Fluid, Electrolytes, Acid-Base, and Renal Review for Nursing Exam

progress okay so guys i will have no um notes i'm sorry i will not gonna

be sharing my screen just get your notes and your learning

decks and if you have copied the list of concepts that would come out in

the exam then please be guided by that so let's start with fluid electrolytes and as we

all know fluid is 60 of a normal adult's body weight okay so once again

it is of the best indicator of fluid loss or fluid gain is our body weight they are directly related okay

now and because of that guys we also should know that um there are differences in the

um in the fluid content of the body of both male and female for example for male and

female we expect more fluids in men because we have more muscles and women has more fat um tissue and fat tissue

once again doesn't have water okay that's why

okay supposedly men would have more water um from obese and thin people okay or normal weight people

obese people would have lesser water in them too okay

as well as um the younger you are the more water you have the older you get the lesser water you have

okay so those are the differences when it comes to fluids all right so um uh what else um

about water and water has so many functions right um it is involved in thermoregulation it's involved in um

delivering oxygen and nutrients to the tissue to your plasma and when we say bodily fluids is a

combination of water and electrically charged ions which we call

electrolytes okay now we have so few electrolytes that we want to focus on um

uh for example if we talk about uh remember guys elect electrolytes or electrically charged ions and we have

two charges right we have the positive charge and the negatively charged ions the positively charged are known as cut

ions and the negatively charged are called an ions okay

not onion not onion and ions okay so um and do remember the relationship right there should be between uh balance

rather between the cut ions and an eye and an ions within the cell and outside the

cell thus if a cation has to go out of the cell cut iron from the outside of the cell should also come in

as basic rule or principle and maintaining homeostasis now

if you are asked what are the uh what is the most abundant cat iron inside the cell your answer will be

yeah yeah yeah you're right potassium okay potassium is the major cut iron intracellularly what about

extracellularly very good good job what about anion intracellularly

potassium phosphate what's faithful very good what about extracellularly

all right all right all right good job guys so basically this gives us the idea of the

relationship between potassium and sodium specifically on um

sodium potassium pump system which is very important for your muscle contraction or for the function of your

muscles now apparently when we talk about sojourn potassium pump system it's a very good example of what

is it just an active um uh uh sorry i got lost

uh somewhere there is it um active transport or just a diffusion or is it a passive transport

what is it transparent what is it lisa

yeah very good transport a very good example of active transport good job girl all right so

let's move on anyways lisa i cannot promise you anything anymore because you have always

been in the list of those people with bonus okay so that now um let's talk about the

different um mechanisms or principle to maintain homeostasis so we just give an example

of actual transport right active transport the best example for that is the sodium potassium pump system we're

in when we say active transport there is what uh uh expenditure atp expenditure meaning

energy is needed right so that there will be openings of this protein embedded within the cellular wall so

that there will be an exchange of potassium and sodium okay next would be um

passive transport passive transport it's just basically um uh

you know the exchange of whatever doesn't even have an exchange but it's definitely as

i said that to maintain homeostasis there should be exchanges of this electric uh electrolytes thus guys when

we say positive think of the smallest uh molecule that can just go in and out without the use of energy or expenditure

of energy within those channels of protein embedded in the cellular wall um and we call that guys what do we call

that again when there is uh okay um transport of let's say electrolytes or any molecule

from lower a higher concentration to a lower concentration what do we call that what's the term

right here job now what if it's the movement of water

from an area of lower concentration of soyuz to a higher solution

very good very good what about what type of uh or what principle um when it comes to homeostasis um which

makes use of the hydrostatic and the osmotic filtration concentration

good good job y'all okay now comes with filtration as well as with osmosis is

the concentration of sodium and then we have i saw tonic hypotonic and hypertonic solutions

as we all know in isotonic the cell remains the same in hypotonic we're in

okay if we will be describing describing hypotonic there is more solvent than solute do you guys agree

very good yeah so there are more solvent than soyuz so

if we place a cell within a hypotonic solution what will happen exactly it will swell even burst

and the cell can die what about if we place this the cell a cell rather in a concentration wherein

there is more um

solute as compared to the solvent or hypertension shrink cells

okay thank you milka shrink cells all right good job now um moving on

now let's talk about our body's mechanism on maintaining fluid balance okay fluid balance um let's start with

the thirst center thirst center of course is activated by different different different factors it can be

activated by the borrow receptors the osmo receptors right now third center of course if it's

stimulated would tell you to take in water and with that in mind guys we know that we are adding fluids in the

body right so we're clear with that now let's talk about bioreceptors again i know you guys have reviewed about this

but it's just you know this is a review so basically we're just going through them for mastery battle receptors

are sensitive to what can you say

okay i did not get that but if you guys said volume or the pressure exerted by the fluid volume then you

guys are correct okay because as we all know if there is much volume of fluids against a receptor or the blood vessel

wall that means high pressure right if there's decreased fluid that would

mean lower pressure and bioreceptors can actually detect that or perceive that now most of

the time they are stimulated if there is sudden decrease in the volume of blood

or plasma and if that's the case or specifically on the pressure in the kidneys and if that's the case what will

happen the thirst center will be stimulated so that you would take in the winds

now what about osmore receptors what is it sensitive to or they are sensitive too

very good the osmolality or osmolarity of the blood okay now when we talk about osmolality and osmolarity of the blood

it's how much solutes are there the concentration of solutes within the blood specifically

sodium okay because that's the most uh that's the best indicator of this sodium and sometimes they would say hematocritu

and hemoglobin but of course sodium will be our best indicator okay so if in there would be an increased sodium in

the blood increasing the osmolality of the plasma that will stimulate our thirst center to once again

you know for us to take influence and then we have ras right an angiotensin aldosterone um

system we're in uh this um is singing oh this is a good question bonus okay what stimulates ross activation

ten nine eight

seven six five pressure center nice time

pressure where alex okay but thank you for trying thank you alex so alex got this one

