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78 Cards in this Set

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WHAT IS ANGIOTENSIN?
angiotensin (ăn″jē-ō-tĕn′sĭn) A vasopressor produced when renin is released from the kidney. Renin is formed by the juxtaglomerular apparatus of the kidney. SEE: apparatus, juxtaglomerular
angiotensin I Physiologically inactive form of angiotensin; converted to angiotensin II in the lungs.
angiotensin II Physiologically active form of angiotensin; a powerful vasopressor and stimulator of aldosterone production and secretion.
angiotensin amide A vasoconstricting compound of angiotensin.
ANGIOTENSIN REGULATES WHEITHER SOLDIUM IS REABORBED. ANGIOTENSIN HAS TO DO WITH SODIUM, WHERE SALT GOES, WATER FOLLOWS BUT ANGIOTENSIN REGULATION OF WATER ...
IS ONLY SECONDARY B/C IT REGULATES SODIUM AND not WATER. THE ANTIDIURETIC IS THE ONE THAT REGULATES WATER.
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WHAT IS THE RENIN ANGIOTENSIN ALDOSTERENE SYSTEM?
The Renin-Angiotensin-Aldosterone System
This system is activated in response to hypotension, decreased sodium delivery, decreased blood volume and sympathetic stimulation. In such a situation, the kidneys release renin which cleaves the liver derived angiotensinogen into Angiotensin I. Angiotensin I is then converted to angiotensin II via the angiotensin-converting-enzyme (ACE) in the pulmonary circulation. The system in general aims to increase blood pressure.
WHAT IS RENAL CLEARENCE?
It is commonly held to be the amount of liquid filtered out of the blood that gets processed by the kidneys or the amount of blood cleaned per time because it has the units of a volumetric flow rate [ volume / time ].
WHAT ARE PROSTAGLANDINS?
HORMONE LIKE SUBSTANCES BUT...
Prostaglandins are a group of hormone-like substances; like hormones they play a role in a wide variety of physiological processes. "Prostaglandins act in a manner similar to that of hormones, by stimulating target cells into action. However, they differ from hormones in that they act locally, near their site of synthesis, and they are metabolized very rapidly. Another unusual feature is that the same prostaglandins act differently in different tissues."
URINE IS FORMED IN 3 STEPS IN THE KIDNEY. WHAT ARE THEY?
FILTRATION
REABSORPTION
EXCRETION
WHAT ARE PRE RENAL CONDITIONS AND WHO CARES?
CONDITIONS BEFORE THE KIDNEYS THAT CAN CAUSE PROBLEMS IN THE URINARY SYSTEM?
INCREASED BLOOD SUGAR
DE HYDRATION
(THE KIDNEYS HAVE TO BE PROFUSSED IN ORDER TO WORK)
HYPOTENSION LIKE SOMEONE IN SHOCK!!! OR HEART ISN'T PUMPING WELL LIKE SEVER CONGESTIVE HEART FAILURE YOU ARE NOT PROFUSSING THE KIDNEYS. SO WE WILL SEE ACUTE KIDNEY FAILURE RELATED TO HYPOTENSION
THERE IS ACUTE RENAL FAILURE AND THEN CHRONIC RENAL FAILURE. WHAT'S THE DIFF?
ACUTE COMES ALONG W/ DISEASE OR TRUAMA AND THEN GOES AWAY.
CHRONIC RENAL FAILURE IS LIKE PERMANENT FROM DISEASE PROCESS, CAN STAY THE SAME OR GO ONTO END STAGE RENAL FAILURE.
HOW CAN WE FIX THIS SITUATION OF HYPOTENSION THAT IS RUINING PROLIFERATION OF THE KIDNEYS?
DRUGS THAT DIALATE THE ARTERIES THAT FEED THE KIDNEYS SO THAT THE BLOOD GOES THERE!
WHAT ABOUT A PERSON WITH HYPERTENSION AND RENAL FAILURE. WHATS THE CONNECTION THIS TIME?
HYPERTENSION WILL DAMAGE THE INTIMA OF THE ARTERIES THAT GO TO THE KIDNEYS. THIS WILL DAMAGE THE GLOMERULI OF THE KIDNEYS
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ALSO DIABETES DAMAGES THE KIDNEYS TOO.
