Use of Diuretics & IVF

Renal physiology

• functions:

  • regulate acid-base balance

  • manage BP

  • produce erythropoietin (main ingredient in RBCs)

• usually issue because of the heart

arterial supply-kidney

20% of our circulation (cardiac output - CO) to kidneys

hypotonic solutions

• thin solution

• patient is dried out → has thick cells (left dry in desert)

• ex. 0.45% saline - not much substance in it

• thick tube feeding → get dehydrated→not getting free water→ need free water→ add water or give IV

• D% added slightly hypertonic w/ 170 calories

isotonic solutions

• ex. 0.9 saline

• lactated ringers (mirror what’s in bloodstream) - some ingredients interact with blood negatively → overdue lactate = shock

• add D5W if you need calories - don’t use for resuscitation; become hypotonic because metabolized by body; doesn’t stay in bloodstream

• lack of perfusion to tissues = shock (worry early)

hypertonic solution

• cells are too swollen (brain and spinal trauma)

• ex. 3% saline - thick solution; more substance than fluid

• give slow

• can cause intravascular volume overload (lots of fluid in blood)

• can cause pulmonary edema (trouble breathing and heart in trouble

• treat hypovolemia by pulling fluid from tissues back into bloodstream increase BP, CO, arterial pressure

colloid solutions

• ex. dextran 40 in NS / 5% DSW

• man made

• plasma expander for intravascular part of extracellular fluid

• can’t see through it

• coats platelets and prevent leaks

normal urine output

30 mL/hr

Q: A patient with heart failure is prescribed furosemide (lasix). The nurse should instruct the patient to consume:

A. oranges, spinach, potatoes

B. basked fish, chicken, cauliflower

C. tomato juice, skim milk, cottage cheese

D. oatmeal, cabbage, bran flakes

Correct Answer - A. oranges, spinach, potatoes (spinach and potatoes high in K+) and bananas

C. tomato juice, skim silk, cottage cheese (dairy is high in sodium

Q. A patient with heart failure is prescribed a low sodium diet. The nurse should instruct the patient to avoid:

A. oranges, spinach, potatoes

B. basked fish, chicken, cauliflower

C. tomato juice, skim milk, cottage cheese

D. oatmeal, cabbage, bran flakes

Correct Answer - C. tomato juice, skim milk, cottage (all of these are high in sodium)

Q: A patient is prescribes spironolactone (Aldactone) for treatment of HTN. What foods should the patient be taught to avoid?

A. baked fish

B. low-fat milk

C. salt substitutes

D. green beans

Correct Answer - C. salt substitutes (make of K+) eating K+ while taking K+ sparing drug will only increase the amount of K+ in body