GROUP ACTIVITY POWERPOINT PRESENTATION Abella, Fernie Acielo, Kharen Grace Celoso, Rickel Dasas, Gerald Cris Otayde, Ruffa Tolentino, Santa Rina
is a group of organs in the body concerned with filtering out excess fluid and other substances from the bloodstream.
Maintain blood volume and concentration
Vitamin D production
are two bean-shaped organs, one on each side of the backbone.
each contains from one to two million nephrons.
balance solute and water transport
excrete metabolic waste products
regulate acid – base balance
The nephron is a tube; closed at one end, open at the other. It consists of a:
Proximal convoluted tubule
Loop of Henle
Distal convoluted tubule
are bilateral tube approximately 10 – 12 inches ( 25 – 30) long. It has 3 layers:
Middle layer of smooth muscles
Outer layer of fibrous connective tissue
transport urine from the kidney to the bladder trhough peristaltic waves.
is posterior to the symphysis pubis. The sizre of the bladder varies with the amount of urine it contain. It can hold 300 – 500 ml of urine before internal pressure rises and signals the need to empty the bladder through micturation.
serves as a storage site for urine.
the bladder lies immediately in front of the rectum.
the bladder lies next to the vagina and the uterus.
is a thin-walled muscular tube that channels urine to the outside of the body. It extends from the base of the bladder to the external urinary meatus.
the urethra is approximately 8 inches long and serves as a channel for semen as well as urine. Prostate gland encircle the urethra at the base of the bladder.
the urethra is approximately 1.5 inches long and the urinary meatus is anterior to the vaginal orifice.
most metabolic processes occurring in the body result in the production of acid.
pH – a reflection of acid to base in extracellular fluid.
It is the hydrogen ion concentration of a solution.
normal pH: 7.35 – 7.45
ACIDS – any substance capable of liberating a hydrogen ion.
BASES – any substance that can accept hydrogen ion, thereby taking out of solution.
2 types of ACID-BASE REGULATION
chemical regulation - occurs through one or more buffering system by which Hydrogen ion are either added or eliminated.
Major chemical regulator of plasma pH is Bicarbonate-carbonic acid buffer system.
ratio = 20 parts bicarbonate-1 part carbonic acid maintains normal plasma pH.
oxygen regulation – lungs and kidneys facilitate the ratio of bicarbonate carbonic acid.
CO 2 + H 2 0 = H 2 CO 3 ( carbonic acid )
6.8 7.35 7.45 8.0
Death Alkalosis Normal Acidosis Death
ACID – BASE IMBALANCES
Acidosis- excessive accumulation of acids or excessive loss of bicarbonate in body fluids.
Alkalosis- excessive accumulation of bases or loss of acid in body fluids.
4 sub types:
METABOLIC ACIDOSIS ↓ ↓ Anorexia Nausea and vomiting Abdominal pain Weakness Fatigue General malaise Decreasing level of consciousness Dysrhythmias Bradycardia Warm, flushed face Hyperventilation acid production. acid excretion bicarbonate loss chloride pH HCO 3 PaCO 2 Rate and depth of respirations increase, eliminating additional CO 2 (bicarbonate deficit)- is characterized by low ph (<7.35) and low bicarbonate (<22 mEq/L). It may be caused by excess acid or loss of bicarbonate from the body.. Manifestation Causes ABG Compensatory Mechanism Definition
METABOLIC ALKALOSIS Confusion Decreasing level of consciousness Hyperreflexia Tetany Dsyrhythias Hypotension Seizures Respiratory failure bicarbonate excess pH HCO 3 PaCO 2 Rate and depth of respirations decrease, retaining CO 2 Metabolic alkalosis (bicarbonate excess) is characterized by high ph(>7.45) and high bicarbonate (>26mEq/L).It may be caused by loss of acid or excess bicarbonate in the body. Manifestation Causes ABG Compensatory Mechanism Definition
Diagnostic Tests: ABG – pH > 7.45 and bicarbonate > 26 mEq/L; PaCO2 is >45 mmHg Serum electrolytes - ↓ potassium-serum (< 3.5 mEq/L) and decreased chloride (< 95 mEq/L). Serum bicarbonate level is high. Urine pH - low (pH 1 to 3) if metabolic acidosis is caused by hypokalemia ECG pattern – show changes similar to hypokalemia. Medical management: Prescribing K ( potassium salt ) if hypokalemia is present or NaCl solutions to correct volume depletion when extracellular fluid volume has decrease rapidly.
