Renal Concepts and Pharmacology Made Easy | Picmonic Nursing Webinar

so my name is Kendall Wyatt uh I am the instructional content strategist here at pic monic I'm broadcasting today from our pic monic office in Tempe Arizona and I am an art RN I'm I started out actually as a paramedic before that and I'm in my third year of medical school doing my rotations here in the Phoenix Valley so one of the things is you know what do i do at pic monic and i work with our content and obviously the instructional content strategist i'm it's not a completely made-up name but so i work with our actual educational content and i kind of been the go-between between you guys the users and our actual our team to make sure we have the most up-to-date content that it's medically accurate relevant and work with our team as well as the rest of our scholars to make sure that it's it's the right stuff you need to learn and I'm also kind of listen to what you guys say and put it all together so again if you have any questions you can type it in and after this we you can email us and if we have something we can address we will definitely take care of that for you that's definitely what we're here for so with that being said also in the background I have Steve who works here in the office and always make sure everything is kind of kosher and working behind the scenes we're actually inside of our pick Manik sound booth here in in Arizona in our pick Manik office so this is actually where all of our audio is actually recorded and of course I have my mood lights behind me so we have that as well so we're going to go and start it without any further ado so what Manik just really quick and basically we are knowledge mastery using images so we use characters and we associate characters with things that you need to memorize you can memorize it longer so everything you see today is going to include a lot of images to help you remember and solidify everything and we give all this for free but of course we have an entire product that's also back behind it so this is kind of a snippet of everything we do so anytime you need to remember anything so like a you know medic or diseases and things like that and viruses maybe like herpes you'll see this herpes harp displayed in our pic Manik we have tons and tons of medications in our product we go with lots of them today but you need to know lots of things about warfarin so will we show you this warfare ii right here and if you need to do psych everyone loves a little psych if we displayed bipolar we'd show a bipolar bear oxytocin octopus toe and of course Pediatrics will show you some type of little baby in there with this little cute baby right here of course this one's supposed to be sick he's got some green glow on so lots of characters that we use to help you memorize things because everyone knows especially as a nurse you have to memorize a thousand things every kind of student but we make that life really easy we're going to go over concepts today okay so we cover over 700 topics for nursing all the things you need to know and to pass and clicks and for your exams for sure so what are we actually going over today we're going to look at some renal system anatomy just really briefly and we're going to hit on the pathophysiology Rene angiotensin system the nephron we're going to look at some pharmacology and then we're actually gonna look at a couple of diseases and some pathophysiology and the concept and once you understand the general concept of everything on how it actually kind of goes together then you can bring in the second piece and that's memorizing everything of course that's where Pig monic really rules rules the roost we'll call it to make sure that you know you have everything you need to know and then with the end we're going to do a QA for you so that if you have any questions you can type it in but of course as always you can type in as we go any types of questions throughout the way so let's go ahead and get jump right in here so one of the things you have to think of right away is all the whole body system as a whole so if you've seen any of our other webinars or any of our other presentations we have lots of them and more to come but we go over all the body systems so we have one on the pipes and that's kind of you need to think about the pipes these veins and arteries they carry all the blood right and then you have the pump the actual pump that pumps blood and that's the heart right the aerator well that's um these are the lungs inside of here and I forgot to say this first we always think about the body itself and then it's this whole giant tank and I teach about this entire concept of how it all goes together you have this big tank which at the body and then you have the fluid kind of like this big giant fish tank almost if you imagine a fish tank it's got you know blood it's got water in it and it's got you know the tank itself it has aerator to oxygenate the water that's in there it has a pump to move all the fluids and then it has been pipes to carry all the fluid now what we're going to talk about today of course is the filter so if you think about a fish tank it has a filter and of course that filter of course in your body is the kidneys and we are going to talk about that today with the renal system renal systems definitely definitely a kind of a tough concept with lots of little tiny tippity facts but a lot of medications that go along with it we're going to tie all those in together and I want to keep referencing back to this whole concept of how it all goes together because we have a shock webinar we do we have and when you think about patient that's in shock which organ goes first which organ goes first in shock which one do we actually have to worry about anybody know it's the kidneys right that's right Eric it's the kidneys every time we have to worry about itwe have that golden hour of kidney perfusion and then with irreversible shock when it gets to that kind of level and that's how we have to think about it because we think on this system a large amount of the blood 25% of the blood volume goes to the kidneys well that's you know cardiac output because it goes together so if I think about all those systems that I just put together here's how you can think about it right here think about this whole system and this is how you have to think about the body all this passive pathophysiology and if you are new a new - maybe you're just starting nursing school you know some of this maybe isn't as you know let's say easy for you to grasp right away but if you've been doing it or you are a second year third year then you can also kind of see how this goes together and then you once you know this then you can talk about compensation and you know when one goes wrong the other one kind of picks up the slack so if you have a problem where the blood is not perfusing well enough to the kidneys well what happens as a compensation mechanism what happens decrease blood perfusion before we get into it what happens what does the body do which one of those systems compensating is going to back to a really quick low blood output to the kidneys which one of these other four systems are going to compensate to help you well two systems right the heart is going to increase its heart rate to increase cardiac output but also vasoconstriction ie hypertension right and you can get problems where it runs away in the system then you know it becomes kind of like a runaway hypertensive machine and we're going to talk about how we can block those with all kinds of drugs and that's where you have to remember all this so if we think about the kidney themselves this is an image I got from Wikipedia here you can just see here the kidneys inside the body right obviously we have to and we have a renal vein and artery comes in and then we it comes in and it goes through the nephrons at the lowest level inside of these calluses and then it dumps urine out the your ureter so just one little quick tidbit what happens when you lose a kidney if you don't have one kidney does your does your urine output decrease by 1/2 duh what happens anybody know what happens you lost a kidney maybe you took out a kidney or you don't have one that's right that's right V Erica is the other one compensates and what happens is it actually enlarges and gets a lot bigger and you have a larger kidney because it compensates it makes up for it and it may if you took somebody's kidney out today let's say you know I take Steve's kidney out here in the office because I I want to sell it in Mexico we're pretty close to Mexico here I know that Steve's gonna you know he's going to build up a little bit of um you know problems at first but eventually the other kidney is going to get larger and compensate and it's going you know you won't have that kind of you know you're still going to be able to get rid of all of the all of the waste so that's just some quick anatomy and one thing inside there is when all this waste is getting done is and the hard path of this part is the nephron itself on the nephron comes in and this is a beautiful low nephron our artists drill here in the office so what is the one thing you know about the nephron how many nephron are there per kidney is that is that even a high-yield fact I know it's not but how many are there let's think about that just talk about renal excuse me got the hiccups again renal failure well you know there's about a million Neff nephron inside of each kidney at least a million and what we see with Rini renal failure is we measure renal failure itself as it levels right well why do we not see any kind of problems um you know decreased urine output why do we not see that until in stage renal failure or you know in renal