Adult Health

 

Learning Objective #1: Explain the function of the kidneys in regulating fluids, electrolyte balance, acid–base balance, blood pressure, RBC production, and Vitamin D synthesis.

a. What are the main functions of the kidneys?

b. During urine formation, which two substances should be reabsorbed and not excreted in the urine?

c. What two major electrolytes do the kidneys help regulate?

d. What is the role of the kidneys in maintaining serum pH through bicarbonate?

e. Explain the renin-angiotensin system in regulating blood pressure, including the roles of anti-diuretic hormone and aldosterone in this system.

f. How do the kidneys contribute to RBC production?

g. How do the kidneys contribute to Vitamin D synthesis?

Learning Objective #2: Explain the renal system changes and nursing implications for older people.

Learning Objective #3: Initiate education, preparation, and monitoring for patients undergoing diagnostic studies, including labs, 24-hour urine collection, any that use contrast media, and kidney biopsy.

a. What are the normal ranges for urine specific gravity, creatinine clearance, serum creatinine, serum BUN, and GFR?

b. What is the significance of abnormal values of urine specific gravity, creatinine clearance, serum creatinine, BUN, and GFR in kidney disorders?

c. What is the purpose and proper collection steps for a 24-hour urine collection?

d. What are the pre-, intra-, and post-procedure interventions and rationales for a patient who will receive intravenous contrast media during a diagnostic test?

 

 

Sample Solution

Adult Health

Most people know that a major function of the kidneys is to remove waste products and excess fluid from the body. These waste products and excess fluid are removed through the urine. The production of urine involves highly complex steps of excretion and re-absorption. This process is necessary to maintain a stable balance of body chemicals. The critical regulation of the body`s salt, potassium and acid content is performed by the kidneys. The kidneys also produce hormones that affect the function of other organs. For example, a hormone produced by the kidneys stimulates red blood cell production. Other hormones produced by the kidneys help regulate blood pressure and control calcium metabolism.

While a set of frameworks complement and build on each other, the delineation of the concept focuses heavily on vertical versus horizontal dimensions in a time-sliced fashion. That is, time dimension in accountability has not been of primary importance. However, it is worth noting that the time dimension is closely interrelated with a series of conceptual distinctions made in previous literature, and it may cover complementary aspects of the question concerning two sequential lines represented by administrative responsibility versus political accountability. First, the positioning of accountability actors depends on the time dimension. Civil servants usually have longer terms to serve the public interest over the long term. At the same time, they are responsible to the elected representatives of the public who tend to have “a limited time horizon” and “prefer policies that yield tangible benefits for constituents in the near term” (Posner, 2004: 137). For this reason, the priorities expressed by elected officials may be far more related to short-term issues and temporal problems instead of long-term solutions, whereas the long-lasting forms of civil service personnel would prioritize sustainable solutions to secure a long-term perspective of the citizens, both current and in the future. Second, the time frame is essential to distinguishing between two main streams of accountability. Accountability mechanisms focus predominantly on retroactive accountability for the past outcomes, while accountability as a virtue takes a proactive approach to ensuring ethical behaviors in the future. The timeline is also useful to distinguishing between ex ante accountability of the decision-making process leading up to the decision and ex post accountability where the results available from the decision already taken or where questions of compliance are identified and addressed. In other words, ex ante accountability refers to being accountable for the decision before an administrator act, while ex post accountability is suggestive of situations where administrators are accountable for the outcome of their decisions. For example, the focus of traditional bureaucratic administration is very much

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