Renin Angiotensin Aldosterone System

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Tarang Patel
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Outline

Overview

  1. Renin Angiotensin Aldosterone System helps the body…
    1. Regulate blood pressure
    2. Regulate blood volume
    3. Regulate fluid and electrolytes
  2. RAAS is active when the kidneys sense…
    1. Hypotension
    2. Decreased blood volume (blood loss, severe dehydration)
    3. Lack of blood flow to the kidneys.
  3. Understanding RAAS helps better understand the following medication classes
    1. Angiotensin Converting Enzyme Inhibitors
    2. Angiotensin II Receptor Blockers (ARBS)
    3. Renin Antagonists

Nursing Points

General

  1. Goals of RAAS-
    1. Improve perfusion to the kidneys
    2. Increase blood pressure
    3. Increase blood volume
  2. How the RAAS works-
    1. Kidneys sense they are getting a decreased amount of blood flow
    2. Kidneys activate the RAAS by releasing the hormone renin
    3. Renin converts Angiotensinogen (an inactive protein) to Angiotensin I (active)
    4. Angiotensin I goes to the lungs where it is converted to Angiotensin II
      1. Converted by an enzyme called an angiotensin-converting enzyme (also known as ACE – a la ACE Inhibitor)
    5. Angiotensin II has a lot of functions in the body
      1. Increases sympathetic nervous system response causing vasoconstriction
        1. This increases blood pressure
      2. Causes kidneys to reabsorp more sodium which increases water retention
        1. This increases blood volume
      3. Causes the pituitary gland to increases secretion of Anti-diuretic Hormone (ADH)
        1. This increases water reabsorption in the kidneys
      4. Causes the adrenal gland to increase secretion of Aldosterone (another hormone)
        1. Causes the kidneys to increase their sodium and water retention

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Transcript

Okay, so we gonna talk about the RAA System in our body and the reason that we gonna talk about RAA system and covering it in our video, that it will help to better understand the Angiotensin Converting Enzyme Inhibitor medications, ARBs which is also called as Angiotensin II receptor blockers and Renin Antagonists. So, if you have a better understanding of the RAA system in our body, it will really help you to understand these 3 pharmacological classes of drugs and it will helpful to understand the side effects, why do we have the side effects and why do we use this medication for the particular diseases.

So, let’s go to the next slide and have a take a look at the RAA system. So, this diagram is basically presenting the RAA system. It may look complicated at first look, but it’s not really. So, if you look at the renin enzyme right here, we have a renin enzyme that gets secreted by the kidneys. When our kidney does not get enough blood flow or due to the blood pressure fall or if we have a blood loss, or it could be different reasons that the kidney is not getting enough blood flow. Or, if our body does not have enough sodium to reabsorb the water, kidney is not getting enough blood flow. Then, there’s a specialized cell in the kidney that’s gonna release renin. Now, what this renin gonna do, it’s gonna convert angiotensinogen protein which is in the inactive form in our blood to angiotensin I. So, the work of the renin, it’s gonna convert angiotensinogen to the angiotenisin I. Now, when the angiotensin I goes to the lungs, through the blood stream, the enzyme here, it’s called ACE inhibitor, right here in the lungs, gonna convert this angiotensin I into angiotensin II. So, this is the enzyme which is really important to remember. This is gonna help you in the ACE inhibitors. So, this is called Angiotensin Converting Enzyme which is present in the lung. Now, when angiotensin I gets converted into the angiotensin II, angiotensin II has many effects on our body. The first effect, when you take a look, it’s gonna increase the sympathetic system. Okay, so when it does increase the sympathetic system, nervous system, it’s gonna increase the vasoconstriction and if you really know your sympathetic nervous system. It’s gonna cause the vasoconstriction and it’s gonna increase the blood pressure. When there’s an increase in the blood pressure, kidneys gonna get enough blood flow. That’s how kidneys gonna get re-perfused. Now, the second action that angiotensin II have is on the kidney tubules. Well, it’s gonna increase the reabsorption of sodium and it’s gonna increase the excretion of potassium. Now, when it increases the reabsorption of sodium, it’s gonna increase the H2O retention, basically, the water retention. When that happens, it’s gonna increase a lot of volume, blood volume increases. When the blood volume increases, it’s gonna increase the blood pressure and that’s how it’s gonna cause, that’s how the kidneys get re-perfused which is the main problem why the renin got secreted. It also has effect on the adrenal gland as well. Angiotensin II is gonna go to the adrenal gland and it’s gonna increases the secretion of Aldosterone which is basically gonna do the same thing. Increase the sodium reabsorption, and it’s gonna increase the potassium excretion. Sodium reabsorption is gonna increase the water reabsorption as well as it’s gonna increase the blood volume. And, the final effect that angiotensin II has, it’s on the collecting ducts of the kidney. Our collecting ducts gonna, it’s main site where all the water excretion or the reabsorption happens. So, what it’s gonna do is it’s gonna go to the pituitary gland and gonna increase the secretion of ADH which is also called as antidiuretic hormone. What this antiduretic is gonna do, it’s gonna increase the water reabsorption in the kidney and it’s gonna increase blood volume. And that’s how kidney is gonna get re-perfused. So, this is how basically the RAA System works, so, have a better understanding of the RAA System and then we can understand ACE inhibitors, ARBs inhibitors and renin antagoist medication wear easily, which we’re gonna cover in the following presentation.

