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KIDNEYS ROLE IN HOMEOSTASIS
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Priority Assessments
Blood…
KIDNEYS ROLE IN HOMEOSTASIS
Priority Assessments
- Blood Pressure, Acid-Base Balance,Lab Values (RBC, Cr, BUN) Patient's understanding of kidney roles in their health
Waste Excretion through urine
- Urine is a waste by product formed from excess water and metabolic waste molecules during the process of renal filtration.
- It regulates blood volume, plasma osmolarity & waste removal via urine
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Things excreted through urine
- excess ions: sodium, chloride, potassium, magnesium, bicarbonate, ammonium and phosphates
- Metabolic wastes: uric acid, area, creatnine,urea & nitrogenous wastes
- drug metabolites: Although most drugs are metabolized through the liver first, they are eventually excreted out of the body through urine
Nursing Diagnosis
- Impaired skin integrity related to accumulation of toxins within the body as evidenced by high levels of creatinine and urea
Outcome
- Patient will maintain skin integrity and report ways of maintaining skin integrity
Intervention
- Frequently monitor skin for any skin breakdowns and changes in blood values
Rationale
- Monitoring for skin breakdowns and monitor blood values like BUN and creatinine can ensure that early interventions are taken to help decrease skin breakdown
Intervention
- Provide skin care that can be soothing, avoiding any harsh soaps
Rationale:
- Proper skin care and moisturizing are helpful in alleviating itchiness and therefore decreasing risk for impaired skin integrity
Blood Pressure Control
Nursing Diagnosis
- Decreased cardiac output related to increased vascular resistance as evidenced by high blood pressure
Outcome
- Patient will be able to identify ways to maintain a healthy blood pressure and remain within normal limits
Intervention
-Frequently monitor blood pressure
Rationale
- Monitoring blood pressure can determine if treatments have been effective
Intervention
- Educate patient on ways to help maintain blood pressure through comfort measures and maintain activity tolerance (rest periods, assistance with care)
Rationale
Promoting a calm environment and activity tolerance is needed to help stimulate relaxation and thus can decrease blood pressure
Renin Angiotensin Pathway
- renin is released from the kidneys when the body senses a drop in blood pressure & fluid volume
- renin then acts on angiotensin to form angiotensin I
- Angiotensin Converting Enzyme (ACE) released by the lungs acts on angiotensin I to form angiotensin II
- Angiotensin II does two things:
- acts on the adrenal glands to stimulate the release of aldosterone.
-aldosterone acts on kidneys to reabsorb NaCl and water.
- stimulates vasoconstriction on blood vessels
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- Kidneys are able to autoregulate the pressure of blood going in to the glomerular capilaries. Therefore, ensuring that glomerular hydrostatic pressure is constant and GFR maintains.
- Kidneys are the source of renin, which effects the blood pressure through the renin-angiotensin pathway.
- A drop in blood pressure in the glomerulus increases renin release, therefore rising systemic blood pressure
- When there is a drop in hydrostatic pressure in the glomeruli or glomerular tissue damage, we see an impairment in the kidney to excrete nitrogenous wastes and to regulate water and electrolytes.
-This will then result in fluid retention and hypertension.
- Consistent hypertension poses a risk to damage to blood vessels especially to the brain, coronary and renal vessels.
- Arteriosclerosis in the renal artery restrains renal blood flow, generating he release of renin => worse hypertension
Acid Base Balance
- The normal body pH is 7.35-7.45.
- Therefore, the body has different buffer systems in order to decrease changes in pH by working together with acids and bases.
- Bicarbonate is filtered and undergoes a reaction sequence to produce water and carbon dioxide
- Water and carbon dioxide disperse in to the proximal tubule and go through a reverse sequence in order to form bicarbonate. The result of the hydrogen ion is secreted back in to the lumen.
- Bicarbonate ion diffuses in to the blood
Acidosis
- Fall in plasma PH. Occurs when there are excess hydrogen ions in the body.
- The bicarbonate reaction system produces carbon dioxide (CO2) and water in response to the excess hydrogen ions.
- The lung then deal with excess CO2 by increasing respiratory rate to "blow off" the extra CO2.
- The kidneys correct the rise in hydrogen ions by secreting the excess through the urine, and generating bicarbonate for for reabsorption in the plasma
Alkalosis
- Rise in plasma pH and occurs when there is a decrease in hydrogen ions.
- Kidneys reduce the amount of hydrogen secretion through urine, however this also results in a decrease bicarbonate level since hydrogen ion and bicarbonate ion reabsorption are linked together.
- Decreasing the ventilation rate by the lungs -> increases CO2 which then causes the sequence to create more bicarbonate ions.
- Renal disease can result in both alkalosis or acidosis due to decreased excretion of acids by kidneys or decrease renal absorption of bicarbonate
Signs & Symptom Acidosis
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- headache, decreased BP, Changes in LOC Kussmaul's Respiration, muscle twitching
Signs & Symptoms Alkalosis
- Confusion, dizzy, irritability, tremors,seizures, anxiety
Nursing Diagnosis
- Metabolic acidosis related to reduced renal excretion of acids & reduced arterial absorption of bicarbonate as evidenced by Kussmaul's breathing
Outcome
- Patient will maintain homeostasis with pH levels of 7.35-7.45
Intervention
- Frequently monitor for any changes in vitals signs, LOC & lab values
Rationale
- Frequent monitoring of the above is important to ensure that vital signs remain within normal limits. Lab values: to see if treatment is working or if other treatments are needed. Decrease in mental status, seizures, confusion, or sudden weakness occur because of decrease pH in cerebral fluid or hypoxia.
Intervention
- Monitor for any changes in respiratory depth and rate
Rationale Kussmaul's breath occur as a compensatory mechanism to blow off excess CO2. However, when acidosis corrects itself and potassium shifts out of the cell, there is respiration depression.
ERYTHROPOIESIS
(RBC production)
- kidney's produce the hormone erythropoietin, which promotes the generation and differentiation of erthrocyte messengers in the bone marrow
- process of erythropoietin (EPO) production is needed for prevention of anemia and to maintain a healthy red blood cell count
- Hypoxia (deficiency in oxygen) is what stimulates the production of erythropoietin.
- The kidney cells are responsible for generating EPO.
- EPO are sensitive to low oxygen levels and thus stimulate the bone marrow to increase RBC production -> increasing oxygen throughout the body
Signs & Symptoms of Anemia
- fatigue, pale skin, low appetite, poor sleep, dizziness
- caused by low EPO levels, because RBC carry oxygen to the body to help give energy
- kidney problems can cause anemia due to the inability to signal the bone marrow to produce EPO
Nursing Diagnosis
- Fatigue related to decreased hemoglobin & diminished oxygen carrying capacity of RBC as evidenced by low RBC count
Outcome:
- Patient will report increased energy and verbalize ways to conserve energy
Intervention
- Assist patient to create a plan for the day, including frequent rest periods
Intervention Educate patient on energy conserving techniques
Rationale
- Certain things may require delegating tasks to reserve energy, clustering tasks & taking breaks. Time energy & organization can help with energy conservation
Signs and symptoms of toxic buildup in the body
- confusion, skin conditions like rashes, acne, eczema, constipation
Mind Map
Hosanna Asistio
n01426063
Humber College
NEPH 510 – 919
Instructor: Linda Ballantine
February 24, 2020
Signs & Symptoms of Hypertension
-headache, confusion, blurry/double vision,