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Drug Therapy for Fluid Volume Excess Flashcards

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1
Q

Anasarca

A

generalized massive edema

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2
Q

Anuria

A

no urine output (don’t give this person a diuretic)

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3
Q

Ascites

A

fluid overload in the abdomen

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4
Q

Edema

A

General medical term for swelling

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5
Q

Dependent Edema

A

dependent on the lowest point in the body. Feet and fingers.

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6
Q

Extracellular Fluid

A

Fluid outside of the cells

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7
Q

Intracellular Fluid

A

Fluid inside the cell

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8
Q

Renal Physiology

A

Kidneys, Ureters, Bladder, Urethra

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9
Q

Primary Function of Kidneys

A

Regulate Volume (how much fluid to get rid of)
Composition of Urine (how many electrolytes we are going to keep)
Regulate pH (How many H+ ions we are going to eliminate)
Eliminating Wastes (medications, diet)
BP Regulation

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10
Q

RAAS System

A

increases perfusion through the kidneys and makes red blood cells through erythropoietin production

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11
Q

RBC Production effect on BP

A

Increase

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12
Q

Vitamin D Conversion

A

maintain strong bones

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13
Q

Amount of Output the Kidney’s receive

A

receive 25% of cardiac output

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14
Q

Renal Capsule

A

the fibrous protection around the kidney to protect it because a bunch of blood is flowing through it

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15
Q

Regions of Kidney

A

Cortex, Medulla, Renal Pelvis

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16
Q

Cortex

A

we are going to see part of the nephron

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17
Q

Nephron

A

functional unit of the kidney. One million nephrons in each kidney

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18
Q

Medulla

A

middle layer that contains the loop of Henle and collecting ducts

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19
Q

Renal Pelvis

A

takes newly made urine and makes it ready to go to the bladder

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20
Q

Nephron Functions

A

Glomerular Filtration
Tubular Secretions
Tubular Reabsorption

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21
Q

Glomerular Filtration

A

filters out things that are good and need to stay in the body (protein, Na, K)
First stop of the blood coming into the kidney

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22
Q

Tubular Secretions

A

things that are secreted out with your urine

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23
Q

Tubular Reabsorption

A

things that your body is reabsorbing for you to use again

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24
Q

bowman’s capsule

A

Blood comes in from the aorta into the glomerulus under high pressure

Under the high pressure, it pushes water, electrolytes, and other solutes out into bowman’s capsule which is like a catchers mitt

