Altered Elimination Renal copy PDF

ALTERED ELIMINATION MODULE 1 RAYAN AL DABBAH RN MSC NSG 0159  ALTERED ELIMINATION Elimination processes are required remove waste products from the body, in order to maintain homoeostasis The impact of altered urinary and gastrointestinal processes...

ALTERED ELIMINATION MODULE 1 RAYAN AL DABBAH RN MSC NSG 0159  ALTERED ELIMINATION Elimination processes are required remove waste products from the body, in order to maintain homoeostasis The impact of altered urinary and gastrointestinal processes will be reviewed in this module https://www.youtube.com/watch?v=QV1Y3dJK0r8  RENAL SYSTEM The renal system is key in helping to manage: Body fluids: volume and composition balance Contributes to blood pressure management Elimination of metabolic waste Synthesize of: Erythropoietin – red blood cell production Renin – fluid balance – blood pressure response Vitamin D – absorption of calcium https://www.youtube.com/watch?v=H2VkW9L5QSU (6.5 min)  URINE PRODUCTION The nephron is the functional unit of the kidneys Role is to 1. Filter water-soluble substances from the blood 2. Reabsorb filtered nutrients, water and electrolytes 3. Secrete wastes 4. https://www.youtube.com/watch?v=SZ3BZBBC-Qc  URINE PRODUCTION Blood enters the kidney thru the renal artery and moves into smaller and smaller arterioles Blood enters the glomerular capillaries (Glomerulus) and under pressure creates filtrate Filtrate is comprised of water, ions (sodium, potassium, chloride), glucose and small proteins As filtrate moves thru proximal tubule, the sodium and other ions are absorbed back into the blood The filtrate moves thru the Loop of Henle – more absorption of water and sodium In the distal tubule – secretion of ions, acids, medications and toxins (K+, urea, ammonia) , some absorption of ions and waters occurs FILTRATION URINE PRODUCTION OVERVIEW  FILTRATE ABSORPTION Within the nephrons several types of mechanism are used to reabsorb substances Diffusion – movement of particles from an area of high concentration to low concentration Osmosis – process in which water passively moves from high concentration to low concentrations Facilitated transport – movement of substances across the cell membrane aided by the use of transport proteins Active transport – requires energy to move particles across cell membranes  URINE PRODUCTION Proximal Convoluted Loop Majority of sodium is reabsorbed Glucose, potassium, amino acids, bicarbonate, phosphate, urea and water also reabsorbed Loop of Henle Water is reabsorbed Sodium is actively reabsorbed  URINE PRODUCTION Distal Convoluted Loop Aldosterone influences sodium reabsorption Secretion of potassium, urea, hydrogen, ammonia into the filtrate Collecting duct Antidiuretic hormone (ADH) influences water reabsorption End product is urine  URINE PRODUCTION Macroscopic analysis Visual appearance – light (straw) yellow, clear Microscopic analysis Ph. – 4.6 – 8.0 Specific gravity 1.005 – 1.030 Proteins < 0.15g/day RBCs 0-4 hpf WBC 0-5hpf Casts – none – occasional (protein meshwork of entrapped cells formed in the distal tubule)  URINE ANALYSIS: ABNORMAL FINDINGS Indicator of diseases/conditions Proteins – if > 0.15g/day = impaired filtration Glucose – if present = hyperglycemia – infection/diabetes https://www.youtube.com/watch?v=xgy5LJAGFbg Ketones – if present = acid/base imbalance – Diabetic Ketone Acidosis (DKA) Leukocytes – if present = infection Nitrites – infection  LAB AND KIDNEY FUNCTION Lab Description Range Indication Blood Urea Nitrate Urea results from 3.6 – 7.1 mmol/L Impacted by GI (BUN) protein bleed, trauma, metabolism; is a excessive muscle waste product breakdown Creatinine End product of 53 – 103 mcmol/L More reliable than muscle and BUN – consistent protein metabolism Potassium Kidney excrete 3.5 – 5 mmol/L Often first majority of K+ electrolyte to become abnormal Glomerular filtration rate (GFR): According to the Kidney Foundation of Canada, normal results are greater than 90 mL/min/1.73 m 2.  URINE REMOVAL Urine enter the ureters in the renal pelvis and are comprised of smooth muscle Peristalsis propel the urine to the bladder The Trigone is located at the base of the bladder, where ureters connect to the bladder It is sensitive to stretch and when the bladder fills – stretch receptors send signal to the sacral region of the spinal column Message travel to the brain – signaling the need to void  MICTURITION REFLEX 1. Stimulation of stretch receptors in the bladder walls transmit impulses to the sacral spinal cord 2. Neural impulses travel to the pons, within the brainstem 3. Neural impulses then descend down the spinal column to detrusor muscles, relaxing the internal sphincter 4. Voluntary relaxation of the external sphincter stimulates the release of urine CATEGORIZATION OF URINARY TRACK PROBLEMS Pre-renal Intra-Renal Post renal Kidney failure GLOMERULONEPHRITIS Inflammation of the tiny filters in the kidneys (glomeruli). The excess fluid and waste that glomeruli remove from the bloodstream exit the body as urine. Glomerulonephritis can come on suddenly (acute) or gradually (chronic). Glomerulonephritis occurs on its own or as part of another disease, such as lupus or diabetes. Severe or prolonged inflammation associated with glomerulonephritis can damage the kidneys. Treatment depends on the type of glomerulonephritis you have.  