BAY, Abijah Sebastian J.

BSN 2-3 November 28, 2020

Assignment 1: Renal Treatment

Instructions. Answer the following questions.

1. What is hemodialysis and peritoneal dialysis?

- Hemodialysis is a procedure done in the hospital to remove fluid and waste products from the
blood and to correct electrolyte imbalances. In this technique, blood is pumped out of the body
by a machine called dialyzer (also known as “artificial kidney”), then the pumped-out blood is
returned to the body by tubes that is connected to the machine. Peritoneal dialysis is a medical
procedure that removes waste products from your blood when the kidney cannot comprehend
to do their functions anymore. In peritoneal dialysis, the inside lining of the belly will act as a
natural filter. In here, wastes are taken out by means of a cleansing fluid called dialysate, which
is washed in and out of the belly in cycles.

2. Common medicines during dialysis treatment?

- There are a variety of medications used during dialysis treatment. Dialysis pt. underwent the
procedure because their kidneys are unable to make RBC, hence, red blood cell stimulating
agents, such as Darbepoetin (Aranesp) and Erythropoietin (Eprex) are given to dialysis clients.
Moreover, iron supplements are also given such as iron sucrose (Venofer), because dialysis
clients tend to have low levels of iron. Aside from that, blood pressure medications are also used
because of the sudden increase/decrease shifting of blood pressure levels. Lastly, phosphate
binders such as calcium carbonate are also given to inhibit build-up of phosphate in the blood.

3. Nursing responsibilities of nursing during dialysis treatment like:

a) Blood Transfusion
• Identify the client that will undergo the procedure
• Verify the doctor’s order of the blood transfusion therapy. Reassess the information given
about the therapy.
• Check for cross matching and typing to ensure compatibility.
• Inform the and explain towards the client the purpose of doing the procedure.
• Obtain and record vital signs.
• Strict aseptic technique should be implemented.
• Check the label of the blood transfusion such as its serial number, blood component, blood
type, Rh factor, expiration date and screening test results of the blood being transfused.
• Warm blood at room temperature before transfusion to prevent chills.
• Use needle gauge of 18-19 to allow easy flow of blood.
• Do not mix medications with blood transfusion to prevent occurrence of adverse reactions.
• Monitor for vital signs and observe possible complications.
 b) Dialysis treatment
• Checking and recording patients’ vital sign before, during and after the procedure.
• Ensuring that the treatment’s procedure are administered correctly.
• Monitoring patients during dialysis treatment to identify any adverse reactions.
o Hemodialysis
9 Low blood pressure 9 Itchy skin
9 Muscle cramps 9 Blood clots
o Peritoneal dialysis
9 Peritonitis 9 potassium imbalance
9 Hernia 9 weight gain
9 Blood sugar changes

c) Giving Epogen
• Control BP adequately prior to initiation of therapy and closely monitor it during therapy.
• Immediately notify physician if blood pressure and hematocrit rise, this may indicate to
reduce the medication.
• Monitor for hypertensive encephalopathy in patients with CRF during period of increasing
hematocrit.
• Monitor the patient for occurrences of possible seizures.

d) If patient has a fever during dialysis what safe medicines to give

• If a dialysis client suddenly has an onset of fever, it is very much advisable to give the
patient antibiotics such as Amoxicillin to prevent its severity.

e) If patient experience chills what should a nurse do?

• When a dialysis patient experiences onset of chills, hence, it is an indication that the client
is experiencing infection. Due to this, it is very advisable to give the patient antibiotics such
as Amoxicillin.

f) What safe meds to give if patient has hypertension during dialysis?

• If patient experiences sudden increase of blood pressure level during dialysis, calcium-
channel blockers such as benzothiazepines (Diltiazem), Dihydropyridines (Amlodipine,
Nifedipine) and phenylalkylamines (Verapamil) should be given to the patient.

