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78 Cards in this Set
- Front
- Back
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duiretics _____ urinary output
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increase
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what are the four therapeutic uses of diuretics?
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HTN
HF removal of edematous fluid prevention of renal failure |
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the renal system works to cleanse and perform maintenence on the _____
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ECF
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the renal system is important in _____ _____ balance
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acid base
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excretion of metabolic wastes and foreign substances occur in which body system?
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renal system
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the renal system revieces about _____ of the cardiac output
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20%
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filtration in the renal system occurs in which structure?
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glomerulus
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reabsorption occurs in which structures of the renal system?
3 structures |
proximal/distal convoluted tubules
loop of henle |
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active tubular secretion is acheived by which structure of the renal system?
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proximal convoluted tubule
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dirty blood comes into the renal system via the renal _____ and cleansed blood exits the renal system via the renal _____
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artery
vein |
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plasma passes through the glomerulus and gets filtered (pushed) out into the _____ _____
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bowmans capsul
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the bowmans capsul catches and collects _____
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filtrate
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filtrate is what is the fluid pushed out of the glomerulus, caught and collected in the bowmans capsul and contains....
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water and electrolytes
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abnormal findings in the filtrate would be...
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wbc
protein glucose these molecules are supposed to be too LARGE to pass through from the glomerulus to the bowmans capsule. what is able to pass through are electrolytes which are SMALL |
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cortical nephrons have _____ loops of henle and penetrate _____ into the renal medulla
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short
a little bit |
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juxtemedullary nephrons have a _____ loop of henle
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long
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juxtemedullary nphonrs are concerned with urine c_____ and are _____ in the kidney than cortical nephrons
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concentration
deeper |
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the juxtemedullary and cortical nephrons have many/few mitochondira
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many
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cells that secrete renin in the kidney are located where in the kidney?
how do they decide whether to secrete renin |
between afferent and efferent tubules.
they sense blood pressure and blood volume |
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how many mL is an ideal output?
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1mL/min or often 60mL/hr
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diuretics work by forming a blockade of _____/_____ reabsorption
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sodium chloride
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on the tubule, this area causes greatest diuresis.
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proximal tubule
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what are three adverse effects of diuretics?
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hypovolemia
acid base imbalance electrolyte imbalance |
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different diuretic act on _____ points of tubules
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different
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s/s of hypovolemia
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high pulse
low bp thirst dizziness poor tissue perfusion elevated |
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what are the 5 classes of diuretics?
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osmotic
loop thiazide K sparring carbonic anhydrase inhib |
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what determines the class of diuretic?
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accordance to what area of the nephron it effects
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which diuretic is a common eye drop which reduced intraocular pressure?
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carbonic anhydrase
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osmotic diuretics effect the _____ tubule
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proximal
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loop diuretics effect the _____ _____ of _____
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aending loop of henle
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thiazide diuretics effect the _____ tubule
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convuluted
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k sparring diuretics are the _____ effective diuretic
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leaste
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k sparring diuretics effect two ares of the tubules..
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late, distal convuluted
and collecting duct |
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this is the most powerful osmoitic diuretic
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mannitol
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mannitol is given via _____
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IV
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which osmotic diuretic is used to prevent cerebral edema
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mannitol
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what sort of injuries could cause cerebral edema?
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head injury
neurosurgery |
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your patient arrives from the ICU with a closed head injury. he has been given mannitol IV to reduce cerebral edema. What could happen to his BP and why?
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it could elevate. fluid is pulled out of the cells and dumped into the central circulation
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your patient has severe HF and post op neurosurgery day 1. earlier the nurse reported s/s of cerbral edema and the resident ordered mannitol. what are some potential problems with this thereapy?
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mannitol can increase the work load of the heart. it can actually put people INTO HF
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mannitol diuresis the _____ part of the nephron
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proximal convoluted tubule
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what are three uses of mannitol?
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renal failure
increased ICP increased intraocular pressure |
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what is a common loop diuretic ?
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furosemide aka lasix
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lasix effects the _____ loop of henle
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ascending
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your patient is given lasix IV. do you expect to see therapeutic effects sooner or later?
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sooner. it is fast acting via IV
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what are three uses of lasix therapy
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pulmonary edema
edematous states HTN |
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lasix promotes vaso_____
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dilation
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lasix would be a good tx for HF patients because..
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it reduces pre/afterload in heart
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explain the ceiling effect of loop diuretics like lasix
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a drug will stop being therapeutic if you hit certain high doses.
