Chamberlain College of Nursing: NR 446 REVIEW NOTES PART 4
Select Prototype Medication: furosemide (Lasix)
Other Medications:
◯Ethacrynic acid (Edecrin)
◯Bumetanide (Bumex)
◯Torsemide (Demadex)
Purpose
● Expected Pharmacological Action
◯High-ceiling loop diuretics work in the ascending limb of loop of Henle.
■ Blocks reabsorption of sodium and chloride and to prevent reabsorption of water
■ Causes extensive diuresis even with severe renal impairment
Therapeutic Uses
◯High-ceiling loop diuretics are used when there is an emergent need for rapid
mobilization of fluid.
■ Pulmonary edema caused by heart failure
■ Conditions not responsive to other diuretics, such as edema caused by liver,
cardiac, or kidney disease; or hypertension
◯These medications also may be used to treat hypercalcemia related to kidney stone
formation.
● Route of administration: oral, IV, IM
›Dehydration, hyponatremia, hypochloremia
›Assess/monitor clients for signs of dehydration: dry mouth, increased thirst,
minimal urine output, and weight loss.
›Monitor electrolytes.
›Report urine output less than 30 mL/hr
. Stop medication and notify the provider.
›If signs of headache and/or chest, calf, or pelvic pain occur, notify the provider.
This may be an indication of thrombosis or embolism.
›Minimize the risk for dehydration by starting clients on low doses and monitoring daily
weights.
›Hypotension
›Monitor clients’ blood pressure.
›Instruct clients about signs of postural hypotension (lightheadedness, dizziness).
If these occur, advise clients to sit or lie down.
›Advise clients to avoid sudden changes of position and arise slowly from lying down or
sitting.
›Ototoxicity (transient with furosemide and irreversible with ethacrynic acid)
›Advise clients to notify the provider of tinnitus, which may indicate ototoxicity.
›Avoid use with other ototoxic medications, such as gentamicin.
,›Hypokalemia
(K+ less than 3.5 mEq/L)
›Monitor clients’ cardiac status and potassium levels.
›Report a decrease in potassium level (K+ less than 3.5 mEq/L).
,›Teach clients to consume high-potassium foods (e.g., bananas, potatoes,
dried fruits, nuts, spinach, and citrus fruit).
›Teach clients signs of hypokalemia, such as nausea/vomiting and general weakness.
›Other adverse effects (hyperglycemia, hyperuricemia, decrease in calcium and
magnesium levels)
›Monitor clients’ blood glucose, uric acid, and calcium andmagnesium levels.
›Report elevated levels
Contraindications/Precautions
● Avoid using these medications during pregnancy unless absolutely required.
● Use cautiously in clients who have diabetes and/or gout.
›Digoxin (Lanoxin) toxicity (ventricular dysrhythmias) can occur in the
presence of hypokalemia.
›Monitor the client’s cardiac status and potassium and digoxin levels.
›Potassium-sparing diuretics often are used in conjunction with loop diuretics to
reduce the risk of hypokalemia.
›Administer potassium supplements as prescribed by the provider.
›Concurrent use of antihypertensives can have additive hypotensive effect.
›Monitor the client’s blood pressure.
›Lithium carbonate (Eskalith) serum levelscan increase, which may lead
to toxicity, if hyponatremia occurs due to the loop diuretic.
›Monitor the client’s lithium levels. Dosage may need to be adjusted.
›NSAIDs decrease blood flow to the kidneys, which reduces the diuretic effect.
›Watch for a decrease in the effectiveness of the diuretic, such as a decrease in urine output.
Nursing considerations
● Obtain the client’s baseline data, including orthostatic blood pressure, weight,
electrolytes, and location and extent of edema.
● Weigh clients at the same time each day with same amount of clothing and bed
linen (if using a bed scale), usually upon awakening.
● Monitor the client’s blood pressure and I&O.
● Avoid administering the medication late in the day to prevent nocturia. Usual
dosing time is 0800 and 1400.
● Administer furosemide orally, IV bolus dose, or continuous IV infusion. Infuse
IV doses at 20 mg/min or slower to avoid abrupt hypotension and hypovolemia.
● If potassium level drops below 3.5 mEq/L, monitor the client’s potassium level,
and notify the provider because the client may need to be placed on a potassium
supplement.
● If the medication is used for hypertension, teach clients to self-monitor blood
pressure and weight by keeping a log.
, ● Advise clients to get up slowly to minimize postural hypotension and check
orthostatic blood pressure to assess for hypovolemia. If faintness or dizziness
occurs, instruct clients to sit or lie down.