failure at the end that's because the kidney still works fine with 500,000 now nephron it works with 300,000 it's not to get down to 200,000 100,000 to where you know those are all damaged and then you see a patient has decreased urine output because it can't compensate anymore so there's lots and lots of nephron and therefore on so what is just really quick what is the disease that we think about right here that is destroying destroying the the nephron glomeruli what is the what is a disease it just we think about it's just this one that's out there all the time there's kind of two but what I really want to hit on more than the other that's always how you're just us getting rid of these things and you guys right away said both of the ones that I was I wanted to say Sanders has diabetes and that's right diabetes I always think of diabetes and I always think about high blood sugar and I think about any time I make a syrup or you have syrup it's too full of sugar and it's really thick so you have sludge coming through these tiny little nephron and that plugs them up and they stop working the other one of course is hypertension and hypertension of course then causes damage because it stretches everything out destroys it it causes damage and that's for sure definitely what you need definitely two very important ones that kind of out there that happened with lots of people that's why we need to control diabetes and that's why we need to control high blood pressure definitely for sure so let's look at the nephron itself we know that it has lots and lots of different pieces right so we have over here as our actually I think I know pulled on and go back so we have all the different pieces so we know in each one of these pieces you may have to remember what gets lost and what's exchanged I unwise in each one of these maybe you are at that stage you need to do the path of physics and we'll convoluted we'll go through we know that there are medications that work on each one of these we have the loop of Henle the thin and the thick ascending loop away and lean this little bullet dot needs to be up a little bit but then we have our distal convoluted tubule on a collecting duct and we know that it comes in here and then it crosses back in and the kidney really nephron reabsorbs reabsorbs you know the particular ions depending on where it's at so here are five pick monix if you need to memorize it here are the five pick monix that you really need to memorize and that is so if you see in the background is the same nephron image so here are the the pig monix to help you remember the renal corpuscle and the proximal convoluted tubule so we actually show you this pea rocks tube and you can see it's kind of smaller but this is our actual Pig monic to help you remember that in here we you know you lose this is a you know bicarb exchange point and you come down to the loop loop of Henle you'll see these loop and you always see hens every time we show you and you come down here we know that loop of Henle is where loop diuretics work right but it's where we have that sodium potassium chloride transporter and that's where those medications work and you can see that they're right in there inside that image and distal tubules well going through and then the collecting duct and collecting duct of course is where we have a lot of free water that gets reabsorbed right so let's look at overall kidney basic function we're going to come back at the end and tie this back in with the medications on the nephron kind of do those all together because I don't want to get into renal pathophysiology because one it's it's not a very exciting topic it's really just the fact of having to memorize kind of what goes where and I'm going to show you how to do that how to tie it all in together at the end so basic function of the kidneys right number one thing these are there are lots of functions but we're talking high-level giant concept here excrete waste so we know they need to get rid of all the waste products right we know that our kidneys regulate our blood pressure and we know they maintain the sodium balance and that's very important they also maintain potassium Allen's as well it probably should have put that on here as its own bullet point and we know that it also works with blood cell production so what works with blood cell production why how does it make blood cell production what is what is that what what does it create Lila says right away erythropoietin and erythropoietin is made in the kidney but what happens is it actually travels to the bone marrow and matures it causes you know red blood cells to mature so then they can increase so we know we have to give a patient who is in renal failure we have to give them erythropoietin procreate or any one of those synthetic erythropoietin medications we have to give it to them because they will become chronically anemic right you can just give them iron because yeah their iron but they're not iron deficiency anemia they're they have a problem with actually maturing their blood red blood cells and I'm creating them so that's kind of you need to think about it you know the basic concepts so excreting waste so if you don't have a kidney what are you going to build up waste what is the number one waste product that builds up when you need to think about renal failure as a whole what is the waste product you need to think about I feel like my forehead super sweaty today I don't know maybe it's I'm not even sweating and I just feel like it's a shiny rather in this reflection ah right away so your urea that's right you guys some right away urea yeah William says long sleeves in the desert there are long sleeves and in the desert long sleeves is actually correct it was 104 degrees when I came here into the office today so definitely definitely hot so anyway so excrete waste urea is the number one thing you need to think about um and we see uremic encephalopathy right with a patient that may end up in renal failure and if you think about it let's say you learn the concept of the renal system the overall concept this is what we're going to go over today concepts then you're going to tie back to all these diseases or presentations and I want you to always think about everything like that if you understand how it really works and you understand it then you should be able to reason through okay well if I don't have a kidney well then I'm not going to be able to maintain my sodium balance I'm not going to be able to excrete waste I'm not going to be able to get rid of fluid so I'm going to have fluid overload I'm going to end with uremia I'm going to end up with retaining sodium which is going to retain water and I'm going to not be able to produce red blood cells those are all problems we have to fix right and we're going to talk about all those as we go through so I thought I had a really cute picture on this one but I guess I don't so so here is the renin-angiotensin system and this is a wonderful graphic I just want to want you to really understand well because one thing I know more than anything on the in cliques is you are going to get hammered on on the renin-angiotensin system indirectly so yeah you're not going to get asked to memorize the renin-angiotensin system as it goes but what I can tell you is if you understand the renin-angiotensin system not only you're going to understand a whole bunch of things you're going to also going to understand how all the medications that you're giving actually work and and we're just going to quickly go through it so we've got some characters in here which are just for you to to have and we're actually gonna share this graphic with you today this is one of the graphics that we are going to share this one here that will send out subscriber or not we send it out for free we haven't posted these on our website yet the ones we do for free but this one is one we're actually going to send to you and I actually believe Steve can upload it at the end when we get near the end for you so you could actually have it right away I think I'm not sure if I don't wanna get quote me on that one but we have it on our pic banach we will have it on a pic monic website if you end up seeing this later recorded so written angiotensin system right wrasse raspberry system is what we like to call it here so you know that the renin-angiotensin system decrease in blood pressure right which cells are a decrease cause a decrease in blood blood pressure I'm which since which what since it well in the glomerulus right next to the renal corpuscle is you're going to see these juxta juxta just a low glomerular cells definitely feeling tongue-tied today and you're going to see these cells and what they do is they secrete renin so we have R in in itself right Renan so Renan goes out and releases it into the bloodstream and then what does it do it turns angiotensinogen into angiotensin one so whereas angiotensinogen made where is it come from whereas angiotensin angiotensinogen come from anybody know where it comes from comes from the liver that's right cat and he was ezel a liver character if you if you know pic Manik you can cheat because we always kind of throw in the hints right there see do this liver throw in this rock into this angel gym and that's how you remember angiotensinogen but here's the little the the part you need to think of Oh Jen anytime you see anything that ends in Oh Jen it's usually a beginning product it's a it's a it's a precursor it's not a final product angiotensin that's kind of you needed is that always true no it's not I mean you know but as a general overarching rule for a nurse you know Oh Jen you can kind of think of a beginning thing you know a a precursor we'll call it because we have angiotensinogen