Examine the side/adverse effects associated with administration of high ceiling loop diuretics.
Articulate the therapeutic uses associated with administration of high ceiling loop diuretics, thiazide diuretics, and potassium-sparing diuretics.
Loop diuretics - edema related to HF, liver diases and nephritic syndrome.
Thiazide diuretics -combination with ACE inhibitors to treat essentail HTN, edema to mild and moderate HF and hepatic/kidney disease
Potassium sparing diuretics - edema related to HF and those at risk for hypokalemia because it spares K+, primary hyperaldosteronism.
Express understanding of the side/adverse effects associated with administration of potassium-sparing diuretics.
Hyperkalemia - retaining potassium due to antagonist effect to aldosterone.
Correlate the medication effectiveness of durgs referred to as diuretics (high ceiling loop, thiazide, or potassium sparing).
Weight loss - fluid is being excreted therby weight is lost
B/P decreases - fluid volume is decreased thereby CO is decreased as well.
Breath sounds are clear indicating there is no pulmonary edema.
Peripheral edema will decrease.
Select appropriate therapeutic nursing interventions for patients receiving thiazide diuretics.
Monitor B/P and teach to change positions slowly - orthostatic hypotension
Obtain K+ baseline and monitor throughout therapy - hypokalemia.
Teach patient to take in the morning - nocturia.
Weight patient daily to evaluate effectiveness.
Monitor cardiac status via telemetry.
Teach to maintain adequate potassium intake.
Demonstrate understanding of the therapeutic uses associated with administration of osmotic diuretics.
Excretion of toxic substances
Specify therapeutic nursing interventions associated with administration of osmotic diuretics.
Use a needle filter due to possible formations of crystals
Obtainn usual diuretic baseline
Monitor S/S of HF related to medication regimen.
Point out the contraindications/precautions associated with administration of phosphate binders.
Pregnancy and breast feeding
Caution - GI disorders, GI surgery, and vitamin deficiency.
Recognize side/adverse effects of potassium supplements.
Hyperkalemia - muscle cramps, numbness and tingling arrhythmias and decrease urine output.
GI upsetness - diarrhea and esophageal ulceration.
Analyze appropriate therapeutic nursing interventions when administering potassium supplements.
Monitor K+ levels and S/S of hyperkalemia.
Monitor heart rhythm.
Teach do not push medicaton and dilute liquid medication to prevent ulceration.
Teach to avoid salt substitutes and excessive foods high in K+.
Monitor IV site for redness and swelling.
Monitor I & O.
Review side/adverse effects associated with administration of magnesium sulfate.
Neuromuscular blockade and respiratory depression.
Diarrhea - laxative effect.
S/S of magnesium toxicity: RR<12/min, absent deep tendon reflex, urinary output < 20 ml/hr.
Apply understanding of therapeutic uses associated with administration of sodium bicarbonate.
Acidosis r/t DM, cardiac arrest and vascular collapse.
Determine contraindication/precautions associated with administration of sodium bicarbonate.
Caution with HF, HTN, and kidney disease.
Summarize medication/food interactions associated with administration of calcium supplements.
Glucocorticoid steroids reduce absorption of this medication
Thiazide diuretics increase risk for hypercalcemia
Digoxin and calcium may lead to severe bradycardia
Tetracyclines and thyoid hormones absorption are decreased by this medication
Do not mix calcium with phosphates, carbonates, sulfates, and tartrates.
Compare and contrast expected pharmacological actions of selective estrogen receptor modulators (SERMs) and Bisphosphonates.
SERMS: bind to estrogen receptors to decrease bone resorption thereby slowing down bone loss, increasing lipid metabolism and blood coagulation. (note: does not affect endometrial lining of menstrual cycle)
Biphosphonates: reduces osteoclast number and activity to to decrease bone resorption leading a decrease in Ca+.
Analyze side/adverse effects associated with administration of bisphosphonates.
Osteonecrosis of the jaw with IV infusion
Hyperparathyroidism with high dose Diarrhea
Determine the expected pharmacological action associated with calcitonin-salmon
Decreases bone resorption by inhibiting osteoclast activity and increases Ca+, Na+ and phosphate by the kidneys.
ESSAY: List at least five therapeutic nursing interventions associated with the administration of bisphosphonates.
Maintain upright 30 min after administration
Instruct to take first thing in the morning with a full glass of water
Instruct patient to avoid any Ca+ containing foods or antiacids
Do not chew/suckmedication due to erosion
Teach to perform weight bearing exercise to promote bone density
Instruct to not take skipped dose
ESSAY: When administering Furosemide (Lasix), explain the rationale for the side/adverse effect of hypokalemia and list four nursing interventions associated with this specific side/adverse effect.
The reason the patient is at risk for hypokalemia is because this medication works in the ascending loop of henle and therby it decreases absorption of sodium/chloride and excretion of potassium.
i. Encourage the intake of potassium rich foods
ii. Monitor potassium level (3.5 – 5.0 mEq/L)
iii. Monitor EKG to detect electrolyte induced arrhythmias
iv. Instruct S/S of hypokalemia such as weakness, thread pulse, hypotension and general muscle weakness and notify PCP if they appear.
ESSAY: Describe at least five therapeutic nursing interventions associated with IV administration of potassium supplements.
Never give K+ bolus
Set IV rate at 10 mEq/hr and no more than 40 mEq/L
Discontinue IV if infiltration occurs
Maintain precise I & O documentation to ensure adequate urine output at 30 mL/hr.
Assess q 2 hrs IV site for phlebitis and irritation.
Monitor telemetry for cardiac arrhythmias related to hyperkalemia.