EP 199: The Renal System and RAAS

EP 199: The Renal System and RAAS

The Renal System

The renal system produces, stores, and eliminates urine. Kidneys make urine by filtering wastes and extra water from the blood. Urine travels from the kidneys through two thin tubes called ureters and fills the bladder. When the bladder is full of urine, a person urinates through the urethra to eliminate the waste.

Functions of the Kidneys

The kidneys are located on either side of the spine at the lowest level of the rib cage, consisting of the functional unit called a nephron. 

There are about one million nephrons in each kidney; these nephrons consist of tiny blood vessels called glomerulus attached to a tubule. 

When blood enters the glomerulus, it is filtered, and the remaining fluid passes to the tubule. In the tubule, minerals, elements, chemicals, and water are absorbed or filtered according to the body’s needs to create the final product, urine.

Our kidneys maintain a delicate balance of water and electrolytes in the body and remove excessive waste:

  • Remove wastes, urea, and ammonia, from the blood.
  • Maintain fluid status balance in the body by holding or retaining water and releasing and removing water from the bloodstream
  • It maintains the electrolyte balance of the blood.
  • Maintain acid-base/pH balance of the blood
  • Assist with endocrine functions such as the production of erythropoietin and calcitriol.
    • It is needed to produce red blood cells and calcium reabsorption, respectively.
  • Produce the enzyme renin
    • Help regulate blood pressure.
  • Convert vitamin D into its active form

Fun Fact: 

  • Every 24 hours, your kidney filters 200 quarts of fluid. About two quarts are removed from the body, and 198 quarts are returned to the bloodstream. 
  • The right kidney sits lower than the left kidney. 
    • It helps accommodate the large size of the liver, right above the right kidney.
  • We call it REabsorption rather the just absorption because the substances filtered from the glomerulus were already absorbed through the GI tract and taken into the bloodstream. Then the substances travel through the body via the heart and are sent to the kidneys through the renal artery to be filtered out. Therefore, our body reabsorbs these nutrients based on their needs, and the leftovers are excreted in the urine.

Anatomy of the Kidney

As a nurse and a nursing student, you’ll need to know these most critical parts of the kidney to understand how the renal system works.

Renal Capsule 

  • The outer layer of the kidney protects the kidney from outside organ infections. 

Renal cortex: 

  • A layer outside contains the renal corpuscles, which house the glomerulus and Bowman’s capsule, whose primary functions are to FILTER the urine and renal tubules. 

Renal medulla: 

  • The inside layer is located within the renal pyramids. It is hypertonic and very salty. Along with the nephron, these conditions help maintain water and salt balance in our body, specifically the Loop of Henle.

Renal artery:  

  • The renal artery takes oxygenated blood from the heart and moves it to the kidney to be filtered. It branches off around the renal columns into the renal cortex, into arterioles, and finally to the peritubular capillaries.

Renal vein:

  • The renal veins take filtered blood to heart for re-oxygenation and are pumped throughout the body. It comes from the efferent arterioles.

Renal pyramids: 

  • Lie Within the renal medulla contains the loop of Henle and parts of the collecting tubule.

Renal papilla, minor and significant calyx:

  • Pointed projections of the renal pyramid play a role in draining urine along with the renal pelvis, ureters, bladder, and urethra.

Nephrons: 

  • The functional part of the kidneys. 
  • Filters the blood via the renal corpuscle
  • Reabsorbs minerals/water and secretes waste via the renal tubule
  • Produces urine which drains down into the ureters, is stored in the bladder, and voided out via the urethra.
  • Each nephron is composed of 
    • Renal corpuscle (glomerulus within Bowman’s capsule)
    • Proximal tubule
    • An intermediate tubule (loop of Henle)
    • A distal convoluted tubule, a connecting tubule, and cortical, outer medullary, and inner medullary collecting ducts.

Glomerulus:

  • Lies within the nephron
  • Circular capillaries that have incredibly high pressure helps perform ULTRAFILTRATION.

Bowman’s capsule

  • Forms a cup-like sack around the glomerulus
  • It helps the glomerulus filter blood 

The Nephron and blood supply

Blood enters the afferent arteriole and sends blood to the first part of the nephron, called the glomerulus.

