Question

PN 105 Fundamentals of Nursing I Case Study: Hypertension/Hydrochlorothiazide Joe Quan is a 58-year-old patient, recently diagnosed with hypertension. His resting bloc pressure is 158/92. He is prescribed hydrochlorothiazide 50mg/day and told to eat foodrich potassium 1. How does hydrochlorothiazide differ from furosemide (Lasix)? What are there similarities and their differences? 2. Why is it necessary for Joe to eat food rich in potassium when taking hydrochlorothiazide? Explain your answer 3. What are the nursing interventions that should be considered while Joe takes hydrochlorothiazide? After one month on hydrochlorothiazide therapy, Joe becomes weak and complains of nausea and vomiting. His muscles are "soft". His serum potassium level is 3.3 mEq/L. Joe's diuretic is changes to triamterene/hydrochlorothiazide (Diazide). Again he is advised to eat foods rich in potassium 4. Explain the rationale for changing Joe's diuretic. 5. Should Joe receive a potassium supplement? Explain your answer. 6. What nursing interventions should the nurse follow for Joe?

Answer 1

1Q).

Thiazide diuretics: These are the most commonly used diuretics but less effective than loop diuretics. Thiazide diuretics inhibit the Na+/Cl^- symporter in the distal convoluted tubules and thus, partly inhibits the reabsorption of sodium and chloride ions. Thiazide diuretics causes loss of potassium and hydrogen ions, which may cause hypokalemia and metabolic alkalosis respectively. Thiazide diuretics decrease the calcium excretion thereby causes hypercalcemia.

The activation of renin-angiotensin-aldosterone (due to decreased blood volume and arterial pressure) may be responsible for part of the hypokalaemia and metabolic alkalosis. This effect is mediated by aldosterone, which increases sodium reabsorption and potassium, hydrogen ion excretion.

Eg: Hydrochlorothiazide, bendrofluazide, indapamide, xipamide

Loop diuretics: Loop diuretics act by inhibiting the sodium-potassium-chloride cotransporter in the thick ascending limb. The decreased sodium reabsorption also reduces the volume of water reabsorbed and thus, causes diuresis and natriuresis. These are more powerful than thiazide diuretics, but causes hypokalemia similar to thiazides. Loop diuretics increase the calcium excretion and causes hypocalcemia.

Co-administration of loop diuretics with the aminoglycoside antibiotics causes dose related ototoxicity.

Eg: furosemide, bumetanide

2Q).

It is important to take potassium supplements with hydrochlorthiazide because it causes potassium excretion and hypokalemia.