What does aldosterone do? What stimulates its release?
CAUSES distal tube to RETAIN SODIUM and therefore water, while losing potassium in the urine.it is a hormone produced by the adrenal gland. Its release is stimulated by angiontensin III as well as high potassium levels.
What does ADH do?
ADH = anti diuretic hormonemaintains fluid balance; antidiuretic effect and fluid retention.ADH is the chemical that tells the kidneys how much water to conserve.it is a hormone produced by the hypothalamus and stored in posterior pituitary
Passage of fluid and small components of the blood through the glomerulus into the nephron tubule is called...
The renal system has four major functions...List them
1.Maintaning the volume and composition of body fluids within normal ranges. (Clears nitrogenous waste, maintain acid-base balance and electrolytes, excrete various drugs&drug metabolites)2. Regulating Vitamin D activation, which helps to maintain and regulate calcium levels3. regulate blood pressure the renin-angiotensin-aldosterone system4. Regulate RBC production through the production/secretion of erythropoietin
T or F: Approx 1600 L of blood flows through the kidneys each day for cleansing.
What are the three protective layers of the kidneys?
fiber layer, perirenal or brown fat layer, renal parietal layer
The functional unit of the kidneys is called the ...
nephronThis filters blood
t or f: Renin and erythropoietin are produced in the juxtagloerular apparatus.
true. next to afferent arteriole.
The glomerulus is an ultrafine semipermeable membrane that keeps blood cells, protein, and lipids inside the vessel. hydrostatic pressure from blood pushes water and smaller components of the plasma into the tubule resulting in filtrate. Scarring and swelling of or damage to the semipermeable membrane leads to the escape of larger plasma components such as blood cells or protein, into the filtrate. What is a clinical sign of renal damage?
presence of blood cells or protein in the urine
When documenting fluids, if a patient is given 8 ounces of ice, what do you write for intake on their chart?
What is emesis?
Average adult water intake according to Tong slides?
How does water escape the body?
kidney, lungs, skin, feces, urine, sweat etc.
T or F: Urine output can be up to 2000cc per day.
True (slide 7)At least 30cc/hour
FVD stands for? FVE?
FVD = fluid volume deficit (more urine output than fluid intake)FVE= fluid volume excess (fluid intake over output)
1 kg of body weight (2.2 lbs) is equivalent to _ ____ of fluid loss or gain
1 LWeigh every morning same time in same clothes to get accurate weight.
1 oz = ___ ml
1 oz = 30 mLOZzy drinks MiLk at 1:30
_____ is produced by the kidney and regulates blood pressure
What is calcitriol (which is produced by kidneys)?
an active form of vitamin D to help maintain bone homeostasis
T or F: the glomerulus acts as a filter for blood and strains fluid into the renal tube.
_____ is the waste product that is produced from muscle metabolism
water follows _____
What condition does someone have if there is blood sugar in the urine?
Urea and creatinine are the most important to be removed. Urea comes from ______. Creatinine comes from _____ ___ _____.
Ammonia (Ammonia comes from amino acid broken down by the liver)breakdown of muscles (produces creatinine)
____ is the main regulator of fluid intake.
For fluid excess, treat with _____
The renin angiotensins system ____ the blood pressure.
increases.Once renin is released it is absorbed into the capillary system and enters circulation. Renin activates angiotensin system Renin released-->stimulates angiotensin I --> + converting enzyme (from lung) = angiotensin II --> vasoconstriction-->increase in blood pressure/increases stroke volume/GFR maintained.
When aldosterone acts on renal tubules to retain sodium and therefore water, the blood volume and blood pressure _______.This leads to increase in blood flow to kidneys
increase. (increases stroke volume too)(think about it... if you retain sodium and water, there is more volume filling arteries, and creates more pressure).
Why would the kidneys want higher blood pressure?
more blood getting to the kidneys = more oxygen to the kidneys(They be hongry for some blood)
What stimulates the release of ADH?
1.falling blood volume2.sympathetic stimulation3.rising sodium levels (wants to dilute the sodium by retaining water)
What is the stimuli for renin secretion?
Decreased renal perfusion** pressure and/or decreased salt delivery to kidney tubules.**Renal perfusion is a term used to describe blood flow to the kidneys Examples: hemorrhage, heart failure, cirrhosis, loop diuretics, decreased salt intake
What is GFR?
Glomerular filtration rate (GFR) is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the glomeruli each minute. Glomeruli are the tiny filters in the kidneys that filter waste from the blood.
