Summary Nur 210 Exam 3 Study Guide

Exam 3 NUR 210

Diuretics:

Hydrochlorothiazide (HCTZ) (Assessment, interventions, and teaching at the end)
 Action:
o Promotes NA, K, and water excretion
o Acts on distal convoluted renal tubule

 Uses:
o Treat hypertension
o Edema from heart failure
 Side effects:
o Dizziness, headache, weakness
o GI distress
o Photosensitivity
 Adverse reactions:
o Fluid and electrolyte imbalances
o Hyponatremia
o Hypotension, orthostatic hypotension
o Hyperglycemia
o Hypokalemia
o Dysrhythmias
 Contraindications:
o Renal failure
o Electrolyte depletion
o Sulfonamide allergies
o Caution: Hepatic dysfunction, diabetes mellitus
 Interactions:
o Increased digoxin toxicity with hypokalemia
o Anti-diabetic drugs: results in hyperglycemia
o Steroids: increased potassium loss
Furosemide (Lasix)
 Action:
o Inhibits water and sodium reabsorption, potassium, magnesium and calcium are also
excreted
o Act on ascending loop of henley
 Uses:
o Treat fluid retention caused by heart failure
o Renal dysfunction
o Cirrhosis
o Hypertension
o Pulmonary edema
 Side effects:
o GI distress
o Dizziness

, o Weakness
o Photosensitivity
 Adverse reactions:
o Fluid and electrolyte imbalances
o Hypokalemia
o Orthostatic hypotension, hypotension
o Hyperglycemia
o Hearing loss-when IV pushing too fast
 Contraindications
o Severe electrolyte imbalance
o Hypovolemia
o Allergy to sulfa drugs
o Caution: heart failure + diabetes
 Interactions:
o Anticoagulants (increased bleeding)
o Steroids (increased K loss)
o Digoxin toxicity: increased with hypokalemia
Mannitol
 Action:
o Causes water, sodium, chloride, potassium to be excreted through the kidneys
 Use:
o Decrease intracranial pressure/cerebral edema
o Decrease intraocular pressure
o Promote excretion of toxic substances
o Most often used in as an emergency medication
 Side effects:
o GI upset
o Fluid and electrolyte imbalance
 Adverse reactions:
o Pulmonary edema from rapid shift of fluids
o Tachycardia from rapid fluid loss
o Rapid fluid loss, acidosis
 Extreme caution:
o Heart disease and heart failure
o Renal failure
Spironolactone
 Action:
o Blocks action of aldosterone
o Because of the blocking aldosterone, the renal tubules promote sodium and water
excretion and potassium retention
o Also excretes magnesium, calcium-can increase blood glucose
 Uses:
o Heart failure
o Hepatic cirrhosis
 Side effects:
o GI distress, dizziness, weakness

, o Erectile dysfunction
 Adverse reaction:
o Orthostatic hypotension, hypotension
o Fluid and electrolyte imbalance
o Hyperkalemia
o Stevens-Johnson Syndrome
 Contraindications:
o Severe kidney/renal disease
o Hyperkalemia
 Interactions:
o Potassium supplements
o ACE inhibitors and angiotensin 2 receptor blockers-increased hyperkalemia
o Salt substitutes containing potassium




Diuretics Assessment:
- Medication/medical history
- Vital signs
- Fluid and electrolyte levels, weight, edema
- Renal/hepatic function
- Allergies
Diuretics Interventions:
- Monitor I & O, daily weight
- Notify HCP if urine output does not increase
- Monitor VS- Blood pressure
- Administers IV furosemide slowly
- For potassium wasting watch for signs and symptoms of hypokalemia
- For potassium sparing watch for signs and symptoms of hyperkalemia
- Monitor electrolyte levels
- Monitor glucose periodically
- Patient safety-falls
Diuretics Teaching:
- Take BP before dose
- Weigh self daily-report gain of 2 lbs overnight or 5 lbs in a week, weight gain of 2.2
pounds is equivalent to one excess liter of body fluids
- Take medication in the morning
- Ok to take with food if GI upset occurs
- Stay out of the sun with photosensitivity
- Teach to get up slowly
- Reinforce need for medication and compliance
- Diet- potassium wasting- increase potassium, potassium supplements, if patient is on
digoxin, especially important
- Diet- potassium sparing- decrease potassium
- Teach that drugs can increase glucose so HCP will monitor blood glucose