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Questions and Answers
What is a key clinical manifestation of hyperkalemia?
Which diagnostic test is essential for assessing hyperkalemia?
What dietary management should be implemented in a patient with hyperkalemia?
Which of the following is NOT a clinical manifestation of hypocalcemia?
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Which medical management option is specifically used for hyperkalemia?
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What is the primary goal of nursing management in cases of hypocalcemia?
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Which sign is indicative of hypocalcemia?
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What is a common cause of hypocalcemia?
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What is the primary characteristic of metabolic acidosis?
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Which of the following is a common cause of metabolic alkalosis?
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What does a plasma pH measurement above 7.45 indicate?
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Which buffer system component plays a role in maintaining pH levels in the body?
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What is a key clinical manifestation of metabolic acidosis?
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What is the treatment focus when managing metabolic acidosis?
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Which arterial blood gas measurement would suggest metabolic alkalosis?
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Which of the following would NOT typically indicate metabolic acidosis?
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Which function is primarily associated with aldosterone?
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What is the primary characteristic of isotonic IV solutions?
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What role does ADH play in the body?
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Which type of IV solution would be most appropriate for treating hypernatremia?
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What is a primary function of the lungs in fluid balance?
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What is the primary purpose of parenteral fluid therapy?
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What happens to cells when placed in hypertonic solutions?
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Which hormone is significant for the regulation of osmotic pressure in the cells?
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What is the primary cause of calculous cholecystitis?
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Which of the following symptoms is NOT commonly associated with cholecystitis?
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Which diagnostic test utilizes a radioactive agent for detecting gallbladder inflammation?
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Which group of individuals is at a higher risk for developing cholecystitis?
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What is the treatment of choice for symptomatic gallbladder disease?
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What does the acronym AIDS stand for?
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What is a known risk factor for the transmission of HIV?
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Which condition is associated with primary immunodeficiency?
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What structure forms the beginning of the urinary space and helps filter blood in the nephron?
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Which type of nephron is characterized by long loops of Henle and is surrounded by vasa recta?
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What percentage of cardiac output do the kidneys receive?
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What prevents the reabsorption of urine in the ureters?
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Which of the following is involved in urine formation within the nephron?
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What is the total capacity of the urinary bladder?
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Which part of the urinary system helps maintain continence?
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What happens to blood after filtration occurs in the glomerulus?
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Study Notes
Kidney Functions
- Regulate ECF volume
- Regulate normal electrolyte levels in the ECF
- Regulate pH of the ECF
- Excretion of metabolic wastes and toxins
- PUMPING ACTIONS circulate blood through the kidneys under sufficient pressure for urine formation
Other Organ Roles in Fluid Balance
- Lungs: Removes 300ml of water daily.
- Pituitary Gland: ADH maintains osmotic pressure of the cells.
- Adrenal Gland: Aldosterone has a profound effect on fluid balance.
- Parathyroid Gland: Regulates calcium and phosphate balance.
- Renin-Angiotensin-Aldosterone System: Aldosterone is a volume regulator and is also released as serum potassium increases, sodium decreases.
- Antidiuretic Hormone (ADH): ADH and the thirst mechanism role is to maintain sodium concentration and oral intake of fluids - the release of ADH increases reabsorption of water and decreases urine output.
- Natriuretic Peptides: Is a hormone affecting fluid and cardiovascular function through the excretion of sodium and direct vasodilation.
Parenteral Fluid Therapy
- Given by IV route when no other route is available
- Used in outpatient diagnostics, surgical settings, and even homes to replace fluids, administer medications, and provide nutrients.
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PURPOSE:
- Provide water, electrolytes, and nutrients to meet daily requirements
- Replace water and correct electrolyte deficits
- Administer medications and blood products
IV Solutions
- Often categorized as isotonic, hypotonic, or hypertonic based on their total osmolality.
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Isotonic Solutions: Fluids that have a total osmolality close to the ECF and do not cause cells to shrink or swell.
- Normal Saline (0.9% Sodium Chloride): Only IV solution that is compatible with blood transfusions.
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Hypotonic Solutions: Lower osmolarity than the extracellular space.
- Water moves from extracellular space to intracellular space.
- Used to:
- Replace cellular fluid
- Provide free water to kidneys for excretion of body wastes
- Treat hypernatremia
- Prevent dehydration
- Causes cells to swell
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Hypertonic Solutions: Higher osmolarity than the extracellular space.
- Water moves out from intracellular space into the extracellular space
- Causes the cell to shrink.
Hyperkalemia
- Pathophysiology: Decreased renal excretion of potassium, rapid administration of potassium, untreated kidney injury, hypoaldosteronism.
