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What You Need to Know About Osmitrol for the NCLEX

Osmitrol is an osmotic diuretic. It focuses on increasing the osmotic pressure of the glomerular filtrate. Osmitrol, osmotic diuretic, and osmotic pressure all start with the letter O.

The higher the concentration of osmitrol in the filtrate, the more diuresis occurs (more fluid removal).

What is Osmitrol (Mannitol) used for:

Prevents, treats oliguric phase (also starts with the letter O) of acute renal failure.
Reduces increased intracranial pressure caused by cerebral edema.
Decreases edema of injured spinal cord.
Decreases intraocular pressure caused by acute glaucoma.
Promotes excretion of toxic substances.

Do not use Osmitrol (Mannitol) for:

Severe renal disease
Dehydration
Intracranial bleeding
Severe pulmonary edema

Be cautious in using Osmitrol (Mannitol) when patient has:

Cardiac failure
Pulmonary edema

Side effects of Osmitrol (Mannitol):

Blurred vision
Dizziness
Tachycardia
Peripheral edema
Headache
Nausea and vomiting (of course)
Backache

Nursing actions to take:

Check vital signs before administering the dose (Got to look at that blood pressure).
Assess urinary output and hydration status
Assess electrolytes (for low sodium and potassium).
Assess BUN, renal, and hepatic panels.
Look for symptoms of congestive heart failure and pulmonary edema.
IV medication may crystallize so it is essential to warm prior to putting into solution to prevent from entering circulation.

What an RN should never ask of a CNA

Any nurse worth their weight in water knows, understand, values and appreciates the function and role every CNA plays in the delivery of our patient care. And yet, I still see RN’s treating their CNA team member horribly.

Here is the best piece of advice I can give to any RN out there when delegating to their CNA team members:

Never delegate out of sheer personal convenience.

Too many times I have seen/heard/witnessed an RN/LPN delegate a task to a CNA simply because it was inconvenient for them. We all know the stories and the urban legends of CNAs always doing the dirty work (bed baths & bedpans to name a few), while the RN/LPN walks away. I have seen them answer a call bell, then learn they need to get their hands dirty. They walk back out of the room and call/delegate the task. Are there actually people out there who believe that once they are licensed, they don’t need to get their hands dirty???

I’m here to publicly apologize to any CNA reading this. Contrary to popular belief, this is not the norm, nor is it acceptable to most of us currently practicing! I still strongly believe that the most important assessment skills can be learned from getting my hands dirty. And I learned that from a CNA.

The professional rapport you have with your CNA can make or break your career. I make it a point to strengthen that relationship, because when the going gets tough and the you-know-what hits the fan, my fellow CNAs are often times the ones that keep me afloat.

What goes around comes around folks. If you cannot make the time to get your hands dirty, the CNA will not have the time to keep you from ‘drowning’ in your time of need. It really is that simple. It’s called teamwork.

A nurses’ aide (Certified Nurses Aid – CNA) is the unsung hero of the nursing world. When someone asks what you do, never simply say “I’m just the aide.” When we speak of bedside care and we refer to the ‘team effort’ this part of the team is probably the most under-appreciated, yet most needed team member. They are the silent majority. When they are doing what they do best, you sometimes (more often than we like to admit) forget they are there. But, when they are absent it turns your whole world upside down. Thank you, CNAs, for all that you do!

Top Key Points You Need to Know About Diuretics

Direct routes of diuretics to administer to the patients are by mouth (PO), IV, and IM. There are loop diuretics and thiazide diuretics that you can mix up, but it’s important to know the difference!

Loop diuretics:

Inhibits sodium and chloride reabsorption directly and it occurs in the ascending loop of Henle
Also occurs in the proximal and distal tubules.

Thiazide diuretics:

Acts mainly in the distal tubules.
Also inhibits sodium and chloride reabsorption.

What diuretics are used for:

Edema; helps to get rid of extra fluid volume in the body
Hypertension (Extra fluid in body can cause hypertension)

Don’t give diuretics to patients who:

Pregnant, breastfeeding
Severe adrenocortical impairment, anuria, progressive oliguria.

Be cautious in giving diuretics to patients who have:

Fluid and electrolyte depletion
Gout
Patients taking digitalis, lithium, NSAIDs, and anti-hypertensive medications.

Side Effects:

Dehydration, hyponatremia, hypochloremia, hypokalemia

If you’re removing fluid, you’re removing electrolytes.

Tiredness, weakness, dizziness
Weak pulse, orthostatic hypotension
Tinnitus, hyperglycemia, hyperuricemia, hearing loss (caused by Lasix)

Nursing Implication:

Monitor intake and output.
Monitor potassium loss.
Monitor weight and vital signs (Watch for blood pressure).
Monitor for hearing loss (most likely temporarily, lasts 1 hour to 24 hours).
Teach patient to take medication early in the day to reduce chances of nocturia.
Teach patient to report hearing loss or gout symptoms.