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48 Cards in this Set

  • Front
  • Back
Identify the three ions that are primarily involved in renal transport.
Na+, -K+, Cl-
What steroid is responsible for making final adjustment in the collecting duct in order to
assure the correct amount of sodium is excreted?
What hormone regulates the removal of water during the concentration process in the
collecting duct?
What are the brand names for: (p. 744)
• Furosemide
• Bumetanide
Lasix; Bumex
Why are furosemide and bumetanide called loop diuretics?
Action is in the loop of Henle.
What ion stays in tubular fluid causing more to be excreted along with an osmotic equivalent
of water?
sodium chloride
What happens when the higher than normal amount of sodium reaches the distal tubule and
collecting duct?
Promotes the exchange of sodium for potassium and hydrogen ions, increasing the urinary excretion of both ions.
What other electrolyte is also excreted in larger amounts in response to loop diuretics?
Which loop diuretic is the most potent? How much more potent is bumetanide than
bumetanide; 40 times stronger
What class of diuretics are most effective in treating edema? What class of diuretics is a
better choice for treating hypertension?
loop diuretics; thiazides
How soon should the nurse expect urine output to increase following oral administration of a
loop diuretic? Past an IV dose? What is the term for this drug response?
within 1 hour; 5-10 minutes; diuresis
While some loop diuretics may be given intramuscularly, what is the preferred parenteral
IV route
Identify seven possible signs of electrolyte depletion.
weakness, lethargy, dizziness, leg cramps, anorexia, vomiting, mental confusion
Identify three types of gastrointestinal disturbances common with loop diuretics.
diarrhea,loss of appetite, stomach pain, cramping
What is a common reaction to the large fluid loss and accompanying reduction of blood
volume caused by these potent loop diuretics? What serious danger should nursing actions
be aimed to prevent?
orthostatic hypotension
Due to the potential for excessive potassium loss, what do many health care practitioners
prescribe for patients receiving loop diuretics for prolonged periods?
potassium supplements
Besides bananas, list at least ten fruits that are high in potassium.
study guide
List four juices that are high in potassium.
study guide
List five green vegetables that are high in potassium.
study guide
List six types of beans that are high in potassium.
study guide
How common is calcium loss in patients taking loop diuretics?
not common
Which of the fives senses may be damaged due to toxicity related to high doses of loop
diuretics? What is this toxicity called?
hearing; ototoxic
Name one class of drugs that is particularly dangerous for patients on loop diuretics with
potassium depletion. Name one common drug (generic and brand name) in this drug class.
cardiac glycosides; digoxin (Lanoxicaps, Lanoxin)
Name one group of patients being treated for a mental illness that should not take loop diuretics.
patients undergoing lithium treatment
Name one class of antibiotics that should be avoided with patients taking loop diuretics.
Why? Name one common drug (generic and brand name) in this drug class.
aminoglycoside antibiotics; they are ototoxic and the combination should be avoided because permanent deafness may result
What may be the effect if a patient taking the anticoagulant warfarin (Coumadin) is started on
loop diuretics?
loop diuretics may replace warfarin from their binding sites on plasma proteins. this action increases the concentration of the free, active form of the displaced drug. Higher concentrations of unbound warfarin produce increased anticoagulant effects and may produce toxicity.
What are the generic names for: (p. 749)
• Diuril
chlorthiazide; hydrochlorothiazide
Where is the primary site of action for thiazide diuretics? What risk is significantly lower with
thiazide diuretics due to the site of action?
distal tubule; risk of dangerous depletion of extracellular fluid volume
In addition to controlling edema associated with heart or renal disease, for what other use are thiazide diuretics prescribed?
treatment of hypertension
What may long term use of thazides (as well as other diuretics) cause? What signs may be present? What electrolyte losses are most likely to occur? What may be required?
fluid and electrolyte imbalance; thirst, weakness, lethargy, restlessness, muscle cramps and fatigue;K+ and Cl-; potassium supplements
What may occur as a result of the inhibition of uric acid secretion? (p. 749) What is this?
increase blood level of urate; gout
What effect do thazides have on the gastrointestinal system?
irritates the GI tract and may cause adverse effects ranging from simple nausea and vomiting to constipation, jaundice, and pancreatitis
How may thiazides affect patients with diabetes?
alters the requirements for insulin or other hypoglycemic drugs
What is the generic name for Aldactone?
How are potassium-sparing diuretics often used?
used in combination with loop or thiazide diuretics to counteract the tendency of those drugs to enhance urinary potassium losses
Where is the site of action of spironolactone? The action of what hormone is altered by
spironolactone? How does this effect sodium and potassium? (p. 751) When is the onset of
spironolactone? (p. 746, table 46-2) When is the peak therapeutic effect of spironolactone?
distal tubule; aldosterone; reduces sodium reabsorption and urinary losses of potassium; 8 hr.
What patients are especially at risk for dangerous increases in serum potassium due to
potassium retention caused by spironolactone?
patients with impaired renal function or high potassium intake
What may happen if potassium-sparing diuretics are taken with (p. 752)
• Other antihypertensives
• Anticoagulants
• Lithium
• Digoxin
Requires reduction of antihypertensives because potassium sparing diuretics may have additive antihypertensive effects.
Increases potency of anticoagulants which may result in excessive anticoagulation and the risk of bleeding.
May promote lithium retention.
Increases half-life of digoxin, leading to accumulation of digoxin.
When administering a diuretic intravenously, what technique may decrease the risk of adverse effects?
a slow administration rate
What vital sign would be measured regularly during diuretic therapy? Describe the proper
method of measuring.
Monitor the patient's BP regularly while he/she is standing, sitting, or lying down. Compare the measurements from each arm.
In the acute care setting, how frequently should the patient on diuretic therapy be weighed?
At what time of day should it be scheduled?
Daily; at the same time everyday (usually in the morning, after the patient has voided or the catheter bag emptied, but before breakfast)
What may be the first sign that a patient is experiencing excessive diuresis?
changes in BP or vital signs
List eleven signs of possible dehydration.
thirst, decrease in skin turgor, nausea, light headedness, weakness, increase in pulse rate, oliguria, decrease in BP, elevated hemoglobin, elevated hematocrit, elevated BUN levels
What serious complication may dehydration lead to?
thromembolic disorders
Identify two different methods to monitor fluid retention.
measure the patient's abdominal girth or the circumference of one or both legs, check dependent areas daily for the presence of or changes in the amount of edema
If a diuretic is taken twice a day, what is the latest recommended time for the evening dose
so diuresis does not interfere with sleep?
before 6 pm
How may gastric irritation be avoided when taking oral diuretics?
take with food
Identify at least two important dietary precautions that should be included in patient teaching
for patients taking diuretics.
not to use salt subs. without first consulting with the health care provider, identify and avoid foods high in sodium content