1 Nursing Furosemide Considerations Azucena Chavez Heredia Morgan Community College NUR 2012: Pharmacology II Preston Klimper Assignment Due Date: November 21st 2022 2 Nursing Furosemide Considerations The Food and Drug Administration (FDA) has approved furosemide to treat illnesses such the nephrotic syndrome that have fluid overload and edema as a result of liver failure, kidney failure, or congestive heart failure exacerbation (Huxel et al., 2022). Congestive heart failure, liver disease, kidney disease, and other medical problems can all lead to fluid retention, edema, and swelling, which can be relieved with furosemide. It causes an increase in urine flow by influencing the kidneys. Furosemide is also used to treat high blood pressure, either by itself or in combination with other medications. The workload on the heart and arteries is increased by high blood pressure and the heart and arteries may not work correctly if the high blood pressure persists for a long time. This can harm the blood arteries in the kidneys, heart, and brain, which can lead to renal failure, heart failure, or a stroke. The risk of heart attacks may also be increased by high blood pressure. Controlling blood pressure may reduce the likelihood that these issues will arise. The core components of this essay will center on the appropriate indication and action of furosemide, adverse effects and reactions, safety measures, and interactions, nursing considerations and assessment with desired outcomes, as well as patient education. The drug furosemide is a member of the class of drugs known as loop diuretics, sometimes referred to as water pills. A diuretic causes the kidneys to filter out surplus fluid from the body. To enhance the amount of salt and water that is passed through the urine, a loop diuretic acts on the loop of Henle, a particular region of the kidney. The ascending limb of Henle's loop transport is prevented by enabling the transfer of isotonic tubular fluid to the distal tubule, it reduces the volume absorption along the early distal convolution in proportion to its water permeability at rest. This implies that there is less fluid in the tissues, which reduces swelling and edema. Additionally, the blood will contain less fluid, which lowers blood pressure and decreases the workload of the heart. Furosemide increases excretion of water, sodium, chloride, magnesium, and potassium while preventing the reabsorption of sodium and chloride in the kidneys. Furosemide causes some adverse 3 effects that are connected to this, including hypotension, dry mouth, increased urine, and with this occasionally also leads to dehydration. This is because it increases the excretion of water along with other electrolytes. Alterations in electrolytes may result from furosemide. In reality, digoxin toxicity risk is heightened by hypokalemia. Additionally, metabolic alkalosis and arthritic symptoms can be brought on by furosemide. It is important to know not to administer furosemide with aminoglycosides due to the potential of ototoxicity, and the importance for renal panels to be used to monitor the patient's kidney function while they are receiving this therapy. Hoffman & Sullivan, (2020) Found that patients with Sulfa allergies are frequently advised against taking furosemide, however there is no evidence that Sulfa antibiotics and non-antibiotic sulfonamides can cause cross-reactivity. Furosemide's action may be impacted by certain medications. They may prevent it from functioning properly or raise the risk of experiencing negative effects. Vallerand & Sanoski, (2022) found that amiodarone, digoxin, disopyramide, flecainide, or sotalol are examples of medications that either treat congestive heart failure and irregular heartbeats and should be used with caution due to the interactions of furosemide with Digitalis that can lead to an increase risk of arrhythmias. Lithium, pimozide, and risperidone are a few examples of drugs used to treat mental health issues and Lithium can increase the risk of lithium toxicity. Non steroidal anti inflammatory medicines, such as diclofenac, ibuprofen, or naproxen can decrease the diuretic effect of furosemide. Vallerand & Sanoski, (2022) revealed that when taking diuretic medications, it is best to avoid herbs that have a diuretic effect because they may intensify the effects of the prescription and result in potential cardiovascular side effects; dandelion, juniper, buchu, cleavers, horsetail, and gravel root are some of these herbs. Patients who have hypersensitivity or who may develop a cross-sensitivity to thiazides and sulfonamides should not use furosemide. The loss of brain function that results from a damaged liver's inability to remove toxins from the blood is another condition in which it is contraindicated, known as hepatic coma or hepatic encephalopathy, and which typically affects people with chronic liver disease, 4 such as cirrhosis or hepatitis. Patients who have anuria, which is the absence of urine production, should not use furosemide (Vallerand & Sanoski, 2022). Patients who are intolerant to alcohol should avoid using liquid furosemide since some liquid formulations may contain alcohol. Furosemide needs to be used with caution in individuals who have electrolyte depletion, diabetes