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Diagnostic Findings:
- Electrocardiogram
- Arterial Blood Gas
- Blood Chemistry
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Clinical Manifestations:
- Muscle Weakness
- Low urine output
- Respiratory Arrest
- Poor Cardiac Contraction
- Early Muscle cramping/twitching
- Abnormal EKG
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Medical Management:
- Obtain ECG
- Administration of cation exchange resins (e.g., sodium polystyrene sulfonate)
- Administration of IV Calcium Gluconate
- Administration of IV Sodium Bicarbonate
- Regular Insulin and a Hypertonic Dextrose Solution
- Loop Diuretics
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Nursing Management:
- DIET: Restrict Potassium
- Monitor ECG
- Monitor Vital Signs
- Monitor and Observe muscle weakness and dysrhythmias
- Monitor Serum-Potassium levels
Hypocalcemia
- Occurs in a variety of clinical situations.
- A patient may have a total-body calcium deficit but a normal serum calcium level.
- Older adults and those with disabilities, who spend an increased amount of time in bed, have an increased risk for hypocalcemia.
- Pathophysiology: Hypoparathyroidism/surgery of the thyroid, massive administration of citrated blood, pancreatitis, kidney injury, and unhealthy lifestyle.
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Diagnostic Findings:
- Arterial Blood Gas
- Blood Chemistry
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Clinical Manifestations:
- Tail Sign
- Trousseau Sign
- Mental Status Changes
- Hyperactive bowel sounds
- Dry brittle hair, nails, and bones
- Seizures/Tetany
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Medical Management:
- Parenteral Calcium Chloride
- Calcium Salt
- If with hyperphosphatemia - Aluminum Hydroxide
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Nursing Management:
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DIET:
- Increase Vitamin D
- Milk
- Salmon, Sardines, Oysters
- TURN PATIENT'S HEAD TO SIDE IF SEIZURE OCCURS
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AVOID:
- Smoking and Alcoholic Beverages
- Laxatives
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DIET:
Hypercalcemia
- Excessive amount of calcium levels in the blood and is a dangerous imbalance when severe.
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Medical Management:
- Magnesium containing medications for compromised renal function
- Magnesium rich foods
Acid-Base Imbalances
- Commonly encountered in clinical practice, especially in critical care units.
- It's important to identify acid-base imbalances to determine the underlying cause of the disorder and to determine appropriate treatment.
- Plasma pH: Indicator of hydrogen ion concentration and measures the acidity of alkalinity of the blood.
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Mechanisms for regulating acid-base balance:
- Buffer systems
- Kidneys
- Lungs
- Buffer Systems: Prevent major changes in the pH of body fluids by removing or releasing hydrogen ions; they can act quickly to prevent excessive changes in hydrogen ion concentration; assessed when arterial blood gases are measured.
Metabolic Acidosis
- A common clinical disturbance characterized by low pH and a low plasma bicarbonate concentration.
- Pathophysiology: Results in direct loss of bicarbonate
- Causes: Diarrhea, lower intestinal fistulas, ureterostomies, and uses of diuretics.
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Assessment and Diagnostic Findings:
- Arterial Blood Gas measurements: low pH (7.35) and low bicarbonate (22mEq/L).
- Blood Chemistry: hyperkalemia.
- ECG
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Clinical Manifestations:
- Headache
- Confusion
- Drowsiness
- Tachypnea
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Medical Management:
- Treatment is directed at correcting the metabolic acidosis.
- When necessary, bicarbonate is given; however, administration of sodium bicarbonate during cardiac arrest can result in paradoxical intracellular acidosis.
Metabolic Alkalosis
- A clinical disturbance characterized by a high pH and a high plasma bicarbonate concentration
- Pathophysiology: Can be produced by a gain of bicarbonate or a loss of hydrogen ions.
- Causes: Vomiting, NG Tube suctioning, pyloric stenosis, use of thiazides, and hypokalemia.
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Assessment and Diagnostic Findings:
- Arterial Blood Gas measurements: pH greater than 7.45 and serum bicarbonate concentration greater than 26mEq/L.
- Blood Chemistry: hypokalemia
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Clinical Manifestations:
- Dizziness
- Respiratory Depression
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Medical Management:
- Treatment is aimed at correcting the underlying acid-base disorder.
- Because of volume depletion from GI loss, the patient's I&O must be monitored.
- Sufficient chloride excretion of excess bicarb.
Blood Supply of Kidney:
- Hilum: Concave portion of kidney through which the renal artery enters and the ureters and renal vein exit.
