高血压英文ppt精品课件the medical patient the renal system hypertensive

The Medical Patient The Renal System; Hypertensive Emergencies,Condell Medical Center EMS System October 2008 CE Site Code # 10-7200E1208,Prepared by: Sharon Hopkins, RN, BSN, EMT-P,Objectives,Upon successful completion of this module, the EMS provider should be able to: List the components and function of the urinary system State signs and symptoms of chronic kidney disease Define hemodialysis Identify the differences between AV fistulas and AV shunts & implications in the field Apply the Renal SOPs given a scenario List the steps in performing an abdominal assessment,Describe the physical assessment of the patient with flank pain Describe the management of the patient with flank pain Define the criteria for a hypertensive emergency List the signs and symptoms of hypertensive emergencies Describe the rationale for treatment using Lasix and Nitroglycerin for hypertensive emergencies Describe the proper technique to obtain a blood pressure Describe the components of a neurological assessment,Successfully calculate the GCS given the findings of the patient assessment Return demonstrate pupillary assessment Return demonstrate the in-line Albuterol set-up Return demonstrate the preparation of an Amiodarone IVPB set-up Identify and appropriately state interventions for a variety of EKG rhythms Identify ST elevation on a 12 lead EKG Successfully complete the 10 question quiz with a score of 80% or better,Urinary System,Contains 4 major structures Kidneys Vital organs Located in upper abdomen; retroperitoneal area 1 behind the spleen; 1 behind the liver Ureters Urinary bladder Urethra,Function of the Urinary System,Major functions Maintains blood volume via proper balance of water, electrolytes, and pH Retains key compounds (ie: glucose) and eliminates wastes (ie: urea) Monitors and maintains arterial blood pressure (in addition to other mechanisms) Regulates erythrocyte (RBC) development,Urinary Bladder,Storage receptacle for the production of urine until it is convenient or necessary to void Fully distended can hold 500 ml of urine The more distended the bladder, the more vulnerable to blunt trauma After urination, the bladder contains about 10 ml of fluid,Chronic Kidney Disease,Can be from a specific kidney disease or as a complication from other conditions Diabetes #1 reason in USA for need for kidney transplant Hypertension Kidney inflammation (glomerulonephritis) Inflammation of blood vessels (vasculitis) Polycystic kidney disease,Chronic Kidney Disease,Diseased or injured kidneys Blood flow through the renal system decreases Inflammatory changes occur in the glomeruli A group of capillaries where blood is filtered into a nephron (structure that produces urine) Capillary walls thicken decreasing permeability Glomerular filtration rate (GFR) is reduced Volume of blood filtered per day thru glomeruli,Symptoms of Chronic Kidney Disease,Most common symptoms Swelling, usually of lower extremities Fatigue Weight loss, loss of appetite Nausea and/or vomiting Change in urination Reduction in volume or frequency Change in sleep patterns Headache Itching high levels of phosphorus in system; dry skin Difficulties with memory or concentration,Complications of Chronic Kidney Disease,Hypertension May be a leading cause but can also develop in the early stages as a complication Anemia Decreased production of red blood cells Bone disease Disorders of calcium and phosphorus Malnutrition Altered functional status and well-being,Dialysis,Dialysis is required when the kidneys fail and a transplant is not performed Peritoneal dialysis uses a catheter thru the abdominal wall to filter the blood,Hemodialysis,Hemodialysis is a procedure in which a machine filters harmful waste and excess salt and fluid from your body Access points are created to be functional within weeks and to last several to many years Usual access point is the forearm,Fistulas and Shunts,Arteriovenous (AV) fistula Most common type of access Fistula created internally by sewing an artery to a vein forming a small opening between the two Pressure from the arterial flow eventually enlarges and strengthens the vein May take 6 weeks to heal but can last for years,Arteriovenous (AV) graft Access is similar to a fistula A synthetic tube is used to surgically connect the artery to the vein AV graft often heals within 2-3 weeks With proper care, can last several years Higher likelihood of forming clots or becoming infected than an AV fistula,Renal Dialysis,Hemodialysis,Most people treated with hemodialysis 3 times a week Each session lasts approximately 3-5 hours Some patients, at some dialysis centers, may choose daily dialysis Usually performed 6 days per week for 2 21/2 hours each session Patients often report improved B/P and quality of life,Continuous Ambulatory Peritoneal Dialysis,CAPD is a self-care treatment where the patient instills dialysate fluid into the peritoneal (abdominal) cavity through a surgically implanted catheter through the abdominal wall The dialysate stays in the abdominal cavity a prescribed period of time and then is drained out,