In the glomerulus, blood will be filtered, and filtrate will be created, a liquid consisting of the collection of fluid and particles from the blood. The filtrate will “drip” down into a capsule surrounding the glomerulus called Bowman’s capsule.

  • Bowman’s capsule collects the filtrate.
    • Water, NA, CL, CA, K, Mg, Phos, Bicarb, amino acids, glucose, creatinine, and urea.

Then the filtered blood exits via the efferent arterioles to the peritubular capillaries surrounding the nephrons. 

Peritubular capillaries carry the reabsorbed nutrients from the filtrate back into the body’s system to the renal vein. They secrete urea, ions, and drugs in the blood into the tubules.

The created filtrate then flows through the proximal convoluted tubule (PCT); here, the tubule reabsorbs most of the parts of the filtrate that we need to function that just came from the Bowman’s capsule.

Then the filtrate enters the Loop of Henle; we are now in the renal medulla. The loop of Henle has a descending limb and ascending limb. Its goal is to concentrate the urine via the renal medulla. The renal medulla’s interstitial fluid is hypertonic, helping reabsorb water from the filtrate to maintain the body’s water and salt balance.

  • Descending limb is only permeable to water.
  • Ascending limb is only permeable to ions.

The filtrate then enters the distal convoluted tubule, where more substances are reabsorbed and secreted. 

Then it travels to the collecting tubule, where parts of the filtrate are reabsorbed. Finally, the filtrate leaves the collecting tubule as urine which flow through the renal papilla, minor/major calyx, renal pelvis, ureters, bladder, and urethra.

Kidney and Blood Pressure Management 

The renin-angiotensin-aldosterone system (RAAS) is the system of hormones, proteins, enzymes, and reactions that regulate your blood pressure and blood volume long-term.

It regulates your blood pressure by increasing sodium (salt) reabsorption, water reabsorption (retention), and vascular tone (the degree to which your blood vessels constrict or narrow). The RAAS consists of three major substances including:

  • Renin (an enzyme).
  • Angiotensin II (a hormone).
  • Aldosterone (a hormone).

RAAS System

  • Increases blood pressure when it drops too low by activating Angiotensin II
    • Angiotensin II increases vasoconstriction, causing an increase in blood pressure. Conserves sodium and water to increase volume. Aldosterone and ADH are released. 
  • RAAS steps
  1. Blood pressure drops too low. 
  2. The sympathetic nervous system sends nerve impulses to Juxtaglomerular Cells in the kidneys to release RENIN.
  3. RENIN present in the blood will activate ANGIOTENSINOGEN in the liver.
  4. ANGIOTENSINOGEN then turns into ANGIOTENSIN I causing a release of ACE
  5. ACE is Angiotensin-Converting Enzyme. ACE converts Angiotensin I into ANGIOTENSIN II
  6. ANGIOTENSIN II activation will cause
  7. Vasoconstriction
    • Increases systemic vascular resistance (SVR) and blood pressure.
  1. Increase Blood Volume
      • Kidneys will keep water and sodium.
      • The adrenal cortex gland will be triggered by angiotensin II to release aldosterone. Aldosterone will also cause the kidneys to keep sodium and water and excrete potassium.
    • Angiotensin II triggers the pituitary gland to release ADH. It causes the kidneys to keep water.

2. Increased blood pressure

To learn more about the renal system, click here for the full episode 👇👇👇

TIMESTAMPS:

00:00 Introduction
02:10 The functional parts of the kidney
03:18 What does a kidney do
04:40 Kidney fun facts
05:40 Anatomy of the kidney
10:00 The nephron and blood supply
15:48 Kidney and blood pressure management
17:39 How the Renin-Angiotensin-Aldosterone System (RAAS) works
21:50 Further views on the episode
24:02 Wrapping up the show

 

 

5 Unique Travel Nursing Career Paths You Must Try

5 Unique Travel Nursing Career Paths You Must Try

5 Unique Travel Nursing Career Paths You Must Try

Regarding nursing career paths, travel nursing opens up many unique opportunities. When you work in this field, there is no telling where you can go or your next assignment. The good news is that if you crave adventure and exploration, being a travel nurse is an exciting career. 