what happens is it is converted by written in to angiotensin one angiotensin one so you can see this angel tennis player with this one one angiotensin one increase the MTO tens and one it goes to where the lungs right the lungs and what converts it to the lungs to angiotensin 2 this is pretty simple stuff right angiotensin converting enzyme so we call it ace and we always show this little ace card in the lungs because angio converting angiotensin converting enzyme ace is in the lungs and that's where it's converted to angiotensin 2 so what you need to remember here with angiotensin 2 is it's the most powerful vaso constrictor in the human body it's the most powerful basal constrictor it is or the most potent and so it causes vasoconstriction so angiotensin 2 you see this increased angel of tennis too with these little tutus so then you know next and it's kind of simple angiotensin 1 gets converted in angiotensin 2 you have vasoconstriction so you see this base amazing a constrictor here vessel constrictor the snake basic constriction angiotensin 2 causes vasoconstriction and it also the other thing that most people forget is that it goes to the adrenal cortex so it goes to the adrenal gland and it causes an increase in aldosterone right aldosterone so here's a little Aldo stereo here aldosterone Aldo stereo and what do you need to remember about aldosterone is that it causes reabsorption of sodium so if you have this increase in aldosterone then you have this increase in sodium well what happens if you have a whole bunch of salt all of a sudden right you increase your blood volume and I always like ticks but I always like to say this and Steve always puts his head down and in shame but anytime that you know if you you have been out drinking alcohol and you know if you drank alcohol after your you've drank it you know usually volume depleted and giving a message right now from Steve saying oh my god here we go yeah I did and so then what happens the next days you crave a salty type of food you know people they say you know hangover food they want this garbage blah blah blah but they actually creating sodium because wherever sodium goes in your body that's where the water goes and that's kinda how you need to think about it it's a concept so if you overload somebody with a whole bunch of sodium in their body are they going to be peeing a lot no no they don't pee because where sodium goes water follows and you've probably heard that I'm sure some people said that before right you know then that's where the if you take a high sodium and have a lot of high sodium in your body then you're going to retain water so what kind of diet do we put a cardiac patient on somebody in congestive heart failure what kind of diet do we put on cardiac diet right that's the obvious answer don't give me that what does that diet consist of decrease in sodium because we don't want these people to hold on to an excess amount of sodium because if we give them lots of sodium well then they're going to have a lot of salt in there in their body and they're going to retain fluid right that's of course so um yeah someone said gravy as a choice I I'm not a big gravy eater but perhaps gravy has a lot of sodium I don't know so increased sodium and when we increase the sodium and we have this basal constriction we increase the blood volume now one thing is important here is we have a central hypertension that's out there right you know and essentially what happens is you have this runaway system I mean there are causes of hypertension but the most hypertension we don't necessarily perhaps maybe know why why it occurs but what I could tell you is right away let's say a diabetic patient why are diabetic patients hypertensive let's just think about the whole concept I just talked about diabetes and sugar I love sugar by the way and sludge so you have sugar in two his sludge then if there's a sludge blood coming in here to these juxta juxta juxta I can't even say it today Wow these J cells then juxta cells then what's going to happen well if they're not getting a lot of they're not getting perfused well we're they getting a slow sludgy blood they're going to start secreting renin so this kicks off this because this system because the nephron is trying to help itself give me more blood give me more blood but what actually happens is then you're shooting the blood pressure sky-high and you see these people with really really high blood pressures so what do we know we need to do I mean this is you know I get a kind of get off on a rant here but we need to you know stop the system system from running amok right we have to stop it and let's actually just think about this so I taught you the pathophysiology I reviewed it you guys should already know this I hope let's talk about the drugs here so if you think about the drugs and maybe you're not too pharmacology or maybe you're in pharmacology now when you forgot about the Randy renin-angiotensin system wherever you're at right now in school it doesn't matter because this is going to be 100% applicable to you because you can come back to it we're going to take the exact same system and now we're going to put in all the drugs so we're just going to quickly run through this so we know that enemas can run through the system the way it goes decrease decrease blood pressure then we know these juxta glow juxtaglomerular I can't even get it today juxta cells just really quick one of the things we're actually hoping to do here in the office is having everyone pronounced medical terms because we make content so you may hear lots of us in the word in the office you know we have audio recordings and so we have to record content in this sound with right here but what you don't know is it's actually really hard for us as well sometimes to say these perfectly every single time so we have some really good bloopers and some fun we're going to have with that upcoming I'm really excited about it but Chuck's juxta can't even get it today Chuck's juxta cells so increase in renin well we know that there's a medication out there that's a direct renin inhibitor and that's Alyce Caron and or Alyce Caron I can't remember I'm really not having a good day here with this but what that does is it prevents angiotensin 1 or angiotensinogen to convert to angiotensin one it works right here so we actually use this character for this alien skirt and you know I was actually the other day I was I was talking to a patient of mine and I was talking to them about furosemide so for us amide is what kind of drug with you right away what is for us am i for us amide for us and I froze my a loop diuretic right so everybody usually knows it's a water pill or lasix and I was like you know the drug it's a laser and they're like huh as if it's a laser because we use laser in pic monic for lasix and I I just I didn't even connect it in my mind because I'm always always talking about our characters and I felt like an idiot but I actually showed them our pic mana cap and lasix and why I accidentally said that and how they thought it was funny but they M they really also you know understood it so a we have this alien skirt here but let's get in let's talk about the ones that you probably know more of because we have this drug we don't actually prescribe quite as often with lots of other drugs so right here we have an ace in hood so ace interpret well what is an ace inhibitor do ah ah these choices angiotensin converting enzyme and that's right it prevents angiotensin it's an ACE inhibitor so it prevents angiotensin one from becoming angiotensin 2 so inside a pick Manik we have an ace card with these inhibiting chains so one thing you have to remember all the time lots and lots and lots and lots of drugs you have to remember hundreds of drugs as when you're ready for take your NCLEX and in school and as a practicing nurse but what is a one thing that you can do to save yourself tons of time and we did a webinar last week on this was farm endings so what is the ending of mace inhibitor if I know inhibitor the ORAC I remember you from last week so I know you already you cheated and you actually said my other my next one too and that's right it's a pretty ACE inhibitors you need to remember the ending pro lisinopril in a lab pro all of those prills are our ace inhibitors right and we actually will show you here's a pearls on this little image so you can kind of keep them together for you but um you need to remember prills so you can remember 2530 medications sometimes especially beta blockers but you remember five or six seven medications and you don't have to memorize all the actual drugs you need to memorize the endings and there are always those outliers and you know those that's what we have actual characters for like our little aliens skirt right here is cute little bugger to the lover to death so next we have a jet engine - so we know after that they may get the side effect of what with an ACE inhibitor what is that side effect I'm skipping over Viorica so she doesn't say to you I'm not saying her answer you guys write awake off ACE inhibitors could cause a cough because it inhibits angiotensin converting on enzyme but you know the mechanism is believed to be because of an increase in bradykinin and them it causes them you know this this cough and if you get a coffee patient is on a lisinopril and they have a coffee stop tell them to not take the medication withhold the medication but what kind of medication do they get put on and that's an ARB an angiotensin receptor blocker angiotensin receptor blocker so I already kind of got it right here but we know that those are the next the next medication and what happens is it actually blocks angiotensin 2 and our vis an angiotensin