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Administer a diuretic in the morning so that your patient's sleep isn't interrupted by night time diuresis. To prevent nausea (a possible adverse effect of diuretics), have the patient take the drug with food.
For intermittent I.V. administration of a loop diuretic, give the drug undiluted at a rate not to exceed 4 mg per minute through a Y-connector, a three-way stopcock, or an intermittent I.V. access device. For a continuous infusion of furosemide, give the drug in normal saline solution or dextrose 5% in water (DsW) at a rate of 5 to 40 mg per hour, using an infusion pump. Remember to protect the solution from light. Make dose adjustments based on the patient's response. And monitor his urine output, blood pressure, and cardiac status frequently.
When administering an I.V. infusion of a thiazide or thiazide-like diuretic, dilute the drug in sterile water or Ringer's, lactated Ringer's, 0.45% normal saline, 0.9% normal saline, DsW, or dextrose 10% in water.
During the course of therapy, monitor your patient's fluid status, including his daily weights, intake, and output. Also, check his blood pressure in the sitting, lying, and standing positions and note any changes that indicate orthostatic hypotension. Monitor his serum electrolytes, including potassium, sodium, chloride, calcium, and magnesium.
Pay particular attention to your patient's potassium level. If it's less than 3 mEq/L, he may need a potassium replacement. If your patient is receiving a potassium sparing diuretic, instruct him to avoid potassium-rich foods such as oranges, bananas, salt substitutes, dried apricots, and dates. Also, if he's receiving triamterene, monitor his liver function studies.
When administering any diuretic, watch for dehydration by checking the patient's mucous membranes and by assessing for skin turgor. Dehydrated patients may also complain of excessive thirst.
Watch for signs of metabolic alkalosis, including drowsiness and restlessness, and for signs of hypokalemia, including malaise, fatigue, tachycardia, leg cramps, and weakness. Monitor the elderly patient for signs of confusion.
Be alert for signs of hearing changes. Large bolus doses may cause ototoxicity. And if your patient is taking digoxin, along with a loop diuretic, look for signs of digitalis toxicity.
After you administer the drug, the patient should change position slowly and sit a few minutes before standing to minimize orthostatic hypotension. If he has any adverse reactions, such as muscle cramps, weakness, nausea, and dizziness, report them to his physician.
Instruct your patient to weigh himself daily and report increases of 2 pounds or more over 48 hours or less. Usually, a patient should increase his fluid intake while taking the drug. He should eat foods that are high in potassium and take any prescribed potassium supplements to prevent hypokalemia. He should also check with his physician before taking any other drugs, including OTC drugs, and herbal supplements during the course of his treatment.
For more information on hypertension go to www.hypertensionblog.org/ for specialized information on blood pressure and coronary artery diseases .
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