[Music] so if there is decreased blood flow we can

say it's pressure to the kidneys the body will think that we are actually what experiencing

poor tissue actually it does experience poor tissue perfusion to the kidneys thus

um the renin-angiotensin-aldosterone system is activated and it will be released um causing um

uh the release of angiotensinogen one which will be converted to

angiotensin angiotensinogen ii there you go and

that is adjacent angiotensin one to angiotensin sorry my bad let me repeat that renin will sorry will will release

your angiotensinogen which will be converted to angiotensin one and then

um apparently as it passed through the liver it will be converted to angiotensin ii which is a potent vassal

constrictor okay and then angiotensin ii will stimulate the release of your

aldosterone which would cause reabsorption of sodium and with the reabsorption of sodium

comes your absorption of water that's correcting your blood volume okay

we good so that's your ras and then we have your vasopressin other name for vasopressin

guys okay very good who said that hi i'm lee

okay so em there you go yes and m can you please tell us what

does uh antiderivative hormones do or the

and my english sucks but yeah um it's em to absorption of sodium in water

okay so basically antidiuretic so it means that it hinders the expression of water

um thus you don't um it lessens the production of urine thank you m okay so

moving on anti-diuretic hormone all of those guys that we have mentioned bioreceptors osmo receptors thirst

mechanism and the antidiuretic hormone cth

all of this um somehow increase the fluid within the body the bar because their their um

their function is to correct that and we only have one that would inhibit all those function and that's your

atrial natriuretic peptide release okay when that is available

it will hit a stop or seize the function of your grass and your adh

thus it means we're we're good okay we're done here we don't need more water

okay that's your atrial network peptide okay now let's move on and let's talk about your

um urine for a bit your urine should be amber in color

it should be uh clear

all right and what's uh what should be the smell it should be aromatic okay and for a bonus point what should be the

you're in specific gravity one point zero one fourth point

okay sorry guys it was jasper who answered first okay so

just very good one point zero one two one point zero two five two five

okay or some books would say just point zero two okay but that's okay now let's move on good job guys now

um of course if your p would become hazy or cloudy it

means there is a lot of wbc in them or even plus and then there could also be an increase

in caste during infection um what else uh the changes in color the

more yellow or even to the point of sometimes it would be as dark as uh orange it means it's super

concentrated or very little water is with it or a medication is taken can you give me medications too possible

medication that could redden or make your pee orange wow all right so

also if you take vitamin c some vitamin c would make them um dark yellow okay

all right is there a possibility that your pee would appear greenish or bluish

yes yes yes bacterial effect exactly in some infection it can even

make your pee appear green all right or bluish

moving on now um weight loss guys so many messages okay

okay so moving on um normal sodium levels

okay and even just a slight increase to 150 could actually cause um uh brain cell shrinkage

already okay and that you know i told you both hypo and hyper neutrino has almost

the same manifestations decreasing level of consciousness even seizures for some coma

okay um [Music] yeah those are basically the

manifestations of it okay now um

so guys if our client let's say is experiencing hyponatremia how do we correct that

yeah solutions hyponatremia right so hyponatremia is

pretty easy we could just give them you know salt salty food okay or if you want to start

any solutions like what you guys mentioned um you would want to give what

okay hypertonic solution right especially if swelling had occurred already or cerebral edema had

occurred already right we can give that so that there would be um

so that we can take out the fluid from the cell okay relieving the cellular edema good job my bad guys

what about if it's hypertonic solution i'm sorry hypertonic solution what about if it's

my bad protein hypotonic hypotonic solutions but guys huh we do not just give this

okay of course it's true through the doctor's order but there's one tip or advice for us you know um a pro

pro uh pro move okay when we're giving both hypertonic or hypotonic solution

correcting sodium imbalances we should what we should watch or monitor closely

because a hyper uh a hypernatremia can suddenly become hyponatremia and hyponatria naturemia

can suddenly become hyper naturemia now meaning guys neuromuscular okay we have to think

about the brain or neuromuscular processes when it comes to sodium imbalances so moving on um

or a client experiencing um hypovolemia okay hypovolemia what are the clinical

uh manifestations that we should expect hypovolemia or fluid volume deficits what will be the temperature of the skin

very good and there would be pallor right um

what about the cvp all right very good good job what about the serum sodium

increase increase okay okay very good because this is fluid volume deficit right okay let's go

demand to fluid volume so if it's fluid volume excess let's not waste our time if it's fluid volume exists guys you

just reverse all those manifestations but there is still tachycardia

right there's still tachycardia but this time around it's bounding rather than

earlier because it's hypo earlier it's fluid volume deficit so with that it's ready or weak but if it's

fluid volume excess it's bounding that's the difference between the two now question though

what could cause fluid volume exist or what are the risk factors for fluid volume excess

renal failure heart failure heart failure

exactly very good a very fast iv infusion excessive sodium intake could also lead

to that um yeah you guys are right heart failure

and renal failure very good of course what about demand for hype oh sorry for fluid volume deficit

can you name some um use of the red use of the urethra very good

what else diarrhea right burns when you when your skin is taken out because of the burn you there would

be um more insensible fluid losses actually active fluid loss because you don't have

your barriers anymore what else um eating hemorrhaging

okay very good or bleeding yes very good vomiting that's active loss excessive perspiration such as if

you have um hydro uh sorry uh what's the term that we use or hyperhidrosis very good what about

