Furosemide Nursing Considerations

Furosemide, commonly known as Lasix, is a potent loop diuretic medication used to treat fluid overload and edema associated with various conditions. It works by preventing the reabsorption of sodium and chloride in the kidneys, leading to increased urine output.

Generic names: Furosemide

Brand names: Lasix, Furocot, Frusix, Fusid

Pharmacologic class: Loop diuretic

Therapeutic class: Diuretic, antihypertensive

Mechanism of action: Inhibits the sodium-potassium-chloride cotransporter in the ascending loop of Henle, preventing the reabsorption of these electrolytes and water. This results in increased urine output and reduced fluid retention.

Indications for use: Edema associated with congestive heart failure, liver cirrhosis, and kidney disease. Treatment of hypertension. Management of fluid overload. Treatment of hypercalcemia.

Precautions and contraindications: Hypersensitivity to furosemide or sulfonamides. Anuria. Severe electrolyte depletion. Hepatic coma. Pregnant or breastfeeding patients require careful consideration.

Drug Interactions

• ACE inhibitors and ARBs may increase the risk of hypotension
• NSAIDs may decrease the effectiveness of furosemide
• Aminoglycosides and other ototoxic drugs may increase the risk of hearing damage.
• Lithium levels may be affected by furosemide
• Digoxin toxicity risk increases due to electrolyte imbalances
• Corticosteroids may increase potassium loss

Adverse Effects

• Severe electrolyte imbalances (especially hypokalemia)
• Dehydration and volume depletion
• Hypotension and orthostatic hypotension
• Ototoxicity (hearing loss or tinnitus)
• Hyperglycemia and hyperuricemia
• Muscle cramps and weakness
• Photosensitivity
• Gastrointestinal disturbances
• Pancreatitis (rare)

Administration Considerations

Available preparations: Oral tablets (20mg, 40mg, 80mg), oral solution, and injectable solution.

Dosages:
Adults: Initially 20-80mg PO once daily. May increase to 600mg daily in severe cases.
For IV administration: 20-40mg initially, may repeat in 2 hours if needed.

Route specifics:
PO: Onset 30-60 minutes, peak 1-2 hours, duration 6-8 hours
IV: Onset 5 minutes, peak 20-60 minutes, duration 2-3 hours

Nursing Considerations for Furosemide

Related Nursing Diagnoses

• Risk for electrolyte imbalance
• Risk for falls related to orthostatic hypotension
• Risk for fluid volume deficit
• Impaired urinary elimination
• Deficient knowledge related to medication regimen

Nursing Assessment

1. Assess fluid status, including intake and output, weight, presence of edema, and skin turgor.
2. Monitor vital signs, especially blood pressure, for hypotension.
3. Assess electrolyte levels, particularly potassium, sodium, and chloride.
4. Monitor kidney function through BUN and creatinine levels.
5. Assess for signs of dehydration: decreased skin turgor, dry mucous membranes, thirst, dizziness.

Nursing Interventions

1. Administer furosemide in the morning to prevent nighttime diuresis.
2. For IV administration, give slowly over 1-2 minutes to prevent ototoxicity.
3. Monitor daily weights at the same time each day.
4. Implement fall precautions due to orthostatic hypotension risk.
5. Monitor and document intake and output strictly.

Patient Teaching Associated with Furosemide

1. Take medication as scheduled, preferably in the morning, to avoid nighttime bathroom trips.
2. Report signs of electrolyte imbalance: muscle cramps, weakness, irregular heartbeat, confusion.
3. Rise slowly from lying or sitting positions to prevent orthostatic hypotension.
4. Maintain adequate fluid intake unless otherwise directed by the healthcare provider.
5. Follow any dietary restrictions, especially regarding potassium and sodium intake.
6. Protect skin from excessive sun exposure due to increased photosensitivity.
7. Monitor weight daily and report sudden weight changes.
8. Avoid alcohol while taking furosemide.

This is not an all-inclusive list of possible drug interactions, adverse effects, precautions, nursing considerations, or patient instructions. Please consult further with a pharmacist for complete information.

References and Sources

1. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. 
2. Bc, J. B. D. A., Rosenthal, L., & Yeager, J. J. (2021). Study Guide for Lehne’s Pharmacology for Nursing Care. Saunders.
3. Brater DC. Update in diuretic therapy: clinical pharmacology. Semin Nephrol. 2011 Nov;31(6):483-94. doi: 10.1016/j.semnephrol.2011.09.003. PMID: 22099505.
4. Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
5. Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
6. Huxel C, Raja A, Ollivierre-Lawrence MD. Loop Diuretics. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK546656/
7. Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
8. Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.