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Nursing Science EXAM 2 > Week 7 - The Urinary System/pH And Homeostasis > Flashcards

Week 7 - The Urinary System/pH And Homeostasis Flashcards

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1
Q

How does the kidney maintain homeostasis?

A
  • regulating blood electrolytes by secreting excessive ions into urine
  • regulates blood pH by excreting/conserving H+ or bicarbonate ions
  • regulating blood volume by conserving or eliminating water
  • regulating blood pressure (by regulating blood volume)
  • maintaining blood osmolarity by secreting excessive Na+ into urine
  • excreting waste products: ammonia, urea, creatinine
  • producing hormones (EPO, calcitriol, and produced the enzyme renin which leads to the production of angiotensin and aldosterone
  • regulating blood glucose
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2
Q

What are nephrons?

A

More than a million microscopic functional units that make up the bulk of each kidney

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3
Q

What are the 2 main regions of the nephrons?

A
  • renal corpuscle

- renal tubule

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4
Q

What is formed when fluid is filtered out of the blood of the nephrons?

A

Forms Filtrate

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5
Q

What are the two parts of the Renal Corpuscle?

A
  • The Glomerulus (a mass of capillaries) - The Glomerular (Bowman’s capsule)
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6
Q

Where does nutrients enter the Renal Corpuscle?

A

Fed by the Afferent Arteriole

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7
Q

Where do nutrients drain in the Renal Corpuscle?

A

Excited into the efferent arteriole

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8
Q

What is the blood pathway through the nephron IN ORDER

A
  • renal artery
  • afferent arterioles
  • glomerulus
  • efferent arterioles
  • peritubular capillaries
  • renal veins
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9
Q

What are the 3 steps to urine formation?

A
  • Glomerular Filtration
  • Tubular Reabsorption
  • Tubular Secretion
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10
Q

What is Glomerular Filtration?

A

Water and small dissolved solutes move from the blood into the glomerular capsule

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11
Q

What does Glomerular Filtration need to be effective?

A

A constant blood pressure to force the fluids and solutes across the membranes into the Glomerular capsule

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12
Q

What type of the bodies nutrients are too large to filter into the Glomerular capsule?

A

Blood cells, plasma proteins, platelets. They remain in the blood

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13
Q

Where does Glomerular filtrate travel?

A

Into the renal tubules

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14
Q

What are the 3 waste products?

A
  • creatinine (a waste product of muscle metabolism, excreted vis Glomerular filtration)
  • urea (limited reabsorption in from the convoluted tubule)
  • some electrolytes (Na+, K+)
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15
Q

What happens is there is a reduction in Glomerular filtration?

A

A rise in creatinine levels in the blood

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16
Q

The is the Glomerular filtration rate?

A

The amount of filtrate for are by both kidneys per minute

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17
Q

What is Tubular Reabsorption?

A

The process of returning important substances from the filtrate back into the blood

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18
Q

How does tubular Reabsorption occur?

A
  • Passive transport (proximal convoluted tubule is ‘leaky’ and allies substances (Na+) to pass through into the capillaries)
    • water flows by osmosis
  • Active transport (sodium/potassium pump)
    • All cells have a decrease in Na+ in the cytosol
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19
Q

What has the greatest level of Reabsorption?

A

The proximal convoluted tubule

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20
Q

What is completely Reabsorbed?

A
  • glucose

- amino acids

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21
Q

What is largely reabsorbed?

A
  • water (99%)
  • Na+, Cl-, Ca2+, H+, HCO3-

Wherever Na+ goes, water will follow

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22
Q

What is reabsorbed somewhat?

A
  • Ca2+

- Mg2+

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23
Q

What is reabsorbed very little

A
  • urea

- Unic acid

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24
Q

What happens as solutes are reabsorbed?

A

Water is reabsorbed via osmosis

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25
Q

Where does tubular reabsorption occur?

A

Mainly in the proximal convoluted tubule

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26
Q

Where does the filtrate move?

A

Through the tubule (loop of Henle & distal convoluted tubule) “finned tuned”

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27
Q

What is tubular secretion?

A

Process of removing waste materials from the blood to the filtrate

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28
Q

How does secretion occur in the proximal convoluted tubule, distal convoluted tubule and collecting ducts?

A

Active transport

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29
Q

The process of tubular secretion controls…

A

Controls pH

  • hydrogen ions (H+) are secreted to raise the pH (less acid) in the body
  • bicarbonate (HCO3-) is conserved (also raises the blood pH)
  • potassium is also secretes - depending on the body’s needs (K+)
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30
Q

What is the renal threshold?

