Term
Discuss conditions treated by diuretic drugs. |
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Definition
Heart failure, HTN, pulmonary edema, increased IOP, increased ICP, ascities, kidney disorders |
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Term
Discuss general nursing education that needs to be provided to all clients taking a diuretic drug. |
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Definition
Take med in am or last dose by 6pm if more than once a day; explain the importance of follow up blood work to monitor electrolytes; teach patients hoe to check BP and pulse; teach patients to avoid injury from falls by rising slowly (orthostatic hypotension); adequate hydration; daily weights |
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Term
| Recognize the classification for each of the following prototype diuretic drugs |
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Definition
Hydrochlorothiazide (HCTZ, HydroDiuril) = thiazide diuretic
Furosemide (Lasix) = loop diuretic
Triamterene (Dyrenium) = Potassium Sparing diuretic
Mannitol (Osmitrol) = osmotic diuretic
Acetazolamide (Diamox) = carbonic anhydrase inhibitor |
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Term
| Explain the action of the following diuretic classifications |
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Definition
Thiazide = acts in the distal tube and possibly in the diluting segment of the ascending loop of henle; increases excretion of sodium and chloride in the distal convoluted tubule by slightly inhibiting the ion pumps that work in Na and Cl reabsorption; inhibits sodium reabsorption and promotes water, Na, Cl, K+ excretion; increases preload and decrease BP.
Loop = inhibits the reabsorption of Na, Cl, and water in the ascending loop of Henle and increases the excretion of K+, Na, Cl, and water.
K+ sparing = inhibits the transport of Na in the distal tubules independent of aldosterone; causes increases loss of Na, Cl, water, bicarbonate, and Ca and promotes retention of K+ and magnesium. |
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Term
| Recognize common adverse effects of the following diuretic classifications |
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Definition
Thiazide = (hypo) kalemia,natremia, chloremia, hypercalcemia, hypotension, dizziness, vertigo, N/V, anorexia, polyuria, nocturia
Loop = (hypo) natremia, kalemia, chloremia,calcemia; orthostatic hypotension, dizziness, vertigo, dehydration, hypovolemia; ototoxicity is a common but serious adverse effect
Potassium sparing = hyperkalemia, nephrotoxiciy, diarrhea, jaundice, liver enzyme abnormalities, azotemia, elevated BUN and creatinine levels, thrombocytopenia, megaloblastoc anemia, fatigue, dizziness, and headache, photosensitivity, rash. |
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Term
| Recognize serious adverse effects that may occur when a client is taking a loop, K+ sparing, or osmotic diuretic |
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Definition
Loop = ototoxicity, hypersensitivity
K+ sparing = hyperkalemia
Osmotic = water intoxication and renal impairment |
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Term
| what are some precautions for thiazide diuretics |
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Definition
| allergy to sulfa, severe renal impairment, diabetics, electrolyte imbalances |
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Term
| What are some precautions for loop diuretics |
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Definition
| anuria, sulaf allergy, diabetics because it increases BS, and pregnancy |
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Term
| What are some precautions for K+ sparing diuretics |
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Definition
| increaseed K+, blood products, elderly, anuria, and diabetics |
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Term
| What are the goals of treatment with combination drugs used for heart failure. |
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Definition
| to increase cardiac output; decrease fluid overload by decreasing preload; decrease compensatory mechanisms |
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Term
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Definition
| positive inotropic effect (increases contractility); negative dromotropic (slow speed conduction); negative chronotropic (slows HR) |
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Term
| common adverse effects of digoxin |
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Definition
| adverse effects are signs of dig toxicity which includes cardiac (bradycardia, AV block, complete heart block, ventricular tachycardia, PVC's, v-fib, AV dissociation, a-fib) and GI (anorexia, nausea, vomiting, diarrhea, and abdominal pain); CNS (headache, weakness, visual disturbances, confusion, restlessness, disorientation, hallucinations) |
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Term
| explain digitalization process |
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Definition
| To speed up the onset of therapeutic effects, a dose higher than normal, a loading dose, may be given to raise the level quickly to a therapeutic range to improve HF or a-fib; rapid digitalization is done in the hospital where IV pushes are given then po; slow digitalization is done at home on po doses. |
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Term
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Definition
| patients with heart block or ventricular arrhthmias; those with undtable renal function or a tendency toward hypokalemia; patients with severe carditis, acute MI, severe pulmonary disease; patients with renal insufficiency; patients with thyroid disorders; elderly; electrolyte imbalances (hypokalemia); pregnacy category C |
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Term
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Definition
| interactions usually relate to decreased or increased serum levels of dig or increased incidence of adverse effects (ex. St. John's Wort) p.544 |
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Term
| usual oral dose of digoxin |
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Definition
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Term
| normal therapeutic range of dig |
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Definition
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Term
| relationship between potassium and digoxin |
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Definition
| digoxin competes with K+ for receptors; low K+ levels allow dig to occupy more receptors increasing the risk for adverse effects |
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Term
| what effect does decreased renal function have on a client taking digoxin |
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Definition
| poor renal excretion may allow digoxin levels to build up to toxic levels; patients with renal impairment may require a lower dose |
