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Why should you give diuretics in the AM?
So Pts do not stay up all night urinating.
What exemplar is our thiazide diuretic?
What is its action?
HCTZ is our exemplar.
Action: blocks Cl- pump in distal tubule, Cl- and Na+ is then excreted = decrease BP.
What are similar uses of HCTZ and furosemide? dissimilar?
- HCTZ & furosemide both are used for HTN.
- However, HCTZ is also used for edema, while furosemide is used for peripheral & pulmonary edema.
Of HCTZ and furosemide, which is considered the "BIG GUNS/High-ceiling" diuretic while which would be considered the "2nd in line" of drugs? Why?
furosemide: BIG GUNS/High-ceiling, b/c it causes rapid fluid elimination and is the drug of choice for emergency fluid elimination; maximum diuretic effects achieved.
HCTZ: 2nd in line.
What contraindications are similar to HCTZ and furosemide?
What are some of HCTZ's contraindications?
HCTZ is also contraindiated for severe renal impairment and hepatic coma.
What are some side effects of HCTZ? Why? What action should a nurse take?
HypoKalemia, HypoNAtremia, HypoChloremia.
B/c hypoKalemia is a K+ depleting drug, the nurse should encourage K+ rich foods.
Which antihypertensives should be monitored for "hyperKalemia" and which diuretics should be monitored for "hypoKalemia?"
HyperK: (ACE) captoPRIL & (ARB) losARtan; K+ is reabsorbed.
HypoK: (thiazide) HCTZ & (loop) furosemide; K+ is excreted.
Of HCTZ and furosemide, which side effect is similar? What other two side effects does HCTZ have?
Both HCTZ & furosemide have: agranulocytosis as a side effect.
HCTZ also has respiratory distress & renal failure.
What is the interaction for HCTZ? (hint: electrolyte; what is its effect in combo therapy?)
What are the drug-drug interactions for HCTZ?
Na+. Na+ decreases HCTZ's effectiveness.
*Antihypertensives, NSAIDs and Opioids.
What nursing actions are involved with HCTZ?
(hint: think about side effects/adverse reactions and its uses)
Monitor: I/O, BP, wt., s/sx of electrolyte imbalance,.
Obtain fluid balance by weighing Pt.
Encourage K+ rich foods.
What is our loop diuretic exemplar?
What is its action?
Action: Works at the loop of Henle, inhibits reabsorption of: Na+, H2O, and Cl- (electrolytes).
K+ is also excreted.
What are some side effects for furosemide? (4)
electrolyte imbalance, otoxicity, hypoKalemia, and photosensitivity.
What are some nursing actions for furosemide?
What should the nurse consider prior to infusing furosemide?
How would you teach photosensitivity side effect?
Monitor for s/sx of hypoKalemia.
Give slowly, 20-40 mg over 1-3 minutes, IV.
Teach protection in sunlight.
What is the K+ sparing exemplar and what is its action?
What are Pts at risk for while on this drug?
Action: Na+ and H2O, excretion in distal tubule; K+ is reabsorbed at the same time.
Pts at risk for hyperKalemia.
What is triamterene primarily used for?
Triamterene is used as an adjunct to manage HTN and edema.
(w/ thiazide & loop diuretics to minimize K+ loss)
What are contraindications of triamterene similar to captoPRIL and losARtan?
What class of diuretic is it?
Contraindicated for hyperKalemics or pregnant/breast-feeding women.
What are some side effects of triamterene?
What must you teach to the Pt about some of the side effects?
Photosensitivity and Jaundice.
Teach Pt how to protect itself from sunlight.
What are some adverse reactions to triamterene?
What are the nursing actions for each/some of the reactions?
Anaphylaxis, thrombocytopenia, hyperKalemia.
Monitor for hyperKalemia and do not give K+ supplements/foods.
Also monitor: electolytes, BP, edema, wt, urine output.
Which exemplar is our osmotic diuretic?
What is its action?
Action: osmotics are not reabsorbed but pull fluid into the vascular space = increase in urine output = decrease BP.
They also prevent reabsorption of Na+, Cl-, and H2O.
Where is the osmotic fluid drawn from which causes the increase in blood plasma?
What is the result of overdrawing fluids from these areas? (purposes)
tissues, brain, CSF, and eyes.
decreased cerebral edema, ICP, IOP, CSF volume.
What are some uses for mannitol? (3) (hint: osmotic fluid withdrawing)
acute renal failure
Decrease ICP and IOP.
Promote renal excretion of drugs that are at toxic levels.
What are some contraindications for mannitol? (3)
What class of diuretic is mannitol?
active IC bleeding
What are some side effects of mannitol?
(hint: fluid loss/overload)
dehydration, hypo/hyper -tension, VASCULAR fluid overload.
What are some adverse reactions to mannitol?
What type of emergency situations are mannitol used for?
What route must be used?
Acute situations only.
Why should nurses warm the vial prior to administering IV?
What should the nurse monitor and when should the Pt notify the provider?
The vial is warmed to room temperature to dissolve potential crystallization in the solution.
Monitor urine output - normal: 30-50 ml/h, BP, P, and assess for water intoxication.
Pt should report any swelling, SOB, angina.