Genitourinary; Diuretics; Fluid & Electrolyte Treatments Flashcards by Kelsey Klipfel

relax smooth muscle bladder; inhibits/blocks effects of acetylcholine (blocks PNS - affects ANS: decreases urination)

Actions: - Urinary Tract Antispasmodics/Anticholinergics: Prototype: Oxybutynin

How well did you know this?

Not at all

Perfectly

Bladder spasm, overactive bladder - urinating at times not want to

Indications: - Urinary Tract Antispasmodics/Anticholinergics: Prototype: Oxybutynin

How well did you know this?

Not at all

Perfectly

Oral

Route/dose: - Urinary Tract Antispasmodics/Anticholinergics: Prototype: Oxybutynin

How well did you know this?

Not at all

Perfectly

exacerbate effects - GI obstruction, obstructive urinary tract problems (BPH), myasthenia gravis

Contraindications: - Urinary Tract Antispasmodics/Anticholinergics: Prototype: Oxybutynin

How well did you know this?

Not at all

Perfectly

Multiple! Check drug reference prior to admin.; any other drug with anticholinergic effects: diphenhydramine; exacerbate AE

Drug/Drug: - Urinary Tract Antispasmodics/Anticholinergics: Prototype: Oxybutynin

How well did you know this?

Not at all

Perfectly

related to blocking PSNS receptors in many places (anticholinergic effects - systemic AE) - Drowsiness, dizziness, blurred vision, tachycardia, dry mouth, nausea, urinary hesitancy, constipation, decreased sweating

AE: - Urinary Tract Antispasmodics/Anticholinergics: Prototype: Oxybutynin

How well did you know this?

Not at all

Perfectly

Assess urinary patterns - is drug being effective, AE

Nursing: - Urinary Tract Antispasmodics/Anticholinergics: Prototype: Oxybutynin

How well did you know this?

Not at all

Perfectly

Maintenance of volume and composition of body fluids
Blood pressure control
Regulation of red blood cell production
Regulation acid-base
Electrolyte stability

Review renal funcs

How well did you know this?

Not at all

Perfectly

Sodium regulation
Done through use of Na - water follows
Try to increase amount fluid volume excreted through kidneys - increase urination

Maintenance of volume and composition of body fluids

How well did you know this?

Not at all

Perfectly

RAAS
Stimulation of RAAS sys
First line treatment HTN: thiazide diuretic: lower BP

Blood pressure control

How well did you know this?

Not at all

Perfectly

Erythropoietin

Regulation of red blood cell production

How well did you know this?

Not at all

Perfectly

Glomerulus - first part; checks and balances along way then get to end where sent down ureters and sent to bladder
Thiazides
Loop
Osmotic
Potassium-sparing
Matters where work - signifies potency of diuretic and understand diff actions of diuretic

Diuretics: sites of action

How well did you know this?

Not at all

Perfectly

Hydrochlorothiazide
Distal tubules

Thiazides

How well did you know this?

Not at all

Perfectly

Furosemide
Ascending loop of Henle

Loop

How well did you know this?

Not at all

Perfectly

Mannitol
Proximal tubule

Osmotic

How well did you know this?

Not at all

Perfectly

Spironolactone
Collecting duct

Potassium-sparing

How well did you know this?

Not at all

Perfectly

Act on kidneys to increase urine output - end result/goal

Mechanism of Action: - Diuretics: gen overview

How well did you know this?

Not at all

Perfectly

Hypertension (reduce/decrease intravascular volume; getting more fluid off) - hydrochlorothiazide
Fluid overload/edema apparent (heart failure, pulmonary edema, kidney/liver failure [ascites; peripheral edema])
Hyperkalemia (remove excess K) - treat high K levels because have K loss with admin

Indications for diuretics (see slides for specifics): - Diuretics: gen overview

How well did you know this?

