Question

Discussion:

Diuretics Rosemary Fox is a 78-year-old client with a history of heart failure. Her treatment regimen includes hydrochlorothiazide, digoxin, an ACE inhibitor, and a potassium supplement. She is now hospitalized with acute exacerbation of heart failure, including a weight gain of 10 lb over the past week, severe 3+ pitting edema of her ankles and feet, and difficulty breathing with orthopnea. Furosemide 40 mg has been added to her drug regimen. The nurse is preparing to administer the first-ordered dose of IV furosemide. Ms. Fox asks what drug the nurse is preparing to administer. Upon learning that it is another type of diuretic, she states, “I’m already on a diuretic. Can’t you just give me a bigger dose of that?” How should the nurse respond?

1. Describe the potential adverse effects that may occur with the combination of drugs being given to Ms. Fox. Discuss nursing measures to prevent, detect, and/or manage these adverse effects.

2. Discuss the client teaching related to diuretic therapy that will be necessary for the nurse to provide to Ms. Fox prior to discharge.

Answer 1

Hydrochlorothiazide and Furosamide both are diuretics, significantly reduces blood pressure and removing accumulated waste from the body (edema). Combined hydrochlorothiazide - furosamide therapy will be used to treat who had an inadequate response to either diuretic alone. as Ms.Fox developed 3+ pitting edema and 10lb weight gain the combined drug will be potentially effective.

1. Expected side effects of this combination therapies are,

weight loss

Hyponatremia

Hypokalemia

Hypotension

Dehydration

Diarrhea

Abdominal pain

Dizziness

management:

* Assess for dehydration and depletion of electrolytes.

* Monitor vital signs and observe for hypotension.

* Advice to drink water to prevent hypovolemic shock.

2. Discharge plan:

• Take your diuretic in the morning. This medicine makes you pee more. If you take it in the morning, you may not need to use the bathroom during the night. That way, the medicine won't interfere with a good night's sleep.
• Take your medicine exactly as directed, even if you feel fine.
• Learn to take your own pulse. Keep a record of your results. Ask your doctor which readings mean that you need medical attention.
• Call your healthcare provider right away if any of these occur:
• Blood in your urine or stool or black, tarry stool
• Cough or hoarseness
• Fever or chills
• Lower back or side pain, or muscle cramps or pain
• Trouble peeing or pain when you pee
• Pinpoint red spots on skin
• Ringing or buzzing in your ears or any hearing loss
• Skin rash or hives
• Severe stomach pain with nausea and vomiting
• Unusual bleeding or bruising