Test 4 Outline

Kidney (Endocrine)
Acute Renal Failure (ARF)-rapid loss of renal fxn due to
damage to kidneys resulting in retention of nitrogenous waste
Secreted hormone From cells Effect (urea and Creatinine) and non-nitrogenous waste products that
are norm excreted to the kidneys
• Incidence and Mortality
Activates the renin- • Prevention
Juxtaglomerular angiotensin system by
Renin (Primarily)
cells producing angiotensin I • Precipitating factors
of angiotensinogen o Prerenal(causes in the blood supply):
• Hypovolemia (decreased blood volume),
usually from shock or dehydration and
Extraglomerular Stimulate erythrocyte
Erythropoietin (EPO) fluid loss or excessive diuretics use.
mesangial cells production
• hepatorenal syndrome in which renal
perfusion is compromised in liver failure
Active form of vitamin • vascular problems, such as
D3
atheroembolic disease and renal vein
Calcitriol (1,25- Increase absorption of thrombosis (which can occur as a
dihydroxyvitamin D3) calcium and phosphate complication of the nephrotic syndrome)
from gastrointestinal • infection usually sepsis, systemic
tract and kidneys inhibit inflammation due to infection
release of PTH o Intrarenal(damage to the kidney itself):

stimulates • toxins or medication (e.g. some

Thrombopoietin megakaryocytes to NSAIDs, aminoglycoside antibiotics,
produce platelets[7] iodinated contrast, lithium)
• rhabdomyolysis (breakdown of muscle nephritis with systemic lupus
tissue) - the resultant release of erythematosus
myoglobin in the blood affects the o Post renal(obstructive causes in the urinary
kidney; it can be caused by injury tract) due to:
(especially crush injury and extensive • Medication interfering with normal
blunt trauma), statins, stimulants and bladder emptying.
some other drugs • Benign prostatic hypertrophy or prostate
• hemolysis (breakdown of red blood cancer.
cells) - the hemoglobin damages the • Kidney stones.
tubules; it may be caused by various • Due to abdominal malignancy (e.g.
conditions such as sickle-cell disease, ovarian cancer, colorectal cancer).
and lupus erythematosus • Obstructed urinary catheter.
• multiple myeloma, either due to • Pathophysiology
hypercalcemia or "cast nephropathy" o Prerenal conditions
(multiple myeloma can also cause o Intrarenal conditions
o Post renal conditions
chronic renal failure by a different
• Clinical manifestations- Metabolic Acidosis and
mechanism) Hyperkalemia most serious biochemical manifestations
• acute glomerulonephritis which may be • DX:
due to a variety of causes, such as anti o BUN, Creatinine
glomerular basement membrane o UA
o CBC
disease/Goodpasture's syndrome,
• Medical Mgmt
Wegener's granulomatosis or acute lupus o Diuretics
o Correct electrolyte imbalances
 o Dialysis
o Fluid restriction
o diet
• Nsg Dx:
o Tissue perfusion
o Alteration in elimination
• Nsg Interventions:
o Pt assessment
o VS
o UOP
o Labs
o QD weights
o Nutrition
o Prevent systemic infection
o Prevent comps of immobility
o Skin and mucous membrane care
o Assess for GI bleed
o Assist with hemodialysis
o Assure pt safety
o Provide psychosocial support
o Pt. teaching
Chronic Renal Failure
• Incidence and Mortality
• Prevention
• Precipitating factors
o Tubulointerstitial disease
o Glomerulonephropathies
o Nephritic syndrome
o Renal vascular disorders
o Renal CA
• Pathophysiology
o Diminished renal reserve
o Renal insufficiency
o End stage renal disease
o Uremic syndrome
• Manifestations
• DX
• Med/Surg mgmt
o Diet
o Fluid restriction
o Pharmacology
o Blood product transfusion
o Dialysis
o Nephrostomy tubes/ nephrectomy
o Renal transplantation
• Nsg Dx:
o Excess fluid vol
o Alteration in nutrition
• Nsg. Interventions
o Pt assessment
o VS
o LAB
o I/O
o QD weight
o Cardio pulmonary assessment
o Adequate nutrition
 o Good skin and mucous membrane care • Dialysis is an imperfect treatment to replace kidney
