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NR 507 Week 4: Alterations in Renal and Urinary

NR 507 Week 4: Alterations in Renal and Urinary

NR 507 Week 4: Alterations in Renal and Urinary

Week 4: Open Forum Discussion 

This is a required, but not graded open forum. Please feel free to post questions related to content or assignments. 

 

  • In our lesson this week, we covered the renal system and it’s functions. We learned about the various issues that can arise like an obstruction, calculi, an infection like a UTI, cystitis, and pyelonephritis, or an infection in the kidney. We then looked at common diseases and disorders that can occur in this system like cancer and nephrotic syndrome. Most of my time this week, however, is going toward studying for the midterm. Looking over the study guide, I found that I should probably take some extra time to look at epigenetics as it is a concept that I can sometimes struggle with. For some reason, DNA and genes and all the accompanying topics are definitely not my favorite part of biology, so I know I need to study those just a bit harder. Good luck on the exam everyone! 

I am also not a great fun of DNA and genetics. I read the chapter on epigenetics and disease. One process I found interesting is, gene silencing (Imprinting), in which genes are inevitably silenced, regulated on which parent transfers them (McCance, Huether, Brashers, & Rote, 2013). I also learnt that imprinted genes are densely methylated in comparison to the nonimprinted clone of the allele, which is usually not methylated (McCance et al., 2013). Disease of imprinting that is consorted with deletion of approximately four million base sets (Mb) of the protracted arm of chromosome 15 (McCance et al., 2013).

When this genetic deletion is from the father, the child exhibits Prader-Willi syndrome, whose clinical representation includes, short height, loss of muscle tone, small upper and lower extremities, obesity, mild to modest mental retardation and hypogonadism (McCance et al., 2013). The same 4-Mb deletion passed down from the mother results in Angelman syndrome, which is distinguished by severe mental retardation, seizure, ataxic posture and spells of unsuppressed laughter (McCance et al., 2013). According to McCance (2013), these illnesses are both seen in one of every 15,000 live births and chromosome deletions are accountable for about 70 percent of cases in both illnesses. 

References 

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby 

class, in this week lesson of the renal system it is whort knowing the difference between the nephrotic syndrome and acute glomerulonephritis.   

Both diseases attract the kidney and result in renal dysfunction.  As a nurse practitioner, it is good to pay attention to the hallmark signs of both diseases since acute glomerulonephritis and nephrotic syndrome have a similar characteristic. Glomerulonephritis is the inflammation of the glomerulus resulting to leakage of into the urine.red blood cells (RBCs) and protein tea-colored urine (cola colored) from hematuria recent strep infection. The cause of the patient disease is not due to strep infection but is due to the bodily reaction to antigen in strep 

Nephrotic syndrome, on the other hand, is due to changes to the glomerulus of the nephron that causes leakage of massive protein greater than 3 grams (Proteinuria) in the urine, hyperlipidemia, hypoalbuminemia, foamy frothy urine dark yellow in color,  generalized edema that start around the eyes and spreads to  other systems of the body. 

 The filtrating system in the glomerulus is faulty in nephrotic syndrome they are bigger than their regular size and allows proteins to pass through. In acute glomerulonephritis there is presence of protein but not to compare to the protein loss in the Nephrotic syndrome. 

This week’s reading covers changes in the body that affect normal renal functioning. Two specific points of focus are functional and anatomical urinary obstructions. Causations mentioned in the text are urinary calculi (kidney stones) and strictures within the urinary tract. Common causes of renal calculi are consistent dehydration and consuming too much salt. What are some other possible causes of renal calculi? A medical stricture is the narrowing of a body passage, such as a tube or a canal. For example,  scar tissue or a tumor may obstruct the ureter. What are some congenital strictures that affect the kidney and disrupt the normal flow of urine or result in renal dysfunction? 

First, I would like to wish everyone good luck on the mid-term, it is much material to study, but we can do it. In week four readings I learned about the function of the renal system and the different disorders that can affect our body. I didn’t realize that ureter stricture is so prevalent in men until I started working in the hospital.  Restraints within the urinary tract may create an anatomical obstruction. It looks like it is a simple problem. However, these men need to undergo surgery and many times the surgeon will take tissue from the buccal mucosa and put in on the penis as a graft.

According to (McCance, 2013) A urethral stricture is a narrowing of its lumen. It occurs when infection, injury, or surgical manipulation produces a scar that reduces the caliber of the urethra. Most urethral strictures occur in men. Urinary tract infection is common in male and female. Female are more susceptible to having a UTI because of the urethral tract and the fact that our vaginal and anal anatomy is closely related. In the lesson it said that sexually active female and pregnant women are at higher risk to develop UTI, I Can relate to that findings.  