As a traveling nurse, you have plenty of opportunities to go around the country for work and make memories. But you can also avoid the hospital setting to enjoy this line of work. You can go out of your comfort zone and explore other paths to nursing. Here are unique travel nurse jobs that you might consider doing.

Cruise Ship Nurse 

Do you love traveling the seas? Becoming a travel nurse on a cruise ship is a different experience that you should consider. With an average of 3,000 guests, a nurse on board is a must. Many cruise ships hire a team of nurses to help their passengers in medical emergencies. 

To become part of a cruise ship nurse team, you must be an NCLEX-RN with at least three years of full-time experience and an ACLS or Advanced Cardiovascular Life Support certification. 

Flight or Transport Travel Nurses 

Flight or transport-trained medical nurses help accompany patients when they are transported by aircraft. Most of the time, these patients are in advanced critical care, and it is the flight nurse’s responsibility to care for the patient while in transport. Many flight nurses are needed in rural areas that don’t have medical resources for emergencies.

To become a flight nurse, you must have 3-5 years combined ICU/ER experience and certification as a Certified Flight Registered Nurse or CFRN. You’ll have even better opportunities if you have flight and navigation experiences. 

Resort Nursing 

Working in this field exposes you to many unique travel nurse locations, cultures, and people. You can work in luxurious hotels in tropical countries or high-end ski resorts. Wherever you want to go, you always have options to choose from. As a travel nurse working in a vacation resort, you will be the primary point of medical contact for tourists and guests. 

To qualify for this position, certifications in first-aid and CPR are needed. You must also have strong communication skills, and speaking a different language is a plus. A resort nurse also interacts with resort guests, mainly if you apply for a resort overseas or in other countries. You must also meet the license and degree requirements needed for the country you choose to work in. 

Humanitarian Nursing 

A humanitarian nurse is one of the best career paths in nursing that you can pursue.  Nurses travel world with medical organizations like Doctors Without Borders and the International Medical Corps. They hire nurses to help them respond to global crises and emergencies. They help immunize children in villages and provide medical assistance to countries or places where natural disasters are on high alert. 

You must have a few years of nursing experience to qualify for this position. You must also take relevant courses in humanitarian health provided by NGOs or universities. They also prefer nurses with a second language, so it’s a good advantage if you’re bilingual or multilingual. 

Camp Nursing 

Do you enjoy working with kids in the summer? If you love exploring the wild and campfires, then becoming a camp nurse is an ideal travel nurse job. You get to work with kids to ensure they are healthy enough to explore the outdoors across the United States. You have to determine what type of camp benefit most from your expertise and background. Many camps specialize in specific activities and focus on children with cancer, mental disabilities, and other special populations. 

There are no specific certifications to become a camp nurse, but you must be certified and trained in CPR or Cardiopulmonary Resuscitation. 

Be a Travel Nurse Today

Travel nursing is an exciting nursing field that opens doors to different opportunities. You get to meet other people, know many cultures and will touch so many lives with your profession. If this sounds like your dream job, go ahead and start sending out your applications! It’s still possible to pursue a travel nursing career. It may be the opportunity you are looking for!

 

7 Attainable Goals for Your Nursing Career

7 Attainable Goals for Your Nursing Career

7 Attainable Goals for Your Nursing Career

Nursing is an incredible career with rewarding rewards. You’ll meet all kinds of people and work in different fields. But it would be best if you had nursing career goals in mind. Remember, you will not be working in this field for the rest of your life. Set goals, work on them, and achieve them. 

Why should you have career goals?

Having your first nursing job is exciting. And while it is good to have a job, you must also have career goals. Why? Career goals help you stay focused. It will keep you from getting stuck on a cycle where everything looks and feels the same. Goals are your finish lines. They make your job more exciting. It gives you something to look forward to, steps to follow, and progress to make. 

As a nurse, your career goals may vary. But as you go through these goals, be sure to have achievable ones. What kind of career goals should you have as a nurse? Here’s what you need to know.

