THE RENAL SYSTEM AT A GLANCE Julie, Ashley, Christen, Candace, Jennifer, Sarah, & Cindy.
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Transcript of THE RENAL SYSTEM AT A GLANCE Julie, Ashley, Christen, Candace, Jennifer, Sarah, & Cindy.
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THE RENAL SYSTEM AT A GLANCE
Julie, Ashley, Christen, Candace, Jennifer, Sarah, & Cindy
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Objectives
BUN• When is it used• Nursing implications• Normal values • Abnormal result
Creatinine• When it is used• Nursing implications• Normal values • Abnormal result
Creatinine Clearance• When it is used• Nursing implications normal values • Abnormal result
Tests for BUN/Creatinine
Renal Diseases/Illnesses
Dialysis Methods
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Blood Urea Nitrogen
• Measures the amount of urea nitrogen in the blood• Urea is formed in the liver as the end product of
protein metabolism and digestion• Protein is broken down into amino acids during
ingestion, once in the liver, these amino acids are catabolized and free ammonia is formed.
• Ammonia molecules are combined to form urea, which is then transported by the blood to the kidneys for excretion.
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When is BUN Used?
• Used to assess kidney function and liver function as well as glomerular filtration rate.
• Levels reflect the balance between the production and excretion of urea.
• It may also be used to determine if body fluids are urine or not.
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Nursing Implications
• Explain procedure to the patient • Provide teaching regarding what the test will
be measuring.• Inform the patient that no fasting is required
with this test.• Monitor puncture site for bleeding
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Normal Values
• Normal values for an adult under the age of 90 years old are 2.9-7.5 mmol/L
• For patients over the age of 90, levels are 3.6-11.1 mmol/L
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BUN
• Cardiac Patients– Reduced Renal Perfusion– Intravascular Fluid Volume Deficit
• Increase as GFR decreases– ARF– CRF– Dehydration
• Altered Protein intake• Protein Catabolism
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Creatinine
• End product of creatine metabolism. • Creatine is an energy-requiring metabolite of the
skeletal muscle. • Creatine is converted to creatinine during metabolism
where it is filtered through the kidney’s and excreted. • Only a small amount of creatine is converted to
creatinine, this level remains stable except when there is damage to skeletal muscle.
• The measuring of creatinine is an indicator of renal function
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Indications
• Before administration of nephrotoxix medications, to assess renal function
• Check glomerular function• Monitor effectiveness of renal treatment• Check accuracy of 24 hour urine collection• Assess level of nephron damage
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Normal ValuesAge SI Units
Adult male 124-230 umol/kg/24hr
Adult female 97-177 umol/kg/24hr
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Nursing Implications
• Inform patient the test if used to assess renal function
• Obtain a detailed history, including medications• Discuss procedure with patient• Instruct patient as to proper procedure for
urine collection.• Discuss with patient the process of a 24 hour
urine collection.
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Factors effecting levels
Creatinine • Extremes of age and body size• Severe malnutrition or obesity• Disease of skeletal muscle• Paraplegia or quadriplegia• Vegetarian diet• Rapidly changing kidney function• Pregnancy
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Creatinine
• Increased In:– Nephritis – Chronic Renal Disease
• Decreased In:– Muscular Atrophy– Anemia– Advanced Degeneration of the Kidneys
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Creatinine Clearance
• Diagnostic test of renal function• Compares the amount of creatinine in a
blood sample and urine sample to determine rate the kidneys are clearing creatinine from the blood
• Measure of glomerular filtration rate
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Indications
• Determine extent of nephron damage in known renal disease
• Before administering nephrotoxic drugs• Accuracy of 24-hr urine collection• Assess glomerular function• Effectiveness renal disease treatment
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Normal Values
• Adult male 85-125mL/min/1.73 m• Adult female 75-115mL/min/1.73 m • Each decade after 40 y decrease of 6-7
mL/min/m (conventional units x 0.0167)
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abnormal result
• Degree of impairment:– Borderline: 62.5-80 mL/min/m– Slight: 52-62.5 mL/min/m– Mild: 42-52 mL/min/m– Moderate: 28-42 mL/min/m– Marked: Less than 28 mL/min/m
2
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Nursing Implications
• Inform patient of test• Obtain pt. genitourinary history & results of
related tests/procedures• Obtain list of medications pt. taking• Review procedure• Inform pt. urine timeframe of urine collection & to
void all urine in collection device• Sensitivity to social & cultural issues
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Creatinine Clearance
• Decreased In: – Kidney Diseases
• Acute Renal Failure• Chronic Renal Failure
• Increased In:– Diabetes– Renal Artery Obstruction– Renal Vein Thrombosis– Glomularulonephritis– Nephritis
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Tests For...