SO, YOU CAN BECOME HYPOVOLEMIC FROM DEHYDRATION OR PUMP FAILURE.
In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. DEHYDRATION, PUMP FAILURE OR HEMORRAHGE.
REMEMBER, ALL THIS PREVIOUS STUFF IS PRE RENAL CONDITIONS. NOW RENAL CONDITIONS HAVE TO DO W/ THE DIRECT DAMGAG TO THE GLOMERULI AND RENAL TUBULES. USUALLY W/ HEAVY METALS OR TRANSFUSION REACTIONS! WHY?
ALL THE RBCs DIE AND CLOG UP THE GLOMERULI AND DAMAGE THEM.
THERE COULD ALSO BE RENAL DIEASE LIKE A TUMOR OR A HERIDETARY DISEASE. THESE ARE DIRECT CONDITIONS. LIKE STREP ALL THIS AGAIN IS A
RENAL CONDITION
MEDICATIONS CAN DAMAGE KIDNEYS. THEY CAN BE NEPHRO TOXIC. ANOTHER RENAL CONDITION. SO LOOK AT DRUGS. WHY
ESP WHEN WE GET OLDER, WE LOOSE ABOUT 80% OF OUR functioning NEPHRONs
NOW POST RENAL. WHAT IS THIS?
ANY DAMAGE TO THOSE THINGS THAT COME AFTER THE KIDNEYS LIKE THE UTRETHRA OR URETURES OR COLLECTING SYSTEMS OR THE PROSTATES.
WHAT ELSE IS CONSIDERED POST RENAL? LIKE WHAT? IN THE KIDNEY PELVIC AREA IS THE COLLECTION AREA CALLED THE CALYX. THATS PAST THE ...
NEPHRONS SO ANYTHING PAST THE NEPHRONS IS CONSIDERED POST RENAL. bUT THE START OF POST RENAL!
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WOULD YOU SEE THE SAME SPECIFIC GRAVITY IN KIDS AS IN ADULTS URINE. WOULD KIDS URINE BE MORE CONCENTRATED?
LESS CONCENTRATED NOT AS MUCH SOLUTES AS AN ADULT B/C THEIR THEY DON'T HAVE THE SAME KIDNEY FUNCTION AS AN ADULT HAS.
WHEN DO WE GET CONCERNED WITH URINARY OUTPUT? AT WHAT LEVEL?
AT LESS THAN 50 AND REALLY AT A PANIC AT 30 OR LESS OUTPUT. BETTER TO GET CONSERNED EARLY THAN LATE. 30 OR LESS IS PANIC
KIDNEYS EXCRET WASTE
REGULATE ELECTOLYTES
REGULATE ACID/BASE
RELEASE URINE
RETAIN BICARBS OR EXCRETE BICARBS
ALSO WHAT?
PLAY A ROLE IN RBCs PRODUCTION
HOW? SO IF SOMETHINGS WRONG W/ YOUR KIDNEYS YOU COLD BE ANEMIC
WHATS THE PROCESS OF RBCs IN THE KIDNEYS?
KIDNEYS SEE WHEIHER OR NOT THERE IS ENOUGH O2 IN THE BLOOD AND IF NOT THEY WILL EXCRETE SOMETHING AND YOU END UP WITH MORE RBC PRODUCTION
WE WILL BE LOOKING FOR 2 THINGS IN OUR LABS THAT HAVE TO DO WITH THE KIDNEYS. WHAT ARE THEY?
CREATININE (GLUMERAL FILTRATION RATE)
CREATININE IN THE URINE
what kind of drugs prohibit prostoglandin?
prostoglandin make for pain so we would might be giving prostoglandin inhibitors you are also contributing that dialation of renal arteries are not as up to pair and that might decrease renal blood flow. so be carefull with elders. Like tylenol. so don't give too many of them
what does angiotension do again?
its a vasoconstrictor so...
its going to constrict the periphery and clamp your blood pressure. the kidneys also convert inactive Vit D to the active form so if your in chronic renal failure you need vit D. so they do alot.
we will assess for things like polyuria. whats that?
excessive urine output
whats Oliguria?
decreased urine output
whats Anuria
no urine output
what's Hematuria?
blood in urine
what is proteinuria?
protein in urine
concerning digoxin, its a med that goes thru us unchanged. so what?
