PHARM ELECTROLYTES, DIURETICS, URINARY DRUGS

Oxybutynin -adverse effects & nursing considerations

"cant see, cant pee, cant spit, cant shit" (r/o obstructions in urinary tract) -anticholinergic effects (may block too much PNS activity) (contraindicated for glaucoma, myasthenia gravis, acute hemorrhage) -sympathetic effects -CNS effects

Hypermagnesemia signs

**Depressed respirations** Hypoactive reflexes Hypotension bradycardia Coma Drowsiness EKG changes

PNS effects

-Constrict pupils (no need to see everything) -Stimulate saliva, peristalsis, bile release, bladder contraction -constrict bronchi -slow HR

Bethanechol -adverse effects & nursing interventions

-PSNS stimulation (contraindicates for asthma, epilepsy, parkinsons) -salivation, sweating (contraindicated for hyperthyroidism) -abdominal cramping (take 1 hr before or 2 hrs after meals) (contraindicated for intestinal obstruction) -hypotension/bradycardia (monitor I&Os) (contraindicated for hx of bradycardia) -cholinergic crisis (atropine antidote)

Methenamine -adverse effects & nursing considerations

-Well tolerated -GI upset from formaldehyde (recommend enteric coated tabs) -Bladder irritation (avoid alkalizing agents, sulfonamides which may cause crystals) -prodrug status (contraindicated for liver dysfunction)

SNS effects

-activated by stress -dilate pupils (see your threat) -inhibit salivation/persitalsis/bladder contraction -relax bronchi (more o2) -increase HR -stimulates orgasm -secrete adrenaline/noradrenaline

Pre-Rx of diuretics, the nurse should assess...

-complete health history -complete med list -baseline electrolytes, CBC and liver/renal panels -weight -vitals -breath sounds -cardiac monitoring -edema

Nurse planning/interventions for diuretics

-ensure its working (increased urine output, decreased BP, monitor weight, monitor I&O) -minimize adverse effects (watch vitals, watch electrolytes, watch BUN/creatinine, monitor nutrition, watch for gout or photosensitivity)

Diuretic uses

-hypertension -CHF -cirrhosis (swelling of liver associated w/ liver failure) -renal disease -increased ICP -pulmonary edema -glaucoma

Overall nursing interventions for UTIs

-push fluids to 4L/day to flush -cranberry JUICE -empty bladder q2 hours, double void QHS -Proper catheter maintenance -abx compliance -proper hygiene, proper positioning -increase fiber (being constipated will push on your bladder and cause more discomfort)

Hypotonic Solutions (examples, definitions)

0.45%NS, 0.2%NS Lower osmolality than the cell Will cause water to rush into the cell (think of this providing water for a shrunk up cell)

Creatinine values

0.5-1.2 think of a "creature" on a scale of 1-10, pretty low on the attractiveness scale right?

Isotonic Solutions (examples, definitions)

0.9%NS, Lactated Ringers Fluids have the same osmolality between intracellular/extracellular environments *just replacing volume

Magnesium values

1.8-2.6

BUN values

10-20 think of a hamburger BUN, you would pay $10-20 for a hamburger

Sodium Range

135-145 mEq/L

Phosphorus values

2.7-4.5 Follows OPPOSITE of whatever calcium does SO, low phos = high Ca = BACK ME SO, high phos = low Ca = CATS

A pt is admitted to the ICU for cerebral edema, which solution would you expect to hang? 0.9% NS 3% NS LR 0.45%NS

3% NS (pt cells are swollen, so we need a hypertonic solution to draw water out of them)

Hypertonic Solutions (examples, definitions)

3%NS / 23.4%NS Have a higher osmolality than the cell Water will rush OUT of the cell (think of the hypertonic solution drawing the water out of the cell)

Potassium values

3.5-5.2

Calcium values

8.2-10.2

Chloride values

96-106 nursing considerations: -monitor neuro status (follows with Na) -Assess for falls (follows Na)

Acidosis (value and signs, tx)

<7.35 hypoventilation, airway constriction, severe diarrhea, kidney failure, Tx: sodium bicarbonate

