Pathophysiology- Renal System
Pathophysiology- Renal System NUR 305
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This 8 page Study Guide was uploaded by Shelby Stephens on Wednesday December 9, 2015. The Study Guide belongs to NUR 305 at University of Alabama - Tuscaloosa taught by Owings in Fall 2015. Since its upload, it has received 25 views. For similar materials see Pathophysiology in Nursing and Health Sciences at University of Alabama - Tuscaloosa.
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Date Created: 12/09/15
Week 4: The Renal System. Chapters 2427 Chapter 24. Review the following: Urine formation, Glomerular Filtration, & Tubular Reabsorption and Secretion. Understanding –How the Kidney Concentrates Urine. Review Regulation of Renal blood flowimportant for understanding kidney failure. Side note: Diagnosis for all disordersdo history & physical exam. The kidneys are superefficient filters that also have important metabolic functions Fluid volume: responds to ADH & Aldosterone, kidneys are very efficient at reabsorbing water and concentrating waste products for excretion (ammonia, urea, uric acid, K+, anything that we have too much). Blood pressure: ADH causes the kidneys to reabsorb (keep) water and put it back into the vascular space (bloodstream). Aldosterone causes the kidneys to reabsorb water & sodium and put it back into the vascular space. Renin is produced and released by the kidneys, causes the conversion of Angiotension I to Angiotension II (this conversion actually happens in the lungs). Angiotension II is a potent vasoconstrictorcauses the blood vessels to constrict. Metabolic waste and drug excretion: ammonia, urea, uric acid, K+, anything that we have too much. The kidneys & electrolytes: Usually excrete K+ and keep Na+. If we do not have aldosterone we will not keep Na+ and as much H O.2 Parathyroid hormone (released by the parathyroid glands) causes bones to release calcium and kidneys to reabsorb calcium and put it back into the bloodstream. In exchange, the kidneys will excrete phosphate. Atrial natriuretic peptide: Released by cells in the cardiac atria when the atria are distended due to plasma volume increases. Decreases sodium and water reabsorption. The kidneys excrete sodium and water (diuretic effect). Also inhibits renin secretion. *ANP helps the body get rid of sodium & water. And helps compensate when a patient goes into HF. In summary: Kidneys reabsorb: Na+, H O, C2++, HCO – (kidne3 also make HCO ), 3 glucose, Kidneys get rid of (excrete): ammonia, urea, uric acid, electrolytes that are in excess in the extracellular fluid (remember that it’s all about balance) Vitamin D is converted into an active form that helps the bones absorb calcium as well as vitamin D. Acidbase balance: secretes bicarbonate, can excrete or retain hydrogen ions Hormone synthesis: renin, erythropoietin, atrial natriuretic peptide How do we determine kidney function? Kidney function tests. Draw blood, send it to the lab and determine if the kidney is effectively removing wastes from our blood. *Best indicator of renal function is glomerular filtration rate. Creatinine is more specific to renal function than BUN. Creatinine: men 0.61.2 mg/dL; women 0.51.1mg/dL. Specific to kidney disease. Waste product off creatine phosphate from skeletal muscle. Elevated (above 1.2mg/dL) in kidney disease. BUN to creatinine ratio is often used to look at kidney function (creatinine 1: to BUN 10). BUN (Blood Urea Nitrogen)normal range 1020 mg/dL Waste product of protein metabolism. Levels go up (above 20mg/dL) in kidney disease, poor blood perfusion to the kidneys, heart failure, shock, dehydration, GI bleeding, high protein diet. Decreased in overhydration, liver failure. Creatinine Clearance (24 hour urine creatinine clearance): the nurse collects the patient/client’s urine for 24 hours in a brown container and keeps it on ice. The following are measured: glomerular filtration rate, can also be used to measure byproducts of hormones to evaluate certain endocrine disorders. Urinalysis: see lab value sheet in the supplemental folder. Notice how most things should be “negative” meaning they should not be present. For example glucose. Urine Sediment: cellular fragments, crystals, byproducts of metabolism. Often see lots of sediment in renal