Altered Elimination Multi System Problem
Altered Elimination Multi System Problem
Layers:
Fascia – wraps around the whole kidney to the PCT – Creatinine, drugs, H
vena cava DCT – H, K
NOTE: HOW MANY LITERS OF BLOOD DOES URINE – 95% h2o, nitrogenous waste, ions,
KIDNEY FILTER EACH DAY: 142L OF BLOOD (but metabolites, wbc and rbc (low levels)
only 2L becomes urine)
RENAL ASSESSMENT:
Urine Formation:
“Kidneys filter and remove” Hyponatremia (<130) – usually asymptomatic
Obvious signs – gross hematuria (blood in Treatment: increase by 0.5 mEq/hr (if seizures
urine), complaints of flank pain is present = increase by 2.4 mEq/hr)
Signs require more assessment – edema, CHEM-8 (Potassium [K+]) – 3.5-5 mEq/L
Hypertension, Signs and symptoms or uremia
Special role for: muscle contraction, fluid
Silent (asymptomatic) signs – Elevated serum balance, nerve transmission
creatinine, abnormal urinalysis results
Check: https://youtu.be/LJai9zjFnTs for chem-8
(Read more on acute kidney injury (AKI) or
acute renal failure (ARF) or chronic renal
➢ CMP – Comprehensive Metabolic Panel
disease)
- Test for liver function
Early identification = Safety - Test for Alkaline Phosphate, AST, ALT,
Bilirubin, Total protein, albumin
- Monitoring and screening of pt’s kidney
function can identify problems earlier
and allow for intervention to slow the
progression of kidney disease
- When disease or damage is discovered,
additional testing is a priority to
determine the degree of damage
and/or progression
DIAGNOSTIC EXAMS
2 Types:
Hypernatremia (>145-150)
- Calculi
- Malignancy
- BPH
- Urethral strictures
PRERENAL vs INTRARENAL/RENAL
MANAGEMENTS FOR AKI: DURING (Cont.)
DURING:
NOTE: Watch out for dehydration (during - Safest is ISOTONIC (Plain NSS, lactated
diuretic phase) ringers)
- IV – large bore needles (to prepare for
CHRONIC KIDNEY DISEASE
the possibility of blood transfusion,
Kidney damage many side drips in a single line)