#1. Having an Advance Degree is a Plus

Furthering your career is always a wise decision. Advancing your career in nursing can boost your resume, increase job opportunities and security, and even help you earn more money. An Associate’s Degree is good but consider working towards your Bachelor’s Degree. It will allow you to work in magnet-status hospitals and offer you management positions. It will also open doors for leadership positions in nursing administration and management. That said, a Master’s Degree of Science in Nursing is helpful to have. 

Advanced practices are also an excellent option to take. This path requires you to have either a Master’s or a Ph.D. It will also give you more one-on-one care relationships with your patients. 

Choosing any specialty is one advantage of having a higher or advanced nursing practice. It will also give you better hours and a pay raise. Sometimes, nurses in this field become physician’s assistants or even pursue being a doctor. The most common paths for advanced practices are:

  • Nurse practitioner 
  • Nurse Anesthetist 
  • Nurse Midwife 
  • Physician Assistant

#2. Upgrade Your Nursing Certifications

As your nursing career grows, so should your certifications. Certifications are helpful in all stages of your nursing career. Whether you are new or already working as a nurse, this could put you in a good position. It will also give you an advantage over other candidates, especially when applying for a particular area you are interested in.

If you aim to work in a specialty area like ICU or other intensive care units, increasing your knowledge and credentials is the best way to do it. 

Be always on the lookout for ways to increase your knowledge. Specific certifications can also increase your competency as a nurse, and the more knowledge and skills you have, the more valuable you are. 

Many hospitals offer classes in-house for nurses who wish to obtain advanced certifications. All you have to do is sign up and start your journey from there. 

#3. Volunteer to boost your career

There is a constant need for nurses to volunteer all the time. Many clinics, hospitals, and other facilities need the help of volunteer nurses both in the United States and abroad. This is the best time to do some volunteer work. Nurses who volunteer internationally are highly appreciated in developing countries. There is a greater need for them in countries that need medical help. 

The excellent news about volunteering is you can start doing them even as a nursing student. As a registered nurse, volunteering can help boost your career. It is also a gratifying experience that no textbook or classroom can teach you. So, list volunteering as one of your career goals in the nursing field. You may enjoy it in the future. 

#4. Learn advanced technologies

The use of medical technology is constantly evolving, and nurses working in medical fields must adapt to these changes. These technologies could be portable patient monitors or telehealth services – all used to create, update or access patient files. Nurses must learn to use these technologies; mastering them can benefit your career in many ways. 

How can you stay updated with advanced technologies? For one, you can read free blogs for nurses. There are also many apps that nurses can use and familiarize themselves with the latest technologies used in patient care. Subscribing to journals and magazines for nurses is also helpful. They keep nurses updated with the latest technologies in healthcare. If you want to take it a step further, joining professional organizations for nurses can also help you. 

#5. Specialize in a specific nursing field

Nurses are the Jack of All Trades in this industry, but it is always wise to master one trade. There must be a reason why you decided to be a nurse. Maybe a family member inspired you to be one, or you have a passion for working with children. Either way, having a specialization helps you advance your career. If you are thinking of an area to specialize in, consider the following:

  • Ambulatory care
  • Cardiovascular 
  • Dialysis 
  • Gastroenterology
  • Geriatrics 
  • Holistic care
  • Infection control and prevention
  • Medical-surgical
  • Neonatal 
  • Neuroscience
  • Obstetrics 
  • Oncology 
  • Orthopedics 
  • Pediatrics or children’s healthcare
  • Psychiatric or mental health care

#6. Improve your communication skills

Nurses must communicate well with patients, families, and colleagues. And improving your communication skills can boost your career and growth as a professional nurse. 

Strong communication skills can boost patient health outcomes and enhance professional relationships with co-workers, patients, and their families. But beyond oral and written communication, nurses must also be good at active listening. It is your job to care for patients, take orders/directions from doctors and be part of a nursing team. 

Effective communication also includes patient education, compassion, awareness of people’s cultures, and presentation skills. 