Not at all

Perfectly

GI effects (n/v/d)
Hypotension - acting on kidneys to get rid extra fluid and done too much get rid too much fluid on any diuretics this can occur
Dehydration (fluid volume deficit) - get rid too much fluid will get dehydrated
Fluid and electrolyte disturbances - hypo/hyper vary with diuretics: Sodium and potassium (mainly messed with)
Fluid rebound

Diuretics: gen AE

How well did you know this?

Not at all

Perfectly

Occurs with patients on diuretics do not take in adequate water
Have too much fluid but if not enough fluid with therapy plasma more concentrated because less water in bloodstream so changes osmolarity blood to make more concentrated
Decrease fluid intake to decrease trips to bathroom
Results in concentrated plasma of smaller volume
Decreased volume is sensed by nephrons/kidneys, which activate RAAS cycle - need no more blood flow so activate RAAS: increase BP and intravascular volume - which body not need; when activated - ADH released - exacerbate prob; body hold onto more fluid exacerbating prob of fluid overload
Still have drink adequate amounts water even if on diuretics
Concentrated blood is sensed by osmotic center in brain, ADH is released to hold water and dilute the blood - hormones cause hang onto more water
Not want drink as much water then not pee as much but make prob worse; but actually make probs worse
Result in “rebound” edema as fluid is retained
2-3 L/day; prob when quit drinking

Fluid rebound explained

How well did you know this?

Not at all

Perfectly

Pregnancy/lactation - gen avoided/contraindicated in this scenario
Severe renal failure - some diuretics not work appropriately if not have functioning kidneys; do not give diuretics because not work as well and can worsen kidney disease
Hypotension - AE
Dehydration - AE

Diuretics: gen contraindications

How well did you know this?

Not at all

Perfectly

Digoxin: Increased potassium (K+) loss may occur - K-wasting (lose K); monitor K closely
Anticoagulants, antidiabetic drugs: reduced effectiveness
Lithium: Increased risk of toxicity because way works and impacts Na

Drug-Drug - Diuretics: gen contraindications

How well did you know this?

Not at all

Perfectly

inhibits reabsorption of NaCl in distal tubule kidneys - inhibiting reabsorption of Na not get into bloodstream which means keep more water in tubule so more water excrete; remains in tubule for excretion (water follows Na); happening later in renal tubule where less Na exchange so so more gentler/milder diuretic

MoA: - Thiazide Diuretics: Prototype: Hydrochlorothiazide (HCTZ)

How well did you know this?

Not at all

Perfectly

First line treatment for HTN - milder diuretic which need for someone who has HTN; not want pull off lots fluid; need little impact on volume

Indications: - Thiazide Diuretics: Prototype: Hydrochlorothiazide (HCTZ)

How well did you know this?

Not at all

Perfectly

oral

Route/dose: - Thiazide Diuretics: Prototype: Hydrochlorothiazide (HCTZ)

Allergy to sulfa drugs - chem properties to sulfa and how formulated

Contraindications: - Thiazide Diuretics: Prototype: Hydrochlorothiazide (HCTZ)

SEE GENERAL; photosensitivity; hypokalemia - some exchanges electrolytes and diff pumps so as causing keep more Na in renal tubules + electric charge so is K - keep electric charges sim so increase excretion of K - so charges = so can lose K: risk is lower risk

AE: - Thiazide Diuretics: Prototype: Hydrochlorothiazide (HCTZ)

SEE GENERAL; use sunscreen

Nursing: - Thiazide Diuretics: Prototype: Hydrochlorothiazide (HCTZ)

inhibits reabsorption of NaCl in loop of Henle which causes a greater degree of diuresis than other diuretics (water follows Na) - typ more Na exchange in body so by using in this location more potent effect; inhibit reabsorption of NaCl so more Na and water in renal tubule so more excreted in urine so get more fluid off; secondary effects: vasodilation reducing preload and BP

MoA: - Loop Diuretics: Prototype: Furosemide (Lasix)

