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Alterations of Renal,Urinary Tract Function, and Gastrointestinal function

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Renal Calculi-types of tests used
ultrasound or CT to determine location, urinalysis (including pH) to identitfy type of stone
Renal Calculi-Calcium stones
calcium phosphate or calcium oxalate most common type no spinach or chocolate
Renal calculi-calcium stones RISK FACTORS
age 20-40yrs white males temperature, humidity, and rain fall inactive consume less fluids 70-80% occurance
Renal Calculi- calcium stones causes
diet supplements, renal impairment, hyperparathyroid
Renal Calculi- calcium stones, uric acid stones, and struvite stones S/S
N&V sidament in urine ONLY CALCIUM STONES show up on X-RAY
Renal Calculi- calcium stones treatment/prevention
celulosphosphate and thiazide diuretic (helps calcium become absorbed in stool), decrease calcium/oxalate (spinach and chocolate), increase water intake, low sodium diet GOAL of Treatment: to reduce urine concentration to prevent formation of stone
Renal Calculi-Uric Acid facts
pH less than 5.5, 10% occurance, cause: increased protein diet, gout,and thiazide diuretics treatment: reduce red meat/wine intake, potassium citrate to increase urine pH most common site: ureters
Renal Calculi-Stuvite stones facts
contain magnesium-ammonium-phosphate matrix forms alkaline urine during infection w/ Klebsiella, Proteus, or Psuedomonas bacterial pathogen, Staghorn configuration in pelvicaliceal collecting system
Renal Fuction test BUN
Urea-end product of protein metabolism excreted by kidneys BUN *indicator of liver and kidney function
Renal Function Test Creatinine
Creatinine is formed when phosphate used in skeletal muscle contraction Excreted in kidneys indcates Kidney function NOT AFFECTED by liver function 50% GFR reduction DOUBLES Creatinine level
Renal Function Test-Urinalysis (UTI)S/S
Cloudy, foul smelling, WBCs
Renal Function Test-Urinalysis (dehydration)S/S
dark yellow urine
Renal Function Test-Urinalysis (glomerular membrane injury)
Protein in urine
Renal Function Test-Urinalysis (diabetes mellitus)
Glucose in urine
Renal Function Test-Urinalysis (fatty acid metabolism)
Ketones in urine
Renal Function Test-Urinalysis (possible renal stone formation)
Crystals in urine
Renal Function Test-Urinalysis (Proteinuria)
Many hyaline casts
Renal Function Test-Urinalysis (nephrotic syndrome)
cellular casts
Renal Function Test-Intravenous pyelogram (IVP)
IV-admin radioqaque dye, allows for visualization of kidneys, renal pelvis, ureters, and bladder
Cronic Renal Failure causes
develops as a complication of systemic diseases (hypertension or DM)
Anatomy and Physiology Site of digestion & absorption of different nutrients SMALL INTESTINE
duodenum: iron, water, calcium, fats, sugars, protiens, vitamins, magnesum, sodium
diabetic neuropathy
pts w/ type 2 diabetes have a 30% or greater chance of developing diabetic neuropathy
Epogen can cause
hypertension
Urimic frost
early indication of renal failure
nephrotic syndrome
andibodies lodge in the glomeruli (Hep B, lupus, DM) NSAIDs, Antiboitics, Acetamenophen
3 causes of ACUTE Renal Failure
Prerenal: decreased CO and blood volume increased renal vascular resistance increaed concentration decrased sodium KIDNEY FUNCTIONS Normally
ADH causes water to
diffuse into the ascending limb of vasa recta and be reabsorbed at the proximal tubule
Potassium is SECRETED
distal convluted tubule
Potassium is REABSORBED by
Proximal convluted tubule
Glomerular filtration rate regulated by
autonomic nervous system atrial natriuretic factor renin-angiotensin system
Atrial natriuretic factor ANF: is excreted by the atrial of the heart to
vasodialate and increase urine output
waste product of protein metabolism
urea
GERD
esophogus is exposed to gastric acid due to reflux (upward movement of gastric juice into the esophagus); the Lower Esophageal Spinchter opens at the wrong time or too frequently
GERD S/S
Heartburn Regurgitation Dysphagia Waterbrash (sudden appearance of sour/salty fluid in mouth when salivary glands are stimulated by reflux)
GERD treatment proton pump inhibitor Omeprazole
used for symptomatic treatment peptic ulcers resuting from H.pylori, heartburn of GERD how it works: metabolized by P-450 system in liver Take BEFORE meals adverse effect: headache diarrhea Not recommended druing breast-feeding
Drugs related to Omeprazole
Nexium and Prevacid
Histamine 2 receptor antagonists Ranitidine (Zantac)
blocks histamine competitively at histamine 2 receptors in gastric parietal cells inhibits all phases of gastric acid secretion used for GERD, duodenal ulcer, gastric ulcer, pathologic hypersecretory conditons, to prevent upper GI Bleeding interacts w/ nurmerous other drugs Serious AE: (all rare) neutropenia, agranulocytosis, thrombocytopenia, anemia maxamizing therapeutic effects: give at least 2 hrs apart from anacids
Antacids (maalox, MOM, TUMs)
increase gastric pH, neutralize gastric acidity Used for upper GI disorders, GERD symptoms (heartburn, indigestion, and upset stomach)
Aluminum Hydroxide w/ Magnesium Hydroxide
Effects last longer if taken w/meals used in conditions of hypersensitivity to releive the symptoms of upset stomach, heartburn, gastric reflux, and sour stomach (all GERD S/S), and discomfort of peptic ulcer, prevents ulcer stress bleeding interacts w/many other drugs by increasing pH, alters absorption or binding w/ drugs Contraindication: avoid in chronic renal failure most common AE: constipation (aluminum), diarrhea (magnesium); combination usually negates both, but either still may occur potential electrolye imbalance Give 2hrs AFTER other drugs
Prokinetic agents Metoclopramide (Reglan)
used to relieve symptomsof diabetic gastropareis increases motility may be used to promote transit of barium through the GI tract after diagnostic procedures distributed throughout the body crosses blood brain barrier and placenta not highly protein bound small amount metabolized in liver, most excreted in urine reduce dose for pts w/ renal insufficiency Contraindications: GI hemorrhage; give cautiously to pts w/ Parkinson disease b/c they may experience exacerbation of symptoms AE: extrapyramidal symptoms, Parkinsonlike reactions, tardive dyskinsia(older women more likely to expeirence this), akathisia
Antiemetics Selective Serotonin Receptor Antagonists Ondansetron (Zofran)
preveings stimulation of type 3 serotonin receptors in the Chemoreceptor Trigger Zone (CTZ) used to prevent nausea and vomiting associate w/cancer chemotherapy and postoperative states AE: headache, constipation, malaise Serious AE: arrhythmias, hypotension, extrapyramidal effects Administer: 30 mins before treatment
Drug Significantly Different from Ondasetron (Zosan) Antidopaminergic drugs/ Phenothiazines (Phenergan)
block the action of dopamine used for nausea nad vomiting
Pharmocotheapeutics: Relieve discomfort of excess gas in the GI tract caused by swallowing air, postoperative gas distention, peptic ulcer, spastic or irritable colon, or diverticulitis; Promotes belching and the passing of flatus Diet: Assess dietary
Simethicone: Antiflatulent

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