ii receptor blocker angiotensin ii receptor blocker or just ARB so why we call it ARB because angiotensin receptor in geo tends in two receptor blocker is way too many words for people to say right away I'm going to put you on an ARB or we're going to put you on what kind of ending and and a sarten right and that's why you have this little Spartan guy right here because for Sartain Spartans and angiotensin 2 receptor blocker these little angels angel tennis players and their little tutus playing with these little blocks yeah maybe a little overwhelming because I feel like I'm going way too much into our characters today but you can remember that SART and Spartans arms and that actually blocks the vasoconstriction and we used to not really give these medications a lot because they were really expensive or more expensive than Aprill but there's still second line medications because they're not as expensive as they were in the last couple years and I really for sure after stay up to that because you know they're not just not as expensive so going into the adrenal gland so we know that also we have adrenal cortex goes in and it creates an increase aldosterone and that causes an increase in sodium retention sodium reabsorption right so we we have actual aldosterone inhibitors aldosterone inhibitors what kind of diuretics are those dosterone inhibitor any other diuretics right yeah like I got you on this one and that's because when you think of us piranhas lactone spironolactone is a potassium sparing diuretic well it's actually yeah it's you remembered it's a potassium sparing diuretic but you need to remember that as well or understand that the idea that it is a aldosterone inhibitor and what actually happens is is it it spares potassium but it also it because because it prevents the reabsorption of sodium which is what aldosterone does what is out Oster and do well aldosterone reabsorb sodium and gets rid of potassium hey potassium by so it reabsorb sodium and gets rid of potassium every time you think of sodium and potassium you should think about them going in opposite directions for the most part anytime you have you almost always have a potassium sodium exchanger sometimes you have a chloride exchanger in there as well and what is a layup sodium potassium - chloride ATPase pump what medication is that I said that maybe too fast we think bout loop diuretics I'm just so just so I don't have to yeah right away you guys you guys said it looked diuretics that's right you think about that do you have to memorize all of those yeah kind of you do have to understand the general idea you have to understand kind of how they work and then you can you could memorize these themes you don't to memorize all these little tiny tidbits you remember as a theme so we have spurinna lactone we always like to show this spiral of milk anything we have aspirin a lactone spiral of milk now we also have potassium spera diuretics but they actually are actually they block the reabsorption of sodium it'll work on aldosterone but they work on on the sodium and that's some triamterene and amelia ride so those are also potassium sparing diuretics but they actually block the reabsorption of sodium not as high yield for sure what you're going to get on you know you need to know right away our ACE inhibitors you got to know that cough sartet is you've got to know right away what is this very important side effect of angiotensin ii receptor blockers and ACE inhibitors very high yield that you need to know very dangerous side effect sometimes my screen doesn't update right away so to give me all the answers oh it does actually look like it's kind of gone a little crazy so yeah it strata genic but most importantly angioedema you know with those more lips big swelled up lips angioedema and that's also believed possibly to be because of brady qaeda sorry i spaced out there for a second so actually Sean Shantay asks about what about thiazide diuretics does it block a angiotensin and the answer is no what dies I diabetics do directly is they work on the distal convoluted tubules and we're going to get to those in just a bit as well so they actually work inside the nephron themselves these work this works other all these drugs here working in other mechanisms because because we know let's let's just tie this together and this is where we're actually going to this next so we talked about this is the renin-angiotensin system right and the adrenal cortex here releases aldosterone but where does that aldosterone go to work where does it actually travel to in the body to work where does this increase sodium travel to work where is all that action happening what's happening in the you happening in the nephron right like in the collecting duct and that's where you're going to see these medications in just a second yeah so that's that's definitely that's how it works with hypertension with hypertension as far as that goes so next slide here so here is the actual the actual nephrite let me just yeah net front again so this is the nephron now what we've done here now is we've added in all of the medications that work actually on the nephron so not as important for what we're going to talk about right now because we're talking Reno but proximal convoluted tubules we know we have a seat as Olamide this is a cheetah's or oh that works on the proximal convoluted tubule does anybody know just as a throw out there side side node one because I get distracted really easy too because I want to take another drink what we give a acetazolamide for acetazolamide acetazolamide we know it works in the proximal convoluted tubule what do we give it for you might have any ideas a couple good ones Katz's high-altitude that's that's absolutely correct what else do we give a seed as Olamide for anybody now it's kind of it it's um we hear from for Glock glaucoma that's definitely something we could do we can give it as a Fred Dima and things like that but what we do really importantly is we alkalis the urine with it because what happens is it's a carbonic anhydrase inhibitor so what happens is it causes the body to become acidic in the urine become very alkaline Oh should I just move a row went like crazy of my slides here it's big I always hit this I do this every single time every week I do this so here we are sorry just ignore all that little buzz enos that just happen so proc that's what I see the acetazolamide works it works with them carbon carbonic anhydrase and which is a carbon product and we know carbon we're going to have an acid base webinar here in a couple weeks but if I said bicarb and co2 what is the balance what is the balance between carbon carbon dioxide and bicarb on a ratio does anybody know what that balance this is it one two one one two five one seven one two ten one to a thousand 150 thousand what's about 1 to 20 is the actual answer so it takes 20 co2 to really equal 1 by car by car but I always think by cars is juggernaut but that's in a separate asset based conversation webinar so we talked about the descending loop of Henle here is where someone said earlier osmotic diuretic so anytime we give osmotic diuretic so you always want to think about mannitol we always show a manatee measure of a whole pig monic on this one but what are we we're getting rid of osmotic diuretic we want to think about it's getting rid of free fluid free water so we didn't just decrease free water and what where do we give manage mannitol I see almost said the drug the manatee is the drug name what do we really give it for we think about it right away glaucoma yeah mostly we give it for excuse me increased intracranial pressure Alvin said of ICP increased intracranial pressure I feel like I've got the hiccups all of a sudden so a little crazy today increase intracranial pressure because we need to decrease overall fluid osmotically fast and that's where we always think about mannitol so we come down the loop of Henle here we come on down here we are loop loop loop I'm all the way down and we think about the thick ascending loop of Henle and what do we know about the thick ascending loop of Henle that should be very high yield you know right away you need to think the thick of ascending loop thick ascending loop I always think thick I think big and I think lots of fluid gone because I need to think of what kind of medication loop diuretics loop diuretics right away Kimberly asked really quick what medications given for intracranial pressure again and that's very commonly is given mannitol mannitol decreases intracranial pressure for sure it could work for intraocular pressure yeah but mostly intracranial pressure decrease intracranial pressure guess yeah I guess cerebral oedema kind of thing um yeah yeah cerebral edema you know increased intraocular pressure increased intracranial pressure primarily IOP yes you know ocular pressure yes and that is including you know increasing glaucoma so that is a good point so the thick ascending loop I think of the thick ascending loop you know you have to think about the thin or the thick think thick think big think loop diuretics because what we know is loop diuretics I mean they just come in they just come in and they just get rid of everything and what is the big loop diuretic is furosemide right furosemide and furosemide for us - two really important side effects that you need to know really important there - you know I thought there were a bunch there's - need to remember - what are the two side effects two side effects of furosemide if I said you can only pick two you guys got the ototoxicity and that's very very important especially if you're giving four austenite IV in an infusion constantly and when I say odo toxicity what is my patient going to present with but I