Conditions of/for fluid overload: HF, liver failure, kidney probs: not able do job effectively to help maintain fluid balance to make up for work of kidneys that other nephrons cannot do since died out; hyperkalemia - sig K loss: lower blood K and if on it automatically K replacements to correct

Indications: - Loop Diuretics: Prototype: Furosemide (Lasix)

oral; IVP (slow IV push rate: 20 mg/min); may be given IM or as IV gtt

Route/dose: - Loop Diuretics: Prototype: Furosemide (Lasix)

See general; ototoxic drugs; sulfa allergy

Contraindications: - Loop Diuretics: Prototype: Furosemide (Lasix)

See general; hypokalemia - dump out lot K with diuretic; CNS effects: paresthesia, ototoxicity (IVP slowly to prevent - more likely occur with IV)

AE: - Loop Diuretics: Prototype: Furosemide (Lasix)

See general; potassium supplements; IV fall risk - given IVP med works quickly (10-20 min) need go badly - figure out how go bathroom safely so not risking fall, think ahead so have things available so not fall; PO will have go but not as potent when PO and not go as quickly and as much of fall risk

Nursing: - Loop Diuretics: Prototype: Furosemide (Lasix)

aldosterone antagonist (norm action: reabsorp Na into bloodstream so lose K); blocks action of aldosterone in the distal tubule: loss of Na (leave more in renal tubule) & increased retention of K - K exchanged so have the potential for hyperkalemia

MoA: - Potassium-Sparing Diuretic: Prototype: Spironolactone

Conditions of fluid overload (CHF and liver disease)

Indications: - Potassium-Sparing Diuretic: Prototype: Spironolactone

Oral

Route/dose: - Potassium-Sparing Diuretic: Prototype: Spironolactone

See general

Contraindications: - Potassium-Sparing Diuretic: Prototype: Spironolactone

hyperkalemia (weakness, cardiac arrhythmias, n/v/d); photosensitivity; androgen effects - blocks androgen like hormones - secondary effect of blocking those: impotence, hirsutism, irregular menses, gynecomastia

AE: - Potassium-Sparing Diuretic: Prototype: Spironolactone

see general; EXCEPTIONS: monitor for high K - not low; Teach: avoid high K foods, use sunscreen

Nursing: - Potassium-Sparing Diuretic: Prototype: Spironolactone

increases osmolarity of glomerular filtrate (mannitol: sugar molecule - filtered into bowman’s gapsule and renal tubule which pulls more water into renal tubule to dilute out renal tubule - all sugar pulls water to dilute out all sugar); inhibits reabsorption of water and electrolytes and increases urinary output; Profound and rapid diuresis; effect all along the way; increases osmolarity of blood - wants bring to baseline so moves water from cells into bloodstream

MoA: - Osmotic Diuretics: Prototype: Mannitol

reduce intracranial pressure of cerebral edema because large fluid shifts and rapid initial diuresis; swelling neurons - move fluid from brain tissues into vascular space then fluid moved out through kidneys; shifting lot fluids in quick way and if shift lot fluids in cellular spaces into vascular spaces in CHF - give more fluid deal with because exacerbates prob; cannot deal with fluid shifts

Indications: - Osmotic Diuretics: Prototype: Mannitol

IV only - into bloodstream

Route/dose: - Osmotic Diuretics: Prototype: Mannitol

Can worsen edema; used with caution; pul. edema, renal failure, CHF, stroke…exacerbated by the large shifts in fluid

Contraindications: - Osmotic Diuretics: Prototype: Mannitol

hypovolemia - potent diuretic so can lose lot volume: not want do too much (hypotension, light-headedness, confusion, headache, electrolyte imbalance….cardiac decompensation and shock)

Adverse effects: - Osmotic Diuretics: Prototype: Mannitol

see general; monitor VS closely

Nursing: - Osmotic Diuretics: Prototype: Mannitol

Which assessment should the nurse prioritize prior to the administration of a diuretic? A.Blood pressure B.Weight C.Lung sounds D.Renal function