diabetes insipidus ooh not familiar yet right don't worry yes

sir yes very good soon you will study that with mom uh ray or mam mom day okay the bit is of

course because you'll be peeing a lot okay you'd be peeing a lot and there's a risk for you to lose fluids very good

now moving on also one thing that you have to remember when it comes to fluid volume excess

is of course there are there is edema and how do we grade edema again special

repeating edema you just multiply it by two right so a two millimeter would mean

one four millimeter would mean two

three millimeter i'm sorry six millimeter would mean

and then eight and above would be four plus so it's just within those range okay guys it's just within that range

okay so that's is uh easy-peasy lemon so do remember that so uh moving on uh what else

now let's talk about because it okay guys if you notice from soju i went straight to fluid problems because you

know they are connected move let's move on to potassium guys what's the normal

potassium level right very good 3.5 to 5. um what's our unit mechs per liter okay

very good so guys with that in mind anything low where then 3.5 is hypo um very good and anything higher than 4.5

or 5 for some bucks hyper okay guys give me

sir guys i needed to relieve myself

um did someone ask a question or called me while i was out all right so we're good

okay so that's potassium and guys if potassium is the problem what will be our main concern

exactly your heart oh okay so that's with potassium um not just the heart huh also think about the muscles but mainly

of course we're concerned about the heart because that's the emergency part of it now now um what could cause

um hypokalemia diarrhea oh diarrhea what else jasper van meeting sir

vomiting and diarrhea okay because you are losing um potassium from those okay what else

gastric suctioning very good now what could cause hyperkalemia

increased intake increased potassium potassium of course fast infusion of potassium if potassium

iv too much eating of bananas transfusion of use of potassium consuming

good job wow okay so basically guys just to explain for the trauma like what jeremiah said

and for those with rapid blood transfusion the thing guys is think about this for trauma especially

cellular trauma the potassium is released from the cell and into the bloodstream while the other one among is

when you give blood transfusion apparently um the rbc's with will especially if you

have given old blood okay

the rbc's will hemolyze and potassium from the rbc will be released into the circulation thus increasing the sodium

within vascularly ah sorry sodium potassium vascularly thus it can lead to

hyperkalemia okay um of course we could only call

hyperkalemia or hypokalemia as a problem if there are clinical manifestations of it so what will be the clinical

manifestations that we should expect from hypokalemia muscle weakness

rhythmia constipation so think about this you guys said muscles or heart right so

weakness slowing down of any muscular activity so slowing down the the gi tract can lead to constipation um

weakness sometimes even paralysis guys there is what we call um

um i had so much patience so many patients in pediatric world who are experiencing

paralysis exactly periodic flaccid paralysis just because they're experiencing hypokalemia it's crazy it's

crazy that they are that they would seem like they cannot move anymore but apparently when they are corrected when

they're given potassium they can they can still walk they can walk actually

so like i said guys be excited when you get to to the

hospital all right now what about hyperkalemia what will be the

manifestations if you have hyperkalemia bradycardia diarrhea richard diarrhea very nice from seaweed so think about

anything that would make your muscle work faster or

contraction would be um stronger but to the point that since

it's super strong your muscles get tired it would still actually lead to

this arrhythmias or even arrhythmias okay so that's the problem there especially

if it's the heart okay it would almost be the same as that of hypokalemia if it's the heart are we good now with

that in mind guys you already know the causes of both hypo and hyper i have a question though is there a possibility

that the client has hyperkalemia and yet there are no clinical manifestations yes

with pseudohyperkalemia guys can you tell me um the uh

the possible causes of pseudohyperkalemia now

interesting okay so for example good examples blood testing exactly delayed blood testing

for example they extracted your blood for potassium

levels or electrolyte levels and yet there was a delay thus your rbc hemolyzed and potassium is

released within the plasma that of course would increase the potassium level right another thing is you just

work out okay there are muscle tearing micro muscle tearing potassium is released

from your muscles and into the bloodstream apparently there would be what an increase in potassium level even

without the manifestations of it or um you receive blood transfusion same thing okay especially old blood okay

so those are the possible reason for um pseudo hyperkalemia what will be the management for that

should there be management no increase yes sir

this is hyperkalemia pseudo hyperkalemia so we cannot do anything about it yet but to retest

okay we have to reevaluate re-evaluate give it some time and then re-evaluate because like what we said it may be an

increase in potassium but if there are no symptoms it's not a problem okay we just have to re-evaluate we take

we take or get another specimen of blood and then check it out

okay now what about what are the solutions for example

if let's say there is only mild hyperkalemia can you give me management for hyperkalemia

increase increase potassium intake in diet hyper guys hyperkalemia higher

very good so give diuretics especially diuretic that doesn't spare potassium okay what else i think someone mentioned

um there should be a lesson potassium intake very good

uh what else um yes very good very good insulin and

glucose okay especially for mild hyperkalemia insulin and glucose because apparently

insulin does not just push glucose inside the cell but as it also pushes potassium back to the cell okay very

good also guys uh another possible management for them is

of course dialysis right dialysis especially if it's too high

already that is causing heart problem okay what about hypokalemia you guys mentioned eating bananas

already anything else using efficiency

okay so it could be oral replacement through tablets such as or it could be through iv infusion but

what should be our precautions it should be administered slowly

device exactly in fusion device administered slowly it should be diluted now if it's orally taken

make sure that the stomach is and it is full

it should not be empty because this is a gastric irritant okay moving on i'm gonna

make palo you guys okay let's talk about calcium for a bit now we have two references for calcium

we have the total and we have the ionized what's the total normal total calcium level

