Medications Affecting Urinary Output Flashcards
What is the mechanism of action for loop-diuretics?
Block the reabsoprtion of sodium, chloride, potassium in the ascending loop of henle to prevent reabsorption of water
This decreases intravascular volume by increasing urine output
How would you give a loop diuretic IV push? Why?
10-20mg per minute (slowly)
It is ototoxic if administered too fast (can cause permanent hearing loss)
How can loop diuretics be administered?
IV and orally, sometimes IM
Are loop diuretics used for chronic management?
NO, they are for more acute situations because of the higher chance for adverse affects
What are some adverse effects of loop diuretics?
Dehydration/hyponatremia/hypochloremia
hypotension (orthostatic)
hypokalemia
What are some nursing considerations for loop diuretics?
Look for low urine output (patient can excrete so much that there could be none left to excrete)
Tell patient to get up slowly, monitor BP, if they get dizzy when they get up check for orthostatic hypotension
Monitor cardiac status
monitor electrolyte levels (especially potassium)
look for signs of hypokalemia (nausea, vomiting, weakness)
LOOK AT POTASSIUM LEVELS BEFORE ADMINISTERING LOOP DIURETIC
dailys weight, i/o
How would you administer IV potassium?
Dont give it any faster than 10 mEq/hr or you can kill the patient
NEVER GIVE IV PUSH
What are some other adverse affects of loop diuretics?
hyperglycemia - monitor especially with DM
Digoxin toxicity - due to hypokalemia, monitor cardiac and potassium levels, also digoxin lvls
Lithium toxicity - due to hyponatremia - monitor lithium levels
ototoxicity - monitor for tinnitus (ringing in ears) give slowly IV
What are some patient teaching points for loop diuretics?
avoid in pregnancy (cat C)
Teach about adverse effects and measure to avoid them
hypokalemia (nausea, vomiting, weakness)
orthostatic hypotension (get up slowly)
Eat foods high in potassium
dried fruits, bananas, nuts, spinach, avocados, citrus fruits, potatoes
monitor BG levels/ BP/ daily weights
Follow up and dont stop until consulting with physician
Take in the morning or when your day starts so you arent peeing all night
What pregnancy category are loop diuretics in?
Category C
What is the mechanism of action for thiazide diuretics?
blocks reabsorption of sodium, chloride, potassium, and water at the early distal convoluted tubule.
What is the huge difference between thiazide and loop diuretics?
thiazide are usually the first choice because they arent as potent so there is less risk for adverse effects.
How are thiazide diuretics usually administered?
PO
What are the adverse effects of thiazide diuretics?
Same as diuretics except:
Not ototoxic
Limited concern for digoxin and lithium toxicity - LESS POTENT
Less risk for hypotension
What are some patient teaching points for thiazide diuretics?
Same as loop diuretics
UNCLEAR ON BLOOD SUGAR EFFECTS ON PPT, LOOK UP THOSE FOR LOOP AND THIAZIDE!!!
What is the mechanism of action for potassium-sparing diuretics?
Blocks the action of aldosterone causing potassium retention and the secretion of sodium and water
GIVEN PO
Do potassium-sparing diuretics reach therapeutic levels quickly?
NO it takes a longer time
the least potent of the diuretics
used for more chronic maintenance
What patients should you not administer potassium sparing diuretics to?
severe kidney failure and anuria (potassium retention is already present)
What are some adverse effects of potassium-sparing diuretics?
hyperkalemia
endocrine dysfunctions - impotence, irregularities in menstrual cycles
What are some nursing considerations for potassium-sparing diuretics?
monitor for symptoms of hyperkalemia (numbness, tingling, weakness, fatigue, irregular cardiac activity
NEVER GIVE SUPPLEMENTAL POTASSIUM
closely monitor cardiac status when given with ACE inhibitors, ARBS, or direct renin inhibitors (all cause the retention of potassium)
MONITOR POTASSIUM LEVELS
What are some patient teaching points for potassium-sparing diuretics?
avoid salt substitutes (contain potassium)
look out for signs of hyperkalemia (numbess, tingling, weakness, fatigue
What is a weird side effect of triamterene?
may turn urine a bluish color
NOT A SAFETY CONCERN
what if patients need to avoid salt, and they are also told to avoid salt substitutes?
Look for substitutes that dont contain potassium
What is the mechanism of action for osmotic diuretics?
draws fluid back into intravascular space by raising serum osmolality, usualy to reduce ICP and IOP and to prevent kidney failure in hypovolemic shock (pulls fluid into intravascular space whihc makes the kidney want to start excreting it)
USUALLY USED FOR HEAD INJURIES AND SOMEITMES SHOCK