- Kidneys receive 20-25% of the total cardiac output, meaning all of the body's blood circulates through the kidneys approximately 12 times per hour.
- Renal Artery: Divides into smaller and smaller vessels, forming the afferent arterioles that branch to form glomerulus (where filtration occurs).
- Blood leaves the glomerulus and flows back to the inferior vena cava.
Nephrons
- Each kidney has 1 million nephrons located within the renal parenchyma that are responsible for the formation of filtrate that will become urine.
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Types of Nephons:
- Cortical Nephrons
- Juxtamedullary Nephrons: Distinguished by long loops of Henle and are surrounded by a long capillary loop called vasa recta.
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Nephrons are made up of 2 basic components:
- Filtering Element
- Attached Tubule
- Bowman's Capsule: Part of the nephron that forms a cup-like sack surrounding the glomerulus - representing the beginning of the urinary space - contiguous with the proximal convoluted tubule of the nephron - helps the glomerulus to filter blood.
Ureters, Bladder, and Urethra:
- The urine formed in the nephrons flows through the renal calyces and then into the ureters, which are long fibromuscular tubes that connect each kidney to the bladder
- Urothelium: Lining of the ureters composed of transitional cells epithelium - prevents reabsorption of urine.
- The urinary bladder is a distensible muscular sac located just behind the pubic bone with a total capacity of 400-500 ml.
- Urethrovesical junction: Provides downward movement of urine.
- The bladder neck contains bundles of involuntary smooth muscle that form a portion of the urethral sphincter known as the internal sphincter (holds urine from exiting the urinary bladder to the urethra).
- External urinary sphincter: Maintains continence.
Functions of the Kidney:
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Urine Formation: Urine is formed in the nephrons through a complex three-step process: glomerular filtration, tubular reabsorption, and tubular secretion.
- Excreted substances in urine: sodium, chloride, bicarbonate, potassium, glucose, urea, creatinine, and uric acid.
- Within the tubule, some of these substances are selectively reabsorbed into the blood.
Cholecystitis:
- Inflammation of the gallbladder.
- Calculous cholecystitis: Gallbladder stone obstructs bile outflow --> bile remains --> chemical reaction --> edema occurs --> compressed blood vessels in the gallbladder
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Risk/Precipitating Factors:
- Female - Forty - Fat - Fertile - Cholelithiasis
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Clinical Diagnostic Tests:
- Cholescintigraphy: Use of a radioactive agent administered intravenously.
- Ultrasonography: Detect calculi in the gallbladder
- Oral Cholecystography
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Clinical Manifestations:
- RUQ Pain
- (+) Murphy's Sign
- (+) Boas' Sign
- Very dark colored urine and clay colored stool
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Medical Management:
-
Surgical Procedures:
- Cholecystectomy/Laparoscopic Cholecystectomy
- Jackson Pratt Drain
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Pharmacological Treatment:
- Ursodeoxycholic Acid: Dissolve small stones
- Lithotripsy: Dissolve larger stones
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Surgical Procedures:
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Nursing Management:
- Pain management (Preop & Postop)
- Breathing Exercise
- Promote Biliary Drainage
- Low fat, high carbohydrate diet
HIV-AIDS
- Immunodeficiency: Results from a loss of function, partial or total of one or more components of the immune system
- Primary immunodeficiency: Involves basic developmental failure somewhere in the system.
- Secondary immunodeficiency: Loss of the immune system due to specific causes at any time during the lifespan.
- AIDS (Aquired Immunodeficiency Syndrome): A disease caused by the Human Immunodeficiency Virus (HIV).
Global Epidemiology of HIV/AIDS
- 39.5 million people living with HIV/AIDS in 2006
- 4.3 million newly infected with HIV (more than half are younger than 25)
- 2.9 million people died from AIDS.
- More than 25 million people have died from AIDS since 1981.
- Africa has over 12 million AIDS orphans.
- Philippines is a low-HIV-prevalence country, with less than 0.1 percent of the adult population estimated to be HIV-positive. As of April 2015, the Department of Health (DOH) AIDS Registry in the Philippines reported 24,936 cumulative cases.
Transmission of HIV:
- Transmission: Through bodily fluids from an infected person.
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Three conditions for transmission:
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- Virus Must Be Present
-
- There must be a high enough concentration of the virus in the infected person.
-
- ??? (The third condition is missing, and this text needs to be completed to provide a full condition for HIV transmission).
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Description
Explore the crucial roles of the kidneys and other organs in maintaining fluid balance in the body. This quiz covers aspects such as electrolyte regulation, hormone interactions, and the mechanisms involved in urine formation. Test your knowledge on how different organs work harmoniously to regulate bodily fluids.