4. What type of meds that are not allowed for patients with Chronic Kidney Disease (CKD)?
- There are a variety of medicines that are not allowed for clients with CKD. The following
medicines are as follows:
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
o Ibuprofen (Advil, Motrin)
o Naproxen (Naprosyn, Aleve)
o Aspirin
• Decongestants
 o Pseudoephedrine
• Antacids and Laxatives
o Mylanta
o Milk of Magnesium
o Amphogel
o Fleets
• Herbal Medicines
• Vitamin and Diet/Food Supplements

5. What are diuretics? Give examples.

- Diuretics (also known as water pills) are medications that helps the kidneys to release more
sodium in the urine. Moreover, diuretics helps in reducing blood pressure and inhibit occurrence
of edema. The following are some examples and the five (5) classifications of diuretics which are
namely:
• Thiazides and Thiazide-like (Chlorothiazide [Diuril])
• Loop Diuretics (Furosemide [Lasix])
• K+ Sparing Diuretics (Spinorolactone [Aldactone])
• Carbonic Anhydrase Inhibitor (Acetazolamide [Diamox])
• Osmotic Diuretics (Mannitol [Osmitrol])

6. What are the functions of each diuretic classification and give example or the name of the meds and
nursing responsibilities and things to watch out?
A. Thiazides and Thiazide-like Diuretics
9 These drugs act directly on the kidneys to promote diuresis by inhibiting reabsorption of
sodium in distal tubules of nephrons, causing an increased excretion of sodium and water,
as well as potassium and hydrogen ions. These are used for treatment for hypertension
and to clear fluid from the body in conditions where your body accumulates too much
fluid.

Signs and Symptoms to Watch

Names Nursing Considerations
Out For
• Monitor signs of fluid, electrolyte, or acid-
base imbalances, including lethargy, • Signs of dehydration and
drowsiness, blurred vision, confusion, electrolyte imbalance
hypotension, and muscle cramps and • Blisters/peeling skin
weakness. • Hives
• Report low blood pressure (hypotension), • Rash
Chlorothiazide (Diuril) especially if patient experiences dizziness • Itching
or syncope. • Difficulty of breathing or
• Be alert for signs of hyperglycemia, swallowing
including confusion, drowsiness, • Fever and other signs of
flushed/dry skin, fruit-like breath odor, infection
rapid/deep breathing, polyuria, loss of • Jaundice (skin and eyes)
appetite, and unusual thirst.
 • Monitor and report signs of
thrombocytopenia (bruising, nose
bleeds, bleeding gums), or unusual
weakness and fatigue that might be due
to anemia or other blood dyscrasias.
• Assess dizziness that might affect gait,
balance, and other functional activities
• When used to treat edema, help
determine drug effects by assessing
peripheral edema using girth
measurements, volume displacement,
and measurement of pitting edema
• Monitor signs of fluid, electrolyte, or acid-
base imbalances, including dizziness,
drowsiness, blurred vision, confusion,
hypotension, or muscle cramps and
weakness.
• Assess dizziness and weakness that might
affect gait, balance, and other functional
activities.
• Assess blood pressure periodically and
• Sore throat with fever
compare to normal values to help
• Unusual bleeding
document antihypertensive effects.
Chlorthalidone • Severe skin rash with
• When used to treat edema, help
(Hygroton, Thalitone) peeling skin
determine drug effects by assessing