#7. Climb the professional ladder

You can stay as a bedside nurse or change your career path. If you want to step away from bedside nursing, you can do that, but you can start small and work your way up. Start with a charge nurse position. As a charge nurse, you can handle different patient issues and are resourceful. You will also manage nursing staff, create shift schedules, and solve disputes during your shift. These roles are your precursor role in becoming a unit manager. 

Unit managers must have at least five years of nursing experience and administrative work. Sometimes, hospitals may require a bachelor’s or a master’s degree to qualify. 

Administrative positions remove nurses from the bedside and direct patient care, but big pay raises and banker’s hours come with that. If you want a thriving nursing career in the future, consider aiming for such a position. It will be an excellent option to keep open. Hopefully, these tips will help you reach your goals for your nursing career. 

 

Miscommunication Among Nurses and How to Avoid It

Miscommunication Among Nurses and How to Avoid It

Miscommunication Among Nurses and How to Avoid It

Nurses are among the essential workers in the healthcare world, especially now that we have a pandemic. However, miscommunication among nurses is an issue that happens quite often. How can this be avoided? What causes miscommunication among nurses? 

How Can Miscommunication Among Nurses Be Avoided?

There are a couple of ways that nurses can avoid miscommunication. Keep in mind that being able to relay the correct information about their patients can make a difference in nursing care. As a nurse, you must provide accurate data regarding their condition so proper nursing can be given. Here’s how you can do that:

1. Make eye contact when endorsing patients.

There is a sense of relief whenever the shift is over, especially if it has been a toxic one since you first clocked in. While it is exciting to exit the nurse’s station once your shift is over, make proper endorsements first. The best way to ensure no miscommunication is to make eye contact with the next nurse on duty when endorsing the patient’s chart. 

Take the time to explain everything, from the procedures done to the patient, medications given, the diagnosis (if you have to), and even the physician/s who came to check in with them.

Making eye contact gives you the chance to scan for any uncertainty in their face or if they understood what was said to them. It is also the best way to engage someone in a conversation and ensure they listen to what you say. 

2. Use bedside nursing boards.

Bedside nursing boards are also commonly known as bed-census boards. These can help you with an open line of communication among nurses in the team/building, the patient’s families, and you as health care providers.

The boards help with the patient’s condition and communicate with their families and the rest of the hospital staff. Understand that there are tons of healthcare providers in the hospital working on patients. Failing to communicate properly can lead to negative consequences.

Bedside boards are essential in providing reports to the next nurse on duty. It can help them understand what happened during your shift and fill them in on the patient’s history if this is their first time handling them. Bed-census boards also prove to the patient’s families that proper care is given to their loved ones. 

3. Take time to talk to your patients.

Nurses are often busy in each shift, and it is not surprising that they cannot give their patients full attention. However, taking the time to check on your patients, listen to their concerns, and show that you can help are enough to put them at ease. It is also a good nursing quality to have. 

Allowing a few minutes of one-on-one conversation with your patients can be rewarding. It is easier to see how they are improving and establish a sense of trust as their nurse. Although you may not do this every day, it is best to create a routine and stick to it. 

How Can Nurses Improve Their Communication Skills

Improving communication among nurses is possible. To do this, nurses like you practice patience and become better listeners. When you listen, you don’t offer one ear but both. Keep in mind that you are working with other nurses who are also busy. Listening to each other is crucial to providing better services to patients. 
 
You can also avoid communication conflict when you practice active listening. Active listening is repeating the key points of the conversation to the speaker. So, make it a habit to listen to your coworkers and improve your listening skills. 
 
Another way to avoid miscommunication among nurses is not to interrupt the speaker. This could be helpful during endorsements at the end of the shift. Allow the person to finish talking first before asking questions.
 
Keep in mind that even the slightest cues can determine the condition of patients. Resist the urge to ask questions whenever someone is talking. 
 
As a nurse, you must also learn to maintain a positive attitude. Remember, happiness is contagious! Your positive outlook can also affect your coworkers and even your patients.
 
When things get a little serious, be sure to keep your emotions in check. Your nurse training taught you to remain professional and courteous during conversations. No matter how angry or upset you are, keep it cool.
 
Be aware that your emotions can affect others and your ability to communicate at work. When you do so, miscommunication among nurses will not happen.

