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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Concepts Covered:

  • Test Taking Strategies
  • Respiratory Disorders
  • Prenatal Concepts
  • Prefixes
  • Suffixes
  • Legal and Ethical Issues
  • Preoperative Nursing
  • Bipolar Disorders
  • Community Health Overview
  • Immunological Disorders
  • Childhood Growth and Development
  • Medication Administration
  • Adulthood Growth and Development
  • Learning Pharmacology
  • Anxiety Disorders
  • Basic
  • Factors Influencing Community Health
  • Integumentary Disorders
  • Trauma-Stress Disorders
  • Somatoform Disorders
  • Fundamentals of Emergency Nursing
  • Dosage Calculations
  • Depressive Disorders
  • Personality Disorders
  • Cognitive Disorders
  • Eating Disorders
  • Substance Abuse Disorders
  • Psychological Emergencies
  • Hematologic Disorders
  • Pregnancy Risks
  • Concepts of Population Health
  • Emotions and Motivation
  • Delegation
  • Oncologic Disorders
  • Prioritization
  • Postpartum Complications
  • Endocrine and Metabolic Disorders
  • Basics of NCLEX
  • Fetal Development
  • Labor and Delivery
  • Gastrointestinal Disorders
  • Communication
  • Concepts of Mental Health
  • Health & Stress
  • Labor Complications
  • Musculoskeletal Trauma
  • EENT Disorders
  • Urinary Disorders
  • Urinary System
  • Digestive System
  • Central Nervous System Disorders – Brain
  • Integumentary Disorders
  • Tissues and Glands
  • Developmental Theories
  • Postpartum Care
  • Cardiovascular Disorders
  • Renal Disorders
  • Newborn Care
  • Disorders of Pancreas
  • Upper GI Disorders
  • Liver & Gallbladder Disorders
  • Renal and Urinary Disorders
  • Newborn Complications
  • Neurologic and Cognitive Disorders
  • Cardiac Disorders
  • Musculoskeletal Disorders
  • Female Reproductive Disorders
  • Shock
  • Infectious Disease Disorders
  • Nervous System
  • Hematologic Disorders
  • Disorders of the Posterior Pituitary Gland
  • Psychotic Disorders

