Pharmacologic: loop diuretics
Edema due to heart failure, hepatic disease, or renal impairment.
Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium chloride, magnesium, potassium, and calcium. Effectiveness persists in impaired renal function. Therapeutic Effects: Diuresis and subsequent mobilization of excess fluid (edema, pleural effusions).
Adverse Reactions/Side Effects
CNS: dizziness, encephalopathy, headache. EENT: hearing loss, tinnitus. CV: hypotension. GI: diarrhea, dry mouth, nausea, vomiting. GU: excessive urination. Derm: photosensitivity, pruritus, rash. Endo: hyperglycemia, hyperuricemia. F and E: dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis. MS: arthralgia, muscle cramps, myalgia. Misc: increased BUN.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor signs of fluid, electrolyte, or acid-base imbalances, including dizziness, drowsiness, blurred vision, confusion, hypotension, or muscle cramps and weakness. Report excessive or prolonged symptoms to the physician.
Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.
Monitor drug effects by assessing peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Also monitor signs of pulmonary edema such as dyspnea and rales/crackles (See Appendix K). Document whether peripheral and pulmonary symptoms are controlled adequately by diuretic therapy.
Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.
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.
Assess any joint pain, muscle pain, or muscle cramps to rule out musculoskeletal pathology; that is, try to determine if musculoskeletal symptoms are drug induced rather than caused by anatomic or biomechanical problems.
Monitor signs of hyperglycemia such as drowsiness, fruity breath, increased urination, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.
Implement fall prevention strategies, especially in older adults or if patient exhibits sedation, dizziness, blurred vision, or other impairments that affect gait and balance (See Appendix E).
Use caution during aerobic exercise, especially in hot environments. Increased sweating will cause fluid and electrolyte loss, and may exaggerate diuretic side effects (dizziness, muscle cramps, and so forth).
To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.
Causes photosensitivity; use care if administering UV treatments.
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