which we use milligram per deciliter i mean exactly what is it again can you repeat

eight points okay that's milligram per deciliter so guys even if even if the situation won't

say total calcium if it's used as milligram per deciliter that's total calcium okay now what about ionized

four point five difference okay four point five two five one one five point okay five point

one very good or four point five to five let's just say and that's

mex per right

exactly max per liter now like i said guys huh if it says max per liter then stick with that yes alex

is max per liter and milligram per deciliter the same value sir um different bro different

this exercise is ionized you put 4.5 to 5.1 milligrams per deciliter i said

[Music] uh sorry i just mixed it up maybe my my bad my bad it should be max pretty

desolate per litter okay all right okay there you go so

so we're good now right now moving on um

hype remember the function of your costume is what what specifically

very good neuromuscular okay we will focus on neuromuscular problems if it's calcium

imbalances right now um just remember this thing remember

calcium maintains the stability of the cell

or its reaction to stimulation okay so if

you're experiencing hypocalcemia there would be hyper reactive muscle cells if you are experiencing hypercalcemia there

will be lesser reactive or less sensitive muscle cells okay meaning guys if it's

hypocalcemia think of anything fast anything hyperactive

if it's hypercalcimia think of slow non-reactive cells okay so with that in mind guys what are the

manifestation of hypocalcemia hypertrophy very good

um uh even diarrhea okay uh you guys mentioned uh

muscle spasms you guys are correct uh twitching of muscles that's correct too

okay so if it's hypercalcemia we reverse that okay

if it's hypercalcemia constipation may occur um

no responses and dipped in uh dependent reflexes there'd be no responses poor reflexes

okay and even muscles can be flossed flaccid all right so that's our

hypocalcemia sorry hypercalcemia what are the causes of

hypocalcemia hypothyroidism hyper hypothyroidism

hypoparasites what about hypercalcimia hyperthyroidism

okay very good very good okay good job so those are the basic okay then we have once again just to mention we have

magnesium which has the same uh function as that of your potassium it helps out on that but its manifestation is the

same as that of calcium okay and then

phosphorus which goes against calcium okay so those are the

common electrolytes that we will be exposed to as nurses now let's talk about

acid-base balance acid-base balance is best seen through what test i'll answer

no no no let me repeat that there you go abg

abg analysis okay acid-base balance is best um seen in an abg analysis now before we do

extraction for abg atonement okay johnson before we do abg

sorry as blood extraction for abg analysis what do we do jones for screening

that's the time we do allen's test yeah that's just to make sure that our arteries are patent

okay and has good circulation okay very good now

normal for ph is 7.35 to 7.45 partial pressure carbon dioxide is 35 to

45 and your bicarbonate is 22 27

and our normal partial pressure oxygen which is actually not needed in their interpretation of abg

is 90 to 180 80 to 100

very good very good so guys huh um that's how we uh that's the normal references or

normal values for your abg's okay now if it's metabolic acidosis what are the

risk factors or causes metabolic acidosis diarrhea

diarrhea because you're losing bicarbonate very good next who's that can i know who that was at

randall hi randall okay

um vomiting love is not for metabolic acidosis because when you are vomiting you're losing hydrochloric acid that

would lead to metabolic alkalosis anyone else who has an example of cause for metabolic acidosis

hyperkalemia very good hyperkalemia is a precursor for acidosis

metabolic acidosis what else keto acidosis very good for that person who says

ketoacidosis you are correct in a client with diabetes mellitus one of their complication is

keto acidosis because they will be using fat as a source of energy but apparently the byproduct of that is

ketones and ketones when accumulating can lead to metabolic acidosis development very good anyone

else excessive alcohol ingestion processor excessive alcohol ingestion pudding

within a month yeah because be excessive acids in the blood uremia very good

thank you for that person who answered your again i think it's denise you're you're you're right because uremia

urea apparently one of its component is uric acid and that could lead to metabolic acidosis very good now with

that in mind guys what are or what can we do as management for metabolic acidosis

i'm sorry what was that emily eliminate the source of chloride eliminate the source of

chloride chloride very good eliminate the source of chloride because chloride is basically acidic good job

that would mean eliminating sodium too because they are partners okay what else we give hemodialysis we increase fluids

what else very good i like that answer give sodium bicarbonate okay because bicarbs we need

that to neutralize our acidity at the same time guys can we actually uh actually dialysis was

mentioned already right yeah that's right um and we also manage the potassium level

because potassium level can cause hyper sorry metabolic acidosis right so we can also manage the potassium

um level by giving okay excellate is that possible

yes yes exactly so that you can excrete them from the poop

very good now moving on let's talk about metabolic

alkalosis what are the causes of metabolic alkalosis gastric suctioning vomiting

dehydration yes very good alkaline ingestion okay because basically for vomiting and um

suctioning we are removing the hydrochloric acid from our body good job all right so with that in mind guys what

can we do to correct that very good what else minister sodium chloride

give salt very good okay

good job good job all right so um i think we have um covered uh covered that okay now

let's move on to respiratory acidosis what are the possible causes of respiratory acidosis meaning carbon

dioxide is accumulating go the overhearing okay so anything that would affect the

breathing anything that would make our breathing shallow can lead to respiratory acidosis such as

traumatic injury of the chest um edema of this of of of the lung tissue congestions of the lungs

anything that would affect the lung the movement of the chest okay can lead to respiratory acidosis

and how do we correct respiratory acidosis well

oxygen oxygen oxygen and anything that we do positioning

yes positioning very good i like that answer positioning high fowlers i'm encouraging to do deep breathing putting

on oxygen and anything that we do with metabolic acidosis we good now what are the causes of

