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53 Cards in this Set
- Front
- Back
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The Urinary System
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consists of
2 kidneys 2 ureters Urinary bladder Urethra |
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Kidney structure
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. paired, bean-shaped
.size of the fist .lie in the back of the upper abdomen . one on each side of the verteral column . right kidney is lower than the left |
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renal receptor
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no pain receptors within te kidney, only on renal capsule
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Renal blood supply
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blood is supplied to each kidney by the renal artery
-- blood flow thru the kidney is about 20 - 25% of the cardiac output (1200ml/min) --- a person's blood supply circulates thru the kidneys about 12x/hour ---the blood leaves the kidney via the renal vein |
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Nephron
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the actual functioning unit of the kidney
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Nephron
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Each kidney is comprised of more than 1 million nephrons
---each nepheron consists of a glomerulus and a tubular component |
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Nephron FILTRATION
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at glomerulus
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Nephron Reabsorption
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at tubules
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Nephron Secretion
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tubules and collecting duct
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Tubular Components of the Nephron
--Proximal convoluted tubule |
drains bowman's capsule, approximately 65% of all reabsorptive and secretory processes that occur in the tubular system take place in the proximal tubule.
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Loop of Henle
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plays an important role in controlling the concentration of the urine
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Distal convoluted tubule
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a major site of regulation of potassium excertion by the kidney
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tubular components of nephron
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collecting duct
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Glomerulus
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consists of compact tuft of capillaries encased in a thin, double-walled capsule: bowman's capsule.
--filters blood (about 125ml/min) -- glomerular filtration rate << how well are kidneys work |
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Know! Vital Functions of the kidney
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Excretory functions:
-- fluid balance -- electrolyte balance -- toxin elimination -- acid-base balance |
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Know! Vital Functions of the kidney
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Endocrine functions:
-- Renin: regulates blood pressure -- Erythropoietin: red blood cell production -- Vitamin D metabolism: converts vitamin D to its active form to maintain the correct levels of Ca and PO in the body --- these are hormones secreted by the kidney |
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Ureters
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10-12 long and 0.08-0.3 inches in dialmeter
--- carry urine from renal pelvis to bladder --- narrow at junctions (trap calculi) --- narrowness causes easy obstruction . externally from tumors, adhesions, inflammation . internally from calculi |
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Bladder
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Distendable
-- reservoir for urine -- normal UA output is 1500ml/day -- bladder holds 600-1000ml -- urge to urinate at 250ml -- gets painful at 600ml ------ elderly become frustrated agituted, restlness after surgery |
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Urethra
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--small tube
-- channels urine to outside of body --female 1-2, . short distance accounts for more UTIs -- male extend the length of the penis |
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Tests of renal function
Urinalysis |
. urine is clear, amber, about 95% water, and 5% dissolved solids. 1.5 L per day, should not contain any plasma proteins, and blood cells, or glucose molecules -- Specific gravity (osmolaity): hydration status .. 1.010-1.025 |
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Tests of renal function
Serum Creatinine: |
Reflects the GFR glomerular filter rate
-- 0.6-1.2 |
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Tests of renal function
BUN blood urea nitrogen |
-- 8.0-20.0
--elvated during dehydration |
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if creatinine is normal and BUN is high
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dehydration
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Blood chemistry
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Sodium 135-145
Chloride 98-106 Carbon dioxide 24-29 Potassium 3.5-5.0 Calcium 8.5-10.5 Phosphate 2.5-4.5 Uric acid 1.4-7.4 pH 7.35 -7.45 |
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Disorders of fluid and electrolyte balance
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Fluids and electrolytes are present in body cells, in the tissue spaces between the cells, and in the blood that fills the vascular compartment
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Disorders of fluid and electrolyte balance
--Body Fluids --purpose |
--Transport gases, nutrients, and wastes
-- Help generate the electrical activity needed to power body functions --take part in the transforming of food into energy -- maintain the overall function of the body |
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Fluid compartments
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Intracellular fluid compartment
-- consists of fluid contained within all of the billions of cells of the body; 2/3 of body water |
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Fluid compartments
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Extracellular fluid compartment
-- contains all of the fluids outside the cells; 1/3 of body water; the fluid levels of electrolytes that are measured clinically |
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Fluid compartments
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Cells membrane serves as the primary barrier to the movement of substances between the ECF and the ICF compartments
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Edema
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- A palpable swelling produced by expansion of the interstitial fluids volume.
- Does not become evident until the interstitial volume has been increased by 2.5 - 3 liters |
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Causes of Edema
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Increased Capillary Filtration Pressure
caused by -- as the capillary filtration pressure rise, the movement of vascular fluid into the interstitial spaces increase: -- increased vascular volume: heart failure, kidney disease, premenstrual sodium retention, environmental heat stress -- Venous obstruction: acute pulmonary edema, liver disease with portal vein obstruction, venous thrombosis |
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Causes of edema, cont.
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Decreased Capillary Colloidal Osmotic Pressure: plasma proteins exert the osmotic force needed to pull fluid back into the capillary from the tissue spaces which is usually the result of inadequate production or abnormal loss of plasma proteins:
-- Protein-losing kidney diseases, extensive burns, starvation, malnutrition |
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Causes of edema, cont.