say a patient is there and furosemide what is it actually going to say they're going to have ringing in their ears that's right ringing in their ears is almost always a very high yield presentation when you're on peroxide ringing in the ears going to be for us my toxicity so I get I got lots of answers for the second choice and I expected that because what I you know there are lots of other side effects of taking furosemide hypokalemia very important very high yield but also hypocalcemia high poke low chloride all it gets rid of everything and the one you need to remember second is that loops lose everything loops lose everything but specifically loops with everything and calcium so loops lose calcium loops lose everything and calcium that's what you need to remember is that side-effect because everything's going to be low you're going to be decreased potassium it's almost always the first one especially if somebody takes lots of lots of lasix furosemide but you're going to see low calcium I'm going to see a little chloride you're going to see all of these electrolytes going to be low because it just gets rid of everything all of them are gone that's how you need to remember and then also ringing in the ears you know as well so when we think about this we know that secondarily we can give after a loop diuretic we can give thiazide diuretics thiazide diuretics right so a thiazide diuretic is hydrochlorothiazide that's seems pretty simple right thiazide diuretic hydrochlorothiazide and they work on the distal convoluted tubules so it's farther away this distal convoluted tubule and we always remove this this hydrant with this Tarzan man Hydra hydrant chlorine Tarzan for hydrochlorothiazide oh yeah it's kind of a good little character to remember that's on the distal convoluted tubules so farther away and what's the difference between lasix a for awesome Ida loop diuretic versus hydrochlorothiazide what is the difference they're big really important difference I'm not letting by Erica answer any more because I feel like she cheated somehow I'm kidding and that's right why did I tell you that loops lose calcium that that's because by azides spare calcium so if you're in a thiazide diuretic you may end up with what you may end up with hyper a high calcium level which which may end up in having lots of different problems right you retain calcium so you end up maybe end up with a lot you can still end up with a low potassium level a low chloride level but you're not going to end up with is a local calcium level that's not going to happen on thiazide diuretic that's for sure so moving on to the collecting duct we think about the collecting duct we think about two things that work here aldosterone we have free water not as much free water but some so mostly we have aldosterone that works here in it it basically this is where we have all of our potassium sparing diuretics all in the collecting all of them are there and we know we just talked about three we have this Amelia Rider which is a Muller ride right we have triamterene triamterene this little triathlete and those are what kind of drugs well they're sodium they work with a sodium exchange so they're going to prevent the reuptake reabsorption of sodium so they're going to their potassium sparing but it's because their sodium losing right they keep you from pre absorbing the sodium and then we have sperm lactone itself and it decreases it's a direct inhibitor about dosterone so what is a side effect of spurinna lactones really important sorry I dropped my stuff here spurn electone if I said I'm going to give you spur on a lactone what is an important side effect and the obvious one is not the one I'm looking for you don't say that one cat shontayne Hanna all well sorry cat and shantae said the obvious one which is it's potassium sparing so you're going to end up with a lot of potassium right you put in with hyperkalemia high potassium yeah that's obvious not the answer I'm looking for what's that another side effect well nobody said this one today but the answer is gynecomastia so you know you could end up with you know you can end up with man boobs essentially if you take that kind of medication because it it blocks out dosterone so blocks this this synthesis of hormones and it could cause as a side effect gynecomastia yeah you could Tamia says you could have a dysrhythmias that is true but it's usually secondary because you had hyperkalemia because hyperkalemia anytime you have an imbalance of potassium you should be thinking about arrhythmias especially hyperkalemia hypo clean you you know you're going to end up with arrhythmias a side effect so let's look at kidney disease a kidney damage itself so we know we have kidney damage we have acute so we have short-term kidney damage so I talked about all this we talked about the renin-angiotensin system and into those juxta cells we could have a cute right acute decrease is going to be to causes dehydration and hypovolemia hypovolemia there's just you know shock you know I have no blood pressure going to it but then you have chronic diabetes but also renal artery stenosis so you have hardening of those renal arteries then that's going to decrease decrease the amount of blood that gets through or what happens well do you increase the amount of renin you kick off the entire cascade and the body tries to push a whole lot more between in that smaller little hole to get a more more actual volume to the kidneys and that that's how you see and this is always this one this this image here always makes me giggle and this is our hippo for hypo low blood volume and these taken showers it just makes me giggle every time I see it so acute renal failure itself acute renal failure itself has really three causes so there's pre renal so this is renal failure that's caused before the kidney so you're not getting enough blood to the kidney so what is it cause of pre mean so pre we know the kidney itself is not getting enough blood but it's because it's before the kidney anybody know the example Oh Cheeta there what's got to it trauma that's right could be trauma so hypovolemia you know no actual blood so if there's no blood in the tank it's not going to get to the kidney and that's right and a blockage somewhere it could be true Shantay typed a little bit of gibberish in there on her answer I'm not I think she's trying to type too fast maybe maybe I am going to fast forward but that's that's really right it's basically above the kidney is a problem so hypovolemia is a big one and one you guys someone mentioned it earlier but it's dehydration dehydration right away and a very very very very high yield point is what is it number one sign very initial sign you see in dehydration or very early sign you see in dehydration you're not allowed to say the obvious one again you're going to cheat I know Victoria is says thirst and that's that's the that's the obvious one I that's correct but that is not what I was looking for when you do your tests they're not going to give you those easy ones the patient's thirsty are they dehydrated man probably yeah they're thirsty right no it's the answer is tachycardia so a patient was dehydrated they have decreased fluid volume so they have decreased fluid volume because they're dehydrated so which mechanism think about the beginning giant picture we we put it all together if you have a decreased volume in your tank well which one of the system is going to actually compensate well the filter can't compensate itself it has mechanisms to help it compensate but there's if you increase the pressure that's there's nothing in the pipes to constrict so what happens is that tiny little bit of fluid you have has to pump around the system faster so you see yeah you see some basil constriction but you most importantly see tachycardia because the body has to fix itself and so it has to keep the cycle fluid going around around ion so you can say oxygenated that's kind of how you need to think about it to put it all together and you guys yeah that's right you said the pump that's right so in terminal direct damage to the actual kidney itself so some just causes in there right away pyelonephritis and infection in the kidneys you know nephrotoxic medications which medication do I say immediately when I say nephrotoxic medication is every single old person on and you should not they should not be taking it for their kidneys Oh several we said JIT my sins you know gentamicin that's true you know aminoglycosides our nephrotoxic um but not really what I was looking for the answer I was really looking for you is a quick think about big picture things you know these are general stuff and that's don't always go to the finite detail think about general old person an old person probably has you know osteoarthritis and they probably take an inset and that's where you think about insides are very toxic to the kidneys and they you know you know they don't want to be you know maybe taken those incense every single day that's for sure and of course you have a direct any kind of actual other direct injury as well so post renal below the kidney so we talked about the kidney when in the nephron and Michaela seas of circulated Radwin ureter so after the kidney so anywhere the ureter down is urinary obstruction so when I say old man and I say urinary obstruction you say what not stones not stones BPH that's right cat BPH old man obstruction I can't pee prosthetic it's always a prostate that's right right away and you know they always every single person I always say and I heard a urologist say this once but kind of stuck with me and it's pretty much if you live old live long enough as a man you're going to end up with prostate problems you're going to have sprung because