respiratory alkalosis very good okay guys hyper um sorry respiratory alkalosis may occur to

client with who is having hyperventilating you know those

um girls in a breakup they would be crying they would be hyperventilating

okay or those who are just you know um for example you know uh

trying to have a secondary gain of attention you know for example they're

on the process of breaking up they would act as if they have asthma hyperventilate and apparently lose their

carbon dioxide too much leading to you know okay but it's not just girls guys can do

that too all right so anyways that's good perfect uh what else

uh yeah fever sorry for fever it's our way you know breathing faster

is another way of actually releasing heat from our body and as we breathe faster we also lose the carbon dioxide

okay so how do we correct respiratory alkalosis manage

manage their anxiety manage their depression if they're just boyfriend if needed

girlfriend if needed i like that very good also we can ask them to

breathe slowly you know do a coaching for breathing and breathe slowly in a paper

paper bag or brown bag very good echo bag very good okay so that um they can

actually take back their own carbon dioxide very good good job y'all i think if guys

huh when you answer the case study questions they're called case study questions and you will not

just experience that here in our exam apparently guys when i took my nclex exam okay when i took my nclex exam

after my exam there were a set of test exams a set of test exams and

they are case study type like what you will be experiencing tonight it was just being tested during that

time okay case studies um type of questions is you're given a

situation like i said you'll be given lab values you will be given management and you will be given um

manifestations and you have to figure out what the problem is

you have to figure out what the management would be okay

and it's a flow all right so guys my concern here is please make sure that you answer the

first question because the first question tells you what the problem will be

yes love sorry you mentioned about our case study for the exam tonight

uh how many hours would that be what do you mean how many hours the exam will be for

it's just a 60 item exam so you are given an hour and a half for that with clinical manifestation okay but i

just wanted yeah it's okay because um it may sound difficult but it's actually just still

in the form of multiple choice there's no matching type there it's still a multiple choice it's just asking you

basically what's going on it's it's a progressive type of question you will have fun definitely

but like i said make sure that you answer the first question correctly okay that would be the

challenge and but if you're good with abg analysis i'm sure you won't have any problem okay

so practice that go back to our review okay so moving on um i think we should skip that because basically

yeah let's talk about um the kidneys now we're done with fluid

and electrolytes let's talk about renal problems now i think we will extend a bit okay that's okay anyways guys um do

remember okay basics anatomy and physiology do remember the layers of the protective layers rather of your kidneys

you have your outer renal fascia in a real capsule middle adipose tissue outer renal fascia basically

is the one that holds the kidneys in place together with the middle adipose capsule middle adipose capsule holds it

in place at the same time protects it or cushions it from any trauma while your inner renal inner renal capsule protects

it from any microorganisms or entry of pathogens into the kidney okay and then within the kidney of course we

have its own layers we have the renal cortex we have the juxta medullary layer and then we have the pelvis okay

okay so basically the calluses are there uh we're in urine are collected okay um and then uh

i'm trying to go faster and within the renal cortex you would find your renal corpuscles which has your glomerulus and

your renal tubules but your renal tubules extends up to the uh mid uh juxtablar area okay or the middle area

of your kidneys okay so with that in mind guys let's start with our first problem um

uti uti as we all know um girls are more susceptible or at risk of this because of their shorter urethra

and um and your their tendency to be pregnant just kidding okay because you know there

could be stasis of urane okay of course it also depends on how on your work if you have access to your

comfort in the comfort room and if you hold your urine if you do tab uh sorry tub bath

um what else um if you have

alkaline urine because you won't have that protection from an acidic urine then definitely you would be at risk for

uti now with uti guys we have to check or do

your analysis right for your analysis um of course in uh how to call this in collecting the

specimen um the ladies should do mid-stream right so first they have to clean out their for jj by doing from

what from front to back and then dispose the new uh

uh cleaning cloth from front to back okay and then that's it and then for

midstream guys they have to pee first hold for a bit place your container there and then pee

again and that's basically a good way of collecting urine okay for testing now what if

you there would be a delay on testing the urine specimen what can you do with the urine specimen should you throw it

out area very good so that we can maintain um the freshness of the urine okay

now normal ph level guys is what

very good very good it should be acidic okay it should be mostly on the acidic part so that it can protect you

okay now should there be wbc in your urine no seriously no no would there be

protein in your grain could there be rbcs in your urine no very good very good actually for rbc

uh for wbc rather sorry for rbc two cells uh within a specimen is okay okay but if

it's go if it goes beyond those number then that's already a problem okay there could be a problem

all right so do remember how the color of the urine the clarity of the urine the smell of the urine um

those are basic things that we have to remember now

um with uti comes pain right and we the person would experience that on the

flank or on the cost of vertebral angle okay

now i believe if we're going for assessment and it's

pain you should know the location okay if it's burning sensation especially on the

uh on your penis for men or on the within the vagina for women burning sensations especially when you're

urinating where could be the problem very good if it's um if it rejects around the umbilicus

especially when you're sorry not not when you're in urinating but when you're moving when you're ambulating and it's

sharp and stabbing pain if it's within your flank or cva perfect

perfect for uti we expect passing the urine and what's the term for passing the urine

very good very good can we expect uh malay and loss of appetite for a person with uti

yes yes yes because i remember yesterday we talked about the system systemic affectation or systemic effect of

inflammation and that could happen to a person with uti oh hi

i think we're good with that all right let's move on to let's let me just check

our list huh uh in our list we are done with uti

cancer okay we have two questions in cancer guys for cancer do remember that cancer um is more common with

men men very good more common in men and kidney cancer

has um uh staging for staging if it's within the renal cortex arena layer it is stage