Select Prototype Medication: furosemide (Lasix)
Other Medications:
◯Ethacrynic acid (Edecrin)
◯Bumetanide (Bumex)
◯Torsemide (Demadex)
Purpose
● Expected Pharmacological Action
◯High-ceiling loop diuretics work in the ascending limb of loop of Henle.
■ Blocks reabsorption of sodium and chloride and to prevent reabsorption of water
■ Causes extensive diuresis even with severe renal impairment
Therapeutic Uses
◯High-ceiling loop diuretics are used when there is an emergent need for rapid
mobilization of fluid.
■ Pulmonary edema caused by heart failure
■ Conditions not responsive to other diuretics, such as edema caused by liver,
cardiac, or kidney disease; or hypertension
◯These medications also may be used to treat hypercalcemia related to kidney stone
formation.
● Route of administration: oral, IV, IM
›Dehydration, hyponatremia, hypochloremia
›Assess/monitor clients for signs of dehydration: dry mouth, increased thirst,
minimal urine output, and weight loss.
›Monitor electrolytes.
›Report urine output less than 30 mL/hr
. Stop medication and notify the provider.
›If signs of headache and/or chest, calf, or pelvic pain occur, notify the provider.
This may be an indication of thrombosis or embolism.
›Minimize the risk for dehydration by starting clients on low doses and monitoring daily
weights.
›Hypotension
›Monitor clients’ blood pressure.
›Instruct clients about signs of postural hypotension (lightheadedness, dizziness).
If these occur, advise clients to sit or lie down.
›Advise clients to avoid sudden changes of position and arise slowly from lying down or
sitting.
›Ototoxicity (transient with furosemide and irreversible with ethacrynic acid)
›Advise clients to notify the provider of tinnitus, which may indicate ototoxicity.
›Avoid use with other ototoxic medications, such as gentamicin.
,›Hypokalemia
(K+ less than 3.5 mEq/L)
›Monitor clients’ cardiac status and potassium levels.
›Report a decrease in potassium level (K+ less than 3.5 mEq/L).
,›Teach clients to consume high-potassium foods (e.g., bananas, potatoes,
dried fruits, nuts, spinach, and citrus fruit).
›Teach clients signs of hypokalemia, such as nausea/vomiting and general weakness.
›Other adverse effects (hyperglycemia, hyperuricemia, decrease in calcium and
magnesium levels)
›Monitor clients’ blood glucose, uric acid, and calcium andmagnesium levels.
›Report elevated levels
Contraindications/Precautions
● Avoid using these medications during pregnancy unless absolutely required.
● Use cautiously in clients who have diabetes and/or gout.
›Digoxin (Lanoxin) toxicity (ventricular dysrhythmias) can occur in the
presence of hypokalemia.
›Monitor the client’s cardiac status and potassium and digoxin levels.
›Potassium-sparing diuretics often are used in conjunction with loop diuretics to
reduce the risk of hypokalemia.
›Administer potassium supplements as prescribed by the provider.
›Concurrent use of antihypertensives can have additive hypotensive effect.
›Monitor the client’s blood pressure.
›Lithium carbonate (Eskalith) serum levelscan increase, which may lead
to toxicity, if hyponatremia occurs due to the loop diuretic.
›Monitor the client’s lithium levels. Dosage may need to be adjusted.
›NSAIDs decrease blood flow to the kidneys, which reduces the diuretic effect.
›Watch for a decrease in the effectiveness of the diuretic, such as a decrease in urine output.
Nursing considerations
● Obtain the client’s baseline data, including orthostatic blood pressure, weight,
electrolytes, and location and extent of edema.
● Weigh clients at the same time each day with same amount of clothing and bed
linen (if using a bed scale), usually upon awakening.
● Monitor the client’s blood pressure and I&O.
● Avoid administering the medication late in the day to prevent nocturia. Usual
dosing time is 0800 and 1400.
● Administer furosemide orally, IV bolus dose, or continuous IV infusion. Infuse
IV doses at 20 mg/min or slower to avoid abrupt hypotension and hypovolemia.
● If potassium level drops below 3.5 mEq/L, monitor the client’s potassium level,
and notify the provider because the client may need to be placed on a potassium
supplement.
● If the medication is used for hypertension, teach clients to self-monitor blood
pressure and weight by keeping a log.
, ● Advise clients to get up slowly to minimize postural hypotension and check
orthostatic blood pressure to assess for hypovolemia. If faintness or dizziness
occurs, instruct clients to sit or lie down.