Study Plan Lessons

12 Points to Answering Pharmacology Questions
Care of the Pediatric Patient
Menstrual Cycle
54 Common Medication Prefixes and Suffixes
Advance Directives
Family Planning & Contraception
Vitals (VS) and Assessment
Therapeutic Drug Levels (Digoxin, Lithium, Theophylline, Phenytoin)
Epidemiology
Essential NCLEX Meds by Class
Growth & Development – Infants
6 Rights of Medication Administration
Growth & Development – Toddlers
Health Promotion & Disease Prevention
Growth & Development – Preschoolers
Growth & Development – School Age- Adolescent
Legal Considerations
HIPAA
The SOCK Method – Overview
The SOCK Method – S
The SOCK Method – O
The SOCK Method – C
The SOCK Method – K
Anxiety
Basics of Calculations
Brief CPR (Cardiopulmonary Resuscitation) Overview
Cultural Care
Gestation & Nägele’s Rule: Estimating Due Dates
Dimensional Analysis Nursing (Dosage Calculations/Med Math)
Environmental Health
Fire and Electrical Safety
Generalized Anxiety Disorder
Gravidity and Parity (G&Ps, GTPAL)
Impetigo
Oral Medications
Pediculosis Capitis
Post-Traumatic Stress Disorder (PTSD)
Burn Injuries
Fundal Height Assessment for Nurses
Injectable Medications
Somatoform
Technology & Informatics
Fall and Injury Prevention
IV Infusions (Solutions)
Maternal Risk Factors
Complex Calculations (Dosage Calculations/Med Math)
Mood Disorders (Bipolar)
Depression
Isolation Precaution Types (PPE)
Paranoid Disorders
Personality Disorders
Cognitive Impairment Disorders
Eating Disorders (Anorexia Nervosa, Bulimia Nervosa)
Alcohol Withdrawal (Addiction)
Grief and Loss
Suicidal Behavior
Physiological Changes
Sickle Cell Anemia
Discomforts of Pregnancy
Antepartum Testing
Hemophilia
Nutrition in Pregnancy
Communicable Diseases
Disasters & Bioterrorism
Maslow’s Hierarchy of Needs in Nursing
Benzodiazepines
Delegation
Nephroblastoma
Prioritization
Chorioamnionitis
Triage
Gestational Diabetes (GDM)
Disseminated Intravascular Coagulation (DIC)
Ectopic Pregnancy
Hydatidiform Mole (Molar pregnancy)
Gestational HTN (Hypertension)
Infections in Pregnancy
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Fever
Overview of the Nursing Process
Dehydration
Fetal Development
Fetal Environment
Fetal Circulation
Process of Labor
Vomiting
Pediatric Gastrointestinal Dysfunction – Diarrhea
Mechanisms of Labor
Therapeutic Communication
Defense Mechanisms
Leopold Maneuvers
Celiac Disease
Fetal Heart Monitoring (FHM)
Appendicitis
Intussusception
Abuse
Constipation and Encopresis (Incontinence)
Patient Positioning
Complications of Immobility
Conjunctivitis
Prolapsed Umbilical Cord
Acute Otitis Media (AOM)
Placenta Previa
Abruptio Placentae (Placental abruption)
Tonsillitis
Preterm Labor
Urinary Elimination
Bowel Elimination
Precipitous Labor
Dystocia
Pain and Nonpharmacological Comfort Measures
Hygiene
Overview of Developmental Theories
Postpartum Physiological Maternal Changes
Bronchiolitis and Respiratory Syncytial Virus (RSV)
MAOIs
Postpartum Discomforts
Breastfeeding
Asthma
SSRIs
Cystic Fibrosis (CF)
TCAs
Congenital Heart Defects (CHD)
Intake and Output (I&O)
Defects of Increased Pulmonary Blood Flow
Blood Glucose Monitoring
Postpartum Hemorrhage (PPH)
Defects of Decreased Pulmonary Blood Flow
Mastitis
Insulin
Obstructive Heart (Cardiac) Defects
Mixed (Cardiac) Heart Defects
Specialty Diets (Nutrition)
Enteral & Parenteral Nutrition (Diet, TPN)
Histamine 1 Receptor Blockers
Initial Care of the Newborn (APGAR)
Nephrotic Syndrome
Enuresis
Newborn Physical Exam
Body System Assessments
Histamine 2 Receptor Blockers
Newborn Reflexes
Babies by Term
Cerebral Palsy (CP)
Renin Angiotensin Aldosterone System
Head to Toe Nursing Assessment (Physical Exam)
Head to Toe Nursing Assessment (Physical Exam)
Meconium Aspiration
Meningitis
Transient Tachypnea of Newborn
Hyperbilirubinemia (Jaundice)
Spina Bifida – Neural Tube Defect (NTD)
ACE (angiotensin-converting enzyme) Inhibitors
Autism Spectrum Disorders
Attention Deficit Hyperactivity Disorder (ADHD)
Newborn of HIV+ Mother
Angiotensin Receptor Blockers
Calcium Channel Blockers
Cardiac Glycosides
Scoliosis
Metronidazole (Flagyl) Nursing Considerations
Ciprofloxacin (Cipro) Nursing Considerations
Vancomycin (Vancocin) Nursing Considerations
Anti-Infective – Penicillins and Cephalosporins
Atypical Antipsychotics
Rubeola – Measles
Mumps
Varicella – Chickenpox
Pertussis – Whooping Cough
Autonomic Nervous System (ANS)
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Parasympathomimetics (Cholinergics) Nursing Considerations
Parasympatholytics (Anticholinergics) Nursing Considerations
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Epoetin Alfa
HMG-CoA Reductase Inhibitors (Statins)
Magnesium Sulfate
NSAIDs
Corticosteroids
Hydralazine (Apresoline) Nursing Considerations
Nitro Compounds
Vasopressin
Dissociative Disorders
Eczema
Proton Pump Inhibitors
Schizophrenia