your prostate just enlarges and it causes frequency and whatnot now post renal urinary obstruction overall in any population of course is of course urinary stones and that's for sure is you know renal calculi kidney stones is going to come down block block the reader your order and you can also have you know strictures and whatnot which could cause renal failure because of poor output anytime the urine stays and becomes you know it has stasis you have problems with infection and whatnot that all occur so we talked about a lot of this already let's talk about people with liver failure in general and liver failure means liver I went to the liver I don't know where I got that renal failure in general we know if you have a renal failure you retain waste products and that waste product right away is urea right so if you have a lots and lots Iria you have your emitting said lovely there's a you know fine if you didn't you know long term you're going to retain sodium potassium and you're not gonna be able to make erythropoietin you know general general things we talked about every single one of these so far you know there are other problems as well of course so chronic kidney disease I feel like I need to sneeze today but I just can't can't get a good sneeze out under why I'll do it afterwards but chronic kidney disease so what happens in chronic kidney disease let's just think about through most let's talk about a diabetic patient the chronic kidney disease so they have this diabetic glomerular no property and they you know long term they have kidney failure we know there's millions of nephron and they end up getting damage over time slowly they end up with this general malaise why do they feel bad well we're getting you know uremia they're getting this buildup of waste products and if you have a buildup of waste products I was like to think about it you know think about a dump and I think every single one of you have driven by a dump at some point right and it's just gross I mean all that stuff sits there Oh or better yet let's think about your garbage no this is even better so you think about your garbage now I hate to take out my garbage and I'm at my place where I live they take the garbage every day thank goodness so I could put it out any night that I want but let's say you do it once a week and you forget one week so you have this bag of garbage and it sits there and it kind of yeah it's okay day one one but day three it's kind of getting stinky it's getting a little gross and you know just not very good it's just kind of yeah you know what I really want to go near it but it's not the best it's not really super bad but it's getting there and that's how really help you think about kidney disease it's really not that bad at first day one day two not so bad you know but it gets worse right it doesn't get any better unless you deal with it unless you stop it unless you get rid of it out of there now with a kidney you can't just get rid of the kidney but you can stop the damage and you think about things like acute tubular necrosis so let's say I have a patient that has lots of insides and they end up with lots of damage well if you stop taking all those insects or you stop having all this pyelonephritis disinfection they get better because they have us acute tubular necrosis acute necrosis chronic it just keeps going and what happens with your bag of garbage if you leave it till the next week it is disgusting it absolutely is nasty especially if you had some hamburger meat in there that you threw away day one the dog wants to get in it but date and that dog is not going anywhere near it well what happens well you have kidney damage well we know right away we have some compensation this nasty bag of garbage is not getting blood flow in there so you have those juxta cells kicks off their systems as hey more perfusion more fusion we gotta get this sludge out of here we gotta get things moving through soon with a hypertension why do you have proteinuria well you have proteinuria because as that think the sludge is going through it's getting damaged and when it gets damaged it creates holes and it lets this stuff kind of flow through it just lets it kind of flow right out into the urine proteinuria and hyperkalemia well let's just talk about hyperkalemia why do you have hyperkalemia talked about it maybe we didn't hit it on ahead exactly we talked about hyperkalemia and the fact of well we talked about sodium and potassium and if sodium can't be reabsorbed well it gets lost and came to Missouri can't be exchanged for the potassium so you end up holding on to the potassium if you have a patient comes in diabetic or I mean I'm a patient who comes in and they're in renal theory in stage renal disease in their own dialysis what's probably going to bring them in in day five without having dialysis for a couple of days is going to be hyperkalemia first think about hyperkalemia our potassium itself is this really fragile little electrolyte you know it's got a tiny amount the body you know the normal potassium is three point five to five depending on exactly what lab you use three point five to five but it was kind of fragile loop diuretics poof gets rid all the potassium really easy for you to drop someone's potassium but exactly the same way if you don't have kidneys potassium is the ones going to build up the first but also it's also kind of you know delicate in the fact that the heart itself is very sensitive to potassium think about that as well think about potassium is kind of there's always this fragile little thing you always have to worry about because with Eva hyperkalemia going to end up with arrhythmias so if I have if I said high potassium right away what is the number-one thing you're going to see on easy ECG I said high potassium what are you going to see how do you know somebody's hyped mmm okay what about the t-waves we're gonna talk about t-waves high potassium ease tall peach tea weights and that's right tall PT waves P tall peach tea ways that's right so mineral and bone disorders again because of calcium as well you're going to have neuropathy well you have in rabaa the-- in general as well but it's all because these ions very often you have somebody's chronic kidney disease it's possibly because of diabetes and neuropathy again the same mechanism met about metabolic acidosis develops why because you're not able to reabsorb bicarbonate about what drug acetazolamide carb carbonic anhydrase we think maybe yes and it you know you can cause this s you have metabolic acidosis because you're not able to reabsorb bicarbonate bicarb so you have these patients some maybe you've done your er rotation maybe not I was a paramedic before but one of the things we have it there's any kind of renal patient as you give them bicarbonate code at the end or you know give them by car because they could be metabolic acidosis as well so it may be a little too much information there so let's talk about severe uremia so severe uremia CNS depression yeah you end up with this uremic and settle off because all this uremia this waste area is the waste product number one number one numero uno waste products urea not so much in little bits but really bad in big bits you CNS depression you have this really problem but why do you have pure itis pruritus what is pruritus pruritus is one of my favorite characters and we have it here in our chronic kidney disease pic monic and it's a gopher i mean i'm a prairie dog so oh wait oh it's not in this one i'm sorry it's in our this we have to this is the early symptoms we have a late symptoms assessment card which has our prairie dog so we have gopher for a GFR and we have a prairie dog for per itis is the fun character so anyway um so why do we have protists well because when you have severe urania what happens is actually hold on we just let me just read the answer see it looks like several of you answered ah Shantay says right away you end up with this uremic frost so what happens is you itch because the uremia their urea builds up in your entire bloodstream and all of your body gets that excessive bit and it actually comes out in your skin you know this uremic frost and so that's a nice word uremic frost and steve's listening i think we should add that word to our list of two-word things that make um that are definitely disturbing you remake frost because no one in our office probably knows what it is but it's a buildup of urea at the skin and it makes you itch and it's definitely something that you see I'm right away so you just check got lots of answers here for this one so I just want to make sure that um make sure that I go through yeah that's right so also you see a demon or do you see a demon because you're not be able to manage your fluid balance and get rid of fluid and that's true and oliguria so decrease your an output now remember decrease your and output is a late sign it's very common for you to have a patient on dialysis that has urine output but they may not actually be getting rid of urea they may not getting rid of things they may produce urine but it may not have any waste products in it because it's just there's holes in those nephrons and blood comes in as a whole and it just gets rid of some fluid and just you know really doesn't function to get rid of waste products that's kind of how you need to think about it so let's quickly talk about the dialysis really fast we took like kidney failure and whatnot we know that dialysis number one major fluid shifts right you know you want to monitor their blood pressure because you're getting rid of this fluid with a machine on this machines a long time especially with them with hemodialysis and no blood pressure in the arm especially with the shunt and every