Crucial Nursing Precautions for Administering Diuretics

What are the important nursing precautions when dealing with clients taking diuretics? What are the necessary things that you need to remember when giving diuretics to a client?

To answer those questions, we’ll give you a rundown of some signs and symptoms of diuretics and what you have to watch-out-for as the nurse in charge for clients who are taking diuretics.

To easily remember the necessary nursing precautions, keep in mind the acronym DIURETIC, which stands for:

  • Diet
  • Input and output with daily weights
  • Unbalanced fluid and electrolytes
  • Ready for decreased blood pressure and increased heart rate
  • Evening dose is a no-no.
  • Take AM
  • Increased orthostatic hypotension
  • Cigarettes

We’ll be discussing each nursing precaution and some of the helpful test question favorites.

Diet

Specifically, with loop diuretics, you have to make sure that the client has a diet that is high in potassium. Loop diuretics are potassium-wasting diuretics, which mean that they deplete potassium from the body and into the potty. For this reason, it is critical that you instruct your client to consume foods that are high in potassium and some examples are:

  • Bananas
  • Oranges
  • Spinach
  • Green, leafy vegetables

Reminder: Diet is a test question favorite. Most of the questions regarding Lasix would revolve around questions like, “A client is on Lasix, what kind of diet should you recommend?”

The answer is a high potassium diet.

Input and Output

Monitoring the input and output (I/O) of a client taking diuretics is vital because usually, these clients are on fluid restriction.

On most occasions, family members are eager to bring their loved ones their favorite foods during hospitalization; however, they are not allowed to consume anything that is high in sodium and potassium, especially those who are taking potassium-sparing diuretics. Therefore, input restrictions have to be made with clients on diuretics.

In scenarios like this, education is necessary to let the client and family members understand that the reason why we give diuretics is to keep the fluid out of the body, and certain foods retain fluid in the body.

Aside from checking the input and output, getting the daily weight is also a huge factor with clients on diuretics. A lot of nurses miss this important step nowadays. Doctors would want to know how much the client weighed when they first came in and on a day-to-day basis to evaluate how well the diuretics are working.

Unbalanced Fluid and Electrolytes

As previously mentioned, clients who are taking diuretics would have problems with their sodium and potassium levels; therefore, as the healthcare provider, you can expect unbalanced fluid and electrolytes.

Ready for Decreased BP and Increased HR

It is expected that blood pressure will drop and the heart rate will increase at any time due to the effects of diuretics. There will be less pressure with regards to the vascular spaces, and at the same time, the heart rate will skyrocket, so you have to monitor the client for those two things closely.

Evening Doses are a No-No

Never give diuretics in the evening. You don’t want your clients to fall on the ground or trip themselves when going to the restroom.

Take AM

To prevent the risk of falling, diuretics are given only in the morning. Take note of this detail because this is another test question favorite.

Increased Risk for Orthostatic Hypotension

Medically termed as syncope, orthostatic hypotension is also known as the fainting spell which happens when clients change their positions too quickly. This is a safety concern and is tagged as a fall precaution in the hospital.

Looking out for orthostatic hypotension is important in adding plan of care for the client and putting them on fall precaution.  

Cigarettes

To complete our DIURETIC acronym, we’ve included cigarettes as one of the things to avoid when taking diuretics. Obviously, cigarettes are contraindicated and are considered as risk factors for nearly every diagnosis.

That’s it for nursing precautions when giving diuretics. For more helpful information like this, visit our SimpleNursing website and YouTube channel.

Acute Renal Failure: Nursing Management & Interventions Pt 2

Part one of our discussions on acute renal failure nursing management, we focused on two interventions – Kayexalate and Dopamine. These two belong to the four nursing processes that are required to manage acute renal failure. To easily remember, you can think of the acronym – HDTV. H stands for hyperkalemia while D stands for dopamine.

In this lecture, we will tackle the remaining two processes – T and V.

Before discussing the remaining two interventions, we’ll quickly go through the first two.

Kayexalate for Hyperkalemia

Kayexalate is the first thing that is given to acute renal failure clients due to the presence of hyperkalemia. Hyperkalemia is just one of the complications of having acute renal failure, and the only way to get it out of the body is through the potty which involves urination and fecal excretion. If urine is not being produced due to acute renal failure, potassium will be expelled through the anus with the help of Kayexalate.

Dopamine

Dopamine helps in renal vasodilation and at the same time, vasoconstricting the peripheral body, causing an increase in pressure. Low blood pressure is one of the main causes of acute renal failure; therefore, dopamine will help in the hyperperfusion of the kidneys.

The T and V

Now, the last two types of intervention are a bit difficult to comprehend because both are concerned with volume.

