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Diuretics
- Uses: treat edema that involves fluid volume excess resulting from a number of disorders of the heart, liver, kidneys
- Contraindications:
- Pregnancy, breastfeeding
- severe adrenocortical impairment
- anuria (urine output of then 30 mL per/hr), progressive oliguria (urine output less then 300/500 mL per/day)
- Precautions:
- fluid and elecrtolyte depletion, gout
- clients taking digitalis, lithium, nonsteroidal antiinflammatory drugs (NSAID's), and other antihypertensive medications
- Side Effects:
- dehydration
- hyponatremia
- hypochloremia
- hypokalemia
- unusual tiredness, weakness, dizziness
- irregular heart beat, weak pulse, orthostatic hypotension
- tinnitus
- hyperglycemia
- hearing loss (lasix)
- Nursing implications:
- monitor for adequate intake and outut and potassium loss
- monitor client's weight and vital signs
- monitor for signs and symptoms of hearing loss, which may last from 1 to 24 hours
- teach client to take medication early in the day to decrease nocturia
- teach client to report any hearing loss or signs of gout
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Mannitol (Osmitrol)
- Classification: Osmotic diuretic
- Action: increases the osmotic pressure of the glomerular filtrate. The higher the concentration of mennitol in the filtrate, the more diuresis occurs
- Uses:
- Prevents, treats oliguric phase of acute renal failure
- reduces increased intracranial pressure caused by cerebral edema, decreases edema of injured spinal cord
- decreases intraocular pressure caused by acute glaucoma
- promotes excretion of toxic substances
- Contraindications:
- severe reanl disease
- dehydration
- intracranial bleeding
- severe pulmonary edema
- Precautions:
- cardiac failure
- pulmonary edema
- Side effects:
- blurred vision, dizziness, tachycardia, peripheral edema
- headache, nausea and vomiting, backache
- Nursing implications:
- check vital signs before administering the dose
- assess urinay output, hydration status, electrolytes (hypokalemia), blood urea nitrogen and renal and hepatic panels
- evaluate for symptoms of congestive heart failure and pulmonary edema
- intravenous (IV) medications may crystallize, need to warm to put into solution. Draw up medication with a filter needle and administer with an in-line filter to prevent any crystals from entering circulation
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Spironolaction (Aldactone)
- Classification: Potassium-sparing diuretic
- Action: competes with aldosterone for cell receptor sites in the distal tubules while inducing urinary excretion of sodium and reducing excretion of potassium and hydrogen ions
- Uses:
- treats hypertension and edema
- reduces edema in clients with severe heart failure
- Contraindications:
- hypersensitivity or renal failure
- anuria (non passage of urine, output of less then 30 mL per/hr)
- hyperkalemia
- Precautions:
- renal dysfunction
- Side effects:
- hyperkalemia, hyponatremia
- weakness
- dehydration
- hyperglycemia, hirsuitism (excessive hairiness), menstrual irregularities, gynecomastia (breast enlargement in men)
- impotence, deepening of voice
- Nursing implications:
- monitor intake and output, and watch for cardiac dysrhythmias
- monitor levels of electrolytes (e.g., potassium, sodium)
- teach client to report cramps, weakness, fatigue, or nausea
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Furosemide (Lasix)
- Furosemide (Lasix)
- Classification: Loop Diuretic
- Action: prevents the reabsorption of sodium and chloride in the loop of henle region of the nephron
- Uses:
- treatment of acute heart failure (because it has the ability to remove large amounts of fluid in a short period of time)
- hypertension
- edema
- Contraindications:
- hypokalemia
- Percautions:
- premature infants and neonates
- geriatric patients may require lower doses
- pregnancy category C
- Side effects:
- dehydration, hyponatremia, hypochloremia, hypokalemia
- unusual tiredness, weakness, dizzinesss
- irregular heart beat, weak pulse, orthostatic hypotension
- tinnitus, hyperglycemia, hyperuricemia, hearing loss
- Nursing indications:
- monitor adequate intake and output and potassium loss
- monitor client'a weight and vital signs
- monitor for signs and symptoms of hearing loss, which may last from 1 to 24 hours
- teach client to take medication early in the day to decrease nocturia
- teach client to report any hearing loss or signs of gout
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