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39 Cards in this Set
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- Back
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Diuretic Agents |
Drugs that increase the output of urine by removal of sodium and water Used to promote excretion of water and electrolytes by kidneys Used in treatment of hypertension and to mobilize edematous fluid |
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Diuretics adverse impact on extracellular fluid |
Hypovolemia/dehydration Thrombosis/embolism Acid-base imbalance Electrolyte imbalace |
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S/S of Dehydration |
Confusion/dizziness Increased HR Decreased BP Orthostatic Hypotension Thick lung secretions Constipation Decreased urine output |
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Loop Diuretics Furosemide, Torsemide (Lasiks) |
Most effective diuretics Furosemide- more frequently prescribed Produces most loss of fluid and electrolytes Admin- IV (onset 5 min, duration 2 hr) or PO (onset 1 hr, duration 8 hr) Adverse- excess Na, Cl, and water loss, severe dehydration, hypotension, hypokalemia, ototoxicity, hyperglycemia |
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Patient Education for Furosemide, Torsemide |
S/S of dehydration, hypokalemia minimized by eating K rich foods, potential plasma glucose elevation, and with Furosemide- transient hearing loss
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Nursing Implications for Furosemide, Torsemide |
Dose early in day to avoid nocturia IV admin- slow IV push (over 1-2 minutes) Monitor BP and Pulse, daily weight, decreasing edema Monitor I&O. Notify physician of urine output less than 25mL/hr Observe for S/S of dehydration Assess for orthostatic hypotension- have patient rise slowly and dangle feet prior to standing |
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Drug Interactions for Furosemide, Torsemide |
Digoxin- increased dysrhythmias, caused by decreased K Aminoglycoside antibiotics- increased hearing loss Potassium sparing diuretics- lessen K loss, good thing |
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Thiazide Diuretics Hydrochlorothiazide |
Less diuresis than loop Ineffective in renal impaired patient PO- onset 2 hr, duration 12 hr, NOT IV Adverse Effects- excess Na, Cl, and water loss, dehydration, hypokalemia, hyperglycemia |
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Patient education for Hydrochlorothiazide |
S/S of dehydration, hypokalemia minimized by eating K rich foods If blood K is low, hold med and notify physician Potential plasma glucose elevation |
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Drug Interactions for Hydrochlorothiazide |
Digoxin- increased dysrhythmias Lithium- potential toxicity NSAIDS- (aleve, ibuprofen, motrin, aspirin, naprocin) lessen diuretic effect. Non steriodal anti-inflam drug Potassium sparing diuretics- lessen K loss |
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K sparing diuretics Spironolactone, Triamterene |
Modest increase in urine production Decreased K excretion Often used to counteract K loss caused by loop or Thiazide diuretics Used to treat HTN, edema, and heart failure |
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Patient Education for Spirolactone, Triamterene |
Monitor for hyperkalemia and resulting dysrhythmias Watch for hormonal effects (menstrual irregularities, deepening voice, impotence) Restrict intake of K rich foods |
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Drug interactions Spirolactone, Triamterene |
Thiazide and Loop diuretics use combined to reduce K loss with diuresis Salt substitutes (have potassium chloride instead of sodium chloride) or K supplements increase risk of hyperkalemia |
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Osmotic Diuretic Mannitol |
Mannitol- only osmotic diuretic in US Reduces Intracranial Pressure, Intraocular Pressure, and risk of renal failure Does not work on the kidney, used in critical care. Does not work on external swelling, only internal. Used to help kidney stay functional |
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Patient Education for Mannitol |
Monitor for increasing edema Watch for headache, nausea, and vomiting Fluid and electrolyte imbalance may occur |
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Agents Affecting the Volume and Ion Content of Body fluids |
Contraction- dehydration, decrease in total body water Expansion- fluid overload, increase in total body water |
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Isotonic Contraction (dehydration) |
Causes include vomiting diarrhea, kidney disease, misuse of diuretics Treatment- isotonic solution replacement slowly to avoid pulmonary edema (lungs very sens to fluid overload, take excess fluid easily) Water and sodium are lost in equal proportions, decrease in total volume but no change in osmolarity Use NS for treatment |
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Hypertonic Contraction (dehydration) |
Causes include excessive sweating, osmotic diuresis, burns Treatment- hypotonic fluid replacement, Use D5W for treatment, hypotonic fluids with no solutes at all, water More particles per amount of fluid than blood, more conc than normal blood Loss of water more than loss of sodium, reduced ECF volume and increased osmolarity |
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Hypotonic Contraction (dehydration) |
