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Questions and Answers
What is a possible symptom of hyponatremia?
During immobility, what cellular adaptation occurs that involves the shrinking of cells?
What distinguishes dysplasia from other types of cellular adaptations?
What type of neoplasm is characterized by slow growth and does not spread throughout the body?
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Which method can a malignant tumor use to spread throughout the body?
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If Mr. Smith's lung radiograph shows a clear result but a mass is observed on the liver, what should be the immediate next step?
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Why is it important for Mr. Smith to take small walks throughout the day during recovery?
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What is the normal range for oxygen saturation levels in an adult at rest?
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In which condition would tachycardia most likely occur?
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What is a key component of cellular adaptation in response to stress?
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Which of the following is a common characteristic of neoplasia?
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What does a lower blood pressure reading indicate in the context of Mr. Smith's condition?
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What is the primary role of fluid regulation in the body during respiratory distress?
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What mechanism might explain the confusion and lethargy observed in Mr. Smith on ICU admission?
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Which of the following is NOT associated with pneumonia?
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What should be the primary focus when studying Module 1 content?
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What key aspect should be reviewed for preparing for the synthesis assignment?
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What is the significance of the LDL level found in Ash's bloodwork?
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Which factor in Ash's lifestyle could contribute to their current health status?
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What vital sign is concerning for Ash at their routine visit?
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What is a potential consequence of hyperlipidemia if left untreated?
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Which intervention might be recommended to address Ash's elevated LDL levels?
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At what age and under what condition does Ash present to the clinic?
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Which of the following best describes Ash's physical examination findings?
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What kind of programs will be opening for applications on September 30th?
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What is the hallmark S/S for hyperlipidemia?
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Which vital information is missing from Ash's health profile?
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When are Pre-Module Worksheets due?
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What is the consequence of completing Post-Module Worksheet A?
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What is the purpose of Worksheet B in relation to Worksheet A?
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Which of the following statements about Post-Module Worksheets is true?
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How often must students submit Pre-Module Worksheets?
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What type of grade do Pre-Module Worksheets receive upon completion?
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What is the deadline for submitting Post-Module Worksheet A?
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What will the score from Post-Module Worksheet A contribute to?
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Which statement about Worksheet B is correct?
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What is the consequence if a student fails to submit Post-Module Worksheet A?
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What potential risk does the use of prednisone pose for Annie's immune function?
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How does passive immunity, such as IVIG, provide protection to individuals with immune deficiencies?
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What distinguishes primary immune deficiencies from secondary immune deficiencies?
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What is a common consequence of using glucocorticoids like prednisone in patients with autoimmune diseases?
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Which type of response is primarily involved when using passive immunity treatments such as IVIG?
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What type of immune response initiates type IV hypersensitivity reactions?
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Which of the following best describes the primary mechanism of type II hypersensitivity?
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Which type of hypersensitivity is characterized by the formation of antigen/antibody complexes that lead to tissue damage?
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What type of immunity is primarily represented by the activity of lymphocytes and antibodies?
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Mast cells are primarily associated with which of the following lines of defense in the immune system?
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Which immune cells are primarily responsible for the cytotoxic response in type IV hypersensitivity?
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What type of immune hypersensitivity reaction is primarily involved in rheumatoid arthritis?
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Which cells are primarily responsible for the humoral immune response?
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What is a defining feature of the acquired immune response compared to the innate immune system?
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What type of antigens are primarily targeted by antibodies in type I hypersensitivity reactions?
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Which substance released during an immune response results in the swelling and redness of joints in rheumatoid arthritis?
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What immune cells signal mast cells to release mediators like bradykinin during inflammation?
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Which of the following statements about type I hypersensitivity is true?
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In Goodpasture's syndrome, which component of the body is specifically targeted by the immune response?
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What is the role of cytokines in the inflammatory process?
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What is a common symptom of a type I hypersensitivity reaction?
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What is a primary symptom associated with pneumonia?
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What clinical sign is indicative of a respiratory acidosis condition during an examination?
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What are some common causes of atelectasis, which can lead to complications in lung function?
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Which condition is characterized by sudden respiratory failure and requires immediate intervention?
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How would you interpret an arterial blood gas (ABG) with a pH of 7.30 and a pCO2 of 57 mmHg?
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Which factor is critical in managing the patient's condition with an elevated CO2 level identified in the blood gas analysis?
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What is the potential impact of a pleural effusion on respiratory function?
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What is an indicative finding of a lung infection in diagnostic imaging?
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What is a potential outcome of poor alveolar ventilation?
