Diuretics
Overview
- Diuretics help remove excess fluid from the body by stimulating urine production.
- Types: Loop, Thiazide, Potassium-sparing, Osmotic.
- Memory trick: "Diuretics think dry inside."
Uses of Diuretics
- Heart Failure: Treat fluid retention and edema due to heart's weakened state.
- Hypertension: Less fluid means less pressure on vessels.
- Chronic Kidney Disease (CKD): Help reduce fluid retention and manage potassium levels.
Types of Diuretics
Loop Diuretics
- Suffix: End in "-mide" or "-nide" (e.g., Furosemide, Bumetonide, Torsomide).
- Mechanism: Inhibit reabsorption of sodium and chloride in the kidneys.
- Works on distal/proximal tubules and Loop of Henle.
- Potassium Wasting: Major side effect is hypokalemia (low potassium).
- Normal potassium level: 3.5-5.0 mEq/L.
- Nursing Considerations:
- Monitor potassium levels.
- Administer potassium replacement orally or intravenously (must not crush/chew extended-release tablets).
- Administer Furosemide slowly to avoid ototoxicity.
Thiazide Diuretics
- Suffix: End in "-thiazide" (e.g., Hydrochlorothiazide, Chlorothiazide).
- Mechanism: Similar to Loop Diuretics but less potent, act on ascending loop of Henle and early distal tubule.
- Nursing Considerations:
- Monitor potassium levels.
- Avoid in patients with gout or sulfur allergies.
Potassium-Sparing Diuretics
- Common Drug: Spironolactone (Aldactone).
- Mechanism: Blocks aldosterone, leading to sodium and water excretion but sparing potassium.
- Nursing Considerations:
- Monitor for hyperkalemia (high potassium).
- Advise patients to avoid high-potassium foods and potassium supplements.
Osmotic Diuretics
- Common Drug: Mannitol (Osmitrol).
- Use: Treat cerebral edema and decrease intraocular pressure.
- Mechanism: Increases filtrate thickness, preventing water reabsorption.
- Nursing Considerations:
- Administered IV; check for crystallization.
- Monitor neuro assessments for cerebral edema.
General Nursing Considerations for Diuretics
- Administer diuretics in the morning to avoid nocturia (night peeing).
- Educate on orthostatic hypotension and low sodium diet.
- Monitor daily weights, intake/output, and potassium levels.
- Report acute weight gain (2-3 lbs).
Potassium Wasting vs. Sparing Diuretics
- Wasting: Loop and Thiazide Diuretics.
- Sparing: Spironolactone (Aldactone).
Practice Question
- Spironolactone and high potassium levels: Report potassium levels before administering if above normal range (e.g., 5.3 mEq/L).
For additional resources and practice questions, refer to the NCLEX study materials mentioned in the lecture.