A

Measurement of the kidneys ability to reabsorb a particular substance from the filtrate

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31
Q

What happens is the threshold of a substance is exceeded?

A

Then the substance cannot be reabsorbed from the filtrate and is excreted in the urine

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32
Q

What is normally found in urine?

A
  • water
  • ions (Na+, K+, Ca2+)
  • dead cells (epithelial cells)
  • hormones (HCG)
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33
Q

What are 4 normal findings in urine?

A
  • colour should be yellow or amber
  • should be transparent when fresh
  • the volume should be 1-2L/24hrs
  • the pH should range between 4.6-8.0
34
Q

What are 4 abnormal findings in urine?

A
  • blood present (present with trauma, infection, during menstruation)
  • glucose present (people with diabetes)
  • leukocytes present (with infection)
  • ketones present (diabetes, starvation, low levels of carbohydrates)
35
Q

What are the three ways urine moves from he kidney to the bladder?

A
  1. Peristaltic contractions
  2. Hydrostatic pressure
  3. Gravity
36
Q

What systems affect urine production?

A
  • cardiac (blood flow and blood pressure)
  • endocrine (hormone release for high and low blood volume)
  • nervous (sympathetic nervous system response)
37
Q

What are the 4 ways in which the renal system contributes to the homeostasis of the cardiovascular system?

A
  • Kidneys filter the blood and dispose of nitrogenous wastes, maintain fluid, electrolyte, and acid base balance in the blood
  • kidneys produce renin which initiates the RAAS pathway when blood pressure is lowered
  • kidneys control blood volume and blood pressure by regulation of Na+ and water balance
  • kidneys produce erythropoietin which stimulates the production of red blood cells
38
Q

What hormones do the kidneys produce?

A
  • Erythropoietin
  • Calcitriol
  • renin
39
Q

What does erythropoietin do?

A
  • plays an important role in production of RBC
  • released in response to hypoxaemia
  • stimulates red bone marrow to produce red blood cells
40
Q

What does calcitriol do?

A
  • active form of VitD
  • helps promote absorption of calcium in food
  • helps regulate bone formation
41
Q

What does renin do?

A

Released from cells in afferent arterioles when blood pressure drops

42
Q

What are the 2 hormones that respond to decreased blood volume and result in less urine production to increase blood volume and BP?

A
  1. Aldosterone

2. Antidiuretic hormone (ADH)

43
Q

What does Aldosterone do to help decrease blood volume?

A
  • released from adrenal cortex (on top of kidneys)
  • works on nephrons to increase tubular reabsorption of Na+ and therefore water by osmosis
  • urine production decreases
44
Q

What does antidiuretic hormone (ADH) do to help decrease blood volume?

A
  • increases water permeability in nephrons to reabsorb more water into blood
  • urine production decreases
  • produced in hypothalamus, stored and released by pituitary gland
45
Q

What is the hormone that responds to increase blood volume and results in more irons production to reduce blood volume and BP?

A
  • Atria Natriuretic Peptide (ANP)
46
Q

What does atrial natriuretic peptide do to help increase blood volume?

A
  • increases Na+ secretion and therefore water
  • urine production is increased
  • released from atria in the heart
47
Q

What are 3 age related changes to the urinary system?

A
  • due to decreased mobility and dehydration, elderly may be more susceptible to:
    • a cute and chronic kidney inflammation
    • kidney stones
  • due to decreased thirst sensation, elderly may have increased susceptibility to dehydration
  • potential for functional incontinence
    • drinking less to avoid using the bathroom, risking the chance of incontinence
48
Q

pH measured at 7 is considered..

A

Neutral

49
Q

pH below 7.35 is considered..

A

Acidic

50
Q

pH about 7.45 is considered…

A

Alkaline

51
Q

What is the normal pH of extracellular fluid?

A

7.35-7.45

52
Q

Why is a pH below 7.35 dangerous

A

Because H+ alterations can:

  • disrupt the stability of cell membranes
  • alter the structure of proteins
  • change the activity of important enzymes
53
Q

What are the 3 mechanisms to control systemic pH?

A
  • buffer systems in the blood respond immediately (HCO3-)
  • respiratory system systems involving exhalation of C02, takes minutes to respond
  • renal response systems involving kidney excretion of H+ take hours to respond (24hrs)
54
Q

What is involved in the regulation of acid-base balance?

A
  • the body’s protein buffer systems
  • the lungs
  • the kidneys
55
Q

What happens if there is excess C02?

A

The blood becomes more acidic

56
Q

What happens when carbon dioxide levels rise?

