6200: Diuretics

What is considered normal urine output?

30-75 mL/hour

A patient with chronic glaucoma is most likely to receive which drug? a. a thiazide diuretic b. a loop diuretic c. a potassium-sparing diuretic d. a carbonic anhydrase inhibitor

d.

What promotes reabsorption of Na+ from the filtrate into the vasculature?

aldosterone

furosemide (Lasix): MOA

blocks sodium & chloride reabsorption at ascending limb of loop of Henle

Adverse effects of thiazide diuretics

dehydration hypokalemia

Drug interactions for thiazides

digoxin- digitalis toxicity r/t hypokalemia

What is the best information for the nurse to provide to the patient who is receiving spironolactone (Aldactone) and furosemide (Lasix) therapy? a. "Moderate doses of two different diuretics are more effective than a large dose of one." b. "This combination promotes diuresis but decreases the risk of hypokalemia." c. "This combination prevents dehydration and hypovolemia." d. "Using two drugs increases the osmolality of plasma and the glomerular filtration rate."

b. Spironolactone is a potassium-sparing diuretic; furosemide causes potassium loss. Giving these together minimizes electrolyte imbalance. It is not accurate to state that the drug combination prevents dehydration and hypovolemia or that it increases the osmolality of plasma and the glomerular filtration rate. Stating that giving two different diuretics is more effective is not specific enough information for the patient.

What acts primarily on water and promotes reabsorption of water when serum osmolality is too high?

ADH

What baseline data would be important to assess when starting a patient on a new prescription of Lasix?

blood pressure potassium levels weight if edema- how much swelling?

How do most diuretics work?

by blocking sodium & chloride reabsorption

A patient is taking furosemide (Lasix) 40mg daily for heart failure & hypertension. It is most important for the nurse to assess the patient for the development of a. low serum potassium, sodium, & magnesium, and elevated calcium b. low serum potassium & sodium, and elevated magnesium and calcium c. low serum potassium, sodium, magnesium, & calcium d. low serum potassium & sodium, with magnesium & calcium remaining normal

c.

A patient with congestive heart failure gains 5 pounds in 1 week. This most likely indicates a fluid weight gain of a. 1/2 L b. 1 L c. 2 L d. 3 L

c.

Diuretics that produce the most significant diuresis will affect reabsorption in a. collecting duct b. distal convoluted tubule c. ascending loop of henle (aka Loop diuretics)

c.

Which statement will the nurse include when teaching a patient about loop (high-ceiling) diuretics? a. take the medication at bedtime b. take the medication on an empty stomach c. rise slowly from a lying or sitting to standing position to prevent dizziness d. avoid fruit and vegetables in the diet

c.

Where in the nephron does the most reabsorption of solutes normally occur?

PCT

A patient is ordered furosemide (Lasix) to be given via intravenous push. Which interventions will the nurse perform? (Select all that apply.) a. Administer at a rate no faster than 20 mg/min. b. Assess lung sounds before and after administration c. Assess blood pressure before and after administration. d. Maintain accurate intake and output record. e. Monitor ECG continuously. f. Insert an arterial line for continuous blood pressure monitoring

a, b, c, d Furosemide (Lasix) can be infused via intravenous push at the rate of 20 mg/min. Furosemide is a diuretic and will decrease fluid in alveoli, and assessing lung sounds can help to determine therapeutic effect. Blood pressure should decrease with the administration of a diuretic. It is appropriate to monitor before and after administration. It is appropriate to monitor intake and output for a patient receiving a diuretic. There is no need to insert an arterial line to continuously monitor the blood pressure since it should not fluctuate that dramatically. Also, there is no need to continuously monitor ECG since the medication is not cardiotoxic.

Which assessment indicates to the nurse a therapeutic effect of mannitol (Osmitrol) has been achieved? a. Decreased intracranial pressure b. Decreased potassium c. Increased urine osmolality d. Decreased serum osmolality

a. Mannitol (Osmitrol) is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This will decrease intracranial pressure, increase excretion of medications, decrease urine osmolality, and increase serum osmolality

The nurse teaches a patient who is taking furosemide (Lasix) about foods and beverages that should be consumed. Which dietary items, if selected by the patient, indicate an understanding of the instructions? a. oranges, spinach, potatoes b. baked fish, chicken, cauliflower c. tomato juice, skim milk, cottage cheese d. oatmeal, cabbage, bran flakes

a. all items listed are high in potassium, which a patient needs when taking Lasix

spironolactone (Aldactone): MOA

aldosterone antagonist- blocks Na+ & K+ exchange- results in K+ retention and Na+ excretion

Lasix is ordered 20mg PO daily. At what time of day should the patient take the medication?

anytime but bedtime

Which of the following nursing implications should be considered when caring for a patient taking a loop diuretic? select all that apply. a. monitor temp daily b. supplement with K+ c. monitor for dehydration d. weigh patient at different times every day e. start low, go slow with dosage

b, c, e daily weights should be monitored @ same time every day

A patient is admitted to the intensive care unit with increased intracranial pressure. The nurse would anticipate administering a. furosemide (Lasix) b. mannitol (Osmitrol) c. triamterene (Dyrenium) d. spironolactone (Aldactone)

b.

