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[h]

Diurectics

[q] Loop Diuretics

[a] Furosemide, Bumetanide, Torsemide

[q] Loop Diuretics Side Effects 1

[a]Dehydration, hyponatremia, hypochloremia, hyperuricemia : Assess/monitor clients for signs of dehydration: dry mouth, increased thirst, minimal urine output, and weight loss. Monitor electrolytes/gout. If signs of headache and/or chest, calf, or pelvic pain- notify doctor (may be signs of thrombosis or embolism)

[q] Loop Diuretics Side Effects 2

[a] Hypotension : Instruct clients about signs of postural hypotension (lightheadedness). Avoid sudden changes of position and arise slowly from lying down or sitting

[q] Loop Diuretics Side Effects 3

[a] Ototoxicity : notify the provider of tinnitus, Avoid use with other ototoxic medications, such as gentamicin

[q] Loop Diuretics Side Effects 4

[a] Hypokalemia : Monitor clients’ cardiac status and potassium levels. Teach clients to consume high-potassium foods (e.g., bananas, potatoes, dried fruits, nuts, spinach, and citrus fruit).

[q] Loop Diuretics : Medication interactions

[a] Digoxin toxicity (ventricular dysrhythmias) can occur in the presence of hypokalemia : Monitor the client’s cardiac status and potassium client’s cardiac status and potassium, Administer potassium supplements

[q] Loop Diuretics : Medication interactions

[a] Lithium carbonate serum levels can increase, which may lead to toxicity,

[q] Loop Diuretics: Nursing considerations

[a] Monitor the client’s blood pressure and I&O. Avoid administering the medication late in the day to prevent nocturia. Instruct clients with diabetes to monitor for elevated blood glucose levels as hyperglycemia can occur with loop diuretics. Instruct clients to observe for signs of low magnesium levels (e.g., weakness, muscle twitching, and tremors as hypomagnesimea can occur.

[q] Thiazide Diuretics

[a] Hydrochlorothiazide, Chlorothiazide, Methyclothiazide, Indapamide, Chlorthalidone, Metolazone

[q] Thiazide Diuretics Adverse Effects 1

[a] Dehydration, hyponatremia, hypochloremia : Assess/monitor clients for signs of dehydration: dry mouth, increased thirst, minimal urine output, and weight loss. Monitor electrolytes. If signs of headache and/or chest, calf, or pelvic pain- notify doctor (may be signs of thrombosis or embolism)

[q] Thiazide Diuretics Adverse Effects 2

[a] Hypokalemia : Monitor clients’ cardiac status and potassium levels. Teach clients to consume high-potassium foods (e.g., bananas, potatoes, dried fruits, nuts, spinach, and citrus fruit).

[q] Thiazide Diuretics Adverse Effects 3

[a] Hyperglycemia :Monitor clients for an increase in blood glucose levels.

[q] Potassium-Sparing Diuretics

[a] Spironolactone, Triamterene, Amiloride :block the action of aldosterone (sodium and water retention), which results in potassium retention and the secretion of sodium and water.

[q] Potassium-Sparing Diuretics Side Effect 1

[a] Hyperkalemia :Monitor potassium level. Initiate cardiac monitoring, restrict potassium in diet, insulin injections if needed, Avoid use of ACE inhibitors/angiotensin receptor blockers – as they increase potassium levels.

[q] Potassium-Sparing Diuretics Side Effect 2

[a] Endocrine effects (impotence in male clients; irregularities of menstrual cycle in female clients)

[q] Osmotic Diuretics – Mannitol

[a] Reduce intracranial pressure and intraocular pressure by drawing fluid back into the vascular and extravascular space

[q] Mannitol Adverse Effects

[a] Heart failure, pulmonary edema, Kidney failure, Fluid and electrolyte imbalances

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