Download Case Study: Which diuretic is best choice?

Case Study: Which diuretic is best choice?
A patient who sustained a head injury is admitted to the critical care unit with increased
intracranial pressure (ICP). The healthcare provider says that a diuretic will be used to
lower the patient’s ICP. The nurse anticipates that which diuretic will be ordered, and why?
A:The nurse anticipates that mannitol, an osmotic diuretic, will be ordered. Intracranial
pressure (ICP) that has been elevated by cerebral edema can be reduced with mannitol.
The drug lowers ICP because its presence in the blood vessels of the brain creates an
osmotic force that draws edematous fluid from the brain into the blood. There is no risk
of increasing cerebral edema because mannitol cannot exit the capillary beds of the
brain.
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Case Study: which diuretic, slide 2
Mannitol IV has been ordered for the patient. When the IV solution of
mannitol arrives from the pharmacy, the nurse notes crystals in the fluid.
What is the most appropriate action by the nurse?
Answer: Most likely, the in-house pharmacy takes care of this issue.
However, if you worked in a rural, under-resourced setting, then it might
be good to know that: mannitol may crystallize out of solution if exposed
to a low temperature. Accordingly, preparations should be observed for
crystals before use. Preparations that contain crystals should be warmed
(to redissolve the mannitol) and then cooled to body temperature for
administration.
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Case Study: which diuretic, slide 3
Are there any other steps the nurse should take regarding IV administration of mannitol?
Answer: Along with following all the appropriate safety precautions for medication
administration, the nurse should use a filter needle to withdraw mannitol from the vial,
as well as an in-line filter for IV infusion, to prevent crystals from entering the
circulation.
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Patient Case TR, slide 1

TR is a 62 YO WM who presents in clinic
complaining of some difficulty breathing while lying
down at night, and increased swelling in his feet and
ankles.


→ these are CLASSIC signs of heart failure, shortness of
breath will also develop
He is diagnosed with mild congestive heart failure
secondary to ischemic heart disease, and is placed on
hydrochlorothiazide 50mg PO QD.
Patient Case TR, slide 2



What do you think is probably causing this patient’s
symptoms?
What parameters are important to monitor in this patient with
respect to:
 Therapeutic effect?
 Adverse effects?
What instructions does this patient need to ensure appropriate
therapy?
Question: furosemide and dietary intake
When providing discharge teaching for a patient who has
been prescribed furosemide [Lasix], it is most important
for the nurse to include which dietary items to
prevent adverse effects of furosemide [Lasix] therapy?
A.
B.
C.
D.
Oranges, spinach, and potatoes
Baked fish, chicken, and cauliflower
Tomato juice, skim milk, and cottage cheese
Oatmeal, cabbage, and bran flakes
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Question: furosemide and dietary intake
When providing discharge teaching for a patient who has been
prescribed furosemide [Lasix], it is most important for the nurse
to include which dietary items to prevent adverse effects of
furosemide [Lasix] therapy?
A.
B.
C.
D.


Oranges, spinach, and potatoes
Baked fish, chicken, and cauliflower
Tomato juice, skim milk, and cottage cheese
Oatmeal, cabbage, and bran flakes
Answer: A
Rationale: Furosemide may have the adverse effect of hypokalemia. Hypokalemia
can be reduced by consuming foods that are high in potassium, such as nuts, dried
fruits, spinach, citrus fruits, potatoes, and bananas.
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Question: spironolactone and dietary intake
A patient is prescribed spironolactone [Aldactone] for treatment
of hypertension. Which foods should the nurse teach the
patient to avoid?
A.
B.
C.
D.
Baked fish
Low-fat milk
Salt substitutes
Green beans
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Question: spironolactone and dietary intake
A patient is prescribed spironolactone [Aldactone] for treatment
of hypertension. Which foods should the nurse teach the
patient to avoid?
A.
B.
C.
D.



Baked fish
Low-fat milk
Salt substitutes
Green beans
Answer: C
Rationale: Spironolactone is a potassium-sparing diuretic. Medications that are
potassium sparing, potassium supplements, and salt substitutes should be avoided.
High-potassium foods should also be avoided.
SALT SUBSTITUTES that use POTASSIUM CAN BE (are) VERY HAZARDOUS!
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Question: bumetanide is a potent loop diuretic
The nurse cares for a patient who is prescribed oral bumetanide
twice daily. It is most important for the nurse to take which
action?
A.
B.
C.
D.
Monitor the patient for signs and symptoms of hyperkalemia.
Insert a urinary catheter and assess the hourly urine output.
Weigh the patient before administering each dose.
Schedule the medication to be given at 0800 and 1400.
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Question: bumetanide is a potent loop diuretic
The nurse cares for a patient who is prescribed oral bumetanide
twice daily. It is most important for the nurse to take which
action?
A.
B.
C.
D.