Alkalosis

>7.45 Hyperventilation, prolonged constipation, severe vomiting

acetazolamide adverse effects & nursing interventions

ABG/electrolyte imbalance (monitor, use cautiously w/ pts who have existing problems) metabolic acidosis (monitor) hypokalemia (increase K in diet / K supplements) confusion/drowsiness urinary frequency (daily weights, I&Os) renal calculi bone marrow suppression (monitor CBC)

Tonicity

Ability of a solution to move water into/out of the cell

Which statements made by the client identify regulatory functions of the kidneys? A. erythropoiesis B. acid-base balance C. vitamin D activation D. BP control E. fluid and electrolyte balance

Acid base Fluid and electrolyte The rest are HORMONAL functions of the kidneys, not regulatory

oxybutynin -purpose -therapeutic use

Anticholinergic drug that competes with ACh for binding with muscarinic response Blocks PNS activity Reduces bladder/urinary tract spasms Treats overactive bladder

Nitrofurantoin -Purpose -Therapeutic effects

Antiseptic for urinary tract (bacteriostatic and bactericidal) - broad spectrum Therapeutic levels achieved ONLY in the urine, so very targeted Prophylaxis for recurrent lower UTIs Not recommended for upper UTIs

A client with a hx of severe diarrhea x3 days is admitted for dehydration. The nurse anticipates which IV solution will be prescribed? a.3% sodium chloride b.0.9% sodium chloride c.5% dextrose and 0.9% sodium chloride d.5% dextrose and lactated ringer solution

B - 0.9% sodium chloride We just need a basic volume expander for diarrhea

In which category of fluids would the nurse classify an intravenous solution of 0.45% sodium chloride? a.Isomeric b.Hypotonic c.Hypertonic d.Isotonic

B - hypotonic

Which finding for a client who has a potassium level of 2.8 meq/L would be of most concern to the nurse? a.Abdominal cramps b.Irregular heart rate c.Decreased reflexes d.Muscle weakness

B - irregular heart rate All are concerns, but heart rate is the most concerning.

5. A nurse is caring for a client whose laboratory values show a sodium level of 130. Which factors does the nurse determine were the most likely cause of the hyponatremia? SATA a.Diabetes insipidus b.Profuse diaphoresis c.Excess sodium intake d.Removal of the parathyroid glands e.Rapid infusion of IV 5% dextrose in water

B - profuse diaphoresis E - rapid infusion of IV 5% dextrose in water

Hypercalcemia s/s

BACK ME bone pain, arrhythmias, cardiac arrest, kidney stone, muscle weakness, excess urination

A client has the following labs: K 4.1, Mg 2.6, and Na 126. You would expect that the patient will: Have absent breath sounds Be at increased risk for falls Need to take potassium supplement Be alert and oriented x4

Be at increased risk for falls (pts with low or high sodium are at risk for altered neuro and muscular status)

signs of UTI in elderly

Behavioral changes Lethargy Confusion Anorexia Incontinence

Sodium Bicarbonate action

Bicarbonate ion directly raises the pH of body fluid

How do diuretics work?

Blockade of sodium and chloride reabsorption

Crystalloids vs Colloids

Both volume expanders -Crystalloid- use mineral salts (IV saline) // cheaper, more hypoallergenic, no coag interference, need a large volume though) -Colloid- use gelatin, blood (causes large volume expansion when necessary, but expensive, takes longer to get from pharm, less hypoallergenic, may exacerbate edema)

Pt is taking 40 mg of IV furosemide BID. At his 1400 lab draw, you note his K is 2. Your next action should be to: Give the next dose of furosemide Call the provider Repeat the labs ASAP Ask him to order a banana for dinner

Call the provider (we need orders to replace this K before administering more furosemide)

You are caring for a client with a calcium level of 6. What is the priority assessment? Bowel sounds Cardiac rhythms Deep tendon reflexes Urine output

Cardiac rhythms

Adverse effects of sodium bicarbonate

Confusion Slow respiration Irritability Vomiting

Why administer sodium bicarbonate

Correct acidosis Excrete acidic substances

Mr. Oxide has hypermagnesemia. SATA for symptoms that would follow with his condition: increased tendon reflexes Decreased heart rate Decreased respirations Decreased BP

Decreased heart rate Decreased respirations Decreased BP

Hypovolemia (define & signs)

Decreased/contraction fluid status hypotension, tachycardia, poor skin turgor, dry mucous membranes, decreased/no urine output, altered sensorium, poor capillary refill, cool extremities