What happens when angiotensin II is converted to angiotensen III in the adrenal gland?
it stimulates the release of aldosterone.Aldosterone acts on renal tubules to retain sodium and therefore water.(ALso potassium excretion takes place and ADH is released which tells the body how much water to conserve)
Water comprises ___% of total body weight
60%2/3 ICF1/3 ECF
Name the major electrolytes in the body.Which ones are regulated by the kidneys?
K Na Cl P MgNa Cl K are regulated by kidneys
What is the normal range for Potassium?
K+ = 3.5-5
What is the normal range for Sodium?
Na = 135-145
Background info: most of potassium that is filtered is reabsorbed into the blood. There is only a little that is lost. When given diuretics, it effects the amount of potassium in urine. You lose potassium when using diuretic.
Na is a major cation that is filtered through and reabsorbed. Where sodium goes,water follows. Diuretic forces a release of sodium therefore forcing a release of water.
The enzyme ______ ____ is a catalyst for the formation of sodium bicarbonate, which is stored as the alkaline reserve in the renal tubule, and for the excretion of hydrogen, which results in slightly acidic urine
Carbonic anhydrase-allows CO2 and H2O combine to make H2CO3 (carbonic acid)-Carbonic acid breaks down to form HCO3 bicarbonate and a free hydrogen and free sodium-HCO3 is stored, while the free hydrogen is excreted forming acidic urine
Chloride hangs out with Sodium (attraction). If the chloride pump's job is to push chloride into the blood (and salt would follow), what happens when we give diuretics that block the chloride pump?
Diuretics block the Chlroide pump, preventing the salt from going back into blood and we void the salt.
T or F: The chloride pump is blocked by thiazide and loop diuretics.
How do diuretics work on the chloride/sodium pump?
Chloride pump's job is to pump chloride into the blood. Due to attraction, salt would follow. Diuretics block the Chloride pump. which prevents the salt from going back into blood. If the salt is not pumped back into the blood, it is left in the fluid. Water follows salt. When we urinate salt, the water will follow. Volume reduced.
What is carbonic anhydrase?
an enzyme that allows carbon dioxide and water to combine and form carbonic acid.blocking actionsi kidney is how it workscarbonix anhydrase causes you to hold on to potassium.
Aldosterone is a hormone that causes retention of sodium and therefore water, while losing potassium into the urine. Aldosterone stimulates the sodium-potassium exchange pump in the distal tube. Normally potassium gets excreted and sodium is retained. If we impact aldosterone with a diuretic, what might happen?
The POTASSIUM SPARRING diuretic will block aldosterone in the distal tube. This will cause a loss of sodium while promoting retention of potassium.
What is the major control of the potassium levels in the body?
Sodium-potassium exchange pump (which is affected by aldosterone)
T or F: Sodium follows water.
False. Water follows sodium.
Kidneys effect the acid base balance by what mechanism?
Kidneys help with vitamin ___ activation to a form which promotes _____ to be absorbed.
Once absorbed from the GI tract, calcium levels are maintained within a very tight range by the activity of _____ _____ and calcitonin
parathyroid hormone (PTH)parathyroid = parallel to the thyroid
Renal failure can lead to a decrease in production of _____, which can lead to anemia.
During severe exertion, a man may lose up to 4L of hypotonic sweat per hour. This loss would result in:
a. decreased plasma volume
b. decreased plasma osmolarity
c. decreased circulating levels of ADH.
d. return of body fluid balance to normal after ingestion of 100 ml of water.
Urine passed through the ureter by:
When describing renal absorption to students, the instructor would identify it as the movement of which of thefollowing?
A. substances from the renal tubule into the blood
B. Substances from the blood into the renal tubule
If a patient lost kidney function, a nurse would expect to see ?
A. increased RBC count
B. decreased fluid volume
C. electrolyte disturbances
D. decreased blood pressure
C.Kidneys regulate Na CL K+ and HCO3
When describing renal absorption to students, the instructor would identify it as the movement of which of the following?
A. substances from the renal tubule into the blood
B. Substances from the blood into the renal tubule
Concentration and dilution of urine is controlled by?A. afferent arteriolesB. the renin-angiotensin systemC. aldosterone releaseD. the countercurrent mechanism
Consider the metabolic functions of the kidneys, renal failure would be expected to cause which of the following? (Select all that apply)a. anemiab. loss of calcium regulationc. urea buildup in the skind. respiratory alkalosise. metabolic acidosisf. changes in the function of blood cellls
All but DA,B,C,E,F
What sort of lab/test results would we see for someone with kidney failure?