causes include diuretics, renal failure, lack of aldosterone Treatment- if mild use isotonic fluid, if severe use hypertonic (3% NaCl). Watch for signs of fluid overload Less particles in fluid compared to blood, dilute fluid volume contraction Loss of sodium exceeds loss of water, both volume and osmolarity of ECF reduced |
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Volume Expansion |
Cause- overdose of fluids, nephrotic syndrome, cirrhosis with ascites, CHF Treatment- diuretics and agents used for heart failure, digoxin |
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Isotonic IV Solutions |
D5W- dextrose 5% sugar in water NS- .9 % sodium chloride in water LR (lactated ringers)- electrolytes in water |
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Hypertonic IV Solutions More particles in water than isotonic |
D10W- twice as much sugar as isotonic 3% NS- three times as much as isotonic D5NS- particles of D5W and NS, so twice as conc D5 0.45%NS- particles of D5W plus part of half NS, one and a half times more than isotonic D5LR- D5W part and LR part so double isotonic |
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Hypotonic IV Solutions Less particles in water than isotonic |
0.45% NS- half of isotonic 0.33% NS- one third of isotonic |
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Normal Blood Gas |
pH- a 7.35- 7.45 b CO2- b 35-45 a (increase lowers pH) HCO3- a 22-26 b (increase raises pH) |
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Resp alkalosis |
ie 7.47, 32-28 Causes- hyperventilation causes decrease in CO2 Treatment- rebreathe CO2 laden expired breath, paper bag |
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Resp acidosis |
ie 7.32, 48-24 Causes- retention of CO2 secondary to hypoventilation, depression of the medullary resp center, pathologic changes in the lung Treatment- correct resp impairment, infusion of sodium bicarbonate if severe |
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Metabolic alkalosis |
ie 7.48, 36-29 Causes- excessive loss of gastric acid (vomit or suctioning), admin of alkalinizing salts such as baking soda Treatment- solution of sodium chloride plus potassium chloride |
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Metabolic acidosis |
ie 7.34, 36-20 Causes- chronic renal failure, loss of bicarbonate during severe diarrhea, metabolic disorders, methanol and certain medication poisoning (aspirin) Treatment- correcting the underlying cause of acidosis, alkalinizing salt if severe, sodium bicarbonate, dialysis |
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Regulation of K levels |
Primarily by the kidneys, increased by aldosterone Influenced by extracellular pH Insulin has a profound effect on potassium levels. Insulin will drive K into cell and get it out of blood stream K in higher conc intracellular |
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Hypokalemia Serum K less than 3.5 mEq/L |
Causes & Consequences- common is treatment with a thiazide or loop diuretic, excessive insulin, alkalosis Adverse effects on skeletal muscle, smooth muscle, blood pressure, and the heart. Increases risk for hypertension and stroke Prevention and Treatment- potassium salts, oral or IV potassium chloride, contraindication to potassium use- pts predisposed to hyperkalermia (severe renal impairment, use of K sparing, hypoaldosterone) |
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Hyperkalemia Serum K more than 5 mEq/L |
Causes- severe tissue trauma, untreated Addison's disease, acute acidosis, misuse of potassium sparing diuretics, overdose with IV K Conseq- disruption of the electrical activity of the heart Treatment- withhold foods that contain potassium, withhold medicines that promote potassium accumulation Management- counteract potassium induced cardiotoxicity, lower extracellular levels of potassium- infusion of sodium bicarbonate if acidotic or insulin |
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Hypomagnesemia |
causes- diarrhea, hemodialysis, kidney disease, prolonged intravenous feeding, chronic alcoholics |
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Hypermagnesemia |
Prevention and treatment- magnesium gluconate and magnesium hydroxide, magnesium sulfate Most common in patients with renal insufficiency |
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Fresh frozen plasma |
contains all coagulation factors used for bleeding problems after trauma or liver transplants |
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albumin |
proteins in the blood used for blood volume replacement after accident |
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platelets |
promotes blood clotting and wound healing used for hemorrhage |
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erythopoietin |
Stimulates the production of RBCs in bone marrow Therapeutic use- anemia & chronic renal failure. anemia- chemotherapy induced, HIV induced Adverse- hypertension Nursing implications- SQ injection once weekly and can be given IV. Do not shake bottle- leads to denaturing of the protein molecule. Monitor hemoglobin level- twice weekly to weekly. 10-12gm/dL is goal for Hg |
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Levels of Fluid loss |
Osmotic, loop, thiazide, then potassium sparing |
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Sources of Potassium |
Nuts, citrus fruits, potatoes, banana, dried fruits, white beans, leafy greens |