o Assess for bone and joint comps function because it does not correct the endocrine
o Assess for seizure activity functions of the kidney.[1]
o Signs of bleeding
o Prevent systemic infections Thermal Burn Injury
o Prepare hemodialysis • Incidence
o Assist with CAPD • Etiology
o Psychosocial support • Prevention
• Classification of thermal burn injury
o Pt teaching
• Calculation of extent of burn
Dialysis- o Rule of nines
• Primarily used to provide an artificial replacement for o Lund-Browder
lost kidney function (renal replacement therapy) due to o Pt’s hand = 1% TBSA
renal failure. • Degree of Burn injury
• Dialysis may be used for very sick patients who have o Superficial thickness/ minor
suddenly but temporarily, lost their kidney function o Partial thickness/ moderate
(acute renal failure) or for quite stable patients who o Full thickness/ major
have permanently lost their kidney function (stage 5 • Phases of burn injury
chronic kidney disease). o Emergent
• When healthy, the kidneys maintain the body's internal o Acute
equilibrium of water and minerals (sodium, potassium, o Rehabilitation
chloride, calcium, phosphorus, magnesium, sulfate) and • Nsg. Dx
the kidneys remove from the blood the daily metabolic o Skin integrity
load of fixed hydrogen ions. The kidneys also function o Altered CO
as a part of the endocrine system producing • Medical Mgmt
erythropoietin and 1,25-dihydroxycholecalciferol o Emergent Phase
(Calcitriol).  O2
• Dialysis treatments imperfectly replace some of these  Circulatory mgmt
functions through the diffusion (waste removal) and  Respiratory
convection (fluid removal).
  Acid-base balance o Components of the immune system
 Pharmacology o Lymphocyte production
 GI mgmt o Cell-mediated immunity
 Renal o Effects of aging on the immune system
 Nutritional • Altered immune response- Hypersensitivity
o Acute o Type I- Anaphylactoid
o Rehabilitation o Type II- Cytotoxic & Cytolytic
 Hemolytic transfusion reactions
Cell Injury and Inflammation o Immune-Complex reactions
• The norm cell o Type IV- Delayed Hypersensitivity reactions
o Cytoplasm  Transplant rejection
o Nucleus Human Immunodeficiency Virus (HIV)
• Cellular Fxns • Significance
• Cell injury • Transmission
o Hypertrophy • Pathophysiology
o Hyperplasia • Spectrum of HIV infection
o Atrophy o Acute retroviral syndrome
o Metaplasia o Early infection
o Dysplasia o Early Symptomatic Disease
o Anaplasia o AIDS
• DX
• Defense Against Injury
• Therapeutic Mgmt
o Mononuclear phagocyte system
o Pharmacology
o Inflammatory response
o Nutrition
o Vascular response
o Nursing mgmt
o Cellular response
• Pretest and post test counseling
o Chemical response
Opportunistic Infections in AIDS
Altered Immune Response
• Illnesses/Organisms
• Norm response
 o Pneumocystis Carinii
o Kaposi’s Sarcoma
o Cytomegalovirus
o Candida Albicans
o Mycobacterium Avium
o Mycobacterium tuberculosis
o Herpes Simplex Type I or II
o AIDS Dementia Coplex
o Infiltrative Emergencies
• Mgmt of Oncological Complications
Management of the pt with Liver CA
• Pathophysiology
• Comparison to cirrhosis
• Nsg Dx
• Nsg Care plan

• Medical Mgmt Liver (Endocrine)

• Nsg Mgmt
Secreted hormone Abbreviation From cells Effect
Cancer
• Significance
Insulin-like growth insulin-like effects
• Biology of Ca
o Proliferation factor (or
IGF Hepatocytes
somatomedin) regulate cell growth
o Cellular differentiation (Primarily)
o Iniatation and development
o Promotion
vasoconstriction
o Progression
• The role of the immune system Release of
• Classification of CA Angiotensinogen
Hepatocytes aldosterone from
• TX and angiotensin
adrenal cortex
o Radiation therapy
o Chemo dipsogen.
o Biological response modifiers stimulates
• Nutritional Mgmt Thrombopoietin Hepatocytes megakaryocytes to
• Mgmt of Oncological Emergencies produce platelets[7]
o Obstructive Emergencies
o Metabolic Emergencies
Liver Failure- ability to regenerate. polypeptide

