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