So, the main goal is to push volume through the kidney which can be referred to as, “tickling the kidney.” Tickling the kidney simply means increasing the perfusion which will lead to increased blood volume and oxygen. By doing so, we’re trying to get the client from the oliguric phase to the diuretic phase in the hopes that the condition will eventually lead to the recovery phase.

After giving dopamine to dilate the blood vessels in the kidneys, fluid is then pushed into the diuretic phase. This is where the T and V come in.

Total Volume

Giving total volume or a bolus of IV fluid means giving more fluid to the client; much like pouring fluid with the use of IV normal saline.

The kidneys are similar to washer machines. Imagine if these washer machines have too much accumulation of mud and are broken. By dilating the renal arteries and pushing more volume, we are restarting the organ and are getting rid of the mud inside the washer machines.

Volume Depletion

Diuretics are given to make sure that the kidneys are receiving sufficient volume. This is what we refer to as the volume depletion stage. Since the primary goal is to get fluid going into the kidneys and have it restarted, diuretics will push the volume through the kidneys. Lasix (Furosemide), the most popular loop diuretic, is a potassium-depleting medication given to acute renal failure clients.

A Summary

In retrospective, when a client in an oliguric phase, the kidneys are not working, and the basic goal is to achieve a diuretic phase. This is done by increasing the amount of perfusion in the kidneys through an IV bolus. Diuretics are given to make sure that there is enough volume that is being pushed inside the kidney to have it restarted and enter the diuretic phase. Once the client’s kidneys are rebooted, the next goal is to achieve the recovery phase.

In our next lecture, we will talk about creatinine clearance tests and how it is connected to clients with renal failure.

Illustration Provided By Injury Map

Congestive Heart Failure & Myocardial Infarction Drugs

Are you having a hard time differentiating congestive heart failure (CHF) drugs from myocardial infarction (MI) drugs? In this lecture, you will learn how to appropriately identify which medication is given to CHF clients and which is given to MI clients.

So the main question is: What is the difference between CHF and MI drugs?

To answer that question, one must first know what’s going on between the two conditions.

Pathophysiology: Congestive Heart Failure

One of the major differences between congestive heart failure and myocardial infarction is where the complication originated. For CHF, it’s due to the ventricles inside the heart that are primarily responsible for pumping blood throughout the different parts of the body, delivering oxygen where it’s needed.

If there’s increased volume being pushed down into the ventricles, the heart tends to give up, leading to congestive heart failure. Furthermore, if there is increased vascular resistance within the vascular beds, the ventricles get exhausted and can either give up or become hypertrophic. Hypertrophy is due to swelling caused by compensation done by the ventricles.

Decreasing the Volume

To take the volume off the heart, diuretics are given. The different types of diuretics are:

  1. Loop
  2. Thiazide
  3. Potassium-sparing
  4. Osmotic

While these diuretics somehow differ in how they react, they do have the same goal – to get the load off of the ventricles.

Loop and Thiazide

Loop diuretics act on the descending loop of Henle, which means that this medication is responsible for triggering the excretion of fluid within the glomeruli.

Loop diuretics and thiazides are potassium-wasting diuretics. This information is vital especially during examinations wherein questions regarding potassium would usually come up.

Digoxin Toxicity

Clients taking potassium-wasting diuretics and who are taking digoxin at the same time, are at risk for digoxin toxicity. Digoxin is a cardiac glycoside that helps in depolarizing, for cases like atrial fibrillation. Therefore, giving potassium-wasting diuretics to clients who have a depleting potassium level will resort to toxicity because as the potassium goes down, the digoxin level will go up.

Remember, anything greater than 2.0 ng/mL, is considered as digoxin toxicity. One of the best indicators for digoxin toxicity is if the client starts seeing halos.

NCLEX® Trick Question

A tricky NCLEX® question when it comes to digoxin toxicity is:

If your client’s digoxin level reaches 1.9 ng/mL, would you give or hold the administration of digoxin?

Answer: Yes, because that is still within digoxin’s therapeutic level.

Potassium-Sparing Diuretics

Spironolactone is a popular potassium-sparing diuretic that blocks aldosterone in the kidneys while keeping potassium inside the body. Aldosterone or Aldos-“Tyrone” can be considered as the bouncer that is responsible for the regulation of the renin-angiotensin-aldosterone system (RAAS).

A good nursing question for potassium-sparing diuretics would be:

A client is going to be placed on a potassium-sparing diuretic, what should be the nurse’s client teaching?

Answer: Tell the client to eat a normal, healthy diet but should avoid potassium-rich foods like spinach, bananas, and green leafy vegetables.

Osmotic Diuretics

Mannitol is the popularly known osmotic diuretic that is usually given to a client with increased intracranial pressure. Osmotic diuretics help in withdrawing all excess extracellular fluid from the brain down to the potty.