In Closing

Communication is an essential part of patient care, and when this is done accordingly, it is nurses can work together effectively. If you feel like you or your coworkers are missing out on proper communication, take the step to address this issue. It will surely help your team and other hospital staff to do better as you provide nursing care to your patients. 

 

Things to Know About Being a Crisis Travel Nurse

Things to Know About Being a Crisis Travel Nurse

Things to Know About Being a Crisis Travel Nurse

Being a crisis travel nurse has its perks, but it comes with real responsibilities too. One of these responsibilities is when you respond to a crisis. As a crisis travel nurse, you must assist wherever this crisis calls you. If you are interested in working as a travel nurse, it is best to understand what you are getting into and how it can help you as a travel nurse. 

Things to Know About Being a Crisis Travel Nurse

As a travel nurse, you have the opportunity to go to different parts of the country and offer assistance. That said, it is also one of your jobs to answer in times of crisis. A crisis contract is crucial to get things started. But, what do you need to be qualified as a crisis travel nurse? Here’s what you need to know. 

There are no additional requirements for travel nurses with crisis contracts. However, you are most likely able to qualify further if you have the following RN certifications:

  • Certification in Critical Care Nurse
  • Certified Emergency Nurse
  • Certification in Pediatric Nurse

To become certified in these departments, you must have an Associate’s Degree, BSN or MSN. Higher degrees are even better. You must also have experience working in Cardia Care units, Surgical ICUs, ICUs, trauma units, transport, and flight operations, specializing in emergency or life-threatening conditions [1]

Differences

Every job has a contract to follow, and a crisis contract is not different. However, there are a few differences that you should know. They are as follows:

The crisis assignment of travel nurses often comes without warning. An event can happen anytime, like a natural disaster. The pandemic is one example of a crisis that went without any notice. Often, a crisis assignment is face-paced and involves high-stress levels. The duration of your job will also depend on how long the crisis is at hand. While the pay is higher for crisis travel nurses, it can be demanding.

Benefits of Being a Crisis Travel Nurse

The crisis assignment of travel nurses often comes without warning. An event can happen anytime, like a natural disaster. The pandemic is one example of a crisis that went without any notice.

Often, a crisis assignment is face-paced and involves high-stress levels. The duration of your job will also depend on how long the crisis is at hand. While the pay is higher for crisis travel nurses, it can be demanding. 

As a crisis travel nurse, there are benefits when you accept the job. One of them is the benefit of a high paid salary. Because of the demands, you can receive 10-100% more than regular nursing staff jobs [2]

You also get to obtain housing, food, and incidental allowances, as well as bonuses for extra shifts. There are also additional shift incentives, primarily if you work night duty or when the health care facility is short-staffed.  

While this sounds good, there are also some downsides to being a crisis travel nurse. For one, you don’t know how long your contract will last, or it will be dropped at the last minute. It can also be an inconvenience because a crisis is not planned. The work is also demanding and often involves critical situations. So, you don’t know what you are in for. 

Before Agreeing to Be a Crisis Travel Nurse

Before agreeing on the job and taking on the risks, remember these three things before signing your contract. 

  • Always consider the location – before you agree on the job, always consider the place of your assignment first. Take the pandemic, for example; some states have higher Covid-19 cases than others. It is also essential to do your research before signing up for the job. 
  • Follow safety protocols – taking a crisis travel nurse job always involves risks. It is also why the pay is higher compared to other nursing jobs. If you are deployed for a job during this pandemic, wearing the proper PPE while at work, wearing face masks, and social distancing are vital. Of course, each crisis differs, so it is best to observe safety protocols. 
  • Consider the pay – crisis travel nurses are paid higher than usual because of the risks involved. However, be on the lookout for agencies that offer ridiculous salary amounts. Often, these contracts are cut off short because of budget reasons. It is also why you should consider contracts with reasonable pay to avoid losing them. 

Being a Crisis Travel Nurse Today is Vital

If you are already a travel nurse, you don’t need many requirements to work in this field. However, working with a good travel nursing agency is a must to set you up with the right job. Your recruiter can help guide you and provide insight on your next crisis travel nursing assignment. Make sure to work only with the best.