if the kidneys aren't working well, they will retain digoxin making you toxic from it.
what are some things that can cause kidney failure? besides diabetes?
infections
heart failure
exposure to poisons
trauma
cancer etc. also stones or calculi
kidney stones can be found anywhere from kidney to the bladder. to much calcium causes hypercalcemia. what is gout?
an accumilation of uric acid and crystalizes
risk factors with a bowel disease on the test.*************************
what happens to calcium in bone when we are immobile?
it leaves the bones and goes into the blood. SO, inactive people are more at risk for stones, right? yes. infection, and urinary statis b/c of bladder retention.
people w/ inflammatory bowel disease are also at risk for calculi. so they think the intestinal mucosa is altered by the bowel disease and ...
creates a situation where pt absorbs chemicals that contibute to renal calculi SO ON THE TEST, RISK FACTORS AND THE PATIENT IS HAD AN INFLAMATORY BOWEL DISEASE, THEN A RISK FACTOR FOR CALCULI.
****************************
WHATS THE NO 1 REASON FOR CALCULI?
DEHYDRATION
WHATS A SYMPTOM OF RENAL CALUCI? EXTEME PAIN, GIVING BIRTH, ESP IF ITS IN A URETUR.
WHAT IS diaphoresis?
Diaphoresis is excessive sweating commonly associated with shock and other medical emergency conditions.

Recognition of diaphoresis is expected of EMTs.
think pain here, esp with a urinary occulsion! so a Cat scan (CT) dye injection and 24 hr urine collection. pain relief is our no 1 focus. what is lithotripsy?
sound waves to break the fucker up into peices, must strain afterwards. there can be surgery to get at this obstruction and of course infection afterwards.
after throwing a stone, your diet might change. so, less calcium, purines in tomato products, what is purines?
Purines from food (or from tissue turnover) are metabolised by several enzymes, including xanthine oxidase, into uric acid. High levels of uric acid can predispose to gout when the acid crystalises in joints; this phenomenon only happens in humans and some animal species (e.g. dogs) that lack an intrinsic uricase enzyme that can further degrade uric acid.
how do you get a kidney infection?
urine backing up into the uretures, then from there backing up into the kidney going from a bladder infection into a kidney infection
what neurotransmitter in your body tells you to pee?
acedelcoline does. so, if you have urinary retention, the doctor will give you a med that minics acedocholine.
what about you get a little urine in your bladder and you have the gotta go gotta go symdrome and gotta go all the time, what kind of drug is the doctor going to give you?
to tell the bladder to stop emplying is called an anticolenergic!
****************************
anticolengerics cause bladder retention b/c anti acedolcoline!
urine that stands around for a few hours becomes what?
alcaline
b/c it starts really really acid and longer it sits, more alcaline it becomes
how much water should be drunk a day?
64 ozs a day and avoid coffe tea and coka b/c they are diuretics and to always pee as much as possible
******************************
what is the leading cause of death in people over 70 years old?
UTI
what is pyelonephritis?
pyelonephritis (pī″ĕ-lō-nĕ-frī′tĭs) [″ + nephros, kidney, + itis, inflammation] Inflammation of the kidney and renal pelvis, usually as a result of a bacterial infection that has ascended from the urinary bladder.
a strep infection can damage the glomeri, how?
the strep will go there, the body will then look at the glomeruli and the body thinks the glomeruli is strep itself and go after it, and the same to the valves in the heatt and you get rhumatic fever SO strep throat isn't anything to fool with.
what 5 things would you ask a patient related to urinary system?
ask about their voiding patterns
about what they think their problem is
pain
odor
color
frequency
what kind of meds are you taking
how much water do you drink every day
cholenergics are used to treat?
overflow! b/c your retaining
and acetelcholine tells your bladder to empty so if your bladder is retaining you want it emptied
****************************
so overflow
anticholenergics are for the
gotta go gotta go syndrome
the urge incontenence
b/c you want to slow that bladder down. you don't want it to think 30 cc it has to empty
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what kind of meds do we use to regulate fluids and electolytes?
diurectics
so what? what kind of diurectic it is and what is being excreted and what is being retained.
steroids. what about it? anti inflammitory. what does steriods have to do with infection?
you want the inflammation I didn't understand this one
nrusin interventions with pain from a urinary tract obstruction. first the nursing diagnosis is
acute pain related to inflammatin, obstruction, and abrasion of the urinary tract.