Pancreatitis
• Acute vs. Chronic
• Cancer of Pancreas
o Whipple procedure
Pancreas (Endocrine)
• The basic concept behind the
Secreted From pancreaticoduodenectomy is that the
Effect
hormone cells head of the pancreas and the duodenum
share the same arterial blood supply.
Intake of glucose, glycogneogensis and These arteries run through the head of
glycolysis in liver and muscle from blood the pancreas, so that both organs must be
ß Islet removed. If only the head of the
Insulin (Primarily)
cells intake of lipids and synthesis of
pancreas was removed it would
triglycerides in adipocytes Other
compromise blood flow to the
anabolic effects
duodenum.
glycogenolysis and gluconeogenesis in
Glucagon (Also a Islet liver • The most common technique of a
Primarily) cells pancreaticoduodenectomy consists of the
increases blood glucose level
en bloc removal of the distal segment
Inhibit release of insulin [11]
(antrum) of the stomach; the first and
d Islet Inhibit release of glucagon [11] Suppress second portions of the duodenum; the
Somatostatin
cells the exocrine secretory action of head of the pancreas; the common bile
pancreas. duct; and the gallbladder.
Pancreatic PP cells Unknown
 • It consists of removal of the distal half of • Communication alternatives
• NG
the stomach (antrectomy), the gall
• Potential for tracheostomy
bladder (cholecystectomy), the distal • Wound drainage devices
portion of the common bile duct • Dressings and bandaging
(choledochectomy), the head of the • Pain control
• Surgical intervention
pancreas, duodenum, proximal jejunum, • Radical neck dissection
and regional lymph nodes.
Reconstruction consists of attaching the
pancreas to the jejunum
(pancreaticojejunostomy) and attaching
the common bile duct to the jejunum
(choledochojejunostomy) to allow
digestive juices and bile to flow into the
gastrointestinal tract and attaching the
stomach to the jejunum
(gastrojejunostomy) to allow food to
pass through.

Radical Neck Dissection

• CA of the mouth, throat and neck
• RF’s
• Prevention
• Symptomatology
• DX
• Pre-op teaching needs

Pharmacology
Anti-inflammatory
• Corticosteroids
• NSAIDS
• Capsaicin, a naturally occurring ingredient in chili
peppers. Studies have shown some success in the
control of pain and inflammation when capsaicin is
applied topically
Antifungal
• Polyene antifungals
• A Polyene is a circular molecule consisting of a
hydrophobic and hydrophilic region. This makes
Polyene an amphoteric molecule. The Polyene
antimycotics bind with sterols in the fungal cell
membrane, principally ergosterol. This changes the
transition temperature (Tg) of the cell membrane,
thereby placing the membrane in a less fluid, more
crystalline state. As a result, the cell's contents leak out
(usually the hydrophilic contents) and the cell dies.
Animal cells contain cholesterol instead of ergosterol
and so they are much less susceptible. (Note: as
polyene's hydrophobic chain is reduced, its sterol
binding activity is increased. Therefore, increased
reduction of the hydrophobic chain may result in it
binding to cholesterol, making it toxic to animals.)
 Natamycin -- 33 Carbons, binds well to ergosterol
 Rimocidin
 Filipin -- 35 Carbons, binds to cholesterol (toxic)
 Nystatin
 Amphotericin B
 Candicin
• Imidazole and triazole antifungals
• The imidazole and triazole antifungal drugs inhibit the
enzyme cytochrome P450 14α-demethylase. This
enzyme converts lanosterol to ergosterol, and is
required in fungal cell membrane synthesis. These
drugs also block steroid synthesis in humans.
• Imidazoles:
• Miconazole (Miconazole nitrate)
• Ketoconazole
• Clotrimazole - marketed as Lotrimin or Lotrimin AF • Voriconazole
(and Canesten in the UK) • Terconazole
• Econazole • Allylamines
• Bifonazole • Allylamines inhibit the enzyme squalene epoxidase,
• Butoconazole another enzyme required for ergosterol synthesis:

• Fenticonazole • Terbinafine - marketed as "Lamisil" in North America,

Australia and the UK
• Isoconazole
• Amorolfine
• Oxiconazole
• Naftifine - marketed as "Naftin" in North America
• Sertaconazole - marketed as Ertaczo in North America • Butenafine - marketed as Lotrimin Ultra
• Sulconazole • Echinocandins

• Tioconazole • Echinocandins inhibit the synthesis of glucan in the cell

wall, probably via the enzyme 1,3-β glucan synthase:
• The triazoles are newer, and are less toxic[citation needed] and
more effective[citation needed]: • Anidulafungin
• Caspofungin
• Fluconazole
• Micafungin
• Itraconazole • Others
• Isavuconazole • Others:
• Ravuconazole • Benzoic Acid has antifungal properties but must be
• Posaconazole combined with a keratolytic agent [1]
• Ciclopirox is a fungicidal. Its real name is ciclopirox • Zinc dietary supplements or natural food sources,
olamine. including pumpkin seeds and chick peas
• Flucytosine, or 5-fluorocytosine, is an antimetabolite. • Selenium dietary supplements or natural food sources,
• Griseofulvin binds to polymerized microtubules and particularly Brazil nuts
inhibits fungal mitosis. • [edit] Dandruff shampoos
• Gentian Violet
• Antifungal drugs are often found in dandruff shampoos.
• Haloprogin
Among the most common are pyrithione zinc,selenium
• Tolnaftate is fungicidal, marketed as Tinactin, Desenex,
sulfide and ketoconazole (Nizoral).
Aftate, as well as other names
Antiviral
• Undecylenic acid is fungistatic
• Alternatives:[2] Immunologic Agents

• Tea tree oil -- ISO 4730 ("Oil of Melaleuca, Terpinen-4- Antineoplastic Agents and BRM
ol type") • Health Effects/Occupational Exposure
• Citronella oil • The adverse health effects associated with
• lemon grass antineoplastic agents (cancer chemotherapy drugs,
• orange oil cytotoxic drugs) in cancer patients and some non-
• palmarosa oil cancer patients treated with these drugs are well-
• patchouli documented. The very nature of antineoplastic agents
• lemon myrtle makes them harmful to healthy constantly dividing cells
• Neem Seed Oil and tissues, as well as the cancerous cells. For cancer
• Coconut Oil -- medium chain triglycerides in the oil patients with a life-threatening disease, there is a great
have antifungal activities benefit to treatment with these agents. However, for the
 healthcare workers that are exposed to antineoplastic • Inhibition of topoisomerase II, thereby stopping DNA
agents as part of their work practice, precautions should from being unwound, which is required for both DNA
be taken to eliminate or reduce exposure as much as replication and RNA/protein synthesis.
possible. Pharmacists that prepare these drugs or nurses • Generating free radicals.
that may prepare and/or administer them are the two • They are products of various strains of the soil bacteria
occupational groups with the highest potential exposure Streptomyces.
to antineoplastic agents. In addition, physicians and
• Examples
operating room personnel may also be exposed through
the treatment of patients. Hospital staff, such as • actinomycin (L01DA01).
shipping and receiving personnel, custodial workers, • The most important immunosuppressant from this
laundry workers, and waste handlers, all have potential group is dactinomycin, which is used to in kidney
exposure to these drugs during the course of their work. transplantations.
The increased use of antineoplastic agents in veterinary • anthracyclines
oncology also puts these workers at risk for exposure to
• doxorubicin (L01DB01)
these drugs.[1]
• daunorubicin (L01DB02)
• Modes of action • epirubicin (L01DB03), which also inhibit

• There are many classes of antineoplastics: topoisomerase II)

• other cytotoxic antibiotics
• Alkylating agents
• bleomycin (L01DC01). Bleomycin acts in unique way
• Antimetabolites
through oxidation of a DNA-bleomycin-Fe(II) complex
• Antimitotics: bind to tubulin and inhibit spindle
and forming free radicals, which induce damage and
dynamics and thus block cell division chromosomal aberrations.
• plicamycin (L01DC02)
• mitomycin (L01DC03)

Diuretics

Drugs used in tx of Burns