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Increased capillary permeability: capillary pores become enlarged or the intergrity of the capillary wall is damaged, capillary permeability is increased.
-- inflammatin, allergic reactions(hives, angioedema), malignancy (pleural effusion), tissue injury and burns |
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Causes of edema, cont.
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Obstruction of lymph flow
-- edema due to impaired lymph flow is commonl refered to as lymphedema -- malignant involvement of lymph structures and removal of lymph nodes at the time of cancer surgery are common causes of lymphedema |
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Sodium 135-145mEq/L
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Hyponatremia: too much water, tx limit water
- Manifestations . Muscle cramps . Weakness . Headache . Depression . Personality changes . Lethargy . Stupor, coma . Anorexia, nausea, vomiting |
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Sodium 135-145mEq/L
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Hypernatremia: too little water, IV fluids give free water drink water, oral water
- Manifestations: . Polydipsia . Oliguria or anuria . High urine sp. Gravity . Dry skin mucous membrnaes . Tongue rough and fissured . Headache . Seizures and coma |
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Potassium 3.5-5.0 mEq/L
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--Mineral that helps the kidneys function normally
-- conducts electricity in the body --Plays a key role in skeletal and smooth muscle contraction -- Crucial to heart function -- Kidneys are the main source of potassium loss |
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Hypokalemia Causes:
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- Inadequate Intake
-- Diet deficient in potassium, inability to eat - Excessive gastrointestinal, renal, or skin losses -- Diuretic therapy -- Vomiting, diarrhea -- GI suction - Redistribution between the ICF and ECF compartments -- Administration of insulin for tx of DKA DIABETIC KAT0 ACIDOSIS |
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Hypokalemia Manifestation
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GI: anorexia, N & V, constipation, paralytic ileus, abdominal distension
-- Nueromuscular: Muscle weakness, cramps, tenderness, paresthesias, paralysis -- Cardiovascular: cardiac dysrhythmias, ECG changes, postural hypotension -- CNS: confusion, depression -- Acid-base: metabolic alkalosis |
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Hyperkalemia Causes
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- Excessive intake: excessive oral intake, treatment with K supplements
- Release from intracellular compartment: tissue trauma, burns, crushing injuries - Inadequate elimination by the kidneys: renal failure, adrenal insufficency (addison's disease) |
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Hyperkalemia: K+ > 5.0
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Clinical manifestations:
- intestinal cramping and diarrhea - Nausea and vomiting - Muscle weakness paresthesias, dizziness - Cardiac: abnormal EKG and disturbances in cardiac conduction --- heart block, bradycardia, ventricular fibrillation - K+ > 8: cardiac arrest is imminent |
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Know! Acid-base balance
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- Hyperkalemia = metabolic acidosis
- Hypokalemia = Metabolic alkalosis |
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Treatment of Hyperkalemia
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- Mechanism:
-- antagonism of membrane action: . Calcium ( get some, IV) - increased K+ entry into cells: . insulin and glucose . Sodium bicarbonate - K+ removal from the body: -- diuretics -- cation exchange resin -- dialysis |
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Treatment of Hyperkalemia
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Onset of action:
- several minutes and then rapidly wanes - works within 3-60 minutes, lasts several hours - several hours - 2-3 hours - several hours |
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Calcium
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Hypocalemia
- Manifestation numbness and tingling skeletal muscle cramps carpopedal spasm tetany posstive chvostek sign possitive trousseau hypotension |
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Calcium
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Hypercalcemia
- Manifestations: Flank pain Signs of kidney stones signs of acute RI (renal insufficiency) anorexia, N&V constipation muscle weakness ataxia, loss of muscle tone stupor and coma hypertension |
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Hypercalcemic crisis
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- an acute increase in the plasma calcium level
- caused by malignant disease and hyperparathyroidsm -polyuria, exessive thrist, volume depletion, fever, altered levels of consciousness, azotemia, a disturbed mental state - Symptomatic hypercalcemia; associated with a high mortality rate; often caused by cardiac arrest |
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Phosphorus
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- essential to many bodily functions: bone formation, metabolic processes (formation of ATP and enzymes needed for metabolism of glucose, fat and protein) , needed for normal function of blood cells (WBC, platelets)
- ingested in the diet (milk, dairy, meat) and eliminated in the urine |
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Hypophosphatemia manifestations
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ataxia
paresthesias confusion, stupor, coma seizures muscle weakness BONE PAIN platelet dysfunction with bleeding disorders impaired WBC function |
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Hyperphosphatemia
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paresthesias
tetany hypotension cardiac arrhythmias |
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Magnesium
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-most of the body's Mg is located within the cells, where it functions in regulation of enzyme activity, generation of ATP, and calcium transport
- ingested in the diet (green vegetables, grains, nuts, meats, seafood) - elimination is through the kidney |
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Hypomagnsemia Manifestation
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personality
nystagmus tetany postive BABINSKI postive trousseau sign tachycardia hypertension cardiac arrthythmias |
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Hypermagnesemia manifestations
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lethargy
hyporeflexia confusion coma hypotension cardiac arrhythmias cardiac arrest severe: muscle and respiratory paralysis, complete heart block, and cardiac arrest |