• Difficulty breathing or
peripheral edema using girth
swallowing.
measurements, volume displacement,
and measurement of pitting edema
• Monitor signs of pulmonary edema such
as dyspnea and rales/crackles
• Monitor signs of hyperglycemia such as
drowsiness, fruity breath, increased
urination, and unusual thirst.
• Patients with diabetes mellitus should
check blood glucose levels frequently.
• Signs of dehydration and
• Give with food or milk if GI upset occurs. electrolyte imbalance
• Mark calendars or provide other • Blisters/peeling skin
reminders of drug for alternate day or 3-5 • Hives
days/wk therapy. • Rash
Hydrochlorothiazide • Reduce dosage of other • Itching
(Esidrix, Microzide, antihypertensives by at least 50% • Difficulty of breathing or
Zide, Hydrodiuril, • Readjust dosages gradually as BP swallowing
Oretic) responds. • Fever and other signs of
• Administer early in the day so increased infection
urination will not disturb sleep. • Unusual bleeding
• Measure and record weights to monitor • Pain at the stomach that
fluid changes. spreads at the back
• Joint pain
 • Assess blood pressure periodically and
compare to normal values to help
document antihypertensive effects.
• Report any rhythm disturbances or
symptoms of increased arrhythmias,
including palpitations, chest discomfort,
shortness of breath, fainting, and
fatigue/weakness.
• Monitor signs of fluid and electrolyte
imbalances, including dizziness,
• Rapid weight loss
drowsiness, blurred vision, confusion,
• Severe skin rash with
lethargy, hypotension, or muscle cramps
Indapamide (Lozol) itching
and weakness.
• Difficulty breathing or
• Assess dizziness and weakness that might
swallowing
affect gait, balance, and other functional
activities.
• When used to treat edema, help
determine drug effects by assessing
peripheral edema using girth
measurements, volume displacement,
and measurement of pitting edema
• Monitor signs of hyperglycemia such as
drowsiness, fruity breath, increased
urination, and unusual thirst.
• Monitor signs of fluid and electrolyte
imbalances, including dizziness,
drowsiness, blurred vision, confusion, • Dark urine
lethargy, hypotension, or muscle cramps • Blisters/peeling skin
and weakness. • Hives
• Assess dizziness and weakness that might • Rash
affect gait, balance, and other functional • Itching
activities. • Swelling
• Report low blood pressure (hypotension) • Hoarseness
Metolazone or other cardiac symptoms such as chest • Difficulty of breathing or
pain or palpitations. swallowing
• When used to treat edema, help • Fever and other signs of
determine drug effects by assessing infection
peripheral edema using girth • Unusual bleeding
measurements, volume displacement, • Pain in the upper right part
and measurement of pitting edema of the stomach
• Monitor signs of hyperglycemia such as • Jaundice
drowsiness, fruity breath, increased
urination, and unusual thirst.
• Signs of dehydration and
• Monitor BP and I&O of the pt. electrolyte imbalance
• Report a sudden fall in BP, which may • Blisters/peeling skin
initiate severe postural hypotension and • Hives
Methyclothiazide
potentially dangerous perfusion • Rash
problems, especially in the extremities. • Itching
• Monitor patient for S&S of hypokalemia • Difficulty of breathing or
swallowing
 • Fever
• Jaundice (skin and eyes)