RESPIRATORY ACIDOSIS ACUTE Headache Warm, flushed skin Blurred vision Irritability , altered mental status Decreasing LOC Cardiac arrest. CHRONIC Weakness Dull headache Sleep disturbance with daytime sleepiness Impaired memory Personality changes Retained CO 2 and excess carbonic acid. ↓ pH HCO 3 PaCO 2 Kidneys conserved bicarbonate to restore carbonic acid: bicarbonate ratio of 1:20 characterized by a pH of < 7.35 and a PaCO2 greater that 45 mmHg. It may be acute or chronic . In chronic respiratory acidosis, the bicarbonate is higher than 26 mEq/L as the kidneys compensate by retaining bicarbonate. Manifestation Causes ABG Compensatory Mechanism Definition
DIAGNOSTIC EXAM ABG’s show pH less than7.35 and Paco2 of more than mmHg Serum electrolytes may show hypochloremia (chloride level < 98mEq/L) in chronic respiratory acidosis. Pulmonary Function Test may be done to determine if chronic lung diseases is the cause of the respiratory acidosis. MEDICATION: Bronchodilator drugs Antibiotics prescribed to treat respiratory infections IV sodium bicarbonate
RESPIRATORY ALKALOSIS Dizziness Numbness and tingling around mouth , of hands and feet Palpitations Dyspnea Chest tightness Anxiety/panic Tremors, tetany seizures, loss of consciousness Loss of CO2 and deficient carbonic acid. pH ↓ HCO 3 ↓ PaCO 2 Kidneys excrete bicarbonate and conserve Hydrogen ions to restore carbonic acid: bicarbonate ratio Respiratory alkalosis is characterized by a pH greater than 7.45 and Paco2 of less than 35 mmHg. It is always caused by hyperventilation leading to a carbon dioxide deficit. Manifestation Causes ABG Compensatory Mechanism Definition
DIAGNOSTIC EXAMS ABG’s generally show a pH greater than 7.45 and Paco2 less than 35 mmHg. In chronic hyperventilation, there is a compensatory decrease in serum bicarbonate to less than 22 mEq/ L and the pH may be near normal. MEDICATIONS: sedative or anxiety
Hematuria, pyuria, dysuria, alternating oliguria and polyuria, and complete anuria
Nausea, vomiting, abdominal fullness, pain on urination, dribbling, and hesitancy
Severe, colicky renal pain or dull flank pain that may radiate to the groin
A ureteral stent (tube that allows the ureter to drain into the bladder)
percutaneous nephrostomy tube (allows the blocked urine to drain through the back)
A narrow or abnormal section of the ureter may be surgically removed
A nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein from the blood into the urine.
tiny blood vessels in the kidneys that filter waste and extra water from the blood is damaged.
High blood pressure
Increased aldosterone secretion Decreased Renal function Salt and water retention Decreased renal function Edema NEPHROTIC SYNDROME Reduced intravascular oncotic pressure Loss of fluid into the interstitial space Reduced plasma volume
Thromboemboli (mobilized blood clots)
Renal vein thrombosis
Deep vein thrombosis
Excess fluid volume related to edema and fluid retention.
Altered nutrition: Less than body requirements related to excessive protein loss and anorexia.
Risk for infection related to suppression of inflammatory response.
Risk for impaired integrity related to edema.
ACE inhibitors with loop diuretics
Mineral & electrolyte replacement
Monitor intake and output.
Check urine protein levels frequently
Give diuretics in the morning
High protein, low sodium diet
Give prophylaxis medication
Give potassium supplements
Give mineral and electrolytes supplements
Provide good skin and oral care.
