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Renal & Urinary Tract Disorders

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by

Judith Turpen

on 15 September 2014

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Transcript of Renal & Urinary Tract Disorders

Kidneys and How do kidneys work?
Renin Angiotension
Aldosterone System
Are you confused?
Lets get some clarity!!
The Kidneys & Kidney Disease
Failing Kidneys &
Different types of Dialysis
Peritoneal Dialysis
Hemodialysis
YOUR DONE!!!
Make sure you took notes & bring to class!!!
Mrs Turpen
Understanding
Renal System

Let's get started!!

Judith Turpen, MSN, APRN, FNP-BC
6L of cardiac output = 60 ml of urine per hour
5L of cardiac output = 50 ml of urine per hour
4L of cardiac output = 40 ml of urine per hour
3L of cardiac output = 30 ml of urine per hour

1L of cardiac output = 30 ml of urine per hour
0L of cardiac output = 0 ml of urine per hour

Anything that affects cardiac output affects the kidney; for ex., heart disease.
Renal Nutrition
Acidic vs alkaline diet
Nursing considerations
& risk
How does it work?
Lab considertions and risk
The Road to Nursing School Success
Goal 1 - NURA 1500

Maintain blood volume & pressure
Fluid & Electrolyte and pH balance
Elimination of waste products
Kidneys
Nephrons
Functional unit or "worker bee - works day and night to get rid of waste in the blood.
1 million tiny filtering units per kidney
Each consist of glomerulus & 4 renal tubules
Let's break down it down to better understand the functions of the urinary system
Urine formation
Urine transport
Urine storage & elimination
Regulates blood pressure
Stimulate erythropoietin (RBC production)
Activation of calcium & vitamin D
pH control
Anatomy
2 Kidneys
2 Ureters
1 Bladder
1 Urethra
20-25% blood flow from heart perfuse the kidneys
What does renin do?
Vasoconstriction
thrist
salt craving
aldosterone release

pH balance
Normal 7.35 - 7. 45
Buffer system - mixture of weak acid & weak base which resist changes in pH.
3 buffers: Bicarbonate, phosphate, protein
Ventilation deph & speed in lungs
H+ secretion in kidneys (most effective but very slow.

There is a direct relationship between cardiac output and renal output

System Specific Physiology
Function of Nephron
Remove excess water, wasters and other substances from your blood.
Return substances like sodium, potassium, or phosphorus whenever any of these substances run low in your body.
Glomerulus responsible for cleansing of the blood - acts as a filter by osmosis and diffusion
The previous diagram is from your book; let's simplify for your understanding. Advance to the next slide.
RAAS = Renin Angiotension Aldosterone System
Instructions
Click on the arrows at the bottom of the presentation to advance through the slides. I have included videos for you to view on several renal system topics. The vidoes will start on their own. It is not necessary to click on the video itself. Make notes, we will review briefly in class. I expect full participation.
Thank you and I hope you enjoy!
Mrs Turpen
Function of Kidneys:
Maintain blood volume & pressure
Ensure balance of sodium, chloride, potassium, calcium, hydrogen, phosphate & pH.
Eliminate products of metabolism, such as urea, uric acid & creatinine.
Urine formation
Filtration of blood by glomerulus to form ultra filtrate urine
Reabsorption - of electrolytes & nutients
Secretion of waste materials.
Nephrons
- considered the functional unit of kidney; over 1 million.
Tubules -
where necessary substance reabsorped from bloodstream & unneeded material wasted through urine.
Proximal convoluted tubule
Loop of Henle
Distal convoluted tubule
Collecting tubule
Let's review!!!!
What to look smart..write it down and bring to class!!!
RED FLAG
Ok, so that did help...let's try again.
RAAS
Renin Angiotensin
Aldosterone System

Signaled by:
decrease BP
decrease blood volume
low Na+
low oxygen
Renin = vasoconstrict arterioles which increases BP

Aldosterone = increased Na+ which increases BP AND...oops....
decrease K+


One more helpful reminder: where Na is water follows....
so......
Mary had a little lamb, his fleece was white as snow & everywhere that Mary went the lamb was sure to go.
Got it!!!
It wasn't that difficult .... right.
Don't forget make your notes so you can be a star in class.
Risk Factors for
Kidney Disease
DM
HTN
Proteinuria
Polycystic kidney dz
Family hx kidney dz
Normal GFR 125 ml/min

Stage 5 = End Stage Kidney Disease (ESKD) = Dialysis
Uremia - build up of urea, salts, potassium, & phosphates leads to bone disease and anemia.
Treatment for ESKD
Peritoneal Dialysis
Hemodialysis
Kidney transplant
New way to filter & balance
your fluid & electrolytes
- Kidney transplant
- Dialysis
Planning starts when GFR = 20 ml/min= 20% kidney function
Symptoms of kidney failure
- fatigue
- nausea
- decreased appetite
- shortness of breath

Hotel California
Reminders issues seen with Dialysis patients
Kidneys regulate hormone production that stimulates RBC production so will see anemia - low hemoglobin - expect low H/H - may give Epogen
Hold medications prior to HD
Prior HD - expect elevated K+, BUN, Creat

**PD REVIEW**
Catheter inserted through abdominal wall
Risk: infection -observe for redenss, tenderness & exudate
Peritonitis - observe for cloudy return of dialysate
Send cloudy fluid for culture
Weight is best gauge of fluid removal
Assess lung sounds for fluid overload.
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