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby. 

WK 4 Open Forum 

This week’s reading material is focused on the pathophysiology and alterations of the renal and urologic systems. Both organ systems according to our textbook and knowledge ascertained throughout the years working not only psychiatric, but other medical disciplines. That we care for patients during vulnerabilities secondary to acute exacerbations of medical comorbidities.  Our textbook References the importance of both organs and appendages in maintaining homeostasis the body. Through the regulation of fluid volume and the removal of toxins and excess waste.

Over the years in the medical discipline, one the principles that remained a constant in my mind that was learned from nursing school, was the need to discontinue the medication Glucophage also known as metformin. At least 48 hours before a patient would be administered radiocontrast media. The generalized understanding was that the pharmacokinetics of the contrast media and Glucophage would lead to a potential toxic level of lactic acid which could progress to lactic acidosis. As a result of the material used in this week’s lesson, the writer learned another fundamental principle.

Which consists of factors that contribute to ischemic acute tubular necrosis (ATN). One of the primary causes of intrarenal acute kidney injury secondary to ischemia have been closely associated with significant exposure to “antibiotics and radio contrast media” and medical conditions such as “glomerulonephritis, disseminated intravascular coagulation (DIC), vascular disease and malignant hypertension” (McCance, Huether, Brashers, & Rote, 2014, p. 1360). 

References 

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2014). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, Missouri: Mosby 

This week has provided information on the renal system. The renal system plays an important role in our body as it filters and excretes unwanted ion, chemicals, and excess water that the body does not need. The primary functioning unit of the kidney is the nephron. The nephron is a microscopic unit that is made of the glomerulus, proximal convoluted tubule, loop of henle, distal convoluted tubule, and the collecting duct (McCance & Huether, 2014). Plasma is filtered through the afferent arteriole into the glomerulus then travels through the entire nephron to create urine. The loop of henle plays a vital role in electrolyte and fluid balance. The descending loop of henle is highly permeable to water and the ascending loop of henle is highly permeable to ions. It is essential to monitor GFR, BUN, and creatinine levels in patients to determine if renal functioning is adequate.  

McCance, K. L. & Huether, S. E. (2014). Structure and function of the renal and urologic system, Pathophysiology: The biologic basis for disease in adults and children, seventh edition (1319-1338). St. Louis, Missouri: Elsevier Mosby 

 classmates, from this week lesson, it was refreshing reviewing the anatomy and functions of the renal and urologic organs especially the kidneys (McCance, Huether, Brashers, & Rote, 2013). I gained more knowledge about various urinary tract infections, both descending and ascending infections. Renal disorders such as; Acute and chronic glomerulonephritis, acute tubular necrosis (ATN), their individual pathophysiology, and how they could both lead to kidney failure if not promptly and properly managed. 

I learned about the causes, stages, and clinical manifestations of both acute kidney injury and chronic kidney failure (McCance, Huether, Brashers, & Rote, 2013).  Another notable important reminder from this week lesson was about the decrease in glomerular filtration rate with aging, hence as a medication prescriber, one must be mindful of drug dosing for the elderly population to avoid medication toxicity due to lack of clearance which may result in a sort of kidney damage and other complications (Chamberlain College of Nursing, 2018). 

Finally, I also learn about different renal and urologic impairment in children some of which are congenital in origin. 

                    

                                          References 

Chamberlain College of Nursing. (2018). NR -507 week 4 alteration in renal                        function (online lesson). Downers Grove, IL. DeVry Education Group.                        Retrieved from                                                                                                             https://chamberlain.instructure.com/courses/30057/pages/week-                               4-lesson?module_item_id=3471558 

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S.                                             (2013). Pathophysiology: The biologic basis for disease in adults and                         children (7th ed.). St. Louis, MO: Mosby. 

 

            This week our primary focus is on the renal system. I have always been fascinated with the renal system because it plays such a vital role in filtering out the unwanted substances in the blood stream and can affect all other body organs if the process is interrupted. In the healthcare field I feel it is very common to see renal diagnosis and complications of some diseases such as chronic renal disease. My grandmother had chronic renal disease and it was a long process that involved dialysis and many other health conditions as a result of the renal disease. One topic that I always find interesting in the renal system is obstruction such as kidney stones.