B. Loop Diuretics
9 These drugs are used for treatment of heart failure and conditions which cause fluid to
build up in the body, such as certain liver and kidney disorders. They work by making the
kidneys pass out more fluid by means of interfering with the transport of salt and water
across certain cells in the kidneys (loop of Henle. As more fluid is passed out by the
kidneys, less fluid remains in the bloodstream. Hence, any fluid which has accumulated in
the tissues of the lungs or body is drawn back into the bloodstream to replace the fluid
passed out by the kidneys.

Signs and Symptoms to Watch

Names Nursing Considerations
Out For
• Monitor signs of fluid, electrolyte, or acid-
base imbalances, including lethargy,
drowsiness, blurred vision, confusion,
hypotension, and muscle cramps and
weakness. Report these to the physician.
• Assess dizziness that might affect gait,
balance, and other functional activities
• Monitor drug effects by assessing
peripheral edema using girth
measurements, volume displacement,
• Ringing in ears
and measurement of pitting edema.
• Loss of hearing
• Monitor signs of pulmonary edema such
• Unusual bleeding or
as dyspnea and rales/crackles.
bruising
• Assess blood pressure periodically and
Bumetanide (Bumex) • Severe rash with peeling
compare to normal levels. Report low
skin
blood pressure (hypotension), especially
• Difficulty breathing or
if patient experiences dizziness or
swallowing
syncope.
• Hives
• Monitor for signs of hyperglycemia,
including drowsiness, fruit-like breath
odor, increased urination and unusual
thirst.
• Be alert for signs of encephalopathy,
including decreased alertness, lethargy,
and incoordination. Notify physician of
these signs before they progress to more
severe changes in mental status such as
dementia, seizures, and coma.
• Watery diarrhea
• Monitor signs of agranulocytosis and
• Loss of hearing
neutropenia (fever, sore throat, mucosal
• Confusion
Ethacrynic Acid lesions, signs of infection) or
• Loss of balance
(Edecrin) thrombocytopenia (bruising, nose
• Tinnitus
bleeds, bleeding gums). Report these
• Hives
signs immediately to the physician.
• Rash
 • Monitor signs of fluid, electrolyte, or acid- • Jaundice (eyes and skin)
base imbalances, including dizziness, • Unusual bleeding
drowsiness, blurred vision, confusion, • Difficulty of breathing or
hypotension, or muscle cramps and swallowing
weakness.
• Assess dizziness and vertigo that might
affect gait, balance, and other functional
activities.
• Assess blood pressure periodically and
compare to normal values to help
document antihypertensive effects.
• Monitor drug effects by assessing
peripheral edema using girth
measurements, volume displacement,
and measurement of pitting edema.
• Monitor signs of hyperglycemia such as
drowsiness, fruity breath, increased
urination, and unusual thirst.
• Monitor signs of aplastic anemia (fatigue,
weakness, shortness of breath, pale skin,
dizziness), agranulocytosis (fever, sore
throat, mucosal lesions, signs of
infection), or other symptoms and
bleeding problems that might be due to
other blood dyscrasias. Report these
signs to the physician immediately.
• Monitor signs of fluid, electrolyte, or acid- • Fever
base imbalances, including dizziness, • Loss of hearing
drowsiness, blurred vision, confusion, • Tinnitus
hypotension, or muscle cramps and • Hives
weakness. • Rash
Furosemide (Lasix)
• Assess dizziness and vertigo that might • Blistering of skin
affect gait, balance, and other functional • Itching
activities. • Jaundice (eyes and skin)
• Assess blood pressure periodically and • Difficulty of breathing or
compare to normal values to help swallowing
document antihypertensive effects.
• Monitor drug effects by assessing
peripheral edema using girth
measurements, volume displacement,
and measurement of pitting edema.
• Monitor signs of hyperglycemia such as
drowsiness, fruity breath, increased
urination, and unusual thirst.

• Signs of dehydration and

• Monitor signs of metabolic acidosis,
electrolyte imbalance
including headache, lethargy, stupor,
Torsemide (Demadex) • Rapid weight loss
seizures, vision disturbances, increased
• Vomiting blood
respiration, cardiac arrhythmias,
• Chest pain
weakness, nausea, vomiting, and
• Blisters or peeling of skin
 abdominal pain. Notify physician • Hives
immediately if these signs occur. • Rash
• Assess blood pressure periodically and • Itching
compare to normal values to help • Difficulty breathing or
document antihypertensive effects. swallowing
• Monitor signs of fluid and electrolyte • Pain at back stomach that
imbalances, including dizziness, spreads at the back
drowsiness, blurred vision, confusion,
lethargy, hypotension, or muscle cramps
and weakness.
• Assess dizziness and weakness that might
affect gait, balance, and other functional
activities.
• When used to treat edema, help
determine drug effects by assessing
peripheral edema using girth
measurements, volume displacement,
and measurement of pitting edema
• Monitor signs of hyperglycemia such as
confusion, drowsiness, flushed/dry skin,
fruit-like breath odor, rapid/deep
breathing, polyuria, loss of appetite, and
unusual thirst.
• Assess any muscle or joint pain

C. K+ Sparing Diuretics
9 These are weak diuretics usually prescribed in combination with other types of diuretics.
They are used to increase the amount of fluid passed from the body in urine, whilst also
preventing too much potassium being lost with it.

