1. DIURETICS CHAPTER 43

2. DIURETICS Purposes of diuretics Lowered blood pressure Decreased edema

3. KIDNEY FUNCTION Diuretics Act on Different Segments of the Renal Tube.

4. KIDNEY FUNCTION (CONT’D) Types of diuretics Potassium-wasting diuretics Thiazide and thiazide-like Loop or high-ceiling Osmotic Carbonic-anhydrase inhibitor Potassium-sparing diuretics Combination of diuretics and antihypertensive drugs

5. THIAZIDE AND THIAZIDE-LIKE DIURETICS Action Serum chemistry abnormalities with thiazides Hypokalemia Hypomagnesemia Hypercalcemia Hypochloremia Hyperuricemia Hyperglycemia Hyperlipemia

6. THIAZIDE AND THIAZIDE-LIKE DIURETICS (CONT’D) Herbal interactions Combinations with potassium-sparing and antihypertensive agents

7. NURSING PROCESS: THIAZIDES Assessment Nursing diagnoses Planning Nursing interventions Client teaching Evaluation

8. DIURETICS Loop diuretics Action Laboratory changes associated with loop diuretics: Hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, hypochloremia Hyperglycemia possible in diabetic clients Hyperuricemia Elevated blood urea nitrogen and creatinine Elevated lipids Thrombocytopenia, leukopenia

9. DIURETICS (CONT’D) Osmotic diuretics Action Side effects/adverse reactions Fluid and electrolyte imbalance Tachycardia and others Carbonic anhydrase inhibitors Action Uses Side effects/adverse reactions

10. DIURETICS (CONT’D) Potassium-sparing diuretics Action Hyperkalemia Effects when given with ACE inhibitors Nursing interventions Checking for signs of hyperkalemia Monitoring serum potassium levels Others

11. PRACTICE QUESTION #1 A client is taking furosemide (Lasix) 40 mg daily for heart failure and hypertension. The nurse knows that electrolyte imbalances that commonly occur and should be monitored include A. low serum potassium, sodium, and magnesium, and elevated calcium. B. low serum potassium and sodium, and elevated magnesium and calcium. C. low serum potassium, sodium, magnesium, and calcium. D. low serum potassium and sodium, with magnesium and calcium remaining normal.

12. PRACTICE QUESTION #1 (CONT’D) Answer: C Rationale: Loop diuretics cause a loss of potassium, sodium, magnesium, and calcium.