N105: Essentials of Nursing Care - Health Differences

Essentials of Nursing Study Guide

©2017 Achieve Test Prep Page 99 of 160 excess; instruct the patient receiving a loop diuretic to increase dietary intake of potassium; provide instruction regarding increased intake of salt prior to strenuous exercise in hot weather; promote continuity of care to include teaching, referrals, support groups, and community resources • Evaluation: assess patient progress toward patient-centered goals by reporting patient’s response; report weight changes, altered hematocrit levels, altered urine specific gravity, alterations in output, increased energy level, adverse effects, 24 hour I/O record, skin turgor, and vital signs Diuretics • Furosemide (Lasix ) is used for edema and associated heart failure, renal disease, and hypertension. Lasix works by inhibiting sodiumand chloride reabsorption in the Loop of Henle (loop diuretic). Side effects include postural hypotension, blurring vision, nausea, vomiting, diarrhea, dehydration, potassium depletion, and hearing loss. Nursing interventions include assessing for weakness, lethargy, leg cramps, and anorexia. Peak action is 1-2 hours, duration in 6-8 hours. Do not give at bedtime. Supplementary KCL is indicated, and Lasix may induce digitalis toxicity. • Hydrochlorothiazide (Hydrodiuril and Esidrix ) are also loop diuretics. They are used to treat edema, congestive heart failure, sodium retention in steroid therapy, and hypertension. They work by inhibiting sodium and chloride and water reabsorption in the distal ascending loop and the distal convoluted tubules. Side effects include hypokalemia, nausea, and vomiting Nursing interventions include watching for muscle weakness. Give well diluted potassium chloride supplements; monitor urine for changes in sugar and acetone. • Mannitol is an osmotic diuretic. Mannitol is used to treat cerebral edema. Mannitol works as a hypertonic solution causing obligatory water loss. Mannitol increases extracellular fluid volume. Nursing interventions include inserting a Foley catheter and monitoring cardiac and respiratorystatus. • Spironolactone (Aldactone) is used if other diuretics are ineffective or if the client has cirrhosis of the liver. Aldactone works by inhibiting the effects of aldosterone in the distal tubules of the kidneys. Side effects include headache, lethargy, diarrhea, ataxia, skin rash and gynecomastia. Nursing interventions include monitoring for signs of electrolyte imbalance. Anti-Diarrheals • Diphenoxylate HCL with atropine sulfate (Lomotil) is used to treat diarrhea. It works by increasing the intestinal tone and decreasing propulsive peristalsis. Side effects include rash, drowsiness, dizziness, depression, abdominal distention, headache, blurred vision and nausea. Nursing interventions include administering cautiously to patients with hepatic dysfunction, because it may precipitate hepatic coma. Lomotil may potentiate the action of barbituates, opiates and other depressants; administer narcotic antagonists such as Lorfan, Narcan and Nalline as ordered. • Kaolin with pectin (Kaopectate) is used after each loose bowel movement. Kaopectate