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

 

 

EP 196: What is Sports Psychology With Sean O’Connor

EP 196: What is Sports Psychology With Sean O’Connor

What is Sports Psychology With Sean O’Connor

Sports psychology is a practical skill that helps address athletes’ optimal performance and well-being. How can this be used? And what do you know about sports psychology? 

Traumas and repressed emotions can affect us in the long run. Some of us can handle these emotions well, while others displace them, creating more trauma, stress, fear, anger, resentment, depression, and anxiety. How can people heal from this? Is there a way to work through these feelings? 

In this episode, we would like to introduce you to Sean O’Connor. Sean is a licensed mental health counselor (LMHC) at Peaceful Living Mental Health Counseling in Scarsdale, NY. He specializes in sports psychology and trauma-informed counseling to help adults and athletes overcome anger, depression, anxiety, PTSD, and stress. 

To treat his patients, he uses a combination of EMDR therapy, mindfulness, meditative science, polyvagal theory for nervous system regulation, and neurofeedback when working with clients. Sean loves working with athletes and survivors of past trauma to help them heal from the past, love the present, and have hope for the future.

Questions for Our Guest

The questions below are some we’d like to tackle. We often go off-topic, so we don’t expect to hit them all. If you have any ideas, please let us know.

Looking forward to our conversation!

These are the questions you had in Calendly. We’ll go off your questions and wherever else our conversation goes.

  1. Can you give us a little background about yourself?

2. How did you get into Sports Psychology & what is sports psychology?

3. How do Athletes cultivate their identity? 

4. What does it take to improve your mental health?

  • What is the simplicity of happy living?
  • What are some common stigmas in mental health?

5. How does holistic health play a role in mental health?

6. What is the Polyvagal theory?

7. What is the problem with the age of information? 

8. Martial arts

ENDING QUESTIONS

Before we end the show, we have one last question we like to ask all our guests. If you had the opportunity to have a Cup of coffee with anybody one last time, who would it be & why? 

Connect with Sean through his Instagram @peacefullivingcounseling Or visit their website at https://www.peacefullivingmentalhealthcounseling.com/. 

Do you want to know more about sports psychology? Click here for more 👇👇👇

TIMESTAMPS:

00:00 Introduction
02:11 About Sean O’Connor
08:41 What is the language of an Athlete
12:13 The most frequent problems that athletes face
15:35 What transpires when an athlete leaves their sport
17:37 How to guide struggling athletes
22:34 What are the traits of an athlete
25:27 How to overcome extreme pressure and performance anxiety
30:38 How to communicate to a person who is tense and fearful
36:02 How important is physical health to mental health
40:16 How to recognize danger and when it exists
43:25 How our emotions make our consciousness
48:18 The negative impacts of the modern age of information
52:31 What makes EMDR more efficient
58:43 How martial arts enhance both mental and physical health
01:08:03 How martial arts foster self-control
01:11:45 The significance of a warm community
01:19:48 What separates an elite athlete from the rest
01:22:13 Wrapping up the show

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.

 

EP 193: The View From The Abortion Clinic With Patrice D’Amato

EP 193: The View From The Abortion Clinic With Patrice D’Amato

The View From The Abortion Clinic With Patrice D’Amato

The view from the abortion clinic paints a different story. It’s where decisions are made, often for a good cause. But can women have an abortion without being judged? That is the real question.

What is Abortion? 

Abortion is defined as a procedure to end a pregnancy. It is also known as the termination of pregnancy through medications or surgical procedures. All around the world, 73 million induced abortions take place each year. Among 6 out of 10 or 61% of these abortions, are unintended pregnancies, while the remaining 21% ended as induced abortions. All abortions are 45% unsafe, and 97% occur in developing countries. 

Unsafe abortion is one of the leading but preventable causes of maternal morbidities and deaths. It also affects the physical and mental health and financial and social burdens of many women in many communities. 

As nurses, what can we do to help women who want to go through an abortion? Do we have the right to refuse to take care of patients who went through an abortion based on moral objection? And when will abortion be normalized in our society? These are the questions we must answer. 

Our Guest for Today’s Episode

In this episode, we would like to introduce you to Patrice D’Amato. Patrice is a nurse, educator, and author of a new book, The View from the Clinic: One Nurse’s Journey in Abortion Care. She has practiced nursing in various settings in her 38-year nursing career, including med/Surg, critical care, nursing education, and women’s health. After earning her Master’s degree in Adult Health, she worked as an NP in several abortion clinics and 20 years later returned to the field while writing her book about her experiences.

QUESTIONS FOR OUR GUEST

The questions below are some we’d like to tackle. We often go off-topic, so we don’t expect to hit them all. If you have any ideas, please let us know.

We are looking forward to our conversation!

These are the questions you had in Calendly. We’ll go off your questions and wherever else our conversation goes.

  1. Can you give us a little background about yourself? 
  2. Working in healthcare for over 30 years, what have you seen over time? 
    • How has nursing evolved or changed?
    • Have you seen a more significant connection to the mind/body/spirit approach vs. just medical treatment?
  3. How was it working in an abortion clinic?
    • How has it changed over time?
  4. Did your perspective or opinion change on abortions while working with them?
  5. Was it hard for you to work in that setting? What made you gravitate toward it? 
  6. One of the counterarguments for legalizing abortion has been its potential intent to be used as a contraceptive. Were there any “frequent fliers”?
  7. Did you get the opportunity to find out why women are getting abortions? If so, what was the most common reason?
  8. You wrote a book titled; The View from the Clinic: One Nurse’s Journey in Abortion Care. What made you decide to write it?
    • What do you outline or focus on in the book?

ENDING QUESTIONS

Before we end the show, we have one last question we like to ask all our guests.

If you had the opportunity to have a Cup of coffee with anybody one last time, who would it be & why? 

Links: 

Book: www.theviewfromtheclinic.com 

To watch and learn more about abortion, click here for the entire episode 👇👇👇

TIMESTAMPS:

00:00 Introduction
01:58 About Patrice D’Amato
04:28 How has nursing evolved or changed?
06:50 How was it working in an abortion clinic?
11:03 Thoughts on abortion
11:47 What is a medical abortion
13:04 How a surgical abortion procedure looks
15:52 Perspective on abortion
18:02 Spirituality and abortion
21:20 How Patrice deals with guilt
24:16 Relief after an abortion
26:41 abortion and the patient’s mental health
29:16 Cases of abuse and unwanted pregnancy
31:21 The future of abortion
34:48 The fetus worship
40:37 Probirth v.s Pro-life
42:12 Generational traumas
46:11 Rewiring your system
48:58 Wrapping up the episode