On our next discussion, we will tackle further about myocardial infarction and its medications.

Quick Overview of Heart Failure Pharmacology

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We’ll be having a quick congestive heart failure review and we’ll also go over the drugs involved in treating the condition.

Antihypertensive drugs are responsible for relieving pressure that’s being set on the heart. The aim is to basically get the heart pumping normally that it can stretch and squeeze to eject and distribute blood to different parts of the body with as little effort as possible.

Congestive Heart Failure

In congestive heart failure (CHF), there is a lot of pressure from the peripheral veins that is being pushed on the heart. A primary cause of CHF would be increased sodium in the diet. Fortunately, there are tons of medications that can take this pressure off of the heart and promote proper blood flow.

What are the drugs that help in alleviating the pressure from the heart? These drugs are categorized into A-B-C-D. What does each letter stand for?

The Drugs for Heart Failure

A is for ACE Inhibitors

ACE inhibitors act on the renin-angiotensin-aldosterone system (RAAS) in the kidneys, which are responsible for bringing the pressure from the peripheral veins and blood vessels to decrease the pressure experienced by the heart.

B is for Beta-blockers

The basic function of beta-blockers is to block the beta receptors that have sympathetic nervous system response. And since the response is sympathomimetic, it’s basically the fight or flight reaction of the body which causes increased blood pressure and heart rate.

Blocking the beta receptors will result in relaxation of the heart, resulting to decreased blood pressure and heart rate.

C is for Calcium Channel Blockers

At SimpleNursing.com, there is a separate video about calcium channel blockers showing a detailed instruction on how calcium affects your body and, specifically, your heart.

So, when you think of calcium, the first thing that would come to mind is, it’s mainly found in the bones and is required for hardening the bone structure. That said, if there is an overload of calcium, the heart will be directly affected, causing it to harden. And if that happens, it will be very difficult for the heart to stretch and squeeze blood to the different parts of the body. Therefore, calcium channel blockers block the channels responsible for heart calcification, bringing back the normal function of the heart.  

D is for Diuretics

You can think of diuretics as the agents that open up the faucet inside your body – the faucet being your kidneys. And because the urinary tract primarily functions to excrete fluid from the body, it is imperative that the kidneys are properly working to relieve the heart of unnecessary pressure due to fluid overload.

Diuretics are effective in opening up these faucets (kidneys) to release toxins and fluids out of the body. Some of the main examples of diuretics are Lasix and hydrochlorothiazide. By decreasing the amount of blood or fluid that is going inside the heart, diuretics reduce stress and workload of the heart. Diuretics are basically calming down the increased pressure being pushed on the heart to the point of normalcy.

On our next discussion, we’ll take an in-depth look at the mechanism of action of ACE inhibitors, beta-blockers, calcium channel blockers, and diuretics.

You can drop by SimpleNursing.com and gain access to tons of topics that will help you pass major nursing exams and your NCLEX®. See you there!

Volume-Decreasing Antihypertensive Meds: ACE and Diuretics

Hello.

Today, we will be focusing our senses on the difference between your volume-decreasing antihypertensive medications – ACE inhibitors and diuretics.

Usually, the challenge when dealing with volume-decreasing antihypertensive drugs is that it’s hard to tell them apart. Somewhere along your study session, there’s confusion between heart failure drugs and electrical conductivity drugs. Here, at Simple Nursing, we’ll put some sense to it the best possible way.

The Mechanisms

Technically, two mechanisms put pressure or increase stress on the heart,  namely:

  1. Heart rate = beats per minute, concerned with the contractions of the heart and cardiac output or blood flow
  2. Pressure = workload

To explain further how heart rate and pressure works, think of this scenario:

For example, you’re an accountant who works in a huge firm who is responsible for handling specific clients on a regular basis. So, let’s say you’re balancing books, doing taxes, and closing accounts. The work that you’ve done in an hour, that’s your rate.

On the other hand, the pressure depends on how much energy and time it needs for you to close an account. While there are accounts that are small which can quickly be closed after a few adjustments, there are large accounts that might need more out of you to finish. The effort that you’re exerting is your pressure or workload.

If there’s too much pressure acting on the heart, the rate is going to have a hard time to pump all that blood out. So, technically, it’s as simple as:

  • Heart rate = electrical conductivity/contractility
  • Pressure/workload = how much work the heart needs to do to push against the vascular system

Volume-Only Drugs

So, here, you should not think about drugs that affect the heart rate, electrical stimuli, contractility, and SA and AV nodes. The primary focus is on volume-only medications which directly affects in decreasing the pressure from the heart.

What are your volume-decreasing drugs?