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Which of the following is a defining feature of acute respiratory distress syndrome (ARDS)?
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Which lab test is essential for evaluating acid-base balance in suspected ARDS cases?
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What causes the decreased carbon dioxide level in the presented ABG analysis?
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In an ABG result showing $pH = 7.48$, what does this indicate?
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What is the significance of a left shift in the oxygen-hemoglobin dissociation curve as seen in the ABG analysis?
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Which symptom can indicate the presence of a lung infection like pneumonia?
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What is the main implication of atelectasis in patients with poor ventilation?
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What is a common symptom of pneumonia that may be observed in patients?
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Which clinical sign would most likely indicate a lung infection?
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What is a potential implication of atelectasis in a patient?
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Which factor is most critical in identifying Acute Respiratory Distress Syndrome (ARDS)?
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In the context of Arterial Blood Gas (ABG) interpretation, what does a low pH level typically indicate?
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What is a hallmark sign of respiratory distress that may appear in patients with serious lung conditions?
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How would a student differentiate between signs of pneumonia and a common cold?
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What change in arterial blood gases would most likely be observed in a patient suffering from pneumonia?
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What is a common cause of acute kidney injury in patients taking certain medications?
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Which condition is characterized by a sudden decline in kidney function, reflected by decreased urine output and increased waste products in the blood?
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How can hydration status affect kidney function?
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What distinguishes pre-renal acute kidney injury from intrarenal acute kidney injury?
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Which nursing care intervention is most appropriate for managing a patient with acute kidney injury?
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Which of the following is considered a common nephrotoxic agent that can lead to acute kidney injury?
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What distinguishes pre-renal acute kidney injury from intrarenal acute kidney injury?
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In the context of nursing care for kidney injury, which intervention is most critical to maintain adequate kidney function?
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Which type of acute kidney injury is primarily caused by a reduction in blood flow to the kidneys?
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What is a primary physiological function of the kidneys that can be affected by hydration status?
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Which clinical presentation is most indicative of acute kidney injury?
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How does dehydration lead to pre-renal acute kidney injury?
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Which statement best describes the mechanism by which acute tubular necrosis occurs?
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Which condition is primarily caused by nephrotoxic agents leading to acute kidney injury?
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What is a characteristic feature of pre-renal acute kidney injury?
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In managing a patient with acute kidney injury, which nursing action is most important?
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Which of the following factors can especially contribute to the development of acute kidney injury in a patient?
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What physiological change is indicated if a patient's creatinine levels double?
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Which of the following statements about blood urea nitrogen (BUN) is correct?
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What is the term for the condition characterized by the accumulation of urine in the kidneys?
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Which type of acute kidney injury is associated with bilateral urinary tract obstruction?
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Study Notes
Mr. Smith's Case
- Mr. Smith, a 55-year-old male, presented to the emergency department (ED) with fever, shortness of breath (SOB), and cough.
- Chest x-ray (CXR) revealed left lung pneumonia.
- Pulse oximeter (pulse ox) showed oxygen saturation (O2 sats) of 89% on room air, which is below the normal range of 95%.
- Mr. Smith was placed on oxygen therapy via nasal cannula.
- He was started on IV antibiotics and admitted to the hospital for further care.
- Over the next 24 hours, Mr. Smith continued to experience high fevers (febrile), SOB, and an increase in his oxygen needs.
- His nurse noticed his last two blood pressure readings were lower than previous measures, and he was increasingly tachycardic.
- Tachycardic means his heart rate was fast.
- Mr. Smith was transferred to the Intensive Care Unit (ICU).
Hyponatremia
- Hyponatremia is a condition where sodium levels in the blood are low.
- Symptoms of hyponatremia include nausea, vomiting, headache, confusion, muscle weakness, cramping, seizures, and coma.
Cellular Adaptations
- Atrophy is a cellular adaptation that involves cells shrinking in size.
- Atrophy can occur as a result of immobility.
- Dysplasia is an irreversible cellular adaptation.
Neoplasms
- Neoplasms are abnormal growths of tissue.
- There are two main classifications of neoplasms:
- Benign: slow-growing, well-defined, solid tumors that form in place and do not spread throughout the body.
- Malignant: cancerous cells that can grow slowly or quickly, spread, and cause metastasis.
Metastasis
- Metastasis is the spread of cancer cells from the original tumor to other parts of the body.