Signs and Symptoms to Watch

Names Nursing Considerations
Out For
• Monitor signs of high plasma potassium
levels (hyperkalemia), including
bradycardia, fatigue, weakness,
numbness, and tingling. Notify physician
• Chest pain
because severe cases can lead to life-
• Tingling in arms and legs
threatening arrhythmias and paralysis.
• Loss of muscle tone
• Assess blood pressure periodically and
• Weakness or heaviness in
Eplerenone (Inspra compare to normal values to help
legs
Pro) document antihypertensive effects.
• Confusion
• Assess dizziness and fatigue that might
• Lack of energy
affect gait, balance, and other functional
• Cold, gray skin
activities.
• Irregular heartbeat
• Report balance problems and functional
limitations to the physician, and caution
the patient and family/caregivers to
guard against falls and trauma.
 • Monitor signs of fluid, electrolyte, or acid-
base imbalances, including dizziness,
drowsiness, blurred vision, confusion,
hypotension, or muscle cramps and
weakness.
• Assess dizziness that might affect gait,
balance, and other functional activities.
• Report balance problems and functional
• Muscle weakness
limitations to the physician, and caution
• Irregular heartbeat
the patient and family/caregivers to
• Diarrhea
guard against falls and trauma.
• Upset stomach
• Assess heart rate, ECG, and heart sounds,
• Extreme tiredness
especially during exercise.
• Lack of energy
• Report any rhythm disturbances or
• Loss of appetite
symptoms of increased arrhythmias,
• Pain in the upper right part
Triamterene including palpitations, chest discomfort,
of the stomach
(Dyrenium Pro) shortness of breath, fainting, and
• Flu-like symptoms
fatigue/weakness.
• Sore throat
• Assess blood pressure periodically and
• Severe dry mouth
compare to normal values to help
• Rash
document antihypertensive effects.
• Jaundice (eyes and skin)
• Monitor drug effects by assessing
• Unusual bleeding
peripheral edema using girth
• Difficulty of breathing or
measurements, volume displacement,
swallowing
and measurement of pitting edema.
• Monitor signs of allergic reactions,
including pulmonary symptoms
(tightness in the throat and chest,
wheezing, cough, dyspnea) or skin
reactions (rash, pruritus, urticaria). Notify
physician immediately if these reactions
occur.
• Muscle weakness, pain, or
• Monitor signs of fluid, electrolyte, or acid-
cramps
base imbalances, including dizziness,
• Pain, burning, numbness,
drowsiness, blurred vision, confusion,
or tingling in the hands or
hypotension, or muscle cramps and
feet
weakness.
• Inability to move arms or
• Assess dizziness that might affect gait,
legs
balance, and other functional activities.
• Changes in heartbeat
• Report balance problems and functional
Spironolactone • Confusion
limitations to the physician, and caution
(Aldactone Pro, • Nausea
the patient and family/caregivers to
CaroSpir) • Extreme tiredness
guard against falls and trauma.
• Dry mouth, thirst,
• Assess heart rate, ECG, and heart sounds,
dizziness, unsteadiness,
especially during exercise.
headache, or other signs of
• Report any rhythm disturbances or
dehydration
symptoms of increased arrhythmias,
• Unusual bleeding or
including palpitations, chest discomfort,
bruising
shortness of breath, fainting, and
• Lack of energy
fatigue/weakness.
• Loss of appetite
 • Assess blood pressure periodically and • Pain in the upper right part
compare to normal values to help of the stomach
document antihypertensive effects. • Yellowing of the skin or
• Monitor drug effects by assessing eyes
peripheral edema using girth • Flu-like symptoms
measurements, volume displacement, • Rash
and measurement of pitting edema. • Hives
• Monitor signs of allergic reactions, • Itching
including pulmonary symptoms • Difficulty breathing or
(tightness in the throat and chest, swallowing
wheezing, cough, dyspnea) or skin • Vomiting blood
reactions (rash, pruritus, urticaria). Notify • Blood in stools
physician immediately if these reactions • Decreased urination
occur. • Fainting

