CH.24 Diuretics

Spironolactone patient education & nursing responsiblites

- avoid potassium rich foods - monitor weight daily, and electrolytes (sodium, potassium)

Priority interventions before administering diuretics

- check blood pressure, hold for low BP - check kidney labs - always put patient on cardiac monitor

furosemide(lasix) nursing responsibilities

- check potassium levels - encourage foods in potassium (bananas, dark leafy greens, potatoes, cantaloupe, avocado, tomatoes) - administer med early in the morning

hydrocholorthiazide (microzide) nursing responsibilities

- encourage patient to eat foods high in potassium - administer med early in the morning

Furosemide (Lasix) indications

- patients with pulmonary edema, edema (r/t heart failure, liver disease, kidney disease) - furosemide furiously gets rid of excess sodium and water

Potassium range

3.5-5.5

The client diagnosed with arterial hypertension (HTN) is receiving furosemide. Which data indicates the medication is effective? A. The client's 8-hour intake is 1,800 mL and the output is 2,300 mL. B. The client's blood pressure went from 144/88 to 154/96. C. The client has had a weight loss of 1.3 kg in 7 days. D. The client reports occasional light-headedness and dizziness.

A

The nurse is preparing to administer spironolactone. Which priority intervention should the nurse implement? A.Check the client's potassium level. B. Monitor the client's urinary output. C. Encourage consumption of potassium-rich foods. D. Give the medication with food.

A

Which action by the nurse is most important when caring for a patient with chronic kidney disease who has an order for furosemide (Lasix) A. Assess urine output and renal lab values for signs of nephrotoxicity B. Check the specific gravity of the urine daily C. Eliminate potassium-rich foods from diet D. Encourage the patient to void every 4 hours

A Because the kidneys excrete most drugs, patient with CKD may need a lower dosage of furosemide to prevent further damage to the kidneys

The client diagnosed with end-stage liver failure with ascites is prescribed spironolac- tone. Which interventions should the nurse implement? Select all that apply. A. Check the serum potassium level. B. Weigh the client daily at the same time. C. Assess the client's bowel sounds. D. Monitor the client's intake and output. E. Monitor the client's abdominal girth.

A,B,D,E

The home health nurse is caring for a client diagnosed with congestive heart failure (CHF) who has been prescribed digoxin and furosemide. Which statements by the client indicate the medications are effective? Select all that apply. A. "I am able to walk next door now without being short of breath." B. "I keep my feet propped up as much as I can during the day." C. "I have not gained any weight since my last doctor's visit." D. "My blood pressure has been within normal limits." E. "I am staying on my diet, and I don't salt my foods anymore."

A,C

The nurse is administering hydrochlorothiazide to a client diagnosed with chronic kidney disease (CKD). Which assessment data should cause the nurse to question the administration of this medication? Select all that apply. A. The client's skin turgor on the upper chest is tented. B. The urine output was 90 mL for the last 8 hours. C. The client's oral mucosa is moist and pink. D. The client has 3+ sacral and peripheral edema. E. The client's blood pressure is 90/60 in the left arm.

A,E Tented skin turgor indicates client is dehydrated. Diuretics may lead to orthostatic hypotension, since the clients BP is already low the nurse should question administering this med.

The nurse is caring for a patient in the telemetry unit who was prescribed spironolactone prior to experiencing cardiac symptoms. On admission, the patient demonstrating ECG changes and is experiencing muscle weakness. A priority outcome for the patient is for resolution of which electrolyte imbalance? A. hypokalemia B. hyperkalemia C. hypocalcemia D. hypercalcemia

B

A client is about to start taking hydrochlorthiazide for hypertension. To assess for adverse effects of this drug, you monitor which during drug therapy? Select all that apply. A. Ototoxicity B. Hyponatremia C. Hypokalemia D. Dehydration E. Hypoglycemia

B,C,D

3 priority nursing actions before putting a patient on a diuretic , acronym BBP

Blood pressure (hold med less than 100 systolic) BUN/creatinine (check be giving) Potassium 3.5-5.0(put patient on cardiac monitor)

Recognizing the potential for a drug interaction between the diuretic, furosemide, and the cardiac glycoside, digoxin, the primary care provider plans to monitor this client for which adverse effect? A. Hyperkalemia B. Ototoxicity C. Digoxin toxicity D. Hypoglycemia

C

Which med is appropriate to administer to a patient with serum potassium level of 6.5 mEq/L. A. Triamterene B. Captopril C. Furosemide D. Spironolactone

C

A patient with history of heat failure will be started on spironolactone (Aldactone). Which drug group should not be used, or used with extreme caution in patients taking potassium-sparing diuretics/ A. NSAIDS B. Corticosteroids C. Loop diuretics D. ACE inhibitors or angiotensin-receptor blockers

D ACE inhibitors and ARBs taken concurrently with potassium-sparing diuretics increase the risk of hyperkalemia

The nurse is preparing to administer medications to the following clients. Which client should the nurse question administering the medication? A. The client receiving losartan who has a blood pressure of 168/94. B. The client receiving the diltiazem who has 1+ nonpitting edema. C. The client receiving the terazosin who is reporting a headache. D. The client receiving the hydrochlorothiazide who is reporting leg cramps.

D, leg cramps can indicate hypokalemia

The patient admitted for heart failure has been receiving hydrochlorothiazide(Microzide). Which laboratory values should the nurse carefully monitor? Select all that apply a. Platelet count b. WBC count c. Potassium d. Sodium e. Uric acid

c,d,e Microzide causes loss of sodium and potassium and may cause hyperuricemia

furosemide (lasix) what do we do if patient overdoses

give pt fluid and electrolytes

Side effects of spironolactone

hyperkalemia

Hydrochlorothiazide side effects

hypokalemia hyperglycemia

furosemide(lasix) side effects

hypokalemia ototoxicity hypotension hyponatremia

loop diuretics (furosemide) indications

pulmonary edema

Spironolactone is contraindicated in patients with ...

severe kidney failure