: gastric irritation, nausea, vomiting
Electrolyte imbalance: hypokalemia, other changes, hyperglycemia
Hyperuricemia
Hypersensitivity |
Digoxin: may increase risk for toxicity
Other medications also | Drug interactions of Thiazide Diuretics |
Instruct patients not to use salt substitutes, which are high in potassium, to prevent hyperkalemia.
Contraindicated in patients with renal impairment because of high risk of hyperkalemia. | Potassium-Sparing Diuretics |
Contraindicated in patients with renal impairment because of high risk of hyperkalemia. | Potassium-Sparing Diuretics |
Drugs: amiloride (Midamor), spironolactone (Aldactone), triamterene (Dyrenium) | Potassium-Sparing Diuretics |
Actions of Potassium-Sparing Diuretics | Induce retention of potassium; excrete sodium at the distal renal tubules |
Uses of Potassium-Sparing Diuretics | In combination with other diuretics to treat hypertension or heart failure, prevent hypokalemia |
Common and serious adverse effects of Potassium-Sparing Diuretics | Nausea, vomiting, anorexia, flatulence, headache, electrolyte imbalance, dehydration |
Electrolyte imbalance: hyperkalemia | Serious adverse effects of Potassium-Sparing Diuretics |
Drug interactions of Potassium-Sparing Diuretics | ACE inhibitors, ARBs may increase risk for hyperkalemia
Potassium supplements, certain salt substitutes may increase risk of hyperkalemia |
Actions of Combination Diuretic Products | Potassium-sparing diuretics/thiazide diuretics |
Uses of Combination Diuretic Products | Promote diuresis while maintaining normal potassium levels |
Common adverse effects of Combination Diuretic Products | Hyperkalemia, hyponatremia |
Combination Diuretic Products | Spironolactone/hydrochlorothiazide (Aldactazide)
Triamterene/hydrochlorothiazide (Dyazide, Maxzide)
Amiloride/hydrochlorothiazide (Moduretic) |