While reading this week I found it interesting that depending on where the obstruction is located highly impacts the complications that arise. I have seen many individuals who have kidney stones present with severe flank pain, nausea, and vomiting. I have always found it interesting calcium is one of the main culprits of kidney stone formation. I have visualized a passed kidney stone before and was surprised that something so small can cause so much discomfort however, I have also visualized stones that I would have thought impossible to pass without surgical intervention.

Healthcare continues to advance with treatment techniques to remove stones from the ureters of patients who will not be able to pass the stones on their own. I feel this is a very interesting topic along with all of the other great information learned this week in regards to the renal system. This week is also our midterm and I must admit I am very nervous to see the questions that will be asked. I have spent the week in an attempt to review all of the learned information and focus in on the study guide outline. I hope everyone succeeds and does great on the midterm and can continue our journeys to becoming advanced practice nurses. 

Reference 

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2014). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, Missouri: Mosby. Chapter 38. 

This has been a very informative week as we gained a deeper understanding of the renal system, its pathophysiology, the different disorders that stem from the kidneys and their causes, and what we often see in the hospital as manifestations of acute and chronic kidney failure (McCance & Huether, 2014). The kidneys play a vital role in helping to maintain homeostasis within our bodies by regulating fluid volume and removing toxins and waste our bodies produce. They use many different mediators to help in this role including adenosine, natriuretic peptides, etc. which help to maintain renal blow and different functions of the kidneys such as diuresis (McCance & Huether, 2014).

One of the procedures perfumed in my department quite often is a paracentesis where we drain ascitic fluid from a patient; while the main cause is usually directed at the liver, the kidneys can also be a culprit for this condition. Having a full understanding of the pathophysiology behind the renal system will help to educate and answer questions patients are having as to why this is happening, why the fluid “keeps coming back”, etc. I also appreciated the refresher on how the filtration rate starts to decline in aging patients; this is a major consideration in prescribing medications to elderly patients and how the effects of medication and their durations change because of having a reduced filtration rate (McCance & Huether, 2014). 

McCance, K. L. & Huether, S. E. (2014). Structure and Function of the Renal and Urologic Systems, Pathophysiology: The biologic basis for disease in adults and children, seventh edition (1063-1068). St. Louis, Missouri: Elsevier Mosby 

This week has been a very interesting week with regards to our readings and trying to study for the midterm exam.  We covered some great topics this week and I leaned towards the renal system and its function.  At the beginning of my nursing career I worked on a Med/Surg unit and of course we had our fair share of UTI’s and Rental stone patients.  

  • Kidney stone – kidney stones affects 10% of people between the ages of twenty and sixty years old, and a recurrence rate within 5-10 years (Dawson & Tomson, 2012). Kidney stones are a result of the growth of crystals into stones.   These crystals are formed in urine that is supersaturated with particular salts such as calcium oxalate, sodium urate, magnesium ammonium phosphate, or cysteine (Sakhaee, 2014). There are mainly four types of kidney stones. 

Calcium oxalate stones are the most common type of stones, accounting for over 70% of all stones. These stones develop under a high degree of supersaturation, crystallization inhibitors, and urinary stagnation. Supersaturation occurs with high concentration of salt within the urine. These stones typically form by eating too much calcium or vitamin D. Genetics and certain medications can increase formation also (Rajat, Anu, & Sumeet, 2011).  

Kidney stones tend to be located either at the area of prior injury or in gravity dependent locations such as lower pole calices. These stones can be small or large in size. Depending on the size of the stone, it can either be voided with urination, or if the stone is too large, lithotripsy or surgery may be required (Malan et al., 2011).  Depending on the size of the stones, individuals may experience considerable pain during their journey through the urinary tract due to the sharp edges of the large stones that may gouge into the walls of the ureters and sometimes the urethra.

This severe pain is called renal colic, and comes in waves that may cause the person to double over. Pain may be localized in the flank or pelvic area, and often to one side. Other symptoms include; nausea, vomiting, fever, sweating, difficulty voiding, and possible hematuria. 

Reference 

Dawson, C. H., & Tomson, C. V. (2012). Kidney stone disease: pathophysiology, investigation and medical treatment. Clinical Medicine, 12(5), 467-471. 

Rajat, M., Anu, W., Sumeet, G. (2011). New Frontiers on Nephrolithiasis: Pathophysiology andManagement of Kidney Stones. International Journal of Research in Avurveda & Pharmacy, 2(3), 775-786. 