- Malignant cancers can spread via:
- Blood
- Lymph
- Seeding of adjacent surfaces
Review Information & Exam Prep
- Module 1 covers:
- The cell
- Fluid regulation
- Cellular adaptation
- Neoplasia
- Focus on:
- Key concepts
- Important processes
- Utilize the "Review Information/Exam Prep" section as a study guide.
Upcoming Assignments
- Patho Orientation Quiz: Due this Friday.
- Synthesis Assignment #1: Due Sunday, September 22nd at 11:59 PM.
- Post-Module 1 (A): Due this Friday.
- Optional: Post Module 1 (B): Due any time between now and the end of the semester.
- The highest grade of the two Post-Module 1 assignments will be used for the course grade.
CV Module Announcements
- Post-CV worksheet due September 27th
- Pre-Renal worksheet due October 1st
- Midterm exam: October 9th
- 60 questions
- 90 minutes to complete
- use the Exam Prep section from each module to guide your studies
Enrichment Programs
- Applications open September 30th
- Fuld Fellows: join quality improvement/patient safety team, mentored by a nurse leader
- Research Honors: join a nursing research team, mentored by a Nurse Researcher
- Policy Honors: work with a mentor to influence health policy
- Birth Companions: become a certified doula, support birthing people in the community
Rapid Review Exercise
- Number off 1-12, form groups
- Provide general definition, typical risks and/or causes, underlying pathophysiology, signs and symptoms, hallmark symptoms, tests/labs/procedures
- Organize the information on a chart, flashcards, or PowerPoint slide
Ash
- 56 year old with no significant medical history
- no medications except occasional OTC pain relievers
- full time employee, works 50+ hours per week, stressful job, sedentary lifestyle
- current health concerns: none
Vitals and Physical Assessment
- Temp: 98.1F (36.7C), HR: 92 bpm, RR: 18, BP: 156/90, BMI: 39.9
- Physical exam is unremarkable
- Blood work significant for hyperlipidemia, LDLs 170 (ideally <100), triglycerides 189 (ideally <150)
Module Worksheets
- Pre-Module Worksheets are due on Tuesdays and are graded for completion.
- Post-Module Worksheet A is due on Fridays and counts towards the course grade.
- Post-Module Worksheet B is optional, but recommended if you did not score high on Worksheet A.
Module Worksheets
- Pre-Module Worksheets are due on Tuesdays.
- Pre-Module Worksheets are graded for completion only.
- Post-Module Worksheet A is due on Fridays and contributes to the course grade.
- Post-Module Worksheet B is optional, but recommended if the student scores poorly on Worksheet A.
Hypersensitivity Reactions
- Type I, II, and III Hypersensitivity Reactions are initiated by humoral immune responses (antibodies)
- Type IV Hypersensitivity Reactions are initiated by a cell-mediated immune response (cytotoxic T cells)
- Type II Hypersensitivity Reactions are characterized by antibodies attacking tissue-level antigens
- Examples include myasthenia gravis
- Type III Hypersensitivity Reactions are characterized by the formation of antigen/antibody chains that cause tissue damage
- Examples include systemic lupus erythematosus
Inflammatory Response
- Characterized by redness, swelling, pain, and heat
- Mediated by substances like bradykinin, clotting factors, and complement
Autoimmune Diseases
- Occur when the immune system mistakenly attacks the body’s own tissues
- Commonly caused by hypersensitivity reactions
Rheumatoid Arthritis
- A type III hypersensitivity reaction
- Characterized by inflammation of the joints
- Involves both CD4+ cells and B lymphocytes
- Mediated by antibodies released from plasma cells (B lymphocytes)
- Treated with glucocorticoids like prednisone, which suppress the immune system
Immune Deficiencies
- Occur when the immune system is weakened, making individuals more susceptible to infections
- Can be caused by factors such as medication use (e.g., prednisone)
- Secondary Immune Deficiencies: caused by external factors
- Primary Immune Deficiencies: are rare and caused by genetic mutations
Passive Immunity
- Protection from disease provided by antibodies produced by another individual
- Example: IVIG infusions for individuals with autoimmune conditions or immune deficiencies
Immune System Overview
- First Line of Defense: physical and chemical barriers like skin and mucus membranes
- Second Line of Defense: the inflammatory response
- Third Line of Defense: acquired immunity, involves specific memory and lymphocytes
Poor Alveolar Ventilation
- Inadequate alveolar ventilation leads to incomplete removal of secretions.
- The buildup of secretions can result in infection and pneumonia.
- This differs from pneumothorax, where there is a separation of the lung from the chest wall.
- Atelectasis is a term for poor alveolar ventilation and/or air trapping or absorption.