Urinary Tract Infection
Occurs when host resistance is impaired
Common in women
Can be acquired through blood or lymph or may enter urethra
May occur in upper portion of the urinary tract (pyelonephritis) or in lower (cystitis, urethritis)
tight-fitting synthetic undergarment
impaired bladder innervation
a.) Urethritis - inflammation of urethra
b.) Prostatitis – infection of prostate gland
c.) Cystitis – inflammation of urinary bladder
Abdominal pain or tenderness over the bladder area Hematuria
Cramps or bladder spasms
Feeling of warmth during urination Nausea and vomiting
Urinary urgency and frequency
a.) Pyelonephritis – inflammation of kidneys( 3 renal pelvis)
Acute – usually results from an infection that ascends to the kidney from lower UTI
Chronic – involve chronic inflammation and scarring of the tubules and interstitial tissues of kidneys
Infection gain access to bladder SCHEMATIC DIAGRAM Colonized epithelium Evade host defense mechanism Inflammation Organisms ascends to urethra and bladder ADHERE MUCOSAL SURFACES
Urinalysis- RBC & WBC increased, Pyuria
Gram stain of the urine
Urine culture and sensitivity
Voiding cystoureterography or excretory urography
CXR of kidney, ureter and bladder
Renal or perirenal abscess formation
Acute pain related to infection within the urinary tract.
Risk for infection related to reflux of urine into the urinary tract.
Impaired urinary elimination.
Ineffective health maintenance.
2.Anticholinergics and antispasmodic- Ditropan and propantheline
Nephritis – describes a group of inflammatory but non infectious diseases characterized by wide spread kidney damage.
Glomerulonephritis – is a type of nephritis that occurs most frequently in children and young adults.
- twice in men than women.
appears about 2-3 weeks after an URTI with group A beta-hemolytic streptococci, impetigo and viral infections such as mumps, hepatitis B or HIV may precede to A.G.
Antigen( group A beta hemolytic streptococcus Antigen-antibody product Deposition of the antigens-antibody complex in glomerulus Increased production of epithelial cells lining the glomerulus Leukocyte infiltration of the glomerulus Thickening of the glomerular filtration membrane Scarring and loss of glomerular filtration membrane Decreased glomerular filtrations PATHOPHYSIOLOGY
Edema and hypertension
In some severe cases/form of this disease may complain of:
Engorged neck veins
URINALYSIS - gross or microscopic hematuria gives the urine a dark, smoky of frankly bloody.
elevated anti – streptolysin o titer
slightly increased BUN and serum creatinine levels
Salt and water retention
Edema, periorbital and facial, dependent
Anorexia, nausea and vomiting
fluid volume excess related to increase Na ion retention.
infection related to group A β – hemolytic streptococcus
high risk for decrease cardiac output related to hypervolemia
risk for injury: Seizures related to hypertensive encephalopathy.
pain related to inflammatory response.
knowledge deficit related to new diagnosis.
Antibiotics for streptococcal infection
Antihypertensive if blood pressure severely elevated
Digitalis if circulatory overload
Fluid restriction if renal insufficiency
Peritoneal dialysis if severe renal or cardiopulmonary problems develop
bed rest when bp is elevated & edema is present.
Bp every 4 Hours as ordered.
encouraging adequate fluid intake.
Na & Protein are restricted.
increase in CHO to prevent catabolism of body protein stones.
A slow progressive disease characterized by inflammation of the glomeruli.
causing irreversible damage to the nephrons.
post streptoccal Glomerulonephritis
rapidly progressive Glomerulonephritis
generalized edema known as Anasarca (fluid shift from intravascular to interstitial & intacellular location.
Slow, progressive destruction of the glomerolus Cortex layer shrinks to 1-2 mm in thickness Bands of scar tissue distort the remaining cortex Surface of the kidney becomes rough & irregular shape Scarring at the glomeruli & tubules Thickenned branches of the renal artery Severe glomerular change End stage renal disease PATHOPHYSIOLOGY GLOMERULONEPHRITIS CHRONIC