1. Drugs Used for Diuresis Chapter 29 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Slide 2 Chapter 29 Lesson 29.1 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

3. Slide 3 Objectives 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.

4. Slide 4 Diuretics 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.

5. Pathologic Conditions Contributing 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 5 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

6. Slide 6 Sites of Action in the Nephron Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

7. Slide 7 Chapter 29 Lesson 29.2 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

8. Slide 8 Objectives 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.

9. Slide 9 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.

10. Slide 10 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.

11. Slide 11 Renal 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.

12. Slide 12 Nursing Assessment for 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.

13. Slide 13 Electrolyte 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 5.5 mEq/L (hyperkalemia) Serum sodium 145 mEq/L (hypernatremia) Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

14. Slide 14 Patient 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.

15. Slide 15 Drug Class: Carbonic 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.

16. Slide 16 Drug Class: Sulfonamide-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.

17. Slide 17 Drug 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, hyperglycemia Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

18. Slide 18 Drug Class: Potassium-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, dehydration Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

19. Slide 19 Drug Class: Combination 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.