Bowman’s capsule pushes it down through the tubules where the urine is made

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25
Glomerular Filtration Rate:
How fast the glomerular is able to filter your blood! The faster the better 125 ml/min is normal 2L of secretion is normal
26
Conditions requiring Diuretic Agents:
Alterations in renal function (GFR) Renal Cardiovascular Hepatic Burns Trauma Allergies Inflammatory Reactions
27
Reasons for Swelling
Increased Capule Permeability Increased hydrostatic pressure Decreased Plasma Oncotic Pressure
28
Decreased Plasma Oncotic Pressure
result from low plasma protein which are responsible for holding on to fluids and keeping them where they should be.
29
Increased hydrostatic pressure
increase blood volume causing high venous pressure. So much volume on the inside that the body tries to push it to the outside
30
Increased Capule Permeability
Part of the response to inflammatory or allergic reactions. Capillaries grow to allow for more blood to flow through
31
Clinical manifestations
Edema Alterations in fluid Electrolyte Imbalance Dependent Edema Pulmonary Edema Anasarca
32
Diuretics
Treatment for Edema: increase urine output and increase urine formation
33
Loop Diuretic Examples
Furosemide, Bumetanide, Torsemide
34
Loop Diuretic: Pharmacokinetics
PO, IV, IM. This is the strongest diuretic. Not K+ sparing
35
Loop Diuretic Action:
Inhibit the Na+ and the Cl- reabsorption. Work in the ascending loop of Henle If we stop the Na+ from going back into the body, we are going to stop the H2O from going back into the body as well!
36
Loop Diuretic Use
Acute conditions of Renal Failure Management of pulmonary edema, CHF, Hepatic and Renal Disease Given alone or in combination with HTN Patients w/ renal impairment Patients with hepatic impairment Critically ill patients Home care patients
37
Loop Diuretics Adverse Effects
fluid and electrolyte imbalance Hypokalemia Fluid volume deficit Ototoxicity
38
Loop Diuretic Drug-Drug Interactions
Aminoglycosides Cephalosporins Corticosteroids Digoxin
39
Loop Diuretic Considerations
**Slow push: 20mg/min Check Labs Baseline weight and daily weight Accurate I+O Closely monitor Vitals, watch for hypotension GIve PO in AM Monitor safety r/t dizziness
40
Loop Diuretic Diet
Low sodium High K diet Record daily weight
41
Thiazide + Thiazide-like diuretics Examples
Hydrochlorothiazide (HCTZ) Metolazone (thiazide-like)
42
Thiazide Route and Class
Given PO. Not as strong so it is good for home management. Works in distal convoluted tube
43
Thiazide Action
Decreases reabsorption of Na+, H2O, Cl-, HCO3
44
Thiazide Use
First line of treatment for mild-moderate HTN Edema associated with CHF or nephrotic syndrome Patients with renal impairment
45
Thiazide Adverse Side Effects:
+Hypotension Weakness +Dizziness Diarrhea/constipation Hypokalemia *Hyperglycemia
46
Thiazide Considerations
Check labs for electrolytes and glucose Baseline weight and daily weight Accurate I+O Closely monitor vitals and watch for hypotension Give in the AM Monitor safety r/t dizziness
47
Thiazide Patient Teaching
Low sodium diet High k+ diet Record daily weight Change position slowly Take in the morning
48
Hypokalemia
below 3.5
49
Hypokalemia S/SX
Confusion GI upset Heart arrhythmias Death
50
Potassium Sparing Diuretics Example
Spironolactone
51
Potassium Sparing Diuretics Pharmacokinetics
Slow onset and peak 24-48 hours 6 week for maximum effect Long term treatment
52
Potassium Sparing Diuretics Action
Block effects of aldosterone (in the RAAS system) Weak diuretic effect Use in combination with other diuretics
53
Potassium Sparing Diuretics Use
*treatment of heart failure *ascites in liver disease Hypokalemia Mild-moderate HTN *hyperaldosteronism (high aldosterone)
54
Potassium Sparing Diuretics Adverse Effects
Adregen (having to do with the male sex hormone) like effects Alginomastia: breast tissue growth in males Irregular periods in women
55
Potassium Sparing Diuretics Black Box Warning:
Increased risk of tumors if built up in the body
56
Potassium Sparing Diuretics Contraindications:
Renal insufficiency Hyperkalemia Drug interactions: ACE-1, ARBs, K+ containing drugs
57
Spironolactone Nursing implications
Check K+ levels Check Kidney levels Accurate I+O Monitor for safety and dizziness
58
Spironolactone Teaching
Avoid salt substitutes Low K Diet Record daily weight Monitor abd girth Change positions slowly Take with morning food
59
Hyperkalemia
K+ level above 5
60
Hyperkalemia S/sx
Muscle cramps EKG changes Heart arrhythmias Death
61
Osmotic Diuretics Example
Mannitol (Emergency Med)
62
Osmotic Action
Increases solute load (osmotic pressure) of glomerular filtrate Pulls fluid into the blood stream and blocks reabsorption Pulls from extravascular into blood Decreases reabsorption of H2O and electrolytes
63
Osmotic Use
Reduction of intracranial pressure Reduction of intraocular pressure Effective in decreased renal circulation and GFR
64
Osmotic Adverse Effect
Hyperosmolar nonketotic coma Confusion Headache Syncope Cardiac dysrhythmias Severe dehydration
65
Osmotic Contraindications
Severe dehydration Abdominal pain Appendicitis Pulmonary edema Severe cardiac decompensation Older adults
66
Osmotic Nursing Implications
Comes in a glass bottle and is given IV Baseline vitals and physical examination Accurate I+O Closely monitor vitals
67
Osmotic Antidote
Hyaluronidase *Osmotic Diuretics are toxic if they infiltrate
68
Carbonic Anhydrase Inhibitors Examples
Acetazolamide
69
Carbonic Anhydrase Inhibitors Action
Inhibits carbonic anhydrase to reduce formation of aqueous humor and lower IOP
70
Carbonic Anhydrase Inhibitor Uses
Open-angle glaucoma Secondary glaucoma
71
Carbonic Anhydrase Adverse Effects
Metabolic Acidosis Stephen johnson syndrome Flaccid paralysis Blood dyscrasias
72
Carbonic Anhydrase COntraindicated
Non-congested angle-glaucoma (getting rid of fluid wont help non-congested…) Addison’s disease Electrolyte imbalance
73
Carbonic Anhydrase Nursing implications
Baseline vision exam Eye gtts administration IV or Eye drops

Nursing (17 decks)

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