failure. Urine will be dark, very concentrated looking. Glomerular Filtration Rate: best indicator of renal function. Changes with Aging: rememberrenal function decreases some in older adults. So an 80 year old may have a BUN of 25 and a creatinine of 1.7mg/dL and this will be “normal” for them, as long as there are no other symptoms. Chapter 26. Renal Failure: Acute versus Chronic Chronic Kidney disease. Very good summary of chronic renal failure. Acute is temporary and they can recover given the appropriate therapy. Chronic is irreversible and they will gradually lose renal function until they reach ESRD (end stage renal disease) stage. Once they reach ESRD they require dialysis to live. A patient in ESRD may live a couple of weeks without dialysis but eventually the fluid, waste products and potassium build up to the point where they develop pulmonary edema rapidly leading to pulmonary failure and their potassium gets so high that their heart will develop bradydysrhythmias and asystole (heart stops). ARFprerenal, intrarenal, postrenal. Prerenal conditions (basically this is a severe lack of blood flow to the kidney) Extremely low blood pressure or blood volume Heart dysfunction Intrarenal conditions Reduced blood supply within the kidneys Hemolytic uremic syndrome Renal inflammation Toxic injury Postrenal conditions (something prevent urine from leaving the body, it has to go somewhere so it backs up) Ureter obstruction Bladder obstruction and dysfunction Know the 4 phases of ARFasymptomatic, oliguric, diurectic, recovery 1. Asymptomatic phase 2. Oliguric phase daily urine output decreases to approximately 400 mL or less, and waste products accumulate. 3. Diuretic phase daily urine output increases to as much as 5 L. 4. Recovery phase glomerular function gradually returns to normal. Know the manifestations of ARF Oliguric phase: decreasing urine output electrolyte disturbances fluid volume excess azotemia metabolic acidosis Diuretic phase: increased urine output electrolyte disturbances dehydration hypotension Recovery phase: symptoms begin resolving Treatment of ARF Correct fluid & electrolyte problem, Treat hypertension Diet high calories but low in protein, sodium, potassium, and phosphates. Give them erythropoietin injections to prevent anemia (kidneys not able to produce it) Dialysis used if absolutely necessary. CRFgradual loss of renal function The biggest risk factors are diabetes and hypertension. Next is renal obstructions. Definitions Renal impairment60% of nephrons lost Renal insufficiency75% of nephrons lost, GFR reduced by 20%, erythropoietin not produced=anemia. End stage renal disease (ESRD)90% of nephrons lost, GFR is only 10ml/hr. Requires dialysis to live. Chapter 27. Urinary Incontinencetypes include stress, urge, reflex, overflow, mixed, functional, gross total. Be familiar with the basic definition of urinary incontinence: loss of urinary control for a variety of reasons. Stress incontinenceloss of control with coughing, straining, exercise, laughing, etc… Urge incontinencethis one is associated with overactive bladder. Reflex incontinence due to nervous system damage. Risk factors for incontinence= female gender, elderly, overweight, smoker, etc… Treatment: bladder training, scheduled toileting, fluid intake management, improve pelvic muscle strength & control (pelvic exercises). Neurogenic bladderinterruption in nervous system innervation to the bladder. Most common cause is spinal disorders. th Congenital disorderskidneys form in the fetus during the 5 week of gestation may be exposed to something that damages kidney formation. Polycystic Kidney Disease: inherited, multiple fluid filled cysts form in and on the kidneys replacing normal, functioning kidney tissue. Eventually they go into the ESRD and require dialysis. Wilm’s Tumor: rare cancer of the kidney that affects kids usually is just one tumorbut it gets big. Urinary Tract Infections (UTI): most commonlower urinary tract infection, caused by E. Coli. Urgencyfeel like you need to urinate all the time dysuriapain & burning during urination frequencyurinating often but very small amounts each time hematuriablood in the urine Bacturiabacteria in the urine cloudy and foulsmelling urine cloudiness from white blood cells, mucus, pus. fever Cystitisbladder infection, bladder is