Acute Respiratory Distress Syndrome (ARDS)
- Refractory hypoxia is a defining feature of ARDS.
- ARDS is a life-threatening condition where the lungs can't exchange oxygen effectively.
- It often develops after an initial lung injury, such as pneumonia.
- Early treatment can prevent progression to ARDS.
Signs and Symptoms of ARDS
- Labored and rapid breathing: Breathing rate may be 26 breaths per minute or higher.
- Low oxygen saturation: Oxygen saturation can dip below 90%, indicating difficulty in oxygen uptake.
- Paradoxical breathing: The chest wall moves inwards during inhalation instead of outward, indicating severe respiratory distress.
- Bilateral wheezing: Auditory sign of constricted airways, heard with a stethoscope.
Arterial Blood Gas (ABG) Interpretation
- High pH (alkalosis): This indicates rapid respirations "blowing off" CO2, resulting in an alkaline blood pH.
- Low pCO2 (hypocapnia): This further confirms the rapid respirations.
- High pO2 (hyperoxia): The high oxygen saturation (95%) in the initial ABG example suggests the hemoglobin is saturated with oxygen but may be less likely to release it to the tissues due to a left shift in the oxygen-hemoglobin dissociation curve.
- Low HCO3 (metabolic acidosis): This indicates a buildup of acid in the body, possibly due to excess acid production from the infection.
- High CO2 (hypercapnia): This indicates CO2 retention in the lungs, leading to respiratory acidosis.
Lung Complications
- Pleural effusion: This is an excess of fluid in the pleural space, which can cause pain, shortness of breath, and difficulty taking deep breaths.
- Infection: Can lead to various lung complications, including pleural effusion.
Case Study: John
- John, a 76-year-old man, is brought to the ED after falling from a roof.
- He presents with paradoxical breathing, low blood pressure (86/50), low oxygen saturation (86%), and a rapid pulse (125).
- His condition suggests severe respiratory distress and likely a lung injury.
- Paradoxical breathing is a key indicator of a possible flail chest, which can complicate lung function.
- Immediate medical attention is crucial to prevent further deterioration.
Kidney Function
- Kidneys filter blood, concentrate urine, maintain acid/base balance, and maintain normal electrolyte levels.
- The nephron is the functional unit of the kidney and is responsible for filtering blood.
- The ADH (Antidiuretic Hormone) increases the permeability of the distal convoluted tubule and collecting ducts to water.
- This allows water to move from the urine back into the bloodstream.
- This action creates more concentrated urine.
- This action increases blood volume and blood pressure.
Monitoring Kidney Function
- We can monitor kidney function through lab work and clinical presentation.
- Normal creatinine levels are between 0.7-1.0 mg/dL.
- A doubling of creatinine levels indicates a 50% decrease in GFR (Glomerular Filtration Rate).
- Creatinine takes 7-10 days to stabilize.
- Normal BUN (Blood Urea Nitrogen) levels are between 8-21 mg/dL.
- We use BUN, creatinine, and eGFR to assess kidney function.
Acute Kidney Injury (AKI)
- AKI is an acute/sudden decline in kidney function.
- AKI is characterized by a decrease in GFR, a decrease in urine output, a build-up of waste products, and increased BUN & Cr levels.
Types of AKI
- Pre-renal: Caused by hypoperfusion due to hypotension, hypovolemia, sepsis, CHF, or renal artery stenosis.
- Renal: Caused by acute tubular necrosis (from ischemia or nephrotoxic agents), acute glomerulonephritis, interstitial disease (e.g., tumor growth).
- Post-renal: Caused by bilateral urinary tract obstruction (e.g., BPH, neurogenic bladder, renal calculi).
Hydronephrosis
- Is a build-up of urine in the kidneys due to obstruction.
Diuretics
- Diuretics help decrease blood pressure by increasing urine production, which lowers blood volume and reduces free fluid build-up in the body.
Furosemide (Lasix)
- Acts on the ascending loop of Henle.
- Loop diuretics can cause electrolyte imbalances, including hypokalemia, hypocalcemia, and hyponatremia, because they block the active transport channels found there.
Potassium Deficiency
- Low potassium levels (hypokalemia) can cause spastic paralysis, fatigue, cramps, and cardiac issues, including arrhythmias.
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Description
This quiz explores the clinical presentation and management of Mr. Smith, who presented with pneumonia and subsequent complications. It covers symptoms, diagnostic findings, and treatment protocols, including the management of hyponatremia. Test your knowledge on emergency medicine and critical care scenarios.