Deficient kniwledge regarding prevention of recurrence of renal stone
what are some goals for the patient w/ stones?
relief of pain and discomfort, prevention of recurrence of renal stone, and absence of complications
what are some nursing internverntions related to kidney stone?
immediate releif of pain w/ admin of opiod analgesic agents.
encourage pt to assume a position of comfort. monitor the pain level closely.
what are the symptoms of renal calculi other than pain
Flank pain or back pain
on one or both sides
progressive
severe
colicky (spasm-like)
may radiate or move to lower in flank, pelvis, groin, genitals
Nausea, vomiting
Urinary frequency/urgency, increased (persistent urge to urinate)
Blood in the urine
Abdominal pain
Painful urination
Excessive urination at night
Urinary hesitancy
Testicle pain
Groin pain
Fever
Chills
Abnormal urine color
whats a kidney stone?
kidney stone is a solid mass that consists of a collection of tiny crystals. There can be one or more stones present at the same time in the kidney or in the ureter. (See also cystinuria.)
again, what are some interventions for pain with stones
Pain may be severe enough to require narcotics. There may be tenderness when the abdomen or back is touched. If stones are severe, persistent, or come back again and again, there may be signs of kidney failure
t or f
the urinary tract is usually sterile above the utherera
t
therefore UTIs are classified as infections involving the upper or lower urinary tract
what is cystitits
inflammation of the urinary bladder
what is bacterial prostatitis
inflammatin of the prostate gland
what is urethitis
inflammatin of the urethera
which are more common. upper or lower UTI infections?
upper are less common. duh
think? where is the infection most likely to orienate?
whats one of the most common reasons people seek health care?
UTIs! mostly women. UTIs are also the most common hospital nonsocialmal whatever infection too.
several things help keep bacteria from getting to the bladder. like what?
the sterility of the bladder is defended by:
urine flow is down so this helps
antibacterial enzymes & antibodies
the uterealvesical junction competence
IF bacteria make it to the bladder, what do they attach to?
the epithelium of the bladder wall, colonize there to avoid being washed out with voiding.
where do most UTI infections in women come from
their ass hole doo doo cross over from perineum to utherea area, happen every time
what is the backward flow of urine called
well, an obstruction of flow is called urethrovesical reflux. that means backward flow from urthera to bladder. this can happen from coughing, sneezing, straining.
what are the varous routes of infection to the bladder?
travel the urethra (ascending infection)
thru the bloodstream
a fistula from the intestine
again the most common way of infection is transurethral which is ...
bacteria from fecal contaimination (doo doo) colonize the periurthral area (ms puss) and enter the bladder by way of the urethra
what are some signs of UTI?
painfull urination
freq urgency
nocturia
incontenence
Hematuria (blood in the pee)
back pain
being catheridized complicates the crap out of all this. It can range from asymptomatic bacteria to ...
gram negative sepsis with shock. complicated UTIs due to lots of bacteria, lower response to treatment, etcq
what is pyurea
an infection where WBC count is greater than 4.
BUT this can also indicate stones, intestinal nephritis, renal ruberculosis
the goal to treatment of UTI is to treat the infection with out screwing w/ disrupting fecal and vagional flora, which can lead to ...
a yeast infection
ok now the nursing process:
the assessment. how do you detect this UTI anyway?
pain
freq of urgency
change in urine
PLUS associate this data w/ sexual incounters, contraceptives, and personal hygene. Assess urine color, odor, concentration, cloudines, etc
OK
nursing diagnosis:
acute pain related to inflammation/infection of urthera, bladder, etc. What are planning and goals?
major goals are relief of pain
increased knowledge of preventive measures
what are the nursing interventions?
pain associated w/ UTI is quickly releived once Tx starts. avoid urinary irritants like coffee, tea, spice, coka cola, alcohol.
what are the patient expected outcomes?
relief from pain
has normal BUN
exhibits normal vital signs
maintan normal urine output1
again, the kidneys regulate what for the body?
electrolytes
acid base balance
RBC production (b/c enemic if not producing erythropoietin)
kidneys control your blood pressure! how?
by renin production
angiotensin increases BP by vasoconstriction,