Low urine output (fyi less than 30cc urine/hr)Protein in the urineBlood in urine (RBC or WBCs)High BUN levels(range10-20 mg/dl)Poor creatining clearance (blood level of creatinine 0.6-1.2mg/dl) - remember it's supposed to leave the body through urineTong says "You don't have to memorize numbers but understand the concept"
Thiazide drugs are commonly given for ______ and ____ ____ ____
edema and high blood pressureacts by blocking the chloride pump, therefore blocks sodium reabsorption. Prototype is hydroCHLORothiazide void sodium = void water
____ _____ also known as high ceiling diuretics block the reabsorption of sodium in the ____ __ ____
loop diuretics; loop of henleexample is furosemide (Lasix) - lasts 6 hours LAST SIX
Which diuretic is used to treat glaucoma?
carbonic anhydrase inhibitorsacetazolamide (DIAmox) (I think diameter of a person's sight - dialate dilate)
Potassium-sparing diuretics are used for patients who are at high risk for hypokalemia associated with diuretic use. They are often used in conjunction thiazide or loop diuretics. They block the action of ______.
Aldosterone - a hormone that causes retention of sodium and therefore water, while losing potassium into the urine. Prototype: spironolactone (Aldactone) - memory: ALDactONE = aldosteroneAldosterone stimulates the sodium-potassium exchange pump in the distal tube. Normally potassium gets excreted and sodium (therefore water) is retained. If we block this salt is excreted but potassium is retained.
What is special about osmotic diuretics?
1. decrease intracranial pressure.
2. reduce intraocular pressure.
3. reverse sever renal hypoperfusion
Prototype: mannitol (Osmitrol) Brain = dream of learning by osmosis (sleeping on your books) = Osmosis = osmitrol
List how each acts in the body:1. Thiazide2. loop diuretics3. carbonic anhydrase inhibitors4. Potassium-Sparing Diuretics5.Osmotic diuretics
1. thiazide - blocks chloride pump (IDE blocks IDE); blocks chloride and sodium reabsorption. Leaves it in the tubule for excretion. Water follows salt. Hydrochlorizide2. loop diuretics - block chloride pump in the loop of Henle; blocks chloride and sodium reabsorption. Leaves it in the tubule for excretion. Water follows salt. Furosemide/Lasix3. blocks effects of carbonic anhydrase = carbonic anhydrase combines CO2 and H20 to make NaHCO3 (produces a free hydrogen); blocking carbonic anhydrase slows down movement of hydrogen ions; as a result, more sodium (Na) and bicarbonate (HCO3) are lost in the urine. Diamox.4. Potassium-Sparing Diuretics - cause a loss of sodium while promoting retention of potassium by blocking the action of aldosterone (remember aldosterone causes salt and water retention).YOu can think of potassium sparing as aldosterone blocking. ALdactone5. Osmotic diuretics - pulls water into the renal tubule without sodium loss. (OSMOTIC - water moves toward area of higher concentration to dilute it). Strawberries and sugar example - mannitol sugar is in tubule, water goes toward it to dilute. Fluid lost through urination. osmitrol
T or F: Diuretics are given to control blood pressure.
True. This is why we need to assess for hypotension before administering diuretics
What are some nursing considerations before administering diuretics?
Baseline testsassess for hyptensionassess for dehydration (skin turgor)/hypovolemiaassess VS, I&OAssess for weight gain >2lbsassess for electrolyte imbalance esp K+Don't take it at bedtime!
T or F: Diuretics are used for edema and blood pressure.
TrueEdema is associated with CHF
Acute pulmonary edema is ...
fluid in the lungsEdema is associated with CHF
Hydrochlorothiazide works by blocking ....
chloride pumpUsed to treat edema related to CHF and liver or renal disease. CHf - CHloride....
What is cirrhosis?
a chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening of tissue. It is typically a result of alcoholism or hepatitis. "Like pouring something through a cloth, doesn't allow straining. It acts as a strainer for your blood."Where do we get edema caused by liver disease? abdomen. Called:ascites - əˈsītēz/the accumulation of fluid in the peritoneal cavity, causing abdominal swelling.
Hydrochlorothiazide diuretics have some adverse effects including?