ALTERED URINARY NEUROMUSCULAR FUNCTION Altered urinary neuromuscular function can result in urinary retention or incontinence Injuries to neurons in spinal cord impact the ability of the impulses to travel to the pons and signal the need to void The level of neural injury influences the impact and functionality  ALTERATION IN URINARY MOTILITY Fluid intake directly impacts urine production Changes in the composition of urine occurs when the urine (filtrate) is slow to move thru the nephrons or remains in the bladder = stasis Allow more water to be absorbed Increases in the number of cells in the urine Stasis in the bladder can promote bacteria growth = infection  ALTERATION IN URINARY PERFUSION The kidney normally filter 1L of blood/min – lack of blood to this organ directly impacts its ability to function Decreased perfusion = decreased oxygenation = tissue ischemia Nephrons cannot function – inadequate filtration = toxins levels rise One of the most important functions of the kidney is the filtration and excretion of nitrogenous waste products from the blood. The measurements of elevated blood urea nitrogen (BUN) and creatinine serve as indicators of decreased renal function indicative of the decreased clearance of these waste products. AKI is currently defined as a rapid decline in the glomerular filtration rate (GFR) resulting in retention of nitrogenous wastes, primarily creatinine and blood urea nitrogen High pressure on the kidney (Hypertension) – damage nephrons = kidney failure  ACUTE KIDNEY FAILURE Kidney failure is the inability of the kidney to excrete waste, concentrated urine and conserve electrolytes Acute: rapid accumulation of nitrates (azotemia) and oliguria (< 500ml/24hrs.) Causes: Hemorrhage Trauma Infection – pyelonephritis or glomerulonephritis Prerenal acute kidney injury (acute renal failure) - causes, sympt oms & pathology (youtube.com)  ACUTE KIDNEY FAILURE NURSING INTERVENTIONS Treatment: Initially fluid restriction 1L/day Strict intake and output, daily weights Low potassium diet Close monitoring of electrolytes, BUN, Creatinine and GFR. Rehydrate when glomerular filtration rate (GFR) improves Acute Renal Failure – YouTube (10 min)  ALTERATION OF URINARY PATENCY Blockage of the structure in the passage of urine affect urine output Prolonged or severe pressure can damage the structures and function of nephrons Blockages can result from precipitation of substances (stones) or external sources (tumors) Urine flow backs up and into the kidney (hydronephrosis) Stasis of urine can lead to infection and possible sepsis  UROLITHIASIS (KIDNEY STONES) Urolithiasis – development of calculi in the renal system Calculi – solid masses, often composed of salts, inorganic and or organic acids that precipitate out of the filtrate Calcium (oxalate and phosphate) most common component of stones Kidney cannot filter the high levels of calcium when it combines with oxalate and or phosphate to form stones – slowly increase in size and get caught in the tubules, or collecting ducts = blockage Sudden onset of flank pain and presence of microscopic blood in urine  UROLITHIASIS (KIDNEY STONES) Risk factors for kidney stones: Clinical Signs: Genetic predisposition Severe, shooting pain localized Urinary tract infection to lower back (flank) Diabetes Hematuria – blood in urine Obesity Nausea & vomiting Hyperparathyroidism Urinary urgency Dietary factors – high oxalate, high animal protein, high sodium, low fluid intake  UROLITHIASIS (KIDNEY STONES) Non Surgical treatment: Pain management Encourage fluids – not caffeinated beverages Antispasmodic medications Strain the urine Patient teaching: Reducing the risk of stones Dietary changes Hydrate with water Less caffeine, fewer foods containing oxalates  UROLITHIASIS (KIDNEY STONES) Treatment: Surgical procedures: Extracorporeal shockwave lithotripsy (ESWL) – shock waves to break stones into small pieces that can be passed Ureteroscope into the ureter that retrieves or breaks the stone – stent may be placed Nursing – post procedural care Vital signs IV fluids Monitoring intake and output Pain management What causes kidney stones? - Arash Shadman – YouTube (5 min)  LEARNING OBJECTIVES Describe the structure and functions of the kidney Describe the nephron and what pathophysiology activity happens in each part of the nephron (proximal tube, loop of Henle and distal tube) Define filtrate and what it is comprised of. Describe the structure and function of the bladder Describe the micturition reflex Identify normal and abnormal urine content  LEARNING OBJECTIVES Describe the following disease processes and key nursing interventions for: Acute kidney failure Urolithiasis Altered urinary motility  QUESTIONS Applied Pathophysiology Chapter 18 Review questions at end of chapter Medical Surgical Nursing in Canada Chapter 47 p. 1141 – 1149; p. 1158 table 47-9 Chapter 48 p. 1175 – 1179; 1186 - 1191 Chapter 49 p. 1201 - 1208 Contact me with questions [email protected]