C H A P T E R 5 1
Diuretic agents
815
and HF,
which could be exacerbated by the large shifts
in fluid related to use of these drugs.
Routine use during
pregnancy is not appropriate; these drugs should be
reserved for situations in which the mother has patho-
logical reasons for use, not pregnancy manifestations
or complications, and only if the benefit to the mother
clearly outweighs the risk to the fetus.
Adverse effects
The most common and potentially dangerous adverse
effect related to osmotic diuretics is the sudden drop
in fluid levels. Nausea, vomiting, hypotension, light-
headedness, confusion and headache can be accompa-
nied by cardiac decompensation and even shock. People
receiving these drugs should be closely monitored for
fluid and electrolyte imbalance.
Care considerations for
people receiving diuretics
Assessment: History and examination
■
■
Assess for contraindication or cautions: any known
allergies to thiazides or sulfonamides
to prevent
hypersensitivity reactions
; fluid or electrolyte
disturbances,
which could be exacerbated by
the diuretic or render the diuretic ineffective
;
gout,
which reflects an abnormal tubule function
and could be worsened by the diuretic or reflect
a condition that would render the diuretic
ineffective
; glucose tolerance abnormalities,
which
may be exacerbated by the glucose elevating
effects
; liver disease,
which could alter the
metabolism of the drug, leading to toxic levels
;
systemic lupus erythematosus,
which frequently
affects the glomerulus and could be exacerbated
by the use of a thiazide or thiazide-like diuretic
;
hyperparathyroidism and bipolar disorder,
which
could be exacerbated due to increased serum
concentrations of calcium
; and current status
of pregnancy or breastfeeding
because of the
potential for adverse effects on the fetus or baby.
■
■
Perform a physical assessment
to establish baseline
data before beginning therapy, to determine
the effectiveness of therapy and to evaluate for
occurrence of any adverse effects associated with
drug therapy.
■
■
Inspect the skin carefully for signs and symptoms
of oedema; note the extent and degree of oedema,
including evidence of pitting,
to provide a baseline
as a reference for drug effectiveness
; check skin
turgor
to determine hydration status.
■
■
Assess cardiopulmonary status, including blood
pressure and pulse, and auscultate heart and
lung sounds for abnormalities
to evaluate fluid
movement and state of hydration and monitor the
effects on the heart and lungs.
■
■
Obtain an accurate body weight
to provide a
baseline to monitor fluid balance.
■
■
Monitor intake and output and assess voiding
patterns
to evaluate fluid balance and renal
function.
■
■
Evaluate liver status
to determine potential
problems in drug metabolism.
■
■
Monitor the results of laboratory tests, including
serum electrolyte levels, especially potassium and
calcium, uric acid and glucose levels,
to determine
the drug’s effect
, and renal and liver function tests
to identify the need for possible dose adjustment
and toxic effects
.
Implementation with rationale
■
■
Administer oral drug with food or milk
to buffer
the drug effect on the stomach lining if GI upset is
a problem.
■
■
Administer intravenous diuretics slowly
to prevent
severe changes in fluid and electrolytes.
■
■
Continuously monitor urinary output, cardiac
response and heart rhythm of individuals receiving
intravenous diuretics
to monitor for rapid fluid
switch and potential electrolyte disturbances
leading to cardiac arrhythmia.
Switch to the oral
form,
which is less potent and easier to monitor
,
as soon as possible, as appropriate.
■
■
Administer oral form early in the day
so that
increased urination will not interfere with sleep.
■
■
Monitor the dose carefully and reduce the dose of
one or both drugs if given with antihypertensive
agents;
loss of fluid volume can precipitate
hypotension.
■
■
Monitor the response to the drug (e.g. blood
pressure, urinary output, weight, serum
electrolytes, hydration, periodic blood glucose
monitoring)
to evaluate the effectiveness of the
drug and monitor for adverse effects.
■
■
Assess weight daily
to evaluate fluid balance.
■
■
Check skin turgor
to evaluate for possible fluid
volume deficit
, and assess oedematous areas for
changes, including a decrease in amount or degree
of pitting
.
■
■
Provide comfort measures, including skin care and
nutrition consultation,
to increase compliance with
drug therapy and decrease the severity of adverse
effects;
provide safety measures if dizziness and
weakness are a problem
to prevent injury.
■
■
Provide potassium-rich or low-potassium diet as
appropriate
to maintain electrolyte balance and
replace lost potassium or prevent hyperkalaemia.