one if it goes down deeper to the middle area or middle

it is stage two very good very good if it has access to

the lymph nodes three three in access to the circulation

very good now guys um what are the risk factors for renal cancer

smoking number one very good exposure to chemicals exposure

to toxin repetitive uti and exposure to virus okay and carcinogens good job you all now with

that in mind guys um it's a silent killer because you don't

know that you have it um you would just know because you would have

pain you would have blood in your urine and of course there's that tumor or an enlarging um

part of the kidney now guys how is this managed surgically we have

radiation therapies okay for surgery thank you zaina we have radical nephrectomy or nephrectomy total

nephrectomy also for medical approach that's the answer there radiation therapy or

chemotherapy if the sorry if the tumor is too big sometimes they would go

for radiation or chemotherapy first to make it smaller and then surgery will be done

but if it's just small and it can be resected then nephrectomy can be done

then follows radiation therapy and um chemotherapy if needed okay now guys though what okay let's talk about

nephrectomy for a bit if it's just a part of the kidneys that is removed

okay it means that whatever is left of the kidney can still function hundred percent right

so guys we should not expect any change in the production of urine okay unless it's the

effect of anesthetics okay the production of urine should still be 30 cc per

hour okay i hope you keep that in mind so um

management of course for people who are undergoing chemotherapy they should be um

psychologically and emotionally prepared because there would be changes on them on their skin and their hair on their

nails and um of course there will also be vomiting and what can we do with the

vomiting of those people um repeating chemotherapy antibiotics should be given oh you guys

are so good and if ever they're experiencing the vomiting already fluid replacement is of

course needed too now in the list what's next agnoba yeah agn and nephrotic syndrome as we

all know agn is any injury to the nephrons or to the working units of your kidneys leading to what an increase in

permeability um of your glomerular basement and brain

allowing rbcs and protein to escape out but not filtering metabolic waste product that's there

would be an increase in uranium creatinine to the point of azotemia and but you're losing

protein and rbc thus there would be proteinuria and

hematorya apparently um there is lesser production of urine thus there would be

a fluid retention leading to edema and high blood pressure okay so

those are the manifestations that we can see in people with agn but specifically with

acute prostate sorry prostatic acute post streptococcal glomerulonephritis this is caused by

a post-infection meaning a post-exposure to streptococcal infection um and with

that guys do remember that we have labs up to to to to make sure that we were exposed

um by checking um the aso titer okay anti-streptolysin or titer apparently it will be increased

because you were exposed to um streptococcal infection you can you they can also test your blood for the

presence of um streptococcus swab can be done also to check for streptococcal infections

okay now with that in mind guys um what are the common streptococcal infections that

could lead to this we have pharyngitis we have poncilitis caused by streptococcal infection also

we have impetigo for the skin now um so

we expect hypertension like what we said we expect hypertension we expect proteinuria hematorya so they're called

their urine will be t collard very dark brown d colored urine okay and we expect that now with that in mind

guys the management would be what because of edema and hypertension we can give antihypertensive medications and we

can give diuretics so that they can expel out the excessive fluid because they have fluid volume excess

um specifically because of the edema um what about the diet what would be the diet for them

high calorie okay so low protein low sodium high calorie okay we're good calories just to

support healing okay let's talk about nephrotic syndrome for a bit nephrotic syndrome can be

primary it could be secondary primary you're just born with a defective kidney and then secondary it's coming from

another disorder such as agn can lead to nephrotic syndrome the problem here is your glomerular basement membrane is so

permeable that it or the person loses so much protein so expect massive proteinuria the problem is if you lose

your protein you lose what pressure guys oncotic pressure exactly and if you lose your oncotic pressure you're at risk for

developing massive edema also known as anasaka or generalized edema so with that in mind guys

question in nephrotic syndrome do we expect hypertension

designer you said something okay very good there is no hypertension in nephrotic

syndrome unless unless it is caused by agn but nephrotic syndrome guys there

shouldn't be any hypertension why let me explain first and foremost

do we have problems with the production of urine there's none

okay we didn't say that there is water retention there's nothing like that and apparently because of the decrease of

oncotic pressure your fluids are actually shifted into the interstitial spaces so think about that you're

actually losing blood volume plasma to be specific water to be specific so with that in mind guys

we expect we rather expect normal bp to actually low blood

pressure okay so we have massive edema we have low blood normal to low blood pressure

we have massive protein area and also we expect hyper lipedemia why will there be hyperlipidemia again

because liver trying to compensate uh the protein very good loss good job because the liver will try to compensate

by releasing protein in the form of lipoprotein protein will be used up but the lipid will remain into their

circulation putting you at risk for hypercoagulability and at the same time atherosclerosis

very good so how do we manage um sorry i got lost how do we manage um nephrotic syndrome my bad

low fat low sodium moderate protein low fat at best okay low fat because we have

hyperlipidemia low sodium so that there would be no more additional edema and moderate protein

because so that we can prevent further hyperlipidemia and we can reinforce aquatic pressure good job also high

calorie to support healing and someone mentioned bed rest bad dress is or should be observed for both agn and

nephrotic syndrome wow

wow wow of course skin care is also needed for both nephrotic and nephrotic syndrome and agn because both

has edema okay

let me go back to the list we're done with agent oxygen kidney trauma kidney trauma guys it's usually

caused by vehicular accident leading to um five grades of kidney trauma right if

there's just blood or contusion that's grade one if there's a tear in the renal cortex that's grade two if that tear

extends to the medial juxta area or the middle layer that stage or grade three right

if um [Music] if the sorry

if the injury extends to the pelvis that's grade four if it's a shattered kidney

that's grade five okay shattered meaning like it's really broken

if you wanna call it that way okay now guys with bleeding especially with contusion expect