Monitor the patient for signs and symptoms of hyperkalemia.
Insert a urinary catheter and assess the hourly urine output.
Weigh the patient before administering each dose.
Schedule the medication to be given at 0800 and 1400.
Answer: D
Rationale: The nurse should administer oral bumetanide with twice-a-day dosing at
0800 and 1400 to minimize nocturia. Daily weights should be obtained in the morning
before eating. Patients receiving IV bumetanide are more likely to need hourly
monitoring of urine output with a urinary catheter. Bumetanide may cause
hypokalemia; signs and symptoms of hypokalemia include irregular heartbeat, muscle
weakness, cramping, flaccid paralysis, leg discomfort, extreme thirst, and confusion.
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Question: furosemide and drug interactions
A patient with heart failure who takes furosemide [Lasix] is
diagnosed with bacterial pneumonia. Which medication, if
ordered by the physician, should the nurse question?
A.
B.
C.
D.
Ciprofloxacin [Cipro]
Gentamicin [Garamycin]
Amoxicillin [Amoxcil]
Erythromycin [E-Mycin]
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Question: furosemide and drug interactions
A patient with heart failure who takes furosemide [Lasix] is
diagnosed with bacterial pneumonia. Which medication, if
ordered by the physician, should the nurse question?
A.
B.
C.
D.


Ciprofloxacin [Cipro]
Gentamicin [Garamycin]
Amoxicillin [Amoxcil]
Erythromycin [E-Mycin]
Answer: B
Rationale: High-ceiling loop diuretics may cause hearing impairment; furosemide
may result in deafness that is transient. Because of the risk of hearing loss, caution
is needed when high-ceiling diuretics are used in combination with other ototoxic
drugs (for example, aminoglycoside antibiotics). Gentamicin is an aminoglycoside.
The other antibiotics are safe to administer with furosemide.
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Patient Case NK, slide 1

NK is a 74 YO WM, POD 6 from CABG surgery. He is on 3L
O2, with bilateral crackles in the bases. Weight is 104.4kg (preop
98kg). His renal function is mildly impaired, with a creatinine of
1.9 mg/dl.

What diuretic would be appropriate for this patient?

Furosemide, orally (draw off the extra fluid, minimize risk of
pneumonia, assure optimal recovery)
Patient Case NK, slide 2

What monitoring parameters should be followed?

What are some options if the patient doesn’t respond?
Best diuretic for pulmonary edema?
A patient is brought to the emergency department with
shortness of breath, a respiratory rate of 30 breaths per
minute, intercostal retractions, and frothy, pink
sputum. The nurse caring for this patient will expect to
administer which drug?
A.
B.
C.
D.
Furosemide [Lasix]
Hydrochlorothiazide [HydroDIURIL]
Mannitol [Osmitrol]
Spironolactone [Aldactone]
Best diuretic for pulmonary edema?
A patient is brought to the emergency department with
shortness of breath, a respiratory rate of 30 breaths per
minute, intercostal retractions, and frothy, pink
sputum. The nurse caring for this patient will expect to
administer which drug?
A.
B.
C.
D.
Furosemide [Lasix] CORRECT
Hydrochlorothiazide [HydroDIURIL]
Mannitol [Osmitrol]
Spironolactone [Aldactone]

A.
B.
C.
D.
Edematous state with hyperkalemia
A patient has 2+ pitting edema of the lower
extremities bilaterally. Auscultation of the lungs
reveals crackles bilaterally, and the serum potassium
level is 6 mEq/L. Which diuretic agent ordered by the
prescriber should the nurse question?
Bumetanide [Bumex]
Furosemide [Lasix]
Spironolactone [Aldactone]
Hydrochlorothiazide [HydroDIURIL]

A.
B.
C.
D.
Edematous state with hyperkalemia
A patient has 2+ pitting edema of the lower
extremities bilaterally. Auscultation of the lungs
reveals crackles bilaterally, and the serum potassium
level is 6 mEq/L. Which diuretic agent ordered by the
prescriber should the nurse question?
Bumetanide [Bumex]
Furosemide [Lasix]
Spironolactone [Aldactone] CORRECT
Hydrochlorothiazide [HydroDIURIL]