• Monitor signs of fluid, electrolyte, or acid-

base imbalances, including dizziness,
drowsiness, blurred vision, confusion,
hypotension, or muscle cramps and
weakness.
• Assess dizziness that might affect gait,
balance, and other functional activities.
• Report balance problems and functional
limitations to the physician, and caution
the patient and family/caregivers to
guard against falls and trauma.
• Assess heart rate, ECG, and heart sounds,
• Signs of dehydration and
especially during exercise.
electrolyte imbalance
• Report any rhythm disturbances or
• Jaundice (skin and eyes)
symptoms of increased arrhythmias,
Amiloride (Midamor • Chest pain
including palpitations, chest discomfort,
Pro) • Hives
shortness of breath, fainting, and
• Rash
fatigue/weakness.
• Itching
• Assess blood pressure periodically and
• Difficulty breathing or
compare to normal values to help
swallowing
document antihypertensive effects.
• Monitor drug effects by assessing
peripheral edema using girth
measurements, volume displacement,
and measurement of pitting edema.
• Monitor signs of allergic reactions,
including pulmonary symptoms
(tightness in the throat and chest,
wheezing, cough, dyspnea) or skin
reactions (rash, pruritus, urticaria). Notify
physician immediately if these reactions
occur.
D. Carbonic Anhydrase Inhibitor
9 These are usually used for the treatment of glaucoma. Still, these agents are primarily
used to reduce the activity of carbonic anhydrase, an enzyme responsible for catalyzing
the reaction between carbon dioxide and water into carbonic acid and then bicarbonate.
This reduces the resorption of bicarbonate from the proximal tubule in the kidneys, which
causes a direct increase in bicarbonate excretion and mild increases in sodium, and
potassium excretion.

Signs and Symptoms to Watch

Names Nursing Considerations
Out For
• Monitor signs of hypersensitivity
reactions and anaphylaxis, including
pulmonary symptoms (tightness in the
throat and chest, wheezing, cough,
dyspnea) or skin reactions (rash, pruritus,
urticaria).
• Monitor for dermatitis, exfoliation, and
other severe skin reactions that might
indicate Stevens-Johnson syndrome.
• Notify physician immediately about any • Numbness and tingling
hypersensitivity reactions. • Increased thirst and
• Monitor for signs of aplastic or hemolytic urination
anemia (unusual fatigue, weakness, • Drowsiness
dizziness, pallor, jaundice, abdominal • Headache
pain), leukopenia (fever, sore throat, • Confusion
mucosal lesions, signs of infection), or • Fever
Acetazolamide fatigue and poor health that might be due • Rash
(Diamox, Sequels) to other anemias and blood dyscrasias. • Blood in urine
Report these signs immediately to the • Painful urination
physician. • Yellowing of the skin or
• Monitor any changes in vision to help eyes
document drug effectiveness in • Seizures
decreasing glaucoma. • Sore throat
• Assess signs of parasthesia (numbness, • Unusual bleeding or
tingling) or muscle twitching. bruising
• Perform objective tests including
electroneuromyography and sensory
testing to document any drug-related
neuropathic changes.
• Monitor and report signs of renal calculi
and kidney stones, including severe pain
in the side and back, pain on urination,
bloody urine, and a persistent urge to
urinate.
• Monitor signs of leukopenia (fever, sore • Blisters or peeling skin
Methazolamide throat, signs of infection) or various • Hives
(Neptazane) anemias (unusual fatigue, shortness of • Rash
breath, dizziness, headache, coldness in • Itching
 your hands and feet, pale skin, chest pain, • Difficulty breathing or
bruising). Report these signs to the swallowing
physician immediately. • Fever, sore throat, chills,
• Monitor signs of fluid, electrolyte, or acid- and other signs of infection
base imbalances, including dizziness, • Unusual bruising or
drowsiness, blurred vision, confusion, bleeding
hypotension, or muscle cramps and • Muscle weakness
weakness. • Seizures
• Report excessive or prolonged symptoms • Nausea
to the physician. • Extreme tiredness
• Monitor signs of allergic reactions, • Loss of appetite
including pulmonary symptoms • Pain in the upper right part
(tightness in the throat and chest, of the stomach
wheezing, cough, dyspnea) or skin • Yellowing of the skin or
reactions (rash, pruritus, urticaria). Notify eyes
physician or nursing staff immediately if • Flu-like symptoms
these reactions occur.
• Monitor for signs of hyperglycemia,
including confusion, drowsiness,
flushed/dry skin, fruit-like breath odor,
rapid/deep breathing, polyuria, loss of
appetite, and unusual thirst. Patients
with diabetes mellitus should check
blood glucose levels frequently.
• Assess signs of paresthesia such as
numbness, tingling, and muscle
weakness.
• Perform objective tests, including
electroneuromyography and sensory
testing to document any drug-related
neuropathic changes.
• Monitor and report depression or other
changes in mood and behavior.