time you have that that fistula we have the Fischler going to have a thrill in a brewery and usually ask this but just because of time I'm just going to explain it so the difference between a thrill and a brewery a thrill and a brewery a thrill and a brew a thrill but wait does anybody really know thrill brewery well a thrill is something you feel you can feel a thrill you can feel this thrill when it's a pulsation can feel a thrill and a bruit you auscultate you can hear a bruit so one thing anytime you had maybe had somebody with them you need to do carotid massage on like a super ventricular tachycardia patient that you need to create about salva maneuver and maybe need to stimulate to slow down their heart you know the doctor may do a carotid massage where you want to auscultate for a bruit listen for a brewery and the brewery is a turbulent blood flow so it's that you hear so you hear it when you auscultate it and a thrill you actually feel so when you put your finger on that officially you can feel the thrill and that's just really about all I want to say about that just for now so really quick pyelonephritis I know we had some questions of the day on pyelonephritis indirectly and directly but pyelonephritis is of course an infection and one thing you have to know about Reno is that all of those infections do what where do the infections come from almost every single one for Pilon Oh hold on let me just got a couple cautions oh so I'm Elena if it's normal to have a brewery and a thrill and yes that's what you do to assess maybe an official if or in a diabetic where you know where you put the catheter you should assess to hear a thrill and you should feel a bruit that lets you know that it is accurate in the in the in the official a-- now if you hear a brouilly a brewery ism essentially like a clot or something that the blood is going around that makes it turbulent or that you know it's a turbulent flow so you don't want to hear a brewery in a carotid artery that's a no-no that serious problem that operation probably needs an inter direct imme i'm going to clean out all the clots you do not want to do a carotid massage in those patients but in a fistula because we've it's man-made like we put that vishal in there you want to have a thrill in a brewery and that's what you assess for assess for thrill I heard a thrill in the brewery and it's good so for sure so pyelonephritis pyelonephritis pyelonephritis so that's a pile Oh and pyelonephritis infection in the kidney right and we talked about here pyelonephritis we know pyelonephritis affections usually Aysen they usually come up from what well they come up from outside right I mean the bladder is sterile the kidneys are stare over the blood it's not most common that a blood infection happens because it goes to the kidney that's not true usually what happens is you have a urinary tract infection that ascends well that means it goes from the urethral meatus me a deceiver words by the way so anyway not the arethe ramírez but you know the auditory meatus may this is an opening at all so the urethral meatus Steve's going to give me a couple of interesting words for that one meatus it's one of my favorite words so you're a through meatus comes up and it sends up the urethra and comes up into the bladder right and that's where that's where infections come well if you think about how in the world is Steve sent me a sad winky face how is an infection going to get up into your bladder right I mean sterile well the only way it's going to happen is if you insert something into your urethra up into it if you're a man now if you're a woman we know that you have a short short urethra tiny little short urethra but a man is a very long urethra so but overall we know the most common cause of urinary tract infection is what well urinary catheters if you're inserting urinary catheter a very high likelihood of developing and urinary tract infection and that's why anytime you have pyelonephritis an inside of our pile oh this pillar kidney on fire pyelonephritis you're going to see an avoid catheters this catheter cat because catheter is a very common cause of urinary tract infection so and we want to avoid them right away so you know you can also have this sepsis so you can have sepsis this sepsis the snake inside the bladder right here so you can end up with the sexes after pyelonephritis so think about a sending infection you're going to end up with it comes up into the bladder that's where the the UTI the catheter would sit essentially into the bladder from the bladder up the ureter in the ureter into the kidney from the kidney where does it go well we know we have that membrane right there and what happens is it crosses the in the blood you end up with septicemia right so pyelonephritis right well anytime somebody is burning urination you should think about possibly the fact that they might have a UTI urinary tract infection a fever right away flank pain nausea and vomiting now if I had a patient and I said they have dysuria burning urination fever and altered Mental Status altered Mental Status in an elderly patient you're probably going to think that that patient has what they may potentially be what septic because of a UTI because that UTI and that you guys are absolutely right that UTI has called an altered mental status you have an elderly patient with a catheter with or an elderly patient with a dysuria even with or without a catheter with altered Mental Status and a fever you should think about definitely the fact that they may have a urinary tract infection that's definitely on the differential diagnosis listen if you're a really good nurse you'll learn that as you go through for sure my stool today is a little squeaky I don't know if you could hear it or not so let's put this all together kind of put it all together whole thing and make it kind of recap here's our medications right so we talked about lots of things that a urinary you know urinary everything this is pee all over the place today so we talked about the nephron itself and all the medications inside the nephron right you guys we have all the PICC monix to help you with them so we talked about all these medications well one thing you need to know is you need to memorize the endings of the medications first so think about this here's just a list here's just a preview image of all the different medications not all but a snippet just to show you how many different medications you need to memorize so let's just take this this these two right here in the middle lamp you can see my mouse we have this um if I have this Hin with this loop earring a hen with a loop earring or a loop earring oh sorry a loop earring hen you're probably going to think of a loop hen loop of Henle on side on top of this dye rocket this dye rocket right here there's a little dye rocket of course our dye rocket always shoots that little urine out at the end just for a little added effect as it's rocket fuel but it's on top of this semi because furosemide sem i'd write for awesome and that's how you can kind of tie it all together how you really just remember that today is this loop diuretic ties it all together for you and that's one of our characters inside of me good morning but here's a really high yield when i know we're not doing this today but here's this betta fish right this betta fish on top of these blocks so if I had a betta fish on top of blocks a betta fish on top of block and then I talked about a betta fish on a block you think block blocker beta blocker those beta blocker medications end in a lollipop or haha lol beta blocker medications don't end in the lollipop but you could accidentally say that if you were talking to your your instructor and then you could say hey I learned that with pic Manik I remember this betta fish always is licking this really weird lollipop because how many people have seen a fish with lips with you've seen pic Manik you've seen fish with lips and we have hundreds of medications and all these medications here with you with all these weird side effects all this stuff you need to remember it's all there and definitely inside there for you so you can remember it so let's look at and one things we have over 150 medications of everything we went over today inside our product but let's just look actually here's a really important thing we talked about this loop diuretics so let's just quickly look at these Sanne had a quick question about them she thought the webinar was great but she had a question about the medications again and let's just look at these so here are actual pic monix for for several of the medications we went over today so let's just look at him so here's loop diuretics education I mean loop diuretics we talked about loop diuretics what do they do they inhibit here's some inhibiting chains on top of this to chloride to chloride dispenser to chloride sodium potassium pump so right there there it is and the loop diuretics and we know they work on the thickest inning limit loop of Henle so you see this thick limb here and you see that they cause ohto toxicity right ototoxicity with these glowing green ears right here and they're a sulphur medication well that's really important and we show this sulphur match inside side effect as well see if furosemide as well and over here on the Marais inside all the side effects and you're always going to see hypotension several of you said that today and ice I skipped over it but hypotension of course is a side effect of a diuretic you can have hypocalcemia you can't see it quite well but here's a hippo cow and here's hypokalemia so you can have a hippo hippo a hippo in a banana suit for hypokalemia and you can't see the banana suit but it's actually a really fun character