inflamed, same symptoms as UTI plus lower abdominal and pelvic pain & pressure. Treatment: increase intake of fluids (no caffeine), acidify the urine by drinking cranberry juice and eating citrus fruits, antibiotics are often required. Teach females to wipe from front to back after urinating, urinate after intercourse. Avoid putting off urination (holding it for long periods). Avoid perfumed bubble bath. *Pyelonephritis: serious, infection has made up to the kidneys, usual cause is E. Coli. Kidneys get edematous & fill with exudate, this leads to renal artery compression. Very painfulhave flank pain, chills, fever, nausea, vomiting, hematuria, burning & pain during urination, and other symptoms. Needs prompt treatmentrisk of permanent kidney damage if not promptly treated. Requires antibiotics46weeks, increase fluids, treat pain, nausea, other symptoms. Glomerulonephritis: serious, inflammation of the glomeruli, usually from streptococcal infection. Leaky glomeruliHematuria “coca cola” urine, proteinuria Oliguria (ineffective excretion of fluid): edema, malaise, headache, N,V, elevated B/P and fluid volume overload, dark urine with blood (cola colored), dyspnea, cardiomegaly, pulmonary edema Anemianot producing erythropoietin What is the difference in glomerular permeability in Nephritic syndrome versus Nephrotic syndrome? Nephrotic Syndrome: Manifestations: Nephrotic Syndrome: autoimmune, antigenantibody complexes lodge in glomerular membrane, complement system is activated and immune system “coats” the glomerular membrane and the immune system attacks it. Manifestations: fluid retention (edema), ascites, large amounts of protein spilled in the urine, anorexia, weight gain. Urolithiasis (kidney stones): stones are composed of calcium, oxalate, phosphate, struvite, cysteine, or a mix. Symptoms are somewhat similar to pyelonephritis. Kidney tend to manifest suddenly, Sometimes need to do an xray or ultrasound to rule out pyelonephritis. There is hydronephrosis if it is a kidney stone and we can see the stone on the ultrasound/xray. flank area pain Groin or leg pain bloody, cloudy, or foulsmelling urine Dysuria Frequency Nausea, vomiting fever; and chills *A cause of postrenal acute renal failure. Hydronephrosis the renal pelvis (area within the kidney) is distended. Urinary Tract obstruction: see kidney stones/urolithiasis above except physician will usually go in with a cytoscope and remove the stone if it blocks the urinary tract. Can cause renal failure if the stone completely block the urinary tract. Bladder Cancerpreventable causes include smoking, exposure to toxic chemicals (occupational), analgesics, and sources of chronic irritation (long term catheter, recurrent UTIs, etc…). *Painless hematuria. Other: abnormal urine color, dysuria, frequency, back pain, abdominal pain, frequent UTIs. Kidney cancer preventable causes include smoking, exposure to toxic chemicals. More common in males. Benign Prostatic Hyperplasiaenlarged prostate, compresses the urethra. Patients with BPH cannot fully empty the bladder, experience dribbling during urination. Hormones Influencing Renal function • Antidiuretic • Released from Water Makes Distal Collecting hormone (ADH) posterior pituitary reabsorbed Tubule and Collecting Duct permeable to water to maximize reabsorption and produce a concentrated urine. • Aldosterone • Released from Water & • Promotes sodium adrenal cortex Sodium reabsorption and reabsobed potassium secretion in Distal Collecting Tubule and Collecting Duct; water and chloride follow sodium movement. • Erythropoietin Renal parenchyma Stimulates bone marrow to make red blood cells. Activated Renal parenchyma Promotes absorption of vitamin D calcium in the gastrointestinal tract. Renin Juxtaglomerular Raises blood pressure as cells of the afferent result of angiotensin and efferent arterioles (vasoconstriction) and aldosterone (volume expansion) secretion. Atrial natriuretic Released by cells in Decreases sodium and peptide the cardiac atria water reabsorption. The when the atria are kidneys excrete sodium distended due to and water (diuretic effect). plasma volume Also inhibits renin increases. secretion. *ANP helps the body get rid of sodium & water. And helps compensate when a patient goes into HF.
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