Answer: A Potential cause most harm fastest Check BP before give diuretic; because if not adequate cont go down; most harm quickly Monitor weight - esp if CHF - track effectiveness of diuretic Lung sounds - listen to esp if for pulm edema/CHF; altered with conditions of fluid overload Renal func - imp can affect the kidneys; Want look at kidney func - look over long-term Most sig to avoid AE is BP Rationale: The nurse must take a blood pressure prior to administering any diuretic! Excessive fluid loss may result in hypotension. See notes for more.

H&P; allergies, contraindications; monitor kidney function - can give if have kidney impairment but can cause kidney injury - see if therapy appropriate; pats with CHF not perfused kidneys as well; end up with CKD Focused assessments: depends on diuretics; depends on why giving meds VS (hypotension = poor perfusion = symptomatic; make sure stable because not want drop too much); Rapid weight gain or loss (fluid balance - weight gain: acute CHF, weight daily to ensure losing the fluid) I&O (fluid overload/dehydration) - tracking output imp for those on diuretic; make sure therapy effective - not see increase not having desired effect because trying get off excess fluid Labs:

Nursing: assess and monitor

Decreased potassium (except K-sparing: increase K) Decreased sodium - all except really with mannitol; lot less likely than K issues with diuretics Increased serum uric acid (decreased excretion - higher risk for development gout - imp if already high risk or lot episodes of it) Increased blood glucose levels (long-term use - not monitor routinely) - change in K keeps glucose out of cells; look at if one for years Decreased kidney function - some DC if renal issues

Labs:

Weigh daily on same scale, same clothes, and at same time each day - esp imp for CHF - not gaining fluid too quickly Monitor blood pressure (hypotension) - esp if outpat; get BP before admin med inpat Potassium supplements as ordered (OR avoid potassium) - K loss predictable and almost have it; good tell why - understand imp on it Maintain fluid intake to prevent fluid rebound or dehydration Take diuretics in AM if possible so not going all night long Change position slowly - can experience orthostatic hypotension - not fall Adverse effects and when to notify PCP: hypotension, abnormal K level CM

Nursing: teaching

Teach aggravating factors fluid loss (diarrhea, vomiting, or excessive heat and sweating) - imp; adequate intake S&S of fluid deficit/electrolyte imbalance or other AE to report - careful when may have extra fluid loss; fluid rebound, lower BP; ill, excessive sweating - may need to be held

Maintain fluid intake to prevent fluid rebound or dehydration

Which diuretics may cause hypokalemia? Select all that apply. A.Mannitol B.Spironolactone C.Furosemide D.Hydrochlorothiazide

Answer: A, C, D Some K loss with mannital and HCTZ - less severe than loop diuretics; not always see HCTZ on K replacement like loop diuretics: loss is milder; mannitol: lose K and Na Spironolactone - K-sparing Rationale: Spironolactone works by blocking aldosterone, thus causing an increase in serum potassium.

The medical-surgical nurse is planning care for a client taking furosemide who was admitted with acute congestive heart failure. The nurse should plan for which expected outcome? A.The client’s potassium level will decrease to 3.2 mEq/L. B.The client’s weight will decrease by 9 pounds in 2 days. C.The client’s urinary output will be 500 mL per day. D.The client’s blood pressure will be 95/65 mmHg.

Answer: B CHF and taking furosemide; which expected outcome: what want to happen with admin: goal for pat: get fluid off; weight down quickly cause getting extra fluid off 3.2 is an AE - might happen: goal for pat is not hypokalemia Urinary output: want to increase; not enough BP: 95/65: lower end: not planning for someone to become hypotensive Rationale: the client needs to excrete excess fluid to decrease the workload on the heart. Weight loss will occur with fluid loss which is one way to assess effectiveness of the medication.