A

More carbonic acid forms, additional hydrogen ions and bicarbonate are released and the pH goes down

57
Q

What happens when Pco2 falls? (Partial pressure of carbon dioxide)

A

The reaction runs in reverse, and carbon acid dissociates into carbon dioxide and water

  • this removes H+ ions from solution and increases the pH
58
Q

What is more common, Acidosis or Alkalosis?

A

Acidosis

59
Q

Why is a shift in pH from neutral to acidic bad?

A

There is a major adverse impact on the nervous and the cardiovascular system
(Individual may become comatose)
(Cardiac contractions become weak and irregular)
(Signs and symptoms of heart failure may develop)

60
Q

What does a buffer system do?

A

Minimise marked changes in the pH of a solution

61
Q

What are the 3 main buffer systems?

A
  • proteins
  • carbonic acid - bicarbonate
  • phosphates
62
Q

When are buffers effective?

A

Only if there is a way to excrete the excess acid or base - primarily accomplished by the lungs or the kidney

63
Q

What is expired in the air with every breath we take?

A

C02 and H20

64
Q

What happens if we change the rate or depth of our breathing?

A

It can adjust pH

65
Q

How does the renal system regulate pH?

A

Maintains pH by controlling secretion and reabsorption of H+ and HCO3-

66
Q

How does the renal system regulate the Acidosis pH?

A
  • more H+ secretes into filtrate (excreted in urine)

- more HCO3- reabsorbed (into blood)

67
Q

How does the renal system regulate the alkalosis pH?

A
  • Less H+ secreted info filtrate (excreted in urine)

- Leas HCO3- reabsorbed (into blood)

68
Q

What are some consequences of acidosis?

A
  • main effect is depression of synaptic transmission
  • clinical signs::
    • weakness
    • fatigue
    • headaches
    • confusion
    • vital signs change
  • pH less that 6.8 cause coma and death
69
Q

What is Respiratory Acidosis?

A

If the pH drops due to respiratory dysfunction

70
Q

What happens in respiratory acidosis?

A
  • rate of C02 production exceeds rate of elimination
  • if C02 accumulates reaction is driven to the RIGHT
  • results in increased H+
71
Q

What is the response to respiratory acidosis?

A
  • rise in PCO2 detected by chemoreceptors
  • pons and medulla react by sending motor signals to respiratory muscles
  • Respiratory rate and depth increase to ‘blow-off’ C02
72
Q

What is respiratory alkalosis?

A

If the pH rises due to hyperventilation

73
Q

What happens in respiratory alkalosis?

A
  • rate of C02 elimination exceeds rate of production
  • if C02 drops, the reaction is driven to the LEFT
  • results in decreased H+
74
Q

What is the response to respiratory alkalosis?

A
  • drop in PC02 detected by chemoreceptors
  • pons and medulla react by inhibiting motor signals to respiratory muscles
  • Respiratory rate and depth decrease to conserve C02
75
Q

What is Metabolic acidosis?

A

If the pH drops due to a non-respiratory cause

  • acids accumulate in the blood due to cellular metabolism
76
Q

What happens in metabolic acidosis?

A
  • Anaerobic cellular respiration produces lactic acid
  • large scale fat metabolism produces ketones
  • excess alcohol metabolism produces acetic acid
77
Q

What is the response to metabolic acidosis?

A
  • Buffer system
    • acts quickly
    • HC03- binds excess H+ to increase
    pH
  • respiratory system
    • acts quickly
    • “blows-off” excess C02 to increase pH
  • Renal system
    • acts slowly
    • eliminates H+ from the body to increase pH
78
Q

What is metabolic alkalosis?

A

If pH rises due to a non-respiratory cause

  • occurs when non-respiratory acids are lost
79
Q

What happens in metabolic alkalosis?

A
  • can happen with loss of stomach acids (hydrochloric acid) with severe vomiting or loss of gastric contents through nasogastric drainage
  • use of diuretics causing excessive loss of H+
80
Q

What is the response to the metabolic alkalosis?

A 
- buffer system
     • acts quickly 
     • HC03- releases H+ to decrease pH
- respiratory system 
     • acts quickly
     • reduces Respiratory rate and depth to 
        conserve C02 to decrease pH 
- Renal system 
     • acts slowly 
     • reabsorbs H+ from the tubule into blood to
        decrease pH
81
Q

What are the consequences of alkalosis?

A
  • main effect is nervous system over-excitability
  • clinical signs::
    • cardiac arrhythmias
    • confusion
    • convulsions
    • hyperreflexia
    • vital signs changes
  • pH greater than 7.65 can cause coma and death

Nursing Science EXAM 2 (10 decks)

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