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Drugs Used for Diuresis
Chapter 29Chapter 29
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 2
Chapter 29
Lesson 29.1
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 3
ObjectivesObjectives
• Identify the action of diuretics• Describe the goal of administering diuretics to
treat hypertension, heart failure, or increased intraocular pressure or before vascular surgery in the brain
• Identify the effects of diuretics on blood pressure, electrolytes, and diabetic or prediabetic patients
• Review possible underlying pathologic conditions that may contribute to the development of excess fluid volume in the body
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 4
DiureticsDiuretics
• Used to increase flow of urine to reduce excess water in the body
• Primarily used to treat heart failure, hypertension
• Other uses: liver disease, renal disease, cerebral edema, increased intraocular pressure, treat hypercalcemia
• Therapeutic outcomes: reduce edema, improve symptoms of excess fluid
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Pathologic Conditions Pathologic Conditions Contributing to Excess FluidContributing to Excess Fluid
• Heart failure Edema, adventitious lung sounds, dyspnea,
change in mental status
• Liver disease Jaundice, ascites, disorientation, history of
alcohol dependence, overdose of OTC medications
• Adverse outcomes if diuretics not given: renal failure, pulmonary congestion, edema, hypertension, stroke, death
Slide 5Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 6
Sites of Action in the NephronSites of Action in the Nephron
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 7
Chapter 29
Lesson 29.2
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 8
ObjectivesObjectives
• Cite nursing assessments used to evaluate renal function
• Cite nursing assessments used to evaluate a patient’s state of hydration
• State which electrolytes may be altered by diuretic therapy
• Review the signs and symptoms of electrolyte imbalance and normal laboratory values of potassium, sodium, and chloride
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 9
Objectives (cont’d)Objectives (cont’d)
• Explain the rationale for administering diuretics cautiously to older adults and individuals with impaired renal function, cirrhosis of the liver, or diabetes mellitus
• Develop objectives for patient education for patients taking loop, thiazide, and potassium-sparing diuretics
• List adverse effects that can be anticipated whenever a diuretic is administered
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 10
Objectives (cont’d)Objectives (cont’d)
• State the nursing assessments needed to monitor therapeutic response or the development of common or serious adverse effects from diuretic therapy
• Cite alterations in diet that may be prescribed concurrently with loop, thiazide, or potassium-sparing diuretic therapy
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 11
Renal Function: AssessmentRenal Function: Assessment
• History of related causative disorders/factors• History of current symptoms• Pattern of urination• Medication history• Hydration status• Electrolyte imbalance
Often subtle changes, such as in mental status, muscle strength/cramps, tremors, nausea, general appearance
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 12
Nursing Assessment Nursing Assessment for Hydration Statusfor Hydration Status
• Evaluate for dehydration: skin turgor, oral mucous membranes
• Monitor laboratory values for changes• Evaluate location of edema, signs of
reduction• Obtain daily weights• Measure intake and output
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 13
Electrolyte ImbalanceElectrolyte Imbalance
• Susceptible people: history of renal or cardiac disease, hormonal disorders, massive trauma or burns
• Assess mental status, muscle strength and cramps, tremors, nausea, general appearance
• Serum potassium < 3.5 mEq/L (hypokalemia), > 5.5 mEq/L (hyperkalemia)
• Serum sodium < 135 mEq/L (hyponatremia), > 145 mEq/L (hypernatremia)
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 14
Patient Education ConsiderationsPatient Education Considerations
• Accurate measurement of fluid intake and output
• Purpose of diuresis• Medication considerations• Nutrition• Health maintenance• Written record/patient self-assessment form
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 15
Drug Class: Drug Class: Carbonic Anhydrase InhibitorCarbonic Anhydrase Inhibitor
• Drug: acetazolamide (Diamox)• Actions
Weak diuretic; inhibits the enzyme carbonic anhydrase in kidney, brain, eye
• Uses Reduces intraocular pressure with glaucoma;
reduce seizure activity with certain types of epilepsy
• See Chapters 19 and 43 for further discussion
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 16
Drug Class: Drug Class: Sulfonamide-Type Loop DiureticsSulfonamide-Type Loop Diuretics
• Actions Inhibit sodium and chloride reabsorption in
ascending limb of the loop of Henle
• Uses Treat conditions such as edema resulting from
heart failure, cirrhosis of the liver, renal disease
• Common adverse effects Oral irritation, dry mouth; orthostatic hypotension
• Serious adverse effects Gastric irritation, abdominal pain; electrolyte
imbalance, dehydration; hyperuricemia; hyperglycemia; hives, pruritus, rash
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 17
Drug Class: Thiazide DiureticsDrug Class: Thiazide Diuretics
• Actions Block reabsorption of sodium and chloride
ions from the tubule
• Uses Treat edema associated with heart failure,
renal disease, hepatic disease, pregnancy, obesity, premenstrual syndrome
• Common adverse effects Orthostatic hypotension
• Serious adverse effects Gastric irritation, electrolyte imbalance,
hyperuricemia, hyperglycemiaMosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 18
Drug Class: Drug Class: Potassium-Sparing DiureticsPotassium-Sparing Diuretics
• Drugs: amiloride (Midamor), spironolactone (Aldactone), triamterene (Dyrenium)
• Actions Induce retention of potassium; excrete sodium
at the distal renal tubules
• Uses In combination with other diuretics to treat
hypertension or heart failure, prevent hypokalemia
• Common and serious adverse effects Nausea, vomiting, anorexia, flatulence,
headache, electrolyte imbalance, dehydrationMosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 19
Drug Class: Drug Class: Combination Diuretic ProductsCombination Diuretic Products
• Drugs Spironolactone/hydrochlorothiazide (Aldactazide) Triamterene/hydrochlorothiazide (Dyazide,
Maxzide) Amiloride/hydrochlorothiazide (Moduretic)
• Actions Potassium-sparing diuretics / thiazide diuretics
• Uses Promote diuresis while maintaining normal
potassium levels
• Common adverse effects Hyperkalemia, hyponatremia
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.