Diuretics

Question 1

diuretics promote the _______ of water

Answer 1

net loss

Question 2

diuretics are the mainstays of treatment for _____ & ______

Answer 2

heart failure
&
hypertension

Question 3

another use of diuretics is _______, but you must ensure vascular space is in a ________.

Answer 3

reducing edema

deficit state

Question 4

stroke volume is directly affected by ________

Answer 4

diruetics

Question 5

patient history assessments for patients on diuretics

Answer 5

renal/hepatic/heart failure

HTN (hypertnesion)

urniation pattern

current diuretic regimen, including dosages

Question 6

patient physical assessments for patients on diuretics

Answer 6

same as ECV & electrolyte balance (hypokalemia for most diuretics)

daily weights

(2 pounds in 2 days is significant)

Question 7

for potassium sparing diuretics, you must watch out for ________

Answer 7

hyperkalemia

(palpitations, numbness/tingling, dyspnea, nausea/vomiting)

Question 8

Lab assessments for diuretics

Answer 8

RENAL!!! BUN, Creatinine (and Creatinine clearance)

Chest x-ray for pulmonary edema

Electrolyte panel (sodium/potassium)

Question 9

Electrolyte panel consists of

Answer 9

sodium
potassium
chloride
CO2 (a good indication of acidosis)

Question 10

basic metabolic panel has

Answer 10

BUN & Creatinine
as well as electrolytes

Question 11

comprehensive metabolic panel has

Answer 11

BUN & Creatinine
electrolytes
and
liver function

Question 12

Creatinine clearance indicates good ______ function

Answer 12

kidney

Question 13

normal eGFR is

Answer 13

> 60 mL/min

Question 14

normal creatinine

Answer 14

male 0.6-1.2 mg/dL
female 0.5-1.1 mg/dL

Question 15

increased BUN/creatinine ratio may be due to conditions that ________ blood flow to the kidneys

Answer 15

decrease

(for example, dehyrdration)

not getting enough volume to nephrons to perfuse the nephrons properly

Question 16

normal BUN/creatinine ratio

Answer 16

15:1

Question 17

dehydrated BUN/creatinine ratio

Answer 17

30:1

Question 18

normal potassium

Answer 18

3.5-5

Question 19

normal sodium

Answer 19

135-145

Question 20

nursing process implementation for diruetics

Answer 20

note potassium intake & type of diuretic prescribed

keep urinal and bedpan available

daily weights

fall risks (hypokalemia/muscle weakness, urgency, dcreased pre-load/orthostatic hypotension)

Question 21

1 liter of urine weighs

Answer 21

1 kg

Question 22

1 kg equals ____ pounds

Answer 22

2.2 pounds

Question 23

take diuretic in the _____ to prevent nocturia

Answer 23

morning

Question 24

furosemide is a

Answer 24

diuretic

Question 25

if there's a severe orthostatic vial sign change, do not administer ______

Answer 25

diruetics that's 20 systolic or 10 diastolic changes

Question 26

if potassium is low do we still give diuretics?

Answer 26

yes, but after we fix the potassium. call HCP

Question 27

too much diuretics could cause

Answer 27

hypotension instruct patients to rise slowly so they don't fall

Question 28

sulfonamide

Answer 28

loop diuretics uses: treatment for heart failure and hypertension also used for treating edema (as long as no vascular volume deficit) common adverse effects: dry mouth, orthostatic hypotension

Question 29

metolazone / zaroxolyn

Answer 29

thiazide helps with diuresis resistance important in patients with renal dysfunction, remains effective for creatinine clearance as low as 10 mL/min given sympotmatic (moderate to severe) heart failure oral form only most effective: give 30 minutes before IV loop diruetics uses: treat edema, maybe first choice for hypertension common adverse side effects: orthostatic hypotension (similar to loops : hypotension, hypokalemia, hyperglycemia, hyperuricemia, cholesterol) interactions: digoxin, lithium, NSAIDs, hypertensive agents

Question 30

spironolactone / Aldactone triamterene / Dyrenium

Answer 30

potassium-sparing diuretics actions: induce retention of potassium, and excrete sodium at distal tubules uses: combo with thiazides to lessen hypokalemic effects, and for certai ntypes of edema, namely ascites adverse effects: electrolyte imbalance, HYPTERKALEMIA drug interactions: ACE inhibitors, ARBs my increase risk for HYPERKALEMIA check for potassium supplements and salt substitutes

Question 31

combination diuretics are usually

Answer 31

thiazides and potassium-sparing

Question 32

acetazolamide / Diamox

Answer 32

carbonic anhydrase inhibitor weak diuretic used mostly for glaucoma (decreases intraocular pressure), but can also help excrete bicarb for alkalosis

Question 33

salt substitutes often contain

Answer 33

potassium

Question 34

ascites is a ______ spacing

Answer 34

third spacing the accumulation of fluid in the peritoneal cavity can't escape reduces the amount of fluid available for normal physiologic functions cirrhosis is the most common cause, but has other causes: decreased synthesis of albumin by the liver and fluid retention

Question 35

postural hyotension and reduced sesrum albumin levels cause capillary hydrostatic pressure to _______ capillary osmotic pressure

Answer 35

exceed the imbalance pushes water into the peritoneal cavity

Question 36

postural hypotension also increases the production of hepatic ______, which weeps into the peritoneal cavity

Answer 36

lymph

Question 37

spironolactone/ hydrochlorothiazide (Aldactazide) triamterene/ hydrochlorthiazide (Dyazide, Maxzide)

Answer 37

combination diuretics action: same as potassium sparing diuretics/thiazide diuretics use: promote diuresis & maintain normal potassium levels common adverse effects: hyperkalemia, hyponatremia

Question 38

for diuretics, make sure to pay attention to the vascular space, especially when there's a _______ or a _______ problem

Answer 38

an albumin problem or a nutrition problem

Question 39

hypouricemia is

Answer 39

low levels of uric acid in the blood / can lead to gout a side effect of loop diuretics