Dr. Sarah Roth's Personal Meeting Room

Introduction

• Host: Dr. Roth, professor teaching Medical Terminology 120.

• Schedule adjustments due to work; second day sessions will be on Wednesdays for the next three weeks.

• Aim for variety in teaching styles and engagement with multiple professors.

Background of Dr. Roth

• Background in emergency medicine; often uses patient examples.

• Continues to work as a contingent staff in the University of Michigan Adult ER while teaching.

GU System Overview

• Focus for Week 8: Gastrointestinal and Genitourinary (GU) systems.

• Previous content covered gastrointestinal topics.

• Importance of midterm evaluations to be sent to students by the end of the week.

Anatomy of the Renal Urinary System

• Key components illustrated: kidneys, ureters, urinary bladder, inferior vena cava, renal arteries, and veins.

• Importance of understanding kidney anatomy for urine production.

Kidney Structure and Function

• Renal structure highlighted:

  • Renal pelvis, fibrous capsule, renal column, renal pyramid.

• Blood flow through the kidneys detailed, including afferent arterioles leading to nephrons.

Urine Production Steps

1. Glomerular Filtration:

   • Occurs in the renal corpuscle; involves glomerulus and Bowman's capsule.

   • High pressure creates filtration of water, waste, and small molecules.

   • Larger substances (plasma proteins, red blood cells) remain in blood.

2. Tubular Reabsorption:

   • Takes place in renal tubule (proximal convoluted tubule, loop of Henle, distal convoluted tubule).

   • Useful substances like glucose and amino acids are reabsorbed into peritubular capillaries by active transport.

   • Water reabsorbed via osmosis.

3. Tubular Secretion:

   • Mainly in distal convoluted tubules; excess wastes and ions secreted into tubular fluid.

   • Wastes travel through urinary system to exit the body.

Acute Kidney Injury (AKI)

• Definition: sudden reduction in kidney function; can be reversible.

• Symptoms: pressure sensation, difficulty urinating (could lead to chronic kidney disease if untreated).

• Sharp increase in serum creatinine indicative of AKI.

Acute vs. Chronic Kidney Disease

• Acute Kidney Injury:

  • Sudden onset, often due to conditions like acute tubular necrosis.

  • Can progress to chronic if untreated.

• Chronic Kidney Disease:

  • Gradual loss over years, commonly from diabetes.

  • Requires ongoing evaluation of glomerular filtration rate (GFR).

Reversibility and Consequences

• AKI may be reversible if treated early, while chronic kidney disease is progressive and irreversible.

• Mortality in end-stage renal disease linked to underlying conditions like cardiovascular diseases.

Staging of Chronic Kidney Disease

• Stage 1: Kidney damage with normal GFR.

• Stage 2: Mild decrease in GFR (60-89 ml/min).

• Stage 3: Moderate decrease (30-59 ml/min);

• Stage 4: Severely reduced GFR (15-29 ml/min), need for dialysis.

• Stage 5: Kidney failure, GFR < 15 ml/min; renal replacement therapy may be necessary.

Systemic Effects of Kidney Failure

• Significant effects on overall health; often leads to electrolyte imbalances, hypertension, cardiovascular diseases.

• Chronic conditions lead to dysfunctional excretion of potassium and sodium.

Glomerulonephritis and Infections

• Glomerulonephritis: inflammation affecting the glomeruli, leading to decreased kidney function.

• Symptoms: blood/protein in urine, confusion, muscle cramps, etc.

Urinary Tract Infections (UTI)

• Causes: often due to bacteria like E. coli; frequent in women.

• Symptoms include urgency, burning with urination, and odor.

• Elderly may present with confusion or fever as main symptoms.

• Importance of urine culture for targeted treatment.

Case Study Discussion

• Patient Scenario: 64-year-old woman post-total hip replacement; not urinating.

  • Consider fluid intake, previous urination, and medication side effects that may hurt kidneys.

  • Assessment includes physical examinations and checks for tenderness, bladder status, and fluid levels.

Further Investigations and Treatment

• Investigate with blood tests, ultrasound, IV fluid treatment.

• Importance of reassessing after interventions; monitor urine output.

Clinical Judgment and Decision-Making Model

• NCLEX Preparation: Tools and models provided to enhance clinical judgment in nursing.

• Emphasis on recognizing clinical cues, prioritizing concerns, generating solutions, and evaluating outcomes in patient care.

• Process includes asking relevant questions, analyzing information, and working through clinical scenarios.

Conclusion

• Successful management of GU system involves understanding signs/symptoms, the anatomy of the urinary system, and effective response strategies to clinical situations.

• Importance of continuous learning and interaction between theory and practice in clinical settings.

• Encouragement to reach out for queries and complete evaluations.