• Inquire about previous hypersensitivity to

sulfonamides prior to therapy.
• Withhold drug and notify physician if S&S • Itching eyes
of local or systemic hypersensitivity • Redness or swelling eyes
Dorzolamide
occur. • Watery eyes
(Trusopt)
• Withhold the drug and notify the • Dryness
physician if ocular irritation occurs. • Skin rash
• Monitor CBC, serum electrolytes, and
renal and liver function tests periodically
with long-term therapy.
• Dizziness
• Monitor signs of fluid and electrolyte • Ataxia
imbalances, including dizziness, • Anorexia
Dichlorphenamide drowsiness, blurred vision, confusion, • Nausea and vomiting
lethargy, hypotension, or muscle cramps • Metallic taste
and weakness. • Diarrhea
• Abdominal discomfort
 • Supervise ambulation since drug may • Crystalluria
cause dizziness and ataxia; other safety • Rash
precautions may be warranted. • Weight loss
• Monitor for hematologic reactions • Fever
common to sulfonamides.
• Obtain baseline CBC and platelet counts
before initiating therapy and at regular
intervals.
• Increase fluid intake to a high level to
reduce risk of renal calculi. Consult
physician.
• Report to physician the onset of sore
throat, fever, unusual bleeding or
bruising, tremors, flank or loin pain, skin
rash.
• Educate the pt. to not drive or engage in
other potentially hazardous activities.

E. Osmotic Diuretics
9 These are agents that inhibit the reabsorption of solute and water by altering osmotic
driving forces along the nephron.

Signs and Symptoms to Watch

Names Nursing Considerations
Out For
• Monitor signs of fluid, electrolyte, or acid-
base imbalances, including lethargy,
drowsiness, blurred vision, confusion,
hypotension, and muscle cramps and
weakness.
• Take care to avoid extravasation. Observe
injection site for signs of inflammation or
edema. • Edema in upper and lower
• Lab tests: Monitor closely serum and extremities
urine electrolytes and kidney function • Little or no urination
during therapy. (painful)
• Measure I&O accurately and record to • Shortness of breath
Mannitol (Osmitrol) achieve proper fluid balance. • Wheezing
• Monitor vital signs closely. Report • Chest pain
significant changes in BP and signs of • Headache
CHF. • Seizure
• Monitor for possible indications of fluid • Signs of dehydration and
and electrolyte imbalance (e.g., thirst, electrolyte imbalance
muscle cramps or weakness,
paresthesias, and signs of CHF).
• Be alert to the possibility that a rebound
increase in ICP sometimes occurs about
12 h after drug administration. Patient
may complain of headache or confusion.
• Take accurate daily weight.
 • Monitor I&O.
• Monitor vital signs.
• Observe signs of hemorrhage.
• Watch for S&S of hyponatremia, • Headache
hypokalemia, dehydration, or transient • Fast heartbeats
overhydration (due to hyperosmotic • Light-headedness
Urea (Ureaphil) activity) • Shortness of breath
• Monitor for complaints of lower • Pale, blue or gray
abdominal pain following intraamniotic appearance skin, lips or
instillation. If patient complains of lower fingernails
abdominal pain, it may be that drug is
going into abdomen rather than into the
amniotic sac.

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https://www.betterteam.com/dialysis-nurse-job-description
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