Comprehensive Nursing Pharmacology Q 283
While providing home care to a client with congestive heart failure, the nurse is asked how long diuretics must be taken. The best response to this client should be:
A. “As you urinate more, you will need less medication to control fluid.”
B. “You will have to take this medication for about a year.”
C. “The medication must be continued so the fluid problem is controlled.”
D. “Please talk to your physician about medications and treatments.”
Correct Answer: C. “The medication must be continued so the fluid problem is controlled.”
This is the most therapeutic response and gives the client accurate information. Diuretics are used to achieve and maintain euvolemia (the patient’s ‘dry weight’) with the lowest possible dose. This means that the dose must be adjusted, particularly after the restoration of the dry body weight, to avoid the risk of dehydration, which leads to hypotension and renal dysfunction.
Option A: In general, due to their greater effectiveness, loop diuretics, such as furosemide, are the mainstay of diuretic therapy in HF. Indeed loop diuretics produce more intense and shorter diuresis than thiazides, which results in more gentle and prolonged diuresis.
Option B: Diuretic efficacy may be limited by adverse neurohormonal activation and by ‘congestion-like’ symptoms. Diuretics are an extremely useful and varied class of agents for the management of hypovolemic states.
Option D: Furosemide is by far the most common oral loop diuretic, but patients with resistance to oral furosemide therapy may benefit from trials with second-generation oral loop diuretics (bumetanide and torasemide). These may be more efficacious, due to their increased oral bioavailability and potency.