Hypernatremia causes

Diabetes Water loss/fever

causes of hyponatremia

Diet Fever Excess sweating Excess water intake (dilutes the Na) Burns/wounds Renal disease Adrenal insuff. DKA

Drug interactions with furosemide

Digoxin (digoxin toxicity) lithium (lithium toxicity) gentamycin (higher risk ototoxicity)

Key point for PO magnesium oxide

Excessive doses may cause diarrhea

Signs of UTI in pediatric patients

Flu like symptoms disturbed sleep Anorexia

Nitrofurantoin -adverse effects & nursing interventions

GI discomfort (take with milk/food) Anaphylaxis/hypersensitivity Blood disorders (monitor CBC, kidneys) Hepatotoxicity (monitor liver) Peripheral neuropathy Stevens Johnson CNS effects (HA, vertigo, nystagmus) will stain teeth if crushed/urine will be brown

Where does filtration start in the kidneys?

Glomerulus

Contraindications for sodium bicarbonate

HTN Peptic ulcers Diarrhea Vomiting

Common accidental cause of hyperkalemia

Hemolysis of blood sample, "pseudohyperkalemia"

hyperphosphatemia s/s

Hyperactive reflexes

tx for hypernatremia

IV fluids or oral fluids to dilute the Na+ Strict i&o Neuro assessments Restrict Na+ intake obviously

Hypervolemia (define & causes)

Increased/expansion fluid status Hypertension Tachycardia Strong/bounding pulse Edema Increased urine output

spironolactone purpose and therapeutics

K sparing diuretic usually combined with other diuretics to combat hypokalemia from those other diuretics also treats heart failure or hypokalemia not the best diuretic of the bunch

furosemide -purpose -indications

Loop diuretic - decreases reabsorption of sodium/water/chloride edema (pulmonary, liver, cardiac, renal failure) HTN hypercalcemia (wastes calcium) for kidney stones PO/IV

Hypertonic Fluid Contraction (define and tx)

Losing more H2O than Na, causes intracellular dehydration Tx: hypotonic fluids (0.45% NS)

Hypotonic Fluid Contraction

Losing more Na and H2O, causes intracellular swelling Tx: hypertonic fluids (3% NS)

Key point for IV magnesium sulfate

MUST GIVE SLOW, hyper Mg levels will cause respiratory depression and paralysis *you can reverse this with calcium though

hydrochlorothiazide -purpose and therapeutic uses

Mild diuresis compared to loop diuretics (works in more distal part of the nephron) 1st choice for essential HTN Treatment mild/moderate heart failure or kidney disease

bethanechol (urecholine)

Muscarinic agonist parasympathomimetic effect / mimics AcH treats non obstructive urinary retention

Isotonic Fluid Contraction (define and tx)

Na and H2O are being lost at EQUAL rates / loss of total volume, not osmolality Tx: isotonic fluids (0.9% NS)

Hypomagnesemia signs

Neuromuscular (trousseau, chvostek) increased tendon reflexes insomnia (think of Mg supplements to make you sleepy) increased BP Torsades on EKG

Hyperkalemia signs

Peaked T wave on EKG, Vfib, cardiac arrest intestinal cramping/diarrhea Paresthesias Muscle weakness with paralysis/twitching

Methenamine -purpose -therapeutic use

Prodrug that under acidic conditions breaks down into ammonia and formaldehyde Urinary tract antiseptic Antiseptic treatment for chronic lower UTIs Not recommended for prophylaxis or upper UTIs

Trimethoprin/Sulfamethoxazole -Purpose & MOA

Purpose: anti-infective for UTI MOA: suppresses bacterial growth by inhibiting synthesis of folate

The SNS releases _______, while the PNS releases ________

SNS - norepinephrine PNS - Ach

Hypokalemia signs

ST depression and shallow T wave skeletal and smooth muscle atony/weakness hyporeflexia hypotension could be brady or tachy Constipation/indigestion/ileus

Tx for UTIs

Testing (urinalysis, urine culture, CBC) Abx Agents to sterilize the urinary tract Specific drugs that can decrease pain, protect cells, block spasms, treat enlargement of the prostate gland

Hypocalcemia s/s

Think of cats being lazy, slow/hypo CATS Convulsions, Arrythmias, Tetany, spasms and stridor (even chvosteks and trousseaus)

If a person has a fever >48 hours, what should automatically be checked?

