Diuretics: In a Nutshell (Nursing)

00:00 Let's wrap up the series on diuretics. Thiazides' effects are similar to loop diuretics. They increase the renal excretion. The kidney is the site to get rid off sodium, chloride, potassium, and of course water because that's what we're going for with diuretics. Now we will elevate levels of glucose, your blood sugar and uric acid. Watch your diabetic patients closely and if the patient has a history of gout, we want them to know if they're having any problems with their joints. Now thiazide is not effective when renal blood flow is low. You need to go for something like furosemide. Thiazide-induced diuresis is less than furosemide or a loop diuretic. That just means, remember, furosemide has the most potent, most significant amount of diuresis. Thiazides are further long in that graphic, remember, in that nephron and they're not as strong or potent as furosemide. Hydrochlorothiazide is the most commonly prescribed thiazide diuretic and you notice I just shortened that to HCTZ so you can recognize that as being hydrochlorothiazide. Now potassium-sparing diuretics cause a mild increase in urine output. Remember the diagram in the graphic. These guys are at the very end. Right? They're not often used in monotherapy, it means by themselves, but we can use them with other loop diuretics if you're about the potassium level.

01:26 So, someone may be on a loop diuretic like furosemide and a potassium-sparing diuretic if we're having trouble managing that potassium level. Because now potassium-sparing diuretics cause elevated potassium and that can give us some problems with life-threatening dysrhythmias. So watch your patient closely if they're on a monitor for any change in dysrhythmias or look for the signs of high potassium. Now spironolactone, because it raises your potassium level, you want to be very careful if the patient is taking any other medication that also raises potassium. Now I put 3 examples for you there; ACE inhibitors, ARBs, and DRIs. Mannitol is a really unusual one because most of that filtered drug remains in the nephron and that's what bumps up that osmotic pressure in the lumen of the proximal tubule and the loop of Henle. So we use it to treat some pretty unusual things; elevated intracranial pressure, we can use it in low output acute renal failure, and increased intraocular pressure in your eyes. So, mannitol will increase the circulatory volume.

02:32 Remember it moves fluid from out of the cell into the circulation. So I want to be really careful in patients that are already volume overloaded like CHF or pulmonary edema. Thanks for watching our video today.