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Term
| what is the antidote for dig toxicity |
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Definition
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Term
| nursing interventions with dig |
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Definition
| assess patient's weight before beginning dig therapy because weight is considered in determining dosage; baseline VS/EKG; medication history; monitor labs and HR |
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Term
| patient teaching for a patient taking digoxin |
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Definition
| teach patient how to take HR; hold if HR <60; take med at same time everyday; if a dose is missed, >12 hours can take; <12 hours, hold; store out of reach of children; report visual disturbances, hypokalemic symptoms, and changes in HR/rhythm |
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Term
| other drugs used to treat heart failure if standard therapies are unresponsive |
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Definition
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Term
| how does ACE inhibitors help in the treatment of heart failure |
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Definition
| Increase peripheral resistance, which decreases cardiac output and further increases on the failing heart (decreases preload and afterload) |
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Term
| how do diuretics help treat HF |
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Definition
| decrease fluid volume and edema; decreases circulating volume and peripheral resistance, reducing the workload on the failing heart (decreasing preloads) |
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Term
| how beta blockers help treat HF |
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Definition
| decrease contractility of the heart, thereby decreasing cardiac output; also causes vasodilation and decreased peripheral vascular resistance (blocks sympathetic nervous system and decreases afterload) |
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Term
| how selctive aldosterone blockers help treat HF |
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Definition
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Term
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Definition
| the heart does not pump effectively to meet the needs of the body |
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Term
| signs of right sided heart failure |
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Definition
| Physical examination can reveal pitting peripheral edema, ascites, and hepatomegaly. Jugular venous pressure is frequently assessed as a marker of fluid status, which can be accentuated by the hepatojugular reflux. If the right ventriclar pressure is increased, a parasternal heave may be present, signifying the compensatory increase in contraction strength. |
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Term
| signs of left sided heart failure |
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Definition
Common respiratory signs are tachypnea (increased rate of breathing) and increased work of breathing (non-specific signs of respiratory distress). Rales or crackles, heard initially in the lung bases, and when severe, throughout the lung fields suggest the development of pulmonary edema (fluid in the alveoli). Cyanosis which suggests severe hypoxemia, is a late sign of extremely severe pulmonary edema.
Additional signs indicating left ventricular failure include a laterally displaced apex beat (which occurs if the heart is enlarged) and a gallop rhythm (additional heart sounds) may be heard as a marker of increased blood flow, or increased intra-cardiac pressure. Heart murmurs may indicate the presence of valvular heart disease, either as a cause (e.g. aortic stenosis) or as a result (e.g. mitral regurgitation) of the heart failure. |
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Term
| what are some compensatory mechanisms involved in HF |
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Definition
| sympathetic nervous system, parasympathetic nervous system, renin-angiotensin, aldosterone |
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Term
| what is the lab test used for diagnosis of HF and what should the value be |
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Definition
| BNP (b-type natriuretic peptide) should be < 100 |
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Term
| what type of drug influences myocardial contractility |
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Definition
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Term
| what type of drug affects conduction speed through specialized conducting tissues |
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Definition
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Term
| what type of drug affects heart rate |
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Definition
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Term
| what is the prototype drug for cardiac glycoside |
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Definition
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Term
| what is the prototype drug for natriuretic peptides |
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Definition
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Term
| what is the prototype inotrope drug |
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Definition
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Term
| what is the action of natrecor |
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Definition
| relaxes smooth muscle and dilates arteries and veins |
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Term
| what condition is natrecor used to treat |
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Definition
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Term
| what is the common adverse effect of natrecor |
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Definition
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Term
| what is a serious adverse effect of natrecor |
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Definition
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Term
| nursing interventions/education for natrecor |
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Definition
| baseline and continuous HR, BP, and EKG; IV administration (onset is rapid; improvement seen in 15-30 min; iv pump only; titrate no more than every 3 hours) |
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Term
| what is the action of primacor |
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Definition
| positive inotropic and vasodilation |
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Term
| what condition does primacor treat |
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Definition
| use for HF when pt not responding to standard therapy; short term treatment and iv route only |
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