A patient is receiving furosemide (Lasix). It is most important for the nurse to monitor the patient for the development of a. hyperkalemia b. hypokalemia c. hyponatremia d. hypernatremia

b.

A patient with heart failure who takes furosemide (Lasix) is diagnosed with bacterial pneumonia. Which medication, if ordered by the physician, should the nurse question? a. ciprofloxacin (Cipro) b. gentamicin (Garamycin) c. amoxicillin (Amoxcil) d. erythromycin (E-Mycin)

b.

Before administering triamterene (Dyrenium), it is most important for the nurse to determine if the patient is also receiving a. digoxin (Lanoxin) b. potassium chloride (K-Dur) c. acetaminophen (Tylenol) d. doxazosin (Cardura)

b.

Which statement about aldosterone does the nurse identify as being true? Aldosterone a. promotes sodium excretion b. is a mineralocorticoid hormone c. promotes potassium retention d. is secreted by the pancreas

b.

Which laboratory value will the nurse report to the health care provider as a potential adverse response to hydrochlorothiazide? a. Sodium level of 140 mEq/L b. Fasting blood glucose level of 140 mg/dL c. Calcium level of 9 mg/dL d. Chloride level of 100 mEq/L

b. Hydrochlorothiazide can cause hyperglycemia. Normal calcium level is approximately 8.8-10.3 mg/dL; normal sodium level is 135-147 mEq/L; normal chloride level is 95-107 mEq/L, and normal fasting blood glucose should be 60-110 mg/dL.

The nurse is assessing a patient who is taking furosemide (Lasix). The patient's potassium level is 3.4 mEq/L; chloride is 90 mmol/L, and sodium is 140 mEq/L. Based on the nurse's understanding of the laboratory results, what prescribed therapy can the nurse anticipate administering? a. Mix 40 mEq of potassium in 250 mL D5W and infuse rapidly b. Administer sodium polystyrene sulfonate. c. Administer 2 mEq potassium chloride per kilogram per day IV. d. Administer calcium acetate, two tablets three times per day.

c. Furosemide is a potent loop diuretic, resulting in the loss of potassium as well as water, sodium, and chloride. The patient needs chloride replacement. Normal potassium level is 3.5 to 5.2 mEq/L; normal sodium level is 135 to 147 mEq/L, and normal chloride level is 95 to 107 mEq/L. Potassium is never given by rapid infusion.

Which patient would the nurse need to assess first if the patient is receiving mannitol (Osmitrol)? a. A 55-year-old patient receiving cisplatin to treat ovarian cancer b. A 21-year-old patient with a head injury c. A 47-year-old patient with anuria d. A 67-year-old patient with type 1 diabetes mellitus

c. Mannitol (Osmitrol) is not metabolized but excreted unchanged by the kidneys. Potential water intoxication could occur if mannitol is given to a patient with anuria. Mannitol is safe to use with diabetic patients and those with head injuries, and it may function as a nephroprotectant when cisplatin is being used.

A nurse is caring for a patient receiving acetazolamide (Diamox). Which assessment finding will require immediate nursing intervention? a. A decrease in bicarbonate level b. An increase in urinary output c. A decrease in arterial pH d. An increase in PaO2

c. Acetazolamide (Diamox) causes excretion of bicarbonate, which would worsen metabolic acidosis. It is used to treat metabolic alkalosis, edema, seizures, and acute glaucoma. A decrease in blood pH would indicate that the patient was becoming more acidotic.

A patient with acute pulmonary edema is receiving furosemide (Lasix). What assessment finding indicates to the nurse that the intervention is working? a. Potassium level decreased from 4.5 to 3.5 mEq/L b. Improvement in mental status c. Lungs clear d. Output 30 mL/hr

c. Furosemide (Lasix) is a potent, rapid-acting diuretic that would be the drug of choice to treat acute pulmonary edema. Furosemide should not cause a drastic change in output or decrease in potassium level, and there is no evidence that it will create any change in mental status

A patient taking spironolactone (Aldactone) has been taught about the medication. Which menu selection indicates that the patient understands teaching related to this medication? a. potatoes b. lima beans c. chicken d. strawberries

c. Spironolactone is a potassium-sparing diuretic that could potentially cause hyperkalemia. Chicken is the only appropriate choice of the foods listed because it is lower in potassium. Potatoes, lima beans, and strawberries are all known to contain high levels of potassium.