Creatinine• Blood/serum:
– Serum (about 1mL) collected in a red or tiger- top tube. Or
– Plasma collected in green- top (heparin) tube is also acceptable
• Urine:– Urine (5mL) collected from an
unpreserved random or timed specimen – needs to be collected in a clean plastic collection container
BUN• Blood/serum:
– Serum (about 1mL) collected in a red or tiger- top tube. Or
– Plasma collected in green- top (heparin) tube is also acceptable
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How to Test...
Blood Urine
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Random Specimen
Clean Catch• Female client procedure• Male client procedure
Timed• Obtain a 3L urine specimen
container, toilet-mounted collection device and a plastic bag for transporting the specimen container
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Dialysis
• When your kidney’s cannot adequately remove waste from your body dialysis may be implemented
• Pts can survive on dialysis for years• The only way to stop dialysis (and still survive)
is to have a kidney transplant
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Why Have Dialysis?
Because it treats:• Renal Failure • Edema• Hepatic coma • Hyperkalemia• Hypercalcemia• Hypertension• Uremia• Fluid overload• Pulmonary edema• Acidosis• Pericarditis• Severe confusion
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There are 2 Types of Dialysis
Hemodialysis Periotoneal Dialysis
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Hemodialysis
• Hemodialysis works to – remove toxins (N) & excess water from the blood
stream– maintain and restore the electrolyte balance &
acid-base buffer system (done in the dialyzer)– have ‘clean’ or filtered blood re enter the body as
it would when leaving the kidney
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Dialyzer
The blood filtering device
• Filtration through:• Diffusion – how the
toxins are removed • Osmosis – takes away
extra water• Ultrafiltration – takes
away extra water
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Complications• Artheriosclerotic cardiovascular
disease• Hypertriglyceridema• Amemia• Fatigue• Gastric ulcer• Fluid overload • Exsangulation• Hypotension• Muscle cramping• Air emboli • Dysrythmia• Chest pain• Cerebral fluid shifts
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Peritoneal Dialysis• Peritoneal dialysis is implemented to...– Remove the toxic fluids – Remove metabolic wastes – Re-establish normal fluid and electrolyte balance.
Who needs treatment?Who should not receive this
treatment?How to patients receive this treatment?
How does this effect a patient receiving this treatment?
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Complications
• Peritonitis• Leakage• Bleeding• Hypertriglyceridemia• Abdominal hernias• Clot Formation• Constipation
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References• Day, R.A., Paul, P., Williams, B., Smeltzer, S.C. & Bare, B. (2006).
Textbook of medical-surgical nursing. Philadelphia, PA: Lippincott Williams and Wilkins.
• McCance, K.L. & Huether, S.E (2006). Pathophysiology: The biological basis for disease in adults and children. St. Louis, MO: Elsevier Mosby.
• Myers, T. (Ed.). (2006). Mosby’s dictionary of medicine, nursing and health professions (7th ed.). St. Louis, MO: Mosby Elsevier.
• Pagana, K.D. & Pagana, T.J. (2010). Mosby’s manual of diagnostic and laboratory tests (4th ed.) St. Louis, MO: Mosby’s Elsevier Inc.
• Van Leeuwen, A.M, Kranpitz, T.R and Smith, L. (2006). Davis’s comprehensive handbook of laboratory and diagnostic tests with nursing implications (2nd ed.). Philadelphia, PA: F.A Davis Company.