Question

The client with hypertension and renal disease is admitted to the clinic with a blood pressure of 190/100. The physician decides to order a beta blocker and a potassium-sparing diuretic. The nurse should anticipate an order for which diuretic? A. Furosemide (Lasix) B. Hydrochlorothiazide (HTCZ) C. Spironolactone (Aldactone) D. Torsemide (Demadex)

Short answer

Answer: C. Spironolactone (Aldactone)

Step-by-step solution

Understanding the problem

Start by understanding the needs of the patient, who is suffering from hypertension and renal disease. High blood pressure indicates the need for a beta blocker, and a potassium-sparing diuretic is needed to lower blood pressure without impacting potassium levels.

Analyzing the given diuretics

Four diuretics are provided as options: A. Furosemide (Lasix) B. Hydrochlorothiazide (HTCZ) C. Spironolactone (Aldactone) D. Torsemide (Demadex) Each of these options has a different mechanism of action and potassium retention properties. We need to find out which diuretic is potassium-sparing.

Identify potassium-sparing diuretic

A. Furosemide (Lasix) is a loop diuretic that is not potassium-sparing. B. Hydrochlorothiazide (HTCZ) is a thiazide diuretic, which is also not potassium-sparing. C. Spironolactone (Aldactone) is a potassium-sparing diuretic that acts as an aldosterone antagonist. D. Torsemide (Demadex) is a loop diuretic and not potassium-sparing.

Select the appropriate diuretic

Based on the analysis, Spironolactone (Aldactone) is the only potassium-sparing diuretic among the given options. Therefore, the nurse should anticipate an order for Spironolactone (Aldactone) as the appropriate diuretic for the patient with hypertension and renal disease. The correct answer is C.

Key concepts

Potassium-Sparing Diuretics

When managing conditions such as hypertension and renal disease, careful attention must be paid to the patient's electrolyte balance. Potassium-sparing diuretics like Spironolactone (Aldactone) play a crucial role in preserving potassium levels while eliminating excess fluid from the body. Unlike loop diuretics like Furosemide (Lasix) and Torsemide (Demadex), or thiazide diuretics like Hydrochlorothiazide (HTCZ), which can lead to increased excretion of potassium, potassium-sparing diuretics prevent this loss.

Spironolactone, in particular, works as an aldosterone antagonist, which means it blocks the hormone aldosterone's action that would otherwise cause potassium to be expelled in urine. This makes it an ideal choice for patients who need to maintain their potassium levels due to conditions like heart failure, liver cirrhosis, and specifically for those with renal disease, where the kidney's ability to regulate potassium is compromised.

Hypertension Management

Managing hypertension is a multifaceted challenge that involves lifestyle changes, medication, and close monitoring. Medications are selected based on their effectiveness in controlling blood pressure and their compatibility with the patient's overall health profile. In the case of patients with both hypertension and renal disease, the choice of medication is particularly important as certain drugs can further impair renal function.

Beta-blockers and certain types of diuretics remain mainstays in hypertension therapy. Beta-blockers work by reducing the heart rate and the heart's output of blood, which lowers blood pressure. In combination with diuretics, which help the body eliminate excess sodium and water, this dual approach effectively manages high blood pressure. However, for patients with concomitant renal disease, potassium-sparing diuretics are often the preferred type to avoid exacerbating electrolyte imbalances that can lead to other health complications.

Renal Disease Treatment

Treating renal disease requires a comprehensive approach that not only addresses the symptoms but also targets the underlying causes. Medications are used to control blood pressure, reduce proteinuria, and maintain electrolyte balance. Additionally, dietary modifications, fluid management, and the control of blood sugar levels (if the patient is diabetic) are essential components of effective renal disease management.

In the context of renal disease, it is crucial to use medications that do not place additional strain on the kidneys while still providing the necessary therapeutic effects. Spironolactone, with its potassium-sparing properties, offers a strategic advantage by protecting the patient from hypokalemia (low potassium levels), a common issue in patients with renal disease who are on diuretics. Regular monitoring of kidney function and electrolyte levels is vital, as even potassium-sparing diuretics can, in some cases, lead to hyperkalemia (high potassium levels) if not carefully managed.