Sakhaee, K. (2014). Epidemiology and clinical pathophysiology of uric acid kidney stones. Journal Of Nephrology, 27(3), 241-245. doi:10.1007/s40620-013-0034-z 

This week has enlightened me more on the renal system and especially the nephron which is the functional unit of the kidney. There are three types of nephrons. 1. superficial cortical nephrons
2. mid-cortical nephrons
3. Juxtamedullary nephrons NR 507 Week 4: Alterations in Renal and Urinary

Superficial cortical nephrons account for 85% of nephrons which extend partially to the medulla. superficial nephrons have glomeruli located near the surface of the kidney and give rise to short-loop nephrons.  

Mid-cortical nephron: Mid-cortical nephrons have glomeruli located between the superficial and juxtamedullary glomeruli and have short or long loops. The deeper the location of the glomerulus, the greater the likelihood that its tubule will descend into the inner medulla. 

Juxtamedullary nephrons: Juxtamedullary nephrons have glomeruli, that are located deep within the cortex, near the cortico-medullary border, and give rise to long-loop nephrons. 

References 

Basiratnia, M., Kosimov, M., Farhadi, P., Azimi, A., & Hooman, N. (2017). Urinary Calprotectin as a Marker to Distinguish Functional and Structural Acute Kidney Injury in Pediatric Population. Iranian Journal Of Pediatrics, 27(5), 1-6. doi:10.5812/ijp.9727 NR 507 Week 4: Alterations in Renal and Urinary

Reading about the structure and function of the renal system this week has been a great refresher. 

I administer many medications that have a direct or indirect effect on kidneys to my patients.  For example, diuretics such as Lasix (Furosemide) or Spironolactone are popular medications used in the hospital.  It is important to monitor potassium levels, blood pressure and urinary output when administering diuretics especially Lasix.  Diuretics increase urine flow and decrease extracellular fluid volume. They are used to treat edema and hypertension secondary to heart failure.  

Lasix blocks active transport of chloride, sodium, and potassium which can cause hypokalemia and uric acid retention and may alter acid-base and electrolytes.  There are many types of diuretics which work in different areas of the renal system. In most cases, hypokalemia is a side effect of diuretics accept for potassium sparing diuretics such as Spironolactone.  Spironolactone, a potassium-sparing diuretic, retain potassium and may cause hyperkalemia, nausea, and confusion (Doig and Huether, 2014). NR 507 Week 4: Alterations in Renal and Urinary

Reference 

Huether, S., & Doig, A. (2014). Structure and function of the renal and urologic systems. In K. McCance, S. Huether, V. Brashers, & N. Rote, Pathophysciology: The Biologic Basis for Disease in Adults and Children Vol. 2(p. 1333). St. Louis: Elsevier Mosby. NR 507 Week 4: Alterations in Renal and Urinary

I apologize for the post being so late but my work schedule has been horrific as I have been working from 7am to 2am.  No excuses.  This week, the Renal and Urologic Systems were covered and I learned about the structure and function, alterations of the renal and urinary tract functions in adults as well as children.  Having sent an elderly person out to the emergency for a urinary tract obstruction, it was noted that her diet consisted of drinking tea to which she had a stone.  Many of my patients have a diagnosis of neurogenic bladder as well as the common overactive bladder syndrome. 

This is one area that I am going to really have to spend time on as a lot of elderly patients are affected.  I am a case manager and visit patients at their house. I just took on this position last week and am getting used to the paper work as well as calculating a route to see the patients.  One patient was 61 miles one way.  Anyway, it is a good learning experience and I do need more time to study to which I am going to approach my boss tomorrow.  I must say that I never realized that children could have urinary incontinence.  This is very interesting.  I thought bedwetting was something normal in small children but as I have read the book and looked at this more in details, I see that they can get bladder infections as their ureters are smaller in size.  Please correct me if I am wrong.  But the structures are smaller which can invite bacteria.   NR 507 Week 4: Alterations in Renal and Urinary

 

This week’s lesson on the renal system peaks my interest after having a family member develop chronic kidney disease, and later go on to receive a kidney transplant. The population I serve in the area I live consists of a high ratio of dialysis patients. The majority of the patients that come through the emergency department do not provide adequate care for themselves which results in the frequent visits to the ER and subsequently an admission. The renal system is imperative in providing adequate filtration to rid the body of noxious wastes that are harmful to the body if not excreted. NR 507 Week 4: Alterations in Renal and Urinary

One of the most intriguing things I learned this week was calcium being the predominant composition of renal calculi. I often educate my patients to strain their urine after each urination in attempts to catch the stone so it can be examined to assist in finding out the cause of the calculi. It was interesting to see such a high percentage of stones being calcium derived. Overall, a very educational week while learning more about the renal system.