mellitus, hypoproteinemia, severely impaired renal function, or severely impaired liver function since it may trigger a hepatic coma. Due to the increased risk of side effects from furosemide, specifically hypotension and electrolyte imbalance at standard doses, it is crucial to use this medication with caution in older geriatric patients. Furosemide should only be used during pregnancy and lactation if the possible benefit to the mother outweighs the potential risk to the unborn child and infant. Additionally, make sure the administration is done at the proper time. Furosemide should ideally be given first thing in the morning to prevent the patient from being awake all night to urinate thus increasing the risk of a fall. Patient safety is priority in nursing and the use of diuretics is associated with increased risk for falls in older adults. Assess falls risk and implement fall prevention strategies. The nurse not only records the medicine administration but also assesses the patient to determine whether the medication is working as intended post administration. Patient's medications are all continuously monitored by the nurse for any negative side effects. Post administration of furosemide, It is important to assess for fluid status. Huxel et al., (2022) found to monitor daily weight, intake and output ratios, amount and location of edema, lung sounds, skin turgor, and mucous membranes to assess if the medication is working effectively and or if the patient is having any adverse effects. It is important to educate the patient to look out for and notify health care professionals if thirst, dry mouth, lethargy, weakness, hypotension, or oliguria occurs. Before, during and after administering furosemide, we must monitor the patients’ blood pressure and pulse. Patients taking digoxin are at increased risk of digoxin toxicity because of the potassium depleting effects of the diuretic. If the patient is in conjunction therapy of digoxin and furosemide the nurse must 5 assess patients receiving digoxin for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion. Huxel et al., (2022) stated that potassium supplements or potassium-sparing diuretics may be used concurrently to prevent hypokalemia Audiometry is recommended for patients receiving prolonged high-dose IV therapy. Hearing loss is most common after rapid or high-dose IV administration in patients with decreased renal function or those taking other ototoxic drugs and it is important to be aware if these side effects that can result from use of IV furosemide therapy to assess patient for tinnitus and hearing loss. The use of furosemide dramatically increases urine, which relieves excess fluid, but may also cause the body to lose certain electrolytes so we need to monitor electrolytes, renal and hepatic function, serum glucose, and uric acid levels before and periodically throughout therapy. Commonly after therapy, low serum potassium results and may cause low serum sodium, calcium, and magnesium concentrations. It can also cause an elevated or high BUN, high serum glucose, serum creatinine, and uric acid levels. One of the biggest challenges in keeping the body's homeostasis is fluid and electrolyte balance, which also plays crucial roles in preserving cellular function, tissue perfusion, and acid-base balance. To effectively treat a variety of clinical disorders, fluid and electrolyte balance must be preserved. It is crucial for nurses to be knowledgeable with the specific diuretic a patient is taking, including the indication, dosage, and administration, contraindications, interactions, and side effects. In addition, a nurse's job includes a large amount of patient education. Educated patients are more likely to comply and participate in interventions that may increase their likelihood of having favorable outcomes when they are actively involved in their care. It is important to go over the medication's intended effects as well as any potential or anticipated negative and adverse effects. Patients can use this to check whether the medication is functioning properly. Additionally, it will assist patients in recognizing unfavorable side effects that could need treatment. Vallerand & Sanoski, (2022) state that with the use of furosemide we must encourage patients to shift positions slowly because they can experience orthostatic hypotension. Patients should inform their doctor if they gain more than three pounds in a single day. Additionally, while taking 6 loop diuretic medication, patients should be advised to eat meals high in potassium. A thorough patient teaching should provide information on the necessity for the medicine as well as simple-to-follow dose and time instructions. To make it easier for the patient to understand, simplified drug information should highlight important details such drug interactions and side effects. 7 References Hoffman, J. J., & Sullivan, N. J. (2020). Davis advantage for medical-surgical nursing: Making connections to practice. F.A. Davis. Huxel , C., Raja, A., & Ollivierre-Lawrence, M. D. (2022, July). Loop diuretics. National Center for Biotechnology Information. Retrieved November 18, 2022, from https://pubmed.ncbi.nlm.nih.gov/31536262/ Vallerand, A., & Sanoski, C. (2022). Davis’s Drug Guide for Nurses, 18th Edition.