shock okay or hypovolemic shock and what are the signs of hypovolemic shock

head pressure pressure blood pressure there will be tachypnea as compensatory

mechanism decreasing level of consciousness cool clammy skin or cool pale skin

uh yeah good job very good okay what else um so basically the management for that is of course

um pain medication for the pain usually uh it would depend but they would give more fin for that

um they should um control the bleeding okay by giving um stabilize uh

bleeding stabilizing medications such as tranexamic acid uh what else

um bed rest and then

uh yeah close monitoring of course because of the risk for shock okay the high risk for shock

now uh moving on chat

kidney trauma let's move on to arf and crf acute renal failure

and chronic renal failure so for a good renal failure and chronic renal failure

let's start with arf for architectural failure it could be intravenous it could sorry it prevental interdental and post

renal causes i hope you guys can still remember if it's pre-renal it's anything that perfuse

blood or any problem with the perfusion or delivery of blood to the kidneys if it's intra-renal anything that would

cause injury in the kidney during the production of urine and if it's post renal any

obstruction within the ureter and urethra okay those are the possible cause of acute

renal failure and when we see acute renal failure it's when the kidney cannot expel out the metabolic waste

product cannot help out in the maintaining homeostasis acid-base balance and fluid

balance okay so with that in mind guys uh what do we

expect okay since the kidneys cannot manage our

electrolytes we expect hyperkalemia and even hypernatremia for hyperkalemia we know how to manage that already right we

can go through dialysis or removing it through caiaxillate okay and then for hypernatremia then

diuretics actually for both diuretics are given for both okay of course there would be fluid volume

excess and for the fluid volume exists diuretic still will be the management of choice as well as fluid

restrictions question how do we divide the fluid restriction fifty thirty twenty

thirty fifty very good fifty percent in the morning thirty percent in the afternoon and twenty for the rest of

that day okay and if we give diuretics when is it best given

late afternoon very good very good now

um arf crf now with crf it's almost the same thing it's just that it's more it's more severe okay there would also

be calcium problems other than potassium and um

sodium problems now with calcium here this time around we expect hypocalcemia okay hypocalcemia thus of course we give

vitamin d we give calcium okay to them now let's move on to the management for both

arf and crf which of course would include hemodialysis now for hemodialysis guys

um as we all know this is with the use of av fistula okay especially if it's going

to be a a permanent thing or a long-term dialysis well if it's temporary or just

for correction we use what two areas femoral guys what to area

no no i'm talking about temporary ones specifically for hemodialysis so that's just two your subclivian and your

femoral chemo very good good job now guys how would um how long does it take

for av fistula to mature and how do we care for the fistula what are the management or care for the

fistula so that we can maintain its stability no restrictive clothing no restrictive

clothings what else no administration of iv no taking of bp even no jewelries on the affected area

or save that arm okay wherever the fistula is

okay now prior to hemodialysis if we have the fistula already prior to hemodialysis what should we do first

of the client void have the client void weigh the clients

ask for what do we ask it for the fistula area very good and check the

vital signs specifically bp and how do we check the vital signs check the vital signs

initially and everything it's very good guys to whom is hemodialysis um indicated four or two

indication for hemodialysis hypercholine those with hyperkalemia those with metabolic acidosis

very good those with of course arf or crm very good those with pulmonary edema or

pulmonary congestions or excessive fluids in the body and those with

experiencing acidosis acidosis and experiencing increased metabolic waste

products in the body okay moving on

guys um what are the complications coming from hemodialysis

hypotension to hypertension hypotension to hypertension or the other way around yes we have hyperlibrium

disequilibrium syndrome air embolism very good good job good job okay so keep that in mind huh

um of course people with arf and crf may also undergo renal replacement therapy

okay renal replacement therapy and um there are criteria for the living donors what should be assessed

emotionally very good thank you for mentioning emotion

tissue compatibility so that would be your station specific antigen and histocompatibility

um the person the individual should have how many healthy functioning kidney

could be two functioning kidneys all right very good and they should be cleared out from

unbelievable medical communicable diseases as well as cancer okay as well as cancer now what about

the what about the recipient

oh sorry not recipient sorry what about the cadaver cadaver as a donor what should be uh what should be make sure

[Music] can we brain dead for any contagious infection

no malignancies no cancers should be kept alive until very good should be kept in mechanical

vent okay despite the fact that the person is dead

okay so that we can keep the circulation going before the removal of the kidney very good um

what would be the diet for a client with air f and crf

low protein low protection low sodium low protein low potassium low sodium do you guys agree

yes okay very good very good yes sir okay good job okay um what else should we discuss

uh [Music] bladder cancer

okay let's talk about bladder cancer for a bit bloody cancer is common to of course men especially older men

okay and bladder cancer is also a silent killer because basically your the most

common indication of this is what uh no no unnecessary no pain well peeing

very good painless haematoria i think that's what jones is trying to say very good painless emotoria there would be

decrease in the caliber of your urine you would be experiencing dribbling of urination okay

and of course with that we can suspect bladder cancer but apparently of course we have to know

if there's better cancer and the only way to know if the person has cancer is through

uh checking their um tissue right or what do we call that

what's the term for that microscopy biopsy biopsy

yes and how do we get a sample through biopsy uh sorry for biopsy it is true that

thing that you mentioned cystoscopy okay so cystoscopy is basically direct visualization through the urethra but at

the same time through that we can actually get a sample of tissue for biopsy now the thing is for cystoscopy

do remember that this is a surgical procedure okay

considered as surgical procedure so that we have pre-operative clearance or checklist for this

