FUROSEMIDE

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(fur-oh’se-mide)
Fumide , Furomide , Lasix, Luramide 
Classifications: electrolytic and water balance agent; loop diuretic
Pregnancy Category: C

NURSING IMPLICATIONS

Assessment & Drug Effects

• Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest has been reported.
• Monitor BP during periods of diuresis and through period of dosage adjustment.
• Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician.
• Lab tests: Obtain frequent blood count, serum and urine electrolytes, CO₂, BUN, blood sugar, and uric acid values during first few months of therapy and periodically thereafter.
• Monitor for S&S of hypokalemia (see Appendix F).
• Monitor I&O ratio and pattern. Report decrease or unusual increase in output. Excessive diuresis can result in dehydration and hypovolemia, circulatory collapse, and hypotension. Weigh patient daily under standard conditions.
• Monitor urine and blood glucose & HbA_1C closely in diabetics and patients with decompensated hepatic cirrhosis. Drug may cause hyperglycemia.
• Note: Excessive dehydration is most likely to occur in older adults, those with chronic cardiac disease on prolonged salt restriction, or those receiving sympatholytic agents.

Patient & Family Education

• Consult physician regarding allowable salt and fluid intake.
• Ingest potassium-rich foods daily (e.g., bananas, oranges, peaches, dried dates) to reduce or prevent potassium depletion.
• Learn S&S of hypokalemia (see Appendix F). Report muscle cramps or weakness to physician.
• Make position changes slowly because high doses of antihypertensive drugs taken concurrently may produce episodes of dizziness or imbalance.
• Avoid replacing fluid losses with large amounts of water.
• Avoid prolonged exposure to direct sun.
• Do not breast feed while taking this drug.

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• ENOXAPARIN (e-nox’a-pa-rin) Lovenox Classifications: blood formers, coagulators, and anticoagulants; low molecular weight heparin Pregnancy Category: B NURSING IMPLICATIONS Assessment & Drug Effects Lab tests: Baseline coagulation studies; periodic CBC, platelet count, urine and stool for occult blood. Monitor platelet count closely. Withhold drug and notify physician if platelet
• VASOPRESSIN INJECTION (vay-soe-press’in) Pitressin Classifications: hormones and synthetic substitutes; pituitary (antidiuretic) Pregnancy Category: X NURSING IMPLICATIONS Assessment & Drug Effects Monitor infants and children closely. They are more susceptible to volume disturbances (such as sudden reversal of polyuria) than adults. Establish baseline data of BP, weight, I&O pattern and
• METOCLOPRAMIDE HYDROCHLORIDE (met-oh-kloe-pra’mide) Clopra, Emex , Maxeran , Maxolon, Reglan Classifications: gastrointestinal agent; prokinetic agent (gi stimulant) Pregnancy Category: B NURSING IMPLICATIONS Assessment & Drug Effects Report immediately the onset of restlessness, involuntary movements, facial grimacing, rigidity, or tremors. Extrapyramidal symptoms are most likely to occur in children, young adults,
• DOBUTAMINE HYDROCHLORIDE (doe-byoo’ta-meen) Dobutrex Classifications: autonomic nervous system agent; beta-adrenergic agonist; catecholamine Prototype: Isoproterenol Pregnancy Category: C NURSING IMPLICATIONS Assessment & Drug Effects Correct hypovolemia by administration of appropriate volume expanders prior to initiation of therapy. Monitor therapeutic effectiveness. At any given dosage level, drug takes 10–20 min to produce
• SPIRONOLACTONE (speer-on-oh-lak’tone) Aldactone, Novospiroton  Classifications: electrolytic and water balance agent; potassium-sparing diuretic Pregnancy Category: D NURSING IMPLICATIONS Assessment & Drug Effects Check blood pressure before initiation of therapy and at regular intervals throughout therapy. Lab tests: Monitor serum electrolytes (sodium and potassium) especially during early therapy; monitor digoxin