If you have any question about RAA System, then you can e-mail us or contact us. Thanks.

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Med-Surg Study Plan

Concepts Covered:

  • Shock
  • Cardiac Disorders
  • Vascular Disorders
  • Pregnancy Risks
  • Emergency Care of the Cardiac Patient
  • Medication Administration
  • Acute & Chronic Renal Disorders
  • Central Nervous System Disorders – Brain
  • Cardiovascular Disorders
  • Disorders of Pancreas
  • Disorders of the Thyroid & Parathyroid Glands
  • Postoperative Nursing
  • Intraoperative Nursing
  • Preoperative Nursing
  • Perioperative Nursing Roles
  • Circulatory System
  • Urinary System
  • Integumentary Disorders
  • Labor Complications
  • Eating Disorders
  • Respiratory System
  • Respiratory Disorders
  • Noninfectious Respiratory Disorder
  • Renal Disorders
  • Hematologic Disorders
  • Oncology Disorders
  • Immunological Disorders
  • Disorders of the Adrenal Gland
  • Disorders of the Posterior Pituitary Gland
  • Respiratory Emergencies
  • Infectious Respiratory Disorder
  • Oncologic Disorders
  • Neurological Trauma
  • Neurologic and Cognitive Disorders
  • Nervous System
  • Central Nervous System Disorders – Spinal Cord
  • Peripheral Nervous System Disorders
  • Emergency Care of the Neurological Patient
  • Neurological Emergencies

