8. Renal Column - support the cortex of the kidney. Renal Sinus - cavity within the kidney which houses the renal pyramid. Renal Artery – carries oxygenated blood from the heart to the kidneys. Hilus - opening of the kidney where nerves and blood vessels pass through into the renal sinus. i. Renal Vein - carries deoxygenated blood from the kidneys to the heart.
9. Nephrons - the basic structural and functional unit of the kidney. There are typically over 10,000 kidney nephrons in each of the two kidneys a. Renal corpuscle (glomerulus and Bowman's capsule) - beginning of the nephron an initial filtering component. b. Renal tubule - containing the tubular fluid filtered through the glomerulus.
20. - 2 forms: 1. high anion gap acidosis 2. normal anion gap acidosis B. Compensatory Mechanism - increased ventilation and renal retention of bicarbonate - lungs “blow off” CO2 to raise pH and conserve HCO3-
21. C.Laboratory Findings (ABG) - low plasma pH (below 7.35) or a normal pH (if compensated) - normal PCO2 or low if compensated in an attempt by the lungs to blow off more acid - low plasma bicarbonate: -below 21 mEq/L in adults,below 20 mEq/L in children - low urine pH (below 6)
22. D. Causes -DKA or Diabetic Ketoacidosis with starvation -Salicylate overdose -Lactic Acidosis 2o hypoperfusion -Methanol and ethylene Glycol toxicity -uremia
23. E. Manifestations A. Acute - headache, drowsiness, nausea and vomiting, confusion - increased RR and depth, shock, peripheral vasodilation, dysrhythmia, cold and clammy skin, decreased BP B. Chronic -asymptomatic
24. F. Medical and Nursing Management 1. Correct metabolic defect 2. If resulted from excessive intake of Chloride, eliminate the source of Chloride. 3. Administer bicarbonate if pH < 7.1 and bicarbonate level < 10. 4. Closely monitor serum potassium level 5. Correct hypokalemia
25. 6. Give alkalizing agents, if serum bicarbonate level < 12meq/L 7. Hemodialysis 2. Metabolic Alkalosis (Base Bicarbonate Excess) A. Definition - marked by the heavy loss of acid from the body or by increased level of bicarbonate - characterized by increased pH and increased plasma bicarbonate.
26. B.Compensatory Mechanism - decreased ventilation to conserve CO2 and increase the PaCO2 - lung retains CO2 to lower pH - kidney conserves H+ to excrete HCO3 C. Laboratory Findings (ABG) - high plasma pH (above 7.45), normal or high PCO2 (above 45 mmHg) as a compensatory elevation
27. - high plasma bicarbonate (above 28 mEq/L in adults andabove 25 mEq/L in children) - high urine pH (above 7) D. Causes - overzealous administration of sodium bicarbonate - excessive or prolonged vomiting,excessive diuresis, excessive diarrhea - gastric suction with loss of hydrogen and chloride ions, pyloric stenosis
28. - hyperaldosteronism, Cushing’s syndrome - villous adenoma, cystic fibrosis, hypokalemia E. Manifestations a. Acute - tingling of fingers and toes -slow, shallow respiration (compensatory), respiratory depression
29. - hypertonic muscles,tetany, decreased motility and paralytic ileus - mental dullness,dizziness - atrial tachycardia may occur,ventricular disturbances. b. Chronic - same with acute metabolic alkalosis - PVC (premature ventricularcontractions or U-waves seen in ECG)
30. F. Medical and Nursing Management: 1. Sufficient chloride must be supplied. 2. Restore normal fluid volume by administering sodium chloride fluids. 3. In patient with hypokalemia, administer potassium as KCl. 4. Administer H2-receptor antagonist such as Cimetidine (Tagamet) to reduce the production of gastric HCl, thereby decreasing the metabolic alkalosis associated with gastric suction. 5. Carbonic anhydrase inhibitors are useful in patients who cannot tolerate rapid volume expansion.
31. 6. Monitor fluid intake and output. 7. Correct the underlying acid-base disorder. 3. Respiratory Acidosis (Carbonic Acid Excess) A. Definition - marked by an increased arterial CO2 concentration (PaCO2), increased carbonic acid, increased hydrogen ion concentration (low pH), may be acute or chronic - due to inadequate excretion of CO2 with inadequate ventilation
32. B. Compensatory Mechanism - excess hydrogen is excreted in the urine in exchange for bicarbonate ions - kidney eliminate hydrogen ion and retain HCO3 - kidney will retain increased amounts of HCO3 to increase pH
33. C. Laboratory Findings (ABG) - low plasma pH (below 7.35) or a normal pH (if compensated) - increased PCO2 (above 45 mmHg) - normal or high plasma bicarbonate (HCO3) if compensated - above 28 mEq/L in adults - above 25 mEq/L in children
34. D. Causes - respiratory depression (drugs, CNS, trauma),pulmonary diseases (COPD, asthma, pneumonia),hypoventilation, acute pulmonary edema, atelectasis - cardiac arrest/respiratory arrest, ventricular fibrillation (in anesthesized person), hyperkalemia - head and spinal cord injury, increased ICP, narcotic coma - aspiration of a foreign object - papilledema - dilated conjunctival blood vessels
35. E. Manifestations a. Acute - increased RR, PR and BP - mental cloudiness, feeling of fullness in head, mental alertness and disorientation - hypoventilation, shallow respiration,poor exhalation - cerebrovascularvasodilation, increased cerebral blood flow
36. b. Chronic - cerebral vasodilation will increase ICP - cyanosis and tachypnea will develop,pneumothorax - overdose of sedatives - sleep apnea syndrome - ARDS - muscular dystrophy - myasthenia gravis - Guillain-Barre Syndrome
37. F. Medical and Nursing Management 1. Improve ventilation 2. Bronchodilators 3. Antibiotics 4. Thrombolytics 5. Pulmonary hygiene measures
38. 6. Adequate hydration 7. Supplemental oxygen PRN 8. Mechanical ventilation, use appropriately 9. Semi-Fowler’s position
39. 4. Respiratory Alkalosis (Carbonic Acid Deficit) A. Definition - marked by decreased PaCO2 and increased pH - clinical condition in which the arterial pHis greater than 7.45 and the PaCO2 is less than 38 mmHg - acute and chronic condition may occur
40. B. Compensatory Mechanism - renal excretion of bicarbonate increase, and hydrogen ion is retained - kidneys will excrete increased amounts of HCO3 to lower pH - kidneys conserve H+and excrete HCO3
41. C. Laboratory Findings (ABG) - high plasma pH (above 7.45) - decreased PCO2 (below 35 mmHg) - decreased plasma bicarbonate as a compensatory measure - below 21 mEq/L in adults and below 20 mEq/L in children - high urine pH (above 7)
42. D. Causes - extreme anxiety,“panic” attack - hypoxemia, gram-negative bacteremia, low serum bicarbonate level - early phase of salicylate intoxication - inappropriate ventilator setting - chronic respiratory alkalosis results from chronic hypercapnia
43. E. Manifestations a. Acute - lightheadedness,inability to concentrate, loss of consciousness at times, mental restlessness and agitation progressing to hysteria - numbness and tingling from decreased calcium ionization - tinnitus - tachycardia,ventricular and atrialdysrhythmias - deep or rapid breathing - paresthesias
44. F. Medical and Nursing Management 1. Instruct patient to breathe more slowly to allow CO2 to accumulate or breathe into a close system (such as a paper bag) 2. Sedative may be required 3. Correct underlying problems
![The Urinary System ,[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)