ADVERSE EFFECTS:HYPOkalemia (the only diuretic that spares potassium are potassium sparing diuretics like aldactone, all others run this risk)HYPOtention (remember we are lowering BP with diuretics, by lowering blood volume. ANytime we lower the BP we risk hypotension)HYPERglycemia (explanation is too long and scientific. Try to remember this cuz it was underlined)
Why does Hydrochlorothiazide have a drug-drug interaction with cholestyramine?
cholestyramine is a powder that mixes to a texture of metamucil. It is so thick that Hydrochlorothiazide gets caught in the cholestyramine and cannot be absorbed
Furosemide (Lasix) is a loop diuretic that blocks the _____ _____.
chloride pump (in the loop of Henle) therefore blocking reabsorption of salt in the loop of henleused for edema and high BP
What are the adverse effects of the loop diuretic, Furosemide (Lasix)?
HYPOkalemia (again, we are not sparing potassium with any diuretic but aldactone)
An example of a carbonic anhydrase inhibitor is acetazolamide or Diamox. These drugs block the effects of carbonix anhydrase which slows down the movement of hydrogen ions.What is this used to treat? What is the common adverse effect (that all diuretics have except aldactone)?
glaucomaHYPOkalemiaOther adverse effects includeHYPERglycemiametabolic ACIDosis - loss of bicarbonate leads to this (remember usually we urinate the extra H+ when carbonic anhydrase breaks down H2CO3 into HCO3/Na/H...if we do not urinate it out because we are blocking this action, it builds up)
What is paresthesias?
tingling of the extremities (like when you get pins and needles after falling asleep on your hand)
The potassium-sparing diuretic called spironolactone or Aldactone, is a (WEAK/STRONG) diuretic. It works by (PROMOTING/BLOCKING) aldosterone, which raises potassium levels.
Why is Aldactone the chosen drug for patients who are at risk for hypokalemia?
Aldactone spares potassium by blocking aldosterone.
adverse effects are HYPERkalemia (we are sparing K+, so we risk saving too much)
hyponatremia (losing too much sodium)
How does mannitol (Osmitrol) work? What is it used to treat?(Give by IV push, not a pill you swallow)
By pulling water into the renal tubule without sodium loss. Used to decrease cranial pressure. Can also treat acute renal failure due to shock, drug overdose or trauma.
Why do you want to check urine specific gravity and osmolarity of the blood before giving osmotic diuretic?
Osmotic drugs can cause a sudden drop in fluid levels. Want to make sure you have the right amount of particles through urine specific gravity and osmolarity of blood. Osmolarity is the thickness of blood, don't want to be too thick, because when you lose fluid from diuretic use, it gets even thicker.
Before administering potassium, check the _____ level
potassium.if ever you give too much potassium, you can give kayexalate. (Shit for your life - causes diarrhea and you lose potassium OD through your poo)
Diuretics cause a loss of fluid volume in the body. The drop in volume activates compensatory mechanisms to restore volume including:a. suppression of ADH release and stimulation of the countercurrent mechanismb. suppression of aldosterone release and increased ADH releaseC. activation of the renin-angiotensin-aldosterone system with increased ADH and aldosterone.d. stimulation of the countercurrent mechanism with reflex drop in renin release.
C. activation of the renin-angiotensin-aldosterone system with increased ADH and aldosterone.
When developing a plan of care for a patient with hyperaldosteronism, the nurse would expect the dr to prescribe which ?A. spironolactoneB. FurosemideC. hydrochlorothiazideD. acetazolamide
The nurse would instruct a patient receiving a loop diuretic to report:A. yellow visionb. 1 lb weight lossc. muscle crampingd. increased urination
Correct answer: CRationale on not the answer:B. this would be a problem if it were two lbs.. 2 lbs = 1 L of lossD. we expect to have increased urination
How do UTI kill people?
UTI develops-->moves to bladder-->moves to kidney-->gets into glomerulus-->infection enters blood to create sepsiscaused by catheterization (lack of proper sterile procedure)bacteria causes: E. Coli
Is E. Coli gram negative or gram positive?
Symptoms of UTI?
urinary frequencyburning on urinationfouls smelling urinechilss, fever , flank pain (associated with acute pyelonephritis)
How do we treat UTI?
Antiobioticsdrugs that block spasms, decrease pain, protect cells of bladder from irritation and treat enlargement of the prostate gland in men
An Antispasm - anti peeing your pants.
Used to treat overactive bladder, bladder spasm.
Prototype: oxybutynin (Ditropan)
Antispasm - anti peeing your pants
Ditropan - Dit u pee in ur PANts
Urinary Tract Analgesics reduce urinary _____. Phenazopyridine (Pyridium)
Pain. You pee orange, it can stain your clothing.