  1. ACE inhibitors (“-pril) – mainly concerned with decreasing the fluid volume only by targeting the renin-angiotensin-aldosterone system (RAAS)

Side note: We have an extensive lecture on ACE inhibitors which introduces you to Club RAAS, involving primary characters like Aldos-Tyrone, Mr. Renin, and Angiotensin I and II. Check this lecture out; it’s a fun and informative discussion.

  1. Diuretics – helps the body to get rid of sodium and water, causing your clients pee a lot; thus, reducing the pressure on your vessel walls. There are three types of diuretics:
  • Loop diuretics – Furosemide (Lasix)
  • Potassium-sparing – Spironolactone (Aldactone)
  • Thiazides – Chlorothiazide (Diuril)

Diuretics mainly act on the distal tubules of the kidneys, the descending Loops of Henle, tapping into them to release fluid.

Client care: Watch out for the potassium level for those taking diuretics and your digitalis toxicity due to a low potassium level. Instruct clients who take diuretics to eat potassium-fortified foods.

Remember, when talking about volume-decreasing medications, only the volume is affected to decrease pressure. It has nothing to do with the rate or the electrical conductivity.

On a separate lecture, we will be thoroughly discussing the mechanism of loop diuretics. See you there!

Antihypertensive Drugs: Diuretics in a Nutshell

When talking about heart conductivity, the first thing that comes to mind is the rate in which the heart contracts – either too much or too little. If the heart is contracting at an increased, irregular, and uncontrollable speed, then what we usually give is a rate-control drug.

Rate-control drugs are your:

  • Beta-blockers
  • Calcium-channel blockers

These drugs affect the electro-excitability within the heart. Diuretics, on the other hand, do not work like that.

What are Diuretics?

In the simplest sense, diuretics are medications that primarily decrease the heart’s workload. Diuretics are medications that are designed specifically to eliminate increased amounts of salt and water inside the body by passing it out as urine. Diuretics that are mainly used for high blood pressure reduces the amount of fluid from the blood vessels which significantly decreases pressure within the vessels. While they are usually prescribed for high blood pressure, there are other conditions that diuretics can treat as well.

Antihypertensive Medications

When talking about diuretics for the heart, there is some pertinent information that you need to know. It can be quite confusing to identify the different kinds of antihypertensive medications. But, there is an easier way to pinpoint which is which; just do the ABCD; those letters stand for the following:

  • A – Ace Inhibitors, Angiotensin Receptor Blockers (ARBs)
  • B – Beta-blockers (rate-control drug)
  • C – Calcium-channel blockers (inhibit electrical stimulations)
  • D – Diuretics (bring down the volume)

Classifications of Diuretics

Think of it this way: diuretics causes diarrhea of the kidneys and the bladder. You are basically diuresing contents out of the body. So what are the different kinds of diuretics?

  1. Loop Diuretics (Furosemide, popularly known as Lasix)
  2. Thiazide Diuretics (Hydrochlorothiazide)
  3. Potassium-Sparing Diuretics (Spironolactone, Aldactone, “-tone”)
  4. Osmotic Diuretics (Mannitol)

To easily ascertain what kind of diuretics you’re encountering, just try to relate to the different suffixes mentioned since these are the most commonly used diuretics in a hospital setting:

  • Loop = Furosemide

Considered as the “big guns” when decreasing workload, loop diuretics are potassium-wasting diuretics; they are fast-acting and effectively take off fluid out of the vascular spaces into the potty and not the body.

  • Thiazide = Hydrochlorothiazide

Thiazides are the second string of potassium-wasting diuretics; think of it as the backup quarterback. This medication is quite effective but not as good as loop diuretics.

  • Potassium-Sparing = Spironolactone, Aldactone

Potassium-sparing diuretics block aldosterone which you can think of as Aldos “Tyrone”). So, Aldostyrone is a nightclub bouncer that stands at the door of your kidneys. He is that bouncer that prevents sodium from going out of the kidneys. Holding back sodium inside the kidneys will attract more water. Blocking Aldostyrone will allow sodium to leave the kidneys and water will instantaneously follow.

Since this type of diuretic is potassium-sparing, there is no need to educate your client about potassium-rich foods. Unlike your loop and thiazide diuretics that you are required to emphasize the need for increased potassium intake because they waste potassium out of the body.

  • Osmotic = Mannitol

Osmotic diuretics are your last line of drugs and are rarely given in hospital settings just because Furosemide is more popular and fast-acting. However, osmotic diuretics can also be provided to decrease blood pressure and volume inside the vascular system.

There you go, a very informative, concise, and useful way of identifying and remembering your antihypertensive diuretics. For other relevant nursing topics, you can head on to our website, simplenursing.com.