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you are taking an order for stat lasix. what route would you expect it to be given?
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IV
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PO lasix is fast/delayed acting?
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delayed. up to one hour
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lasix is like vancomycin in that when it is given IV you must...
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perfuse it slow. no faster than 4mg/min
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much like vancomycin, if you infuse IV lasix too quick _____ can occur
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ototoxicity
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your patient is a 85 year old women with cardiovascular disease taking lasix 40 mg BID. what about this pt puts her at risk for adverse effects?
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her age and dx of cardio disease
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what can develope in the elderly and those with CV disease during lasix therapy?
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electrolyte imbalance
cardiac arrhythmias |
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what is pulmonary edema?
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fluid accumulation in the alveoli and lungs
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adverse of effects of diuretics
3 hypo 3 hyper 1 toxic |
hypo
-tension -kalemia (except k sparring) -natremia hyper -glycemia -uricemia -lipidemia ototoxicity (loop) |
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an example of a thiazide diuretic is...
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hydrochlorothiazide (HCTZ)
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which diuretic is most widely used?
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HCTZ
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HCTZ act upon the _____ _____ tubule
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distal convuluted
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ou give your pt his dose of HCTZ at 1200. what time would you expect the drug to cause the greatest therapeutic effect?
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1600-1800
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You look at your MAR and it says to give thiazide 60mg/10mL IV BID x 7 days r/t dependent edema. what part of this statement warrents clarification?
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IV. this drug can only be given PO
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Thiazides are used for pt with the following dx
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HTN
Edema |
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Is it proper to give a pt experiencing diabetes insipidus a thiazide?
diabetes insipidus: characterized by excessive thirst and urine output |
yes. diabetes insipidus causes excess thirst and urine output. thiazide causes a paridoxical effect which would conserve fluid and rehydrate the person
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spironolactone is different in that it...
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conserves potassium. often called K sparring diuretic
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spironolactone blocks _____ in the _____ nephron
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aldosterone
distal |
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spironolactone's are used for pt with
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htn
edema |
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what are two endocrine effects of spironolactone?
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hirsutism
hyperaldosteronism |
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your patient is taking the following meds: colace, regular insulin, furosemide, potassium, aggrenox, penicillin (for 10 days) and spironolactone. which drugs are problems?
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loop diuretics - because they will increase the effects of the other spironolactone
K+ - spironolactone already have a potassium sparring aspect and could increase K levels dangerously high spironolactone - could increase effect of feurosemide |
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your pt is experiencing liver failure and is edematous around the abdomen. what is this fluid retention called and which diuretic would you expect to use ?
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acites
spironalactone can also be used as a HF alternative |
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triamterne is a _____ _____ diuretic
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potassium sparring
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triamterene disrupts _____/_____ exchange in the _____ nephron
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sodium/potassium
distal |
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triamterene reduces _____ transport indirectly by blocking _____
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ion
aldosterone |
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amiloride is similar to _____ which is a _____ _____ diuretic
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triamterene
potassium sparing |
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what areas are pertinent in assessment of pt taking diuretics?
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vs
io weight edema breath sounds lab values |
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lab values to check during diuretic therapy
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glucose
uric acid cholesterol kidney/liver fucntion |
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what is the best time of the day to take a diuretic?
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morning
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list some foods high in K+
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Apples, Apricots, Bananas, Brazil Nuts, Brown Rice, Cantaloupe, Figs, Honeydew, Kiwi, Legumes, Lima beans, Milk, Oranges, Orange Juice, Peaches, Potatoes, Prunes, Rasins, Roasted Peanuts with skin, Spinach, Squash, Vegetable Juices, Wheat Bread, White Rice, Winter Squash, Yogurt
Tomatoes, milk products, avocados, meats, potato, celery Carrots, broccoli, rasins, prunes, watermelon, Fish: Cod, flounder, sardines, salmon, poultry: chicken, turkey are high potassium foods. Hamburger, grains such as bran and wheat. Artichoke, Asparagus, Broccoli, Cabbage, Corn, Dates, Green Beans, Green Peppers, Iceburg Letttuce, Kidney Beans, Onions, Papayas, Parsley, Pumpkin, Peas, Romaine Lettuce, Strawberries, Sweet Potato, Tomato. Note that potassium is found in the skin of many vegetables. LOL!! |
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what are clinical improvements r/t diuretic therapy?
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bp in target range
lungs clearer weight is decreaed or stable no symptoms of dehydration or electrolyte imbalance lab values normal no glucose/uric acid problem |
