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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  • Learning Pharmacology
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Study Plan Lessons

Steps in the Nursing Process 1 Nursing Mnemonic (ADPIE)
Anatomy of an NCLEX Question
Diagnostics Terminology
Head to Toe Nursing Assessment (Physical Exam)
How to Take Nursing Report
How to Write A Nursing Progress Note
Intro to Community Health
Lung Sounds
MedTerm Suffixes
Nursing Process
Nursing Process – Assess
Nursing Process – Diagnose
Nursing Process – Evaluate
Nursing Process – Implement
Nursing Process – Plan
Nutrition (Diet) in Disease
Overview of the Nursing Process
Head to Toe Nursing Assessment (Physical Exam)
10.02 Breath Sounds for CCRN Review
Heart (Cardiac) Sound Locations and Auscultation
Heart (Cardiac) and Great Vessels Assessment
Heart Sounds Nursing Mnemonic (APE To Man – All People Enjoy Time Magazine)
Lung Sounds
Biohazard Material Handling and Disposition (Blood, Microbiology, Creutzfeldt-Jakob Disease) for Certified Perioperative Nurse (CNOR)
Inserting a Foley (Urinary Catheter) – Female
Inserting a Foley (Urinary Catheter) – Male
Sterile Field
Sterile Gloves
Sterile Field Maintenance (Aseptic Technique) for Certified Perioperative Nurse (CNOR)
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Sterilization and Storage Environment Conditions for Certified Perioperative Nurse (CNOR)
Transportation and Storage (Single Use Items) for Certified Perioperative Nurse (CNOR)
Using Aseptic Technique
Wound Care – Assessment
Wound Care – Dressing Change
Wound Care – Wound Drains
Complex Calculations (Dosage Calculations/Med Math)
Dimensional Analysis Nursing (Dosage Calculations/Med Math)
ABGs Nursing Normal Lab Values
Albumin Lab Values
Altered Mental Status- Delirium and Dementia for Progressive Care Certified Nurse (PCCN)
Blood Plasma
Bowel Obstruction Concept Map
C. Difficile for Certified Emergency Nursing (CEN)
Dehydration
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Electrolyte Imbalances for Progressive Care Certified Nurse (PCCN)
Electrolytes – Location in Body Nursing Mnemonic (PISO)
Electrolytes Involved in Cardiac (Heart) Conduction
Fluid & Electrolytes Course Introduction
Fluid Shifts (Ascites) (Pleural Effusion)
Fluid Volume Deficit
Fluid Volume Overload
Formation & Excretion of Urine
Giving Medication Through An IV Set Port
Heart (Cardiac) Failure Therapeutic Management
Heat Temperature-related Emergencies for Certified Emergency Nursing (CEN)
12 Points to Answering Pharmacology Questions
54 Common Medication Prefixes and Suffixes
ACE (angiotensin-converting enzyme) Inhibitors
ACLS (Advanced cardiac life support) Drugs
NRSNG Live | The S.O.C.K Method for Mastering Nursing Pharmacology and Never Forgetting a Medication Again
The SOCK Method – Overview
The SOCK Method – S
The SOCK Method – O
The SOCK Method – C
The SOCK Method – K
6 Rights of Medication Administration
Drawing Up Meds
EENT Medications
Ethical Dilemmas for Certified Emergency Nursing (CEN)
Hanging an IV Piggyback
Insulin Mixing
IM Injections
IV Drip Administration & Safety Checks
IV Push Medications
Medication Errors
Medications in Ampules
NG Tube Med Administration (Nasogastric)
NG Tube Medication Administration
Nursing Case Study for Mania (Manic Syndrome)
Pill Crushing & Cutting
Safety Checks
Spiking & Priming IV Bags
SubQ Injections
Topical Medications
02.08 Cardiac Catheterization & Acute Coronary Syndrome for CCRN Review
ACLS (Advanced cardiac life support) Drugs
C – Content
Epinephrine (EpiPen) Nursing Considerations
Nursing Care Plan (NCP) for Angina
Renin Angiotensin Aldosterone System
Renin Angiotensin Aldosterone System (RAAS)
Artificial Airways
Hierarchy of O2 Delivery
Oxygen Delivery Module Intro
54 Common Medication Prefixes and Suffixes