Summary NUR 265 ADVANCED EXAM 1 REVIEW

NUR 265 ADVANCED EXAM 1 REVIEW Anatomy of the Kidney: - The nephron is the functional unit of the kidney. - Normal GFR is 120-125. - If 75% of nephrons quit = renal insufficiency. - Kidneys are sensitive to changes in cardiac output. VOLUME DEPENDENT. A decrease in urine output indicates a decrease in cardiac output. - If the SBP is below 70 for over 40 minutes, the kidney will become hypo then ischemic. - If the SBP drops, the arterioles dilate. If the SBP elevate, arterioles constrict. Normal Functions of the Kidney: - Regulation of Water: Thirst regulates body fluid. Aldosterone- excretes K and reabsorbed NA. ADH- reabsorbs water, is water conserving. ANP- inhibits NA and reabsorbs water. A decrease in volume causes as increase in aldosterone. When encouraging the patient to drink, provide a GOAL. - Excretion of Metabolic Waste: Reabsorbed = water and electrolytes. NOT reabsorbed = creatinine, urea, lactic acid, and ketones. Check creatinine and BUN to assess kidney function Lactic acid is a byproduct of metabolism. When the lactic acid is high in decrease kidney function, these patients have soreness everywhere. *give them water. - Regulation of Acid-Base Balance: The kidneys are 2nd place after the lungs. They excrete hydrogen and reabsorb bicarb. - Regulation of Blood Pressure: Maintain VOLUME. Renin-Angiotensin- vasoconstricts then releases aldosterone. Aldosterone. Prostaglandins- vasodilatation. Bradykinins- vasodilation and vascular permeability. - RBC Synthesis: Renal Erythropoietin Factor stimulates bone marrow to make RBCs. A dialysis patient is often anemic. - Regulation of Electrolytes: effecting neuro, cardiac, mental, and GI. Electrolytes: - Sodium NA: 135-145. Hypo = change in LOC, seizures, and vascular collapse. Hyper = dehydration. Treat hyper with diuretics, D5W because glucose pulls NA out. Correct the problem slowly to avoid cerebral edema. 48 hours or more. - Potassium K: 3.5-5.2. Hyper = MI, chemo, autotransfusion (we did it), crushing injuries. Hypo = diuretics, diarrhea, and GI suctioning. *CARDIAC DYSRHYTHMIAS* No K to renal patients, if the kidney is not working correctly, they’re not regulating levels causing build up. Monitor closely, and give slowly. Pt should be on monitor.