Study Plan Lessons

Norepinephrine (Levophed) Nursing Considerations
Vasopressin (Pitressin) Nursing Considerations
Nitroglycerin (Nitrostat) Nursing Considerations
Nitroprusside (Nitropress) Nursing Considerations
Hydralazine (Apresoline) Nursing Considerations
Verapamil (Calan) Nursing Considerations
Nifedipine (Procardia) Nursing Considerations
Losartan (Cozaar) Nursing Considerations
Lisinopril (Prinivil) Nursing Considerations
Propranolol (Inderal) Nursing Considerations
Metoprolol (Toprol XL) Nursing Considerations
Heparin (Hep-Lock) Nursing Considerations
Streptokinase (Streptase) Nursing Considerations
Procainamide (Pronestyl) Nursing Considerations
Warfarin (Coumadin) Nursing Considerations
Epinephrine (EpiPen) Nursing Considerations
Enoxaparin (Lovenox) Nursing Considerations
Enalapril (Vasotec) Nursing Considerations
Diltiazem (Cardizem) Nursing Considerations
Digoxin (Lanoxin) Nursing Considerations
Captopril (Capoten) Nursing Considerations
Atorvastatin (Lipitor) Nursing Considerations
Atenolol (Tenormin) Nursing Considerations
Amlodipine (Norvasc) Nursing Considerations
Amiodarone (Pacerone) Nursing Considerations
Adenosine (Adenocard) Nursing Considerations
Hypoglycemia
Nursing Care and Pathophysiology for Hyperparathyroidism
Discharge (DC) Teaching After Surgery
Surgical Incisions & Drain Sites
Postoperative (Postop) Complications
Post-Anesthesia Recovery
Intraoperative Nursing Priorities
Intraoperative (Intraop) Complications
Intraoperative Positioning
Sterile Field
Surgical Prep
Malignant Hyperthermia
Moderate Sedation
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General Anesthesia
Intubation in the OR
Preoperative (Preop) Nursing Priorities
Preoperative (Preop) Education
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Informed Consent
Perioperative Nursing Roles
Perioperative Nursing Course Introduction
Hypoparathyroidism
Nursing Care and Pathophysiology for Hashimoto’s Thyroiditis
Pressure Line Management
Hanging an IV Piggyback
Spiking & Priming IV Bags
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Fluid & Electrolytes Course Introduction
Fluid Compartments
Fluid Pressures
Fluid Shifts (Ascites) (Pleural Effusion)
Isotonic Solutions (IV solutions)
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Potassium-K (Hyperkalemia, Hypokalemia)
Sodium-Na (Hypernatremia, Hyponatremia)
Calcium-Ca (Hypercalcemia, Hypocalcemia)
Chloride-Cl (Hyperchloremia, Hypochloremia)
Magnesium-Mg (Hypomagnesemia, Hypermagnesemia)
Phosphorus-Phos
ABG Course (Arterial Blood Gas) Introduction
ABGs Nursing Normal Lab Values
ABG (Arterial Blood Gas) Interpretation-The Basics
ROME – ABG (Arterial Blood Gas) Interpretation
ABGs Tic-Tac-Toe interpretation Method
Respiratory Acidosis (interpretation and nursing interventions)
Respiratory Alkalosis
Metabolic Acidosis (interpretation and nursing diagnosis)
Metabolic Alkalosis
ABG (Arterial Blood Gas) Oxygenation
Lactic Acid
Base Excess & Deficit
Hematology Module Intro
Nursing Care and Pathophysiology for Anemia
Nursing Care and Pathophysiology for Sickle Cell Anemia
Nursing Care and Pathophysiology for Disseminated Intravascular Coagulation (DIC)
Thrombocytopenia
Oncology Module Intro
Leukemia
Lymphoma
Oncology Important Points
Immunology Module Intro
Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care and Pathophysiology for Anaphylaxis
Nursing Care and Pathophysiology for Lyme Disease
Systemic Lupus Erythematosus (SLE)
Metabolic & Endocrine Module Intro
Addisons Disease
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Diabetes Mellitus (DM) Module Intro
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Diabetes Management
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Respiratory Course Introduction
Respiratory A&P Module Intro
Lung Sounds
Nursing Care and Pathophysiology for Asthma
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Respiratory Infections Module Intro
Nursing Care and Pathophysiology for Influenza (Flu)
Nursing Care and Pathophysiology for Tuberculosis (TB)
Nursing Care and Pathophysiology of Pneumonia
Isolation Precautions (MRSA, C. Difficile, Meningitis, Pertussis, Tuberculosis, Neutropenia)
Oxygen Delivery Module Intro
Hierarchy of O2 Delivery
Artificial Airways
Airway Suctioning
Blunt Chest Trauma
Nursing Care and Pathophysiology for Pneumothorax & Hemothorax
Chest Tube Management
Respiratory Procedures Module Intro
Bronchoscopy
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Neuro A&P Module Intro
Neuro Anatomy
Impulse Transmission
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Levels of Consciousness (LOC)
Routine Neuro Assessments
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Nursing Care and Pathophysiology for Parkinsons
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Miscellaneous Nerve Disorders
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Nursing Care and Pathophysiology for Hemorrhagic Stroke (CVA)
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Neurological Fractures
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Cardiovascular Disorders (CVD) Module Intro
Nursing Care and Pathophysiology of Hypertension (HTN)
Nursing Care and Pathophysiology for Valve Disorders
Nursing Care and Pathophysiology of Endocarditis and Pericarditis
Nursing Care and Pathophysiology for Cardiomyopathy
Nursing Care and Pathophysiology for Arterial Disorders
Nursing Care and Pathophysiology for Aortic Aneurysm
Nursing Care and Pathophysiology for Thrombophlebitis (clot)
Cardiac Course Introduction
HMG-CoA Reductase Inhibitors (Statins)
Cardiac Glycosides
Calcium Channel Blockers
Angiotensin Receptor Blockers
ACE (angiotensin-converting enzyme) Inhibitors
Renin Angiotensin Aldosterone System