Urine culture/specimen to check for UTI

Hypernatremia symptoms

brain cells are shrinking hyperactive reflexes thirst neuro changes weight gain pounding pulse increased BP

signs of hyponatremia

cerebral edema (too much H2O, dilutes the Na) Neuro changes Depressed reflexes Increased bowel sounds Weakness

hydrochlorothiazide adverse effects & nursing interventions

dehydration (I&Os, daily weight, skin turgor) hypotension (monitor vitals) hypokalemia (increase K in diet) hypercalcemia (NOT Ca wasting, so monitor) hyperglycemia (diabetic monitoring) hyperuricemia (gout flare up monitoring) digoxin, lithium toxicity

furosemide adverse effects & nursing interventions

dehydration (daily weights, I&Os, edema) hypotension (monitor BP) electrolyte imbalance (monitor electrolytes, educate to eat high potassium foods) ototoxicity (monitor for tinnitus) hyperglycemia/hyperuricemia (monitor diabetes and gouty arthritis flare ups)

mannitol adverse effects & nursing interventions

heart failure (monitor cardiac) pulmonary edema (monitor lung sounds) kidney failure (monitor BUN/creatinine) severe fluid and electrolyte imbalance (monitor electrolytes) must use filter needle/filter iv tubing monitor i&o, daily weights

spironolactone adverse effects & nursing interventions

hyperkalemia (monitor K, insulin to treat) arrhythmias from hyperkalemia (monitor cardiac) endocrine effects (hair, irregular menses) monitor vitals & weight NO RENAL FAILURE PTS NO ACE INHIBITORS AVOID SALT SUBSTITUTES WITH HIGH K

Trimethoprin/Sulfamethoxazole -adverse effects

hypersensitivity rxn (take on empty stomach w/ water) photosensitivity (avoid sunlight/use sunscreen) stevens johnson syndrome hemolytic anemia (monitor CBC) renal damage (increase fluid intake) hyperkalemia (monitor K) Kernicterus in newborns (contraindicated for nursing moms, pregnant individuals, infants)

Importance of calcium in the body

neuronal activity muscular contractions myocardial conduction blood coagulation bone formation

benign prostatic hypertrophy

noncancerous enlargement of the prostate gland age related cause unknown

mannitol purpose & therapeutic use

osmotic diuretic, sugar pulls large amounts of fluid into urine via osmosis no sodium loss acute renal failure helps decrease ICP decrease IOP (glaucoma) drug overdose (pushes toxic substances through and out of kidneys)

ABG values (pH, HCO3, PaCO2, PaO2)

pH - 7.35-7.45 HCO3 - 22-25 PaCO2 - 35-45 PaO2 - 80-100

tamsulosin -purpose -therapeutic use -adverse effect

purpose: block alpha 1 receptors to relax bladder and urethra therapy: relieve obstruction and increase urine flow side effects: selective, so no BP effects, abnormal ejaculation, headache, dizziness, avoid taking until after cataract sx

finasteride -purpose -therapeutic use -adverse effects

purpose: blocks DHT from converting to testosterone therapy: shrinks prostate gland over several months side effects: sexual dysfunction, teratogenic to male fetus, increase risk for prostate cancer

phenazopyridine: -purpose -therapeutic uses -nursing interventions

purpose: local anesthetic for mucosa of urinary tract therapeutic use: relieve burning, pain, frequency, urgency nursing considerations: -contraindicated for renal disease -will stain urine red/orange -urine may stain clothes -give w/ meals to prevent GI discomfort

hypophosphatemia s/s

respiratory muscle weakness CNS dysfunction

acetazolamide purpose & therapeutic uses

slows hydrogen ions / causes loss of sodium and bicarb in the urine treats glaucoma treats as adjunct to other diuretics treats acute heart failure

tx for hyponatremia

watch for demyelination syndrome watch for sezures monitor Na+ intake in diet and increase it IVF (3%NS if severe --> draws water out to increase osmolality) Strict I&O Restrict water Diuretics

benign prostatic hypertrophy symptoms

weak urinary system frequent urinating urination takes longer than normal can cause bladder infections/kidney failure