When you urinate, the urine has a topical effect on the urethra. Turns urin reddish-orange
Pyridium - Py = pee, rid = get rid of, um = um this damn pain
You can protect your bladder with drugs. One example is pentosan polysulfate sodium also known as _____
Elmironworks by adhering to mucosal membranes and acts as a buffer to control cell premeability, therefore preventing irritation(memory: PPS - protects pee sensation)
For men, Doxazosin makes you go son!
Norfloxacin (Noronix) is an anti-infective that may be prescribe in lower doses for _______ . (Notice it ends in cin, like mycin...treats bacterial infection so it is antiinfective)
prophylaxis - action taken to prevent disease.
norfloxacin (noronix) can be used as prophylaxis with urinary tract anatmocial abnormalities and residula urine disorders.
- effective against gram negative bacteria such as e. coli that commonly causes UTI
T or F: Nitrofurantoin (Furadantin) is an older but common drug with a very short half-life that should be taken with meals. It turns the urine brown.
Norfloxacin (Noronix) acts through either direct antibiotic effect or through ________.
acidificationNorFLOxaCINFlo = urinaryCin = antibiotic SIDE NOTE: The suffix “–cin” is shared by many antibiotics. But not all antibiotics end in ;“-cin”: and not all drugs whose names end in “-cin” are antibiotics.
What is the danger in using antispasmotics such as oxybutynin/Ditropan ?
It can increase the intraocular pressure causing glaucoma, which means it is contraindicated for people who have glaucoma
An adverse effect is pyloric/duodenal obstruction...
How do antispasmodics work?
block spasm of urinary tract musclesblock parasympathetic activity (shifts to sns, fight flight, urinary retention)Relaxes detrusor and other urinary tract muscles.
Analgesics can slow down peristalsis AND voiding (remember pain meds caused constipation?). The same thing can happen in the urinary tract. Therefore, if you take phenazopyridine (Pyridium), what might happen?
Like other pain meds such as tylenol, Pyridium can cause hepatic toxicity. What is a sign of this?
Liver enzymes rise when the liver is stressed. What are the LFT's we use to look for this?
ALT (6-59)AST (10-34)Alkaline Phosphatase (44-147)LIver enzyme indicates that the liver is unhappy but not WHY it's unhappyVideo on importan liver values:https://www.youtube.com/watch?v=3hQwzG2D2WI
Bilirubin comes from thebreakdown of ______. It is what turns feces brown and urine yellow. That color will cause our skin to look jaundice.
Medication that blocks dilation of arterioles and veins in the bladder and urinary tract is used to treat? What is an example drug for this?
BPH (obstructive)doxazosin (cardura)adrenergic blocker-->blocks sns-->puts you into psns-->rest and digest-->relaxed sphincter -->urination
For non obstructive urinary retention, tone of the bladder is the issue. There is not enough tone to "squish" out the urine. What drug can we use to increase the tone of the detrusor muscle and relax the bladder sphincter for improved bladder function?
Bethanechol (Urecholine, Duvoid)urecholine = ur going
What are insensible losses?
lung sweat skin feces
Angiotensin II increases blood pressure, increases circulating volume and aids with renal autoregulation. Can you explain how angiotensin works to do those things?
blood pressure - angiotensin II causes vasoconstriction, increased musocardial contractility and prostaglandin releaseincreases circulating volume-angiotensin causes aldosterone release which retains sodium and therefore water. ADH is released. Na and H2O are reabsorbed.Aids with renal autoregulation - angiotensin causes efferent arterioles constrict, GFR maintained
As sodium moves out of the filtrate, it takes Cl ions with it along with some water. This occurse by _____ diffusion
Once calcium is absorbed from the GI tract, into the kidneys, the calcium levels are maintained within a tight range by ____ ____ and ______
parathyroid hormone (elevates calcium) and calictonin (tones the calcium down)PTH (parathyroid hormone) is prpduced by parathryoid glands.
What functions do diuretic agents have?
- increase the amount of urine production
- Increase sodium excretion
- decrease edema
- decrease blood pressure
What are diuretics used to treat?
- edema associated with CHF
- acute pulmonary edema
- Liver disease including cirrhosis
- renal disease
- conditions caused by hyperkalemia
What is the action of the bladder protectant pentosan polysulfate sodium (elmiron)?
- Has a heparin like effect (anticoagulant)
- Adheres to the bladder wall mucosal membranes and acts as a buffer
If PPS (Elmiron), a bladder protectant has an anticoagulant effect, what is a possible adverse effect?
What drugs would we want to avoid taking with it?
Bleeding (that could progress ot a hemorrhage)
Avoid anticoagulants, aspirin or nsaids