Chapter 50 and 51 Diuretics

What three ways do the kidneys maintain fluid composition and volume in the body?

1. Clearing nitrogenous wastes from protein metabolism 2. Maintaining acid-base balance and electrolyte levels 3. Excreting various drug and drug metabolites

What are the 4 functions of the kidneys?

1. Maintain volume and composition of body fluids within normal ranges 2. Regulates vitamin D activation which helps maintain and regulate calcium levels 3. Regulates blood pressure though the renin-angiotensin-aldosterone system 4. Regulates RBC production through the production and secretion of erythropoietin

What does natriuretic hormone cause?

A decrease in sodium reabsorption; results in diluted urine or increased volume

What compensatory mechanisms are activated to restore fluid volume?

Activation of the renin-angiotensin-aldosertone system with increased ADH and aldosterone

The nurse would instruct a patient receiving a loop diuretic to report: A. Yellow vision B. Weight loss of 1lb/d C. Muscle cramping D. Increased urination

C. Muscle cramping

Which diuretic is indicated by glaucoma?

Carbonic anhydrase inhibitors

What 4 routine nursing care interventions would be relevant for a client receiving a diuretic?

Daily weighing Periodic electrolyte evaluations Monitoring urinary output Teaching the patient to report muscle cramping

Which loop-diuretic has a larger margin of safety for home use?

Furosemide

What is the most common adverse effect of potassium-sparing diuretics?

Hyperkalemia

What are the 5 signs and symptoms of hyperkalemia?

Lethargy Confusion Ataxia Muscle cramps Cardiac arrhythmias

Where do loop-diuretics work?

Loop of henle

What drug is used when rapid and extensive diuresis is needed?

Loop-diuretics

What is the only osmotic diuretic currently available?

Mannitol

What is a relatively common and potentially dangerous effect that occurs when bicarbonate is lost?

Metabolic acidosis

What is the functional unit of the kidney?

Nephron

A patient with severe glaucoma who is about to undergo eye surgery would benefit from a decrease in intraocular fluid. This is often best accomplished by giving the patient:

Osmotic diuretic

What can occur with rapid intravenous administration of furosemide?

Ototoxicity

What should be regularly monitored in a patient receiving a loop diuretic?

Potassium levels

Where do carbonic anhydrase inhibitors work?

Proximal tubule

What should be monitored if a patient is taking diuretics and digoxin?

Serum potassium

What substance is reabsorbed in the ascending limb of the loop of Henle?

Sodium

What is the drug of choice for treating hyperaldosteronism?

Spironolactone

What chemical class do Thiazide and Thiazide-like diuretics belong to?

Sulfonamides

Thiazide diuretics are considered mild because:

They cause loss of sodium and chloride but little water

Most diuretics act in the body to cause:

loss of sodium