okay uh local anesthetics can be administered

and anesthetics can be administered for them and of course this is invasive because we have to push

a probe with through the urethra the injury of course and trauma sorry trauma to the tissue can can actually

occur thus what do we expect post cystoscopy do we expect pinch uh pink tinge you're

in yes yes [Music]

when they are peeing yes yes do we expect bladder spasms yes but only in a few days thank you for

for emphasizing that only in a few days actually within the first 40 no 24 hours only within the first 24 hours only

now if within the first 24 hours there would be chills then that would mean

we have to check the temperature that could mean fever also check minus wbc

that could mean that the client is experiencing infection

now with bladder cancer um surgery is needed and how do we do or what surgery is done

t u r trans-urethral resection of the bladder tumor

there you go of the bladder tube okay so that's what we do now um what else is in our

list let me just check we have renal calculi fun okay let's

talk about adrenal calculi we know calculi in our discussion

it could be caused by an infection right it could be caused by too much intake of calcium it could be caused by

too much intake of organ meat products or anything that is high in protein that would give us

more more uric acid okay what else

[Music] yeah basically those are the common ones

right so in dealing with calcium stone guys okay um anyways all of this

if the stones are too big of course all of them um will uh the surgery of choice will be what or

the management of choice will be surgery and the surgery is called what what do we call the surgery for this

guys cystoscopy sir why thank you for that up what is

histoscopy if it's within the bladder but what if it's in the kidney very good

very good so it's where we remove the lith okay so lithotomy is or removal of the stone from the

kidney itself now that could be the management for that or if it's still small

we are sorry if it's still small not that if it's large enough and the person is

has a lot of money for this procedure what's a non-invasive

uh non-surgery very good very good what is it again

mr harper yeah okay very good we're in of course the patient is still placing anesthetics

but a shock wave or a sound wave is sent through the tissue

and to the stone so that the stone can be crushed into smaller pieces a stent will

be placed on the urethra so that they can just come out through your urine very good guys what do you expect for

the pain what type of pain do you expect if you have a renal calculi very good sharp

pain very good yes yes it could be uh especially when you are

ambulating it could be so painful to the point that the person would even have flank pain

or if it's in the urethra it's within the umbilicus the patient would even have nausea and vomiting okay because of

the pain all right so with that in mind guys um

let's talk about the diet because it could also be managed by the diet right if it's calcium stone what will be the

diet acid dairy

acid not dairy huh acid ash diet and what do we include in our acid ash diet [Music]

grapes or any any meat products what about if it's uric stone alkaline ash diet that's when we include

dairy products and any fruits and vegetables except prune juice and

cranberry and cranberry if it's called if if it's the stone

it's caused by an infection still acid acid very good acid ash diet guys um

what else what else should i ask you um how do we visualize the stone or what procedure can we actually use to

visualize the stone ray geography specifically the kidney urether bladder ray geography

right the kuv right and how do we prepare the client for kuv

remove metal wow remove any metal yeah that's true what else

what else ah drink a lot of water drink a lot of water very good prior to

the procedure what else are you doing allergy do we need that though

guys if it's just ub it's just removing of any rage opaque material

as well as um it's just it's ray geography ray geography it's just for geography it's

just visualization of the kidney utilitar bladder yes you are right increased fluid

of the person during the procedure so that we could check the bladder okay

but anything else there are no special preparation for them okay if it's kub but if it's intravenous pallogram that's

the time we're in we would check four allergies because we will be using

iodine right as you pick material what else we do enema prior to the procedure very

good okay and of course the client will be sitting

or lying down on a bed lying lying very good very good

hmm what else what else um [Music]

okay i think we've covered that [Music] oh

guys sorry going back to dialysis okay what's the other type of dialysis that can be

used which is more of that the person can be more mobile it can be done at home what do we call that

and what do we use as your semi-permeable membrane that

that what we use the month to clear or to filter

uh will be your dialysate okay good job okay now um question though

uh when when we start the client for peritoneal uh dialysis is the same as

your hemodialysis you check the weight you ask the client to void and you check the bp as well and of course you check

the pattern c of the that too all right but also guys we have to warm the dialysis why do we warm the

dialysate prevent you avoid chills as well as to promote what

dilation exactly to avoid sorry to promote vasodilation

for better exchange of better blood flow and better exchange or

filtration of your blood very good um now uh remember there are three phases the inflow

then what's the next one and then the outflow okay the inflow um

is when we allow the dialysate to go in the dwelling time is when we allow the filtration filtering to occur and the

outflow is when we allow the um excretion of the dialysate and whatever the dialysate was able to take

out from our body the question is during the outflow if

there would be lesser because if you administer one or two liters of dialysate you expect one to

two liters of outflow or even more right what if there's decrease outflow what should we do

turn okay very good turn the patient side to side what about if it suddenly stops

check for kinks guys check for kinks melania naman there's just kinks or clamps

okay also guys you can also turn the patient from side to side maybe that area is empty and some of the fluids are

within the peritoneal cavity so that you can bring it through that now of course it's important that during the outflow

the bag is lower than the body because the outflow is without the use of any machine it is only by the pull of

glass very good very good now um when the peritoneal outflow is clear or yellowish is that normal

okay yeah it's normal very good what if it's brownish what does it indicate separation or vowel preparation what if

it's cloudy okay after hemodialysis and peritoneal dialysis what do we expect on the weight

of the client decrease to decrease what do we expect on the the

the bp of the client increase increase after hemodialysis

increase or decrease decrease normal or at least

lower than your initial bp okay normal or at least lower than your initial vp okay i think we've covered everything

and i think you're ready for the exam um do you have any questions clarifications