Adult total body water 50%-60% of body weight Continuous exchange across semipermeable membranes (SPM) between intracellular and extracellular compartments Can manipulate movement of water - IVF Intracellular fluid (ICF) 70% Extracellular fluid (30%)

Compartments of fluid in the body

Intravascular - plasma Interstitial fluids

Extracellular fluid (30%)

measure of solute concentration “Pulling power” In body fluids, 3 solutes determine osmolarity: Sodium, glucose, urea Normal osmolality is 275–295 mOsm/kg Greatest contributor is sodium: Sodium controlled by hormone aldosterone

Osmolarity

ability of solution to cause change in water movement across membrane due to osmosis Tonicity of plasma used as a reference point: Plasma is isotonic; remains in intravascular space Depends on Na composition

Tonicity

same concentration of particles as plasma Stays in intravascular space IV fluid same concentration as plasma Not cause movement of water Not change osmolarity of blood

Isotonic—

greater concentration than plasma Water will move out of cells into solution (shrink) Greater tonicity than osmolarity of the blood

Hypertonic—

lesser concentration than plasma Fluid moves from extracellular compartments into cells (swell) IV fluid lower tonicity than osmolarity of the blood Causes shift of water

Hypotonic—

Increase: fluid volume deficit (dehydration) Decrease: fluid overload (dilution); massive blood loss

Hemoglobin and Hematocrit - Diagnostics: lab studies for fluid imbalance

Increase: dehydration or impaired renal function Decrease: fluid overload

BUN (blood urea nitrogen) (8-20 mg/dl) - Diagnostics: lab studies for fluid imbalance

Increase: renal failure

Creatinine (0.6-1.2mg/dl) - Diagnostics: lab studies for fluid imbalance

Increases: dehydration Decreases: fluid overload measure concentration of urine

Specific gravity: (1.010-1.025) - Diagnostics: lab studies for fluid imbalance

IV solutions with electrolytes; given IV - given into bloodstream; increase vascular volume - put fluid into vein increasing vascular fluid; causes shift of fluid Used to replace fluids and promote urine output Capable of leaving vascular space and moving to interstitial spaces and intracellular fluid Infusions increase total fluid volume but compartment most expanded depends on solute (sodium) concentration

IV fluids: crystalloids

Isotonic: Normal saline (0.9% (NaCl)) Hypertonic: 10% Dextrose (D10W); 3 % NaCl Hypotonic: 0.45% NaCl (1/2 strength saline/NS)

Infusions increase total fluid volume but compartment most expanded depends on solute (sodium) concentration

Expands vascular fluid volume with no shifts in compartments No shift/movement of water Not change osmolarity of blood Uses: AE: fluid overload HTN - staying in vascular space and given too much Examples:

Isotonic IV fluids

Isotonic fluid volume deficient (hydration) Expands volume (ECF) to correct hypotension

Uses: - Isotonic IV fluids

Normal saline (0.9% NaCl): Sometimes abbreviated NS Lactated ringers (LR) 5% dextrose in water (D5W)

Examples: - Isotonic IV fluids

Concentrate blood with more Na: water moves from cells and tissues into bloodstream to dilute it out; bring osmolarity back to baseline by taking water from cells and tissues Expands plasma volume by drawing water away from cells and tissues Helps dilute out all Na to get osmolarity backt to norm to get back to vascular space Uses: AE: excessive expansion of intravascular compartment (plasma); fluid overload and hypertension; overload vascular space: HTN, other signs of fluid overload Examples:

Hypertonic IV fluids

Hyponatremia Cerebral edema - common use

Uses: - Hypertonic IV fluids

3% Normal saline/NaCl (3% NS) - saltier; more concentrated than blood

Examples: - Hypertonic IV fluids

Lower osmolality than the blood; water moves from blood into cells; lower concentration - get osmolarity back to baseline Water moves out of vascular space to cells (ICF) Use: hypernatremia and cellular dehydration AE: depletion of intravascular compartment and consequential hypotension AE: too much expansion of intracellular compartment (peripheral edema) - low BP; expanding cells too much Example:

Hypotonic IV fluids

0.45% NaCl (1/2 NS) Less concentrated with Na Give this IV fluid and already diluted and put in bloodstream diluting bloodstream - take water from bloodstream to get osmolarity back to baseline so water moves from vascular space to cells to get rid excess water because want certain osmolarity

Example: - Hypotonic IV fluids

Molecules too large to easily cross capillary membrane - not leave vascular space and draws water into vascular space Draw water from intracellular fluid and interstitial spaces into plasma Examples:

IV therapy: colloids

Stay in intravascular space & rapidly expand plasma volume

Molecules too large to easily cross capillary membrane - not leave vascular space and draws water into vascular space

5% Albumin - responsible for holding fluid in vascular space Trauma (major blood loss) Ascites (cirrhosis of liver - liver disease; not synthesizing albumin - replace what not have to help draw fluid from periphery back to vascular space; never synthesize albumin not correct underlying prob so short fix for pats)

Examples:

Transmission of nerve impulses, cardiac contraction, renal function, intracellular ion maintenance

Action: - Electrolyte replacement: Prototype: Potassium chloride

Prevention and treatment of hypokalemia; replace K

Indication: - Electrolyte replacement: Prototype: Potassium chloride

PO, IV

Route: - Electrolyte replacement: Prototype: Potassium chloride

Hyperkalemia (too much K): n/v/d, GI cramping, bradycardia, cardiac arrest

Adverse effects: - Electrolyte replacement: Prototype: Potassium chloride

Utilize electrolyte replacement protocol - admitted and ordered if pat admitted; in place - not have call for orders Throughout administration monitor for: Teach patient:

K chloride: nursing considerations - Electrolyte replacement: Prototype: Potassium chloride

Oral administration preferred Follow dosing and lab draw times

Utilize electrolyte replacement protocol - admitted and ordered if pat admitted; in place - not have call for orders - K chloride: nursing considerations

Cardiac abnormalities (tele not required) - potential; hyperkalemia is a potential Vein phlebitis (if intravenous) - burning at IV site; caustic to veins: slow down rate; can give through peripheral IV - use central line if can

Throughout administration monitor for: - K chloride: nursing considerations

Increase intake of high K+ foods if suffering from hypokalemia Do NOT break, crush or chew ER caps or enteric capsules - PO - must take whole because could die Report burning sensation at IV site

Teach patient: - K chloride: nursing considerations

Do NOT break, crush or chew ER caps or enteric capsules With or after meals with full glass water Dissolve effervescent tabs in 8 oz. cold water

Oral - K admin

Central line preferred: Caustic to veins Admin rate (infusion): Not exceed 10 mEq/hour for most pats; can give slightly faster: 20mEq/hr if necessary: ER/extrodinary circumstances - require tele because risk for hyperkalemia more sig Slower through PIV if needed Tele not required* Monitor IV site (phlebitis) Do NOT admin SQ or IM

IV infusion - K admin

H&P Monitor: Fluid intake and output Daily weights (gain and loss) Laboratory studies

Nursing: fluid and electrolytes

Fluid volume (overload or dehydration); HR, BP; heart, lungs

Monitor: - Nursing: fluid and electrolytes

Should be balanced; urine 30 mL/hr

Fluid intake and output - Nursing: fluid and electrolytes

Best way to determine fluid status Edema not apparent until 5-10# excess fluid Rapid gain or loss of 1 kg (2.2#)=1 L of fluid

Daily weights (gain and loss) - Nursing: fluid and electrolytes

As appropriate to administration

Laboratory studies - Nursing: fluid and electrolytes

Genitourinary; Diuretics; Fluid & Electrolyte Treatments Flashcards

(92 cards)