that we have as well and there's all these drugs so you ace inhibitors inhibit a s-- you know here's this Arkansas Arkansas war right here because they the Indians Sartain for the Spartans right here these Spartans with blocks and what's a side effect of angiotensin 2 receptor blockers ARBs right here angioedema here's an angel edamame with these big old lips and I don't know if you can see it right there but they're they're big ellipse angioedema you see it and you can see that and then of course there are other medications as well here's the betta fish again which we talked about which isn't renal today so with that being said let's put it all together really quick went way over today and I don't know for just because I was excited or where I was talking about way so much urine today and just urine was so exciting I don't know why I was such an exciting topic today but let's put it all together so let's here's this wonderful body system we talked about in the very very very beginning so let's look at the body system themselves so we have the veins and arteries right so here's a veins and arteries these pipes all the way out and pipes carry the blood so you know the pipes always you know they just move the Bloods all they do they move it any any type of pipe if you maybe so I had a house back in West Virginia that had really little pipes and what I realize is that they don't move a lot of water the tiny little pipes but they can have high pressure and so you know pipes can change in diameter see and big giant pipes and little tiny pipes but the pressure through them can change so you know the pipes and the pipes move the blood so then you also have this pump where you have to have a pump because inside of any type of great tank if you said fish tank maybe you need to have a pump to move all the fluid around so here's a pump this heart pump to move all the fluid around inside the pipes well it also goes through the pipes but through the pipes it also goes through the actual aerator the filtration or the aeration device to put oxygen into that that tank because if you have great fish in one of these really healthy wonderful fish you know they need to be oxygenated so we have the lungs for that now you know that the lungs themselves can they can you can breathe faster to compensate you can breathe less you can breathe more volume and there's a whole respiratory webinar we have on just the lungs alone to help you show all those lung pathology whatnot so aside from the lungs themselves and you know you have the actual body itself the body itself maybe you if you if you lost an arm so we took this entire tank you lost an arm you may lose a lot of volume and blood out of your tank your whole tank and you could have hypovolemia well one of the things that gets a very large amount of blood flow is of course the kidneys 25% of your cardiac output ish goes to the kidneys and the kidneys are the filters and they get rid of all the waste that goes on and definitely all the waste that just filters out gets rid all this waste so let's think about it kidneys themselves have a lot of functions so what you need to do to think of all of it together is understand the whole concept they'll concept of it what every single systems does so if you have a heart failure we have a heart failure webinar of course if your if your pump is not pumping lots of fluid well then you know the kidneys themselves are going to respond and try to increase by increasing renin-angiotensin system so what's going to happen they're going to constrict the arteries the veins and arteries and I try to constrict all of it as much as possible but maybe that doesn't work so what happens is then the patient doesn't get very good oxygenation so the you end up with a faster respiratory rate and you can see how all these things help compensate and that's just kind of how they work they all go together because if the filters aren't getting rid of the waste you can see these little yellow tubes here coming out get rid all that yellow urea the waste products then they build up in the body and if you have lots of buildup in the product it's kind of like you have a fish tank and you don't the filter doesn't work for you well what happens it turns green and it turns this ugly mess of a green tank and that's what you don't want I mean I hate cleaning and nasty fishtank I mean everyone does you've got to get rid of gotta take half the flu it out and get read and put new fluid in and what's that called when we get rid of half the fluid it's called dialysis we take it out of the tank and we wash it and we put new in that's called dialysis and that's where you have to do if the filters aren't working the kidneys aren't working we're putting the concepts together and if you if you learned anything today is what you want to make sure you understand the concepts understanding the written an angiotensin system is amazing and it's exactly we need to do how it all works together with all that pathophysiology but you have to understand the actual concept um William asked some you missed the first couple minutes of this webinar as it recorded somewhere so we're actually recording today's webinar providing I didn't say any cuss words or anything too graphic and we're going to post it on YouTube Steve's rolling his eyes again I'm sure he's I can't even see him but I always get something but we do record them and we post them on YouTube so if you we have a several of our webinars up there on YouTube our YouTube channel is pick monic video you can go view any of the webinars that we have up there some of them we are doing over again with some new ones I recommend you come to the live ones so you can see all my corny jokes not recorded but we're going to put it up I don't know how quick we have to process the video and Steve has to then send me a couple of mean emails so it'll probably be tomorrow or the next day before we post it up on YouTube for you Oh Michael SM what about this NCLEX study guide so we actually have if you are getting ready to prepare for in clicks right now we have an in click study guide there are two parts store and click study guide that we have right now you can go to pick Montcalm slash NCLEX or just click on resources and you'll see it under nursing but there are two parts to right click study guide the first part is actually helping you understand the questions and one thing I need to point out we have a webinar on Thursday this week we usually don't do to nursing webinars in a week but this Thursday we have a webinar for answering English style questions and pretty much what I do in that webinar is I cover everything that's in the NCLEX study guide in the first part of how to really understand some questions and how to really make sure you put your best critical thinking cap on to understand and get the questions right or at least how number one not to add anything to any questions and that's really really important but so that's the first part how to answer the questions how to go about it and the second part of it is actually all the content that you need to cover I'm using pick Monica has all of the kind of all the ones you need to know as well going through them as well so it's kind of how it goes um-hmm so Kat asks about our pick monic of renal tubular acidosis this would be great and Kat I would let's see I think we actually have an infographic on renal tubular acidosis that we have in production right now that isn't public so it's actually going to be free to the public so maybe I could send you that actually just email us at feedback and pick Montcalm and I'll email you the infographic over because maybe you could double-check it for us and see how it looks as a first pass because I just saw it last Friday a first pass of it should actually have a have some images should be finalized for you to take a look at it's great because it helps you about kind of a process of which one it is and goes to reach of the different types of renal tubular acidosis um Farina asks she wants to ask me about lights and I hope you mean electrolytes oh yeah I know it's not relevant today but I find it difficult to memorize all the lights by heart Farina I have amazing news for you if you just go to pick monic I think it's the link is on our website pick Monica comment go to resources we have an electrolyte sweb anar an entire webinar I'm going over all of the electrolytes I think I just did it a couple of weeks ago and it will help you get those I mean we went through them kind of some really great overarching tips of how to memorize them all as they go through and then at the end we actually we made a playlist for you of pick monic and we have my 18 pick monix just on all the electrolytes hypomagnesemia hypermagnesemia and all of the things and if you watch the webinar and you went through that pick morning playlist I guarantee will remember them because it really you know puts it all together for you if you have any other questions go ahead and send us an email feedback pick mana calm other than that thanks for attending - guys check out our YouTube channel if you have any other questions you can check out some other webinars have a great night thanks a lot for Cohn you

Channel: PicmonicVideo

Views: 39,573

Keywords: Pharmacology (Field Of Study), Renal Failure (Disease Or Medical Condition), Renal, nursing help, nursing videos, picmonic, visual learning, audiovisual, Nursing School (Organization), Nursing (Field Of Study), nclex, ati, hesi, mnemonics, nursing student, nursing mnemonics, medical school application, nursing school videos, nursing student morning routines, Renal Concepts and Pharmacology, Picmonic Video

Id: KGYQnlWSuCQ

Length: 77min 34sec (4654 seconds)

Published: Wed Aug 26 2015