Unit 1
What is Total Body water {TBW}?
% of body weight per category?
TBW-
1) Intracellular Fluid (inside cell)= 40% body weight
2) Extracellular Fluid = 20% body weight
- Interstitial fluid (b/w cells)
- Intravascular fluid (inside blood vessels)
At a pH of 7.4 the ratio of bicarbonate acid is?
20:1
Electrolyte disturbances caused by ABG abnormalities?
Potassium (K+)-
leaves the cell in acidosis
comes into the cell during alkalosis
When the GFR is low (ex: 13) does this mean it is normal or abnormal?
ABNORMAL!!!
Note: High GFR is normal (ex: 93), low is abnormal!
Which part of the nephron has the most diuresis?
Prox. tubule
Hydrostatic vs oncotic?
What is net sum?
Hydrostatic- adds a POSITIVE value to the net sum (like your money earnings in your bank account) PUSHES water away!
Oncotic- A NEGATIVE force that pulls water in. (takes value away from the bank, like bills...) ATTRACTS water!
Net sum= (net filtration pressure)- is the sum of the two (what is left in your bank account after your bills)
Hyperkalemia- Tall, peaked T Wave
Hypokalemia- Shallow T Wave
ABG what are the four different names?
Resp Acidosis
Resp Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
What main component is for most kidney stones?
Calcium
Where is Mannitol in the nephron? (this is not a prototype but she mentioned this in her review lecture)
Prox. tubule
What is Edema?
Causes of Edema?
What kind of spacing is Edema?
Edema- Accumlation of fluid w/in the interstial spaces.
Causes:
- increase in capillary hydrostatic pressure
- decrease in plasma oncotic pressure
- increase in capillary permeability
-lymph obstruction.
2ND spacing!!
What MAJOR precaution do you have with sodium disorders?
What do you need to look out for Potassium disorders?
Sodium- Seizure precautions!
Potassium (K+) - Cardiac Monitor (EKG)
Causes- Anxiety, hyperventilation, and fever.
REMEMBER: Resp Alkalosis is TOO much O2
Acute Pyelonephritis vs Chronic Pyelonephritis?
Acute- small infection in the ureter, renal pelvis, and interstitium.
Causes: E. Coli, Proteus, or Pseudomonas.
Chronic- Persistent or recurrent acute pyelonephritis. This results into scar tissue from sooo many acute episodes. This scarring makes this tissue not usable because it is scarred.
Nephron: what medication (PROTOTYPES) goes with which?
Loop?
Distal tubule?
Collecting duct/tubule?
Loop- Furosemide
Distal- Hydrochlorothiazide
Collecting duct/ tubule? Spironolactone
What is the MAIN goal of RAAS?
Simple terms of the steps?
Watch RegisteredNurseRN to simply the image Dr. Vincent provided for us!:)
RAAS- helps increase BP
1) BP drops too low
2) Sympathetic NS stimulates Juxtaglomerular Cells to RELEASE renin
3) Renin will ACTIVATE a substance in the liver to Angiotensinogen
4) Causes it to turn Angiotensin I--> ACE comes into play
5) ACE {Angiotensin Converting Enzyme} converts Angiotensin I into...
6) ANGIOTENSIN II: This causes-
Kidneys to keep water and Na+
Adrenal Cortex releases Aldosterone this will cause Kidneys to keep water and Na+ ALSO excrete K+
Pituitary releases ADH which causes the kidney to keep water
7) END: Increased BP!! (:
Thirst- is osmotic pressure increased or decreased when an individual is dehydrated? what about hydrated?
Dehydrated- Increased plasma osmotic pressure
Hydrated- decreased plasma osmotic pressure
What are the S/S and causes of Metabolic Acidosis?
S/S- deep increased breathing, fatigue, lethargy, N/V, and altered mental status.
Causes- Ketoacidosis, Lactic Acid Accumulation (shock), severe diarrhea, and renal insuff./failure.
REMEMBER: Metabolic Acidosis is TOO MUCH H+
Creatine (what is CrCl?) vs GFR?
Creatine- is a waste product. CrCl is a INDIRECT measurement (estimate) volume of blood plasma cleared per unit time in mL/min. This is blood and urine
GFR- Total filtration rate of the functioning units of the kidney, determines the stage of kidney disease. GFR is more accurate and the DIRECT measure
Furosemide and Hydrochlorothiazide are very similar. Which drug CAN be combined w/ ototoxic agents w/out increased risk of hearing loss???
Hydrochlorothiazide!
Normal levels of Na+ and K+?
Na+ is 135-145 mEq/L
K+ is 3.5-5.0 mEq/L
Hypertonic vs Isotonic vs Hypotonic?
Hypertonic- cells shrink by the H2O leaving the cell.
Isotonic- EQUAL solution
Hypotonic- Increased/Swollen cells from H2O coming into the cells
S/S, causes, and treatment for Resp Acidosis?
S/S- increased heart rate, altered mental status, headache, and diaphoresis.
Causes- hypoventilation, resp insuff./failure, and airway obstruction.
Treatment- Sit patient up, cough, breathe deep, and request oxygen (last step if the others do not work)
CKD complications- Fluid and electrolyte balance?
Sodium and water balance- sodium excretion increases with water excretion to sodium deficit and volume loss.
potassium balance- Once oliguria sets in potassium retained
Calcium, phosphate, bone- reduced renal phosphate excretion decreased renal synthesis of vitamin d3 dn hypocalcemia
3 basic processes of renal excretion?
3 functions of diuresis?
Renal Excretion:
1) Filtration- in glomerulus
2) Activated Tubular Secretion- prox. tubule
3) Reabsorption- 99% water, electrolytes, and nutrients at specific sites of the nephron.
Diuresis:
1) Cleansing of ECF and maintenance of ECF volume and composition
2) Maintenance of acid-base balance
3) Excretion of metabolic wastes and foreign substances
3)