What intervention will the nurse perform when monitoring a patient receiving triamterene (Dyrenium)? a. Assess urinary output every other day. b. Monitor for side effect of hypoglycemia. c. Assess potassium levels. d. Monitor for hypernatremia.

c. Triamterene (Dyrenium) is a potassium-sparing diuretic. The nurse should monitor potassium for potential hyperkalemia.

A patient is prescribed spironolactone (Aldactone) for treatment of HTN. Which foods should the nurse teach the patient to avoid? a. baked fish b. low-fat milk c. salt substitutes d. green beans

c. b/c made up of KCl- pt should avoid excessive intake of potassium when on potassium-sparing diuretic

A patient is prescribed furosemide (Lasix). Regarding loss of potassium, it is priority to monitor for what? a. hunger & fatigue b. 4+ DTRs c. muscle weakness & constipation d. tall, tented T waves on ECG

c. muscle weakness, constipation = sign of hypokalemia tall, tented T waves on ECG = sign of hyperkalemea

Due to hyperkalemia risk, patients on spironolactone and which of the following drugs (see endings) should have K+ levels monitored? Select all that apply a. -floxacin b. -olol c. -pril d. -sartan e. -statin

c. -pril (ACE inhibitor) d. -sartan (ARBs)

The nurse cares for a patient who is prescribed oral bumetanide (a loop diuretic) twice daily. It is most important for the nurse to take which action? a. monitor the patient for signs and symptoms of hyperkalemia b. insert a urinary catheter and assess hourly urine output c. weigh the patient before administering each dose d. schedule the medication to be given at 0800 and 1400

d. -monitor the patient for s&s of hypokalemia -UTI major concern for inserting foley -weigh the patient only once a day

A patient is prescribed chlorthalidone (Thalitone). What is the most important information the nurse will teach the patient? a. "Do not drink more than 10 ounces of fluid a day while on this medication." b. "Take this medication on an empty stomach." c. "Take this medication before bed each night." d. "Wear protective clothing and sunscreen while taking this medication."

d. Adverse effects associated with chlorthalidone include photosensitivity. The nurse should teach the patient to protect himself when out in the sun. There is no evidence that fluid should be restricted while taking the medication, that it should be taken on an empty stomach, or that it should only be taken at bedtime.

Drug interactions with loop diuretics

digoxin (digoxin-induced toxicity r/t hypokalemia) ototoxic drugs (aminoglycoside antibiotics)- end in -mycin HTN meds (hypotension possible)

What foods should a patient on spironolactone be cautioned about eating?

foods high in K+ spinach, bananas, nuts

Parts of the nephron (listed in order)

glomerulus PCT loop of henle DCT (early segment, late segment) collecting ducts

What electrolyte imbalance is a common adverse reaction when taking spironolactone?

hyperkalemia

spironolactone (Aldactone): adverse effects

hyperkalemia!

Major adverse effects of furosemide (Lasix)

hypokalemia dehydration hypotension ototoxicity

Potential side effects of diuretics

hypovolemia acid-base imbalance altered electrolyte levels

What would happen if all filtered plasma left the body?

hypovolemia! pt would be very dry!

Patient teaching for the patient taking HCTZ and digoxin

increase intake of bananas, oranges, potatoes (all high in potassium) in order to prevent hypokalemia induced digitalis toxicity tell patient to report any muscle weakness, leg cramps, or cardiac dysrhythmias (S&S of hypokalemia)

Diuretics produce _____ UOP by inhibiting _____ & ______ reabsorption from the kidney tubule

increased UOP inhibiting sodium & water reabsorption

What are the main purposes of diuretics?

lower blood pressure reduce edema

How is mannitol (Osmitrol) given?

must be given IV

What is the main difference in adverse effects between thiazides and loop diuretics?

ototoxicity is the difference- not a risk for thiazides

spironolactone (Aldactone)

potassium-sparing diuretic

Therapeutic uses for mannitol (Osmitrol)

prevention of renal failure lowering intracranial pressure

Nursing implications for patient taking thiazide diuretic

supplement with K+

5 different types of diuretics

thiazide (HCTZ) loop/high-ceiling (Lasix) osmotic (mannitol) carbonic anhydrase inhibitor (Diamox) potassium-sparing (Aldactone)

Diuretics treat _____ & ________, and help to prevent _________

treat HTN & edema prevent renal failure

Which potassium-sparing diuretic works faster, spironolactone (Aldactone) or triamterene (Dyrenium)?

triamterene (Dyrenium)

In potassium-sparing diuretics, is adequate kidney function needed?

yes! If poor GFR, consider loop diuretic instead