Loop and Thiazides
This is the rate for pushing an IV dose of furosemide?
Slowly!
no more than 10 mg/min, which could take 2-4 minutes
List four dietary sources of potassium
What are potatoes, bananas, spinach, mushrooms, raisins, tomatoes, butternut squash, beans, oranges
This lab value indicates a patient is in end stage renal failure. (Both the lab name and the value)
What is estimated GFR <15
Creatinine will be elevated but GFR is definitive for ESRD
This is the location in the neprhon where spironolactone has its action
Collecting ducts
This daily vital sign should be monitored in patients taking diuretics, as a noninvasive way to measure fluid retention
What is Daily weight
A patient allergic to this should not be given furosemide or thiazide diuretics.
Sulfa allergy
The nurse suspects this condition when a patient taking thiazide diuretics reports stomach upset, bone pain, flank pain, and heart palpitations.
What is hypercalcemia
This portion of the nephron is the strongest for sodium, potassium, and water exchange
What is the Loop of Henle
This hormone is impacted by the main action of spironolactone in the kidneys.
Aldosterone
This diuretic is safest to use in cases of acute kidney injury and can be given IV or PO
Loop diuretics
This dietary instruction - to avoid something - should be given to patients taking any diuretic, but especially loop and thiazide diuiretics.
What is a low sodium diet
This assessment finding is demonstrated by palpating the facial nerve and looking for twitching in response. Name the assessment technique and what a positive finding indicates.
What is Chvostek's sign, assessing for hypocalcemia
Why might a patient who has chronic kidney disease also have anemia?
The kidney promotes RBC production through erythropoietin hormone, which is reduced in CKD
Patients with elevated blood pressure are advised to follow a low sodium diet. This extra education about this diet is important to provide for patients taking spironolactone.
What is: avoid salt substitutes, because they are often derived from potassium
This lab(s) should be checked daily for patients taking diuretic medications
Check this lab value before administering loop diuretics, and this action should be taken if the value is abnormal.
What is potassium, and hold the dose!
The nurse should request this lab test for a patient taking furosemide who reports constipation, fatigue, muscle weakness, and heart palpitations?
What is a potassium level, suspecting hypokalemia
A patient with chronic kidney disease reports a moderate headache, pain level 4/10, and asks for some pain medication. Knowing that the patient has chronic kidney disease, what medication would the nurse know to avoid?
NSAIDs such as ibuprofen
This lab value should be monitored before administering spironolactone.
Hint: It's not an electrolyte
BUN/Creatnine and GFR: Spironolactone is contraindicated in acute kidney injury or reduced renal function
This education is important for patients taking diuretics, no matter the classification of diuretic, to prevent a particular side effect that often causes patients to stop taking diuretics
What is take the medications early to reduce nocturia
The nurse should provide this education to explain why a patient would be prescribed both spironolactone (Aldactone) and furosemide (Lasix).
This combination promotes diuresis (furosemide prevents reabsorption of fluid) but decreases the risk of hypokalemia (spironolactone decreases excretion of potassium)
The nurse is caring for a patient with CKD. This routine medication to address electrolyte imbalance will often also keep calcium levels in check (medication class)
What is phosphate binders
If asymptomatic, treat elevated phosphate and recheck before addressing low calcium
A patient with chronic kidney disease has a potassium level of 5.8 in the morning labs. What action(s) should the nurse take?
Notify provider
Expect orders for polystyrene sulfate
A patient with hypertension and arthritis is prescribed the following medications. Which medication order should the nurse question?
Spironolactone 50mg daily, Lisinopril 20mg daily, Acetaminophen 650 mg every 6 hours, Omeprazole 20mg daily before breakfast
ACE inhibitors and spironolactone should not be administered together; they both increase potassium retention and can cause hyperkalemia
The provider tells the patient their diuretic medications are NOT effective based on this assessment finding (hint: it is not a lab value)
What is oliguria
Other symptoms of fluid retention: edema, ascites, hypertension, adventitious lung sounds (crackles)