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Regulatory Hormonal Changes (Nursing)

by Prof. Lawes

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    00:00 Now we're going to look at that 3rd category. We looked at structure. We looked at functional changes. Now we're going to look at regulatory hormones. Okay, this one seems like it's more complicated. I promise you it's really not. Here is again our framework slide.

    00:18 This is where you want to stop and really look through this. With normal aging, we're going to go after 3 major hormonal areas. So the first one, vasopressin otherwise known as ADH which is anti-diuretic hormone. Okay, so why do I say it that way? Because anything that you can do in your studying that's a little bit different, that seems a little weird, can sometimes help it stick in your brain better. So, I'm willing to do back flips if it helps you study better, that's why we're here, that's why Lecturio exists. So first up, vasopressin or ADH. Now the name tells you right there, anti is against, diuresing is peeing out or pulling out a lot of fluid, and hormone just means messenger. Okay, so this messenger tells my body to be against diuresis. So I want you to think if I have excess ADH what happens to my urine level? "Okay, well if I have excess of this hormone that tells my body to be against diuresing, Ahh my urine volume is less. If I don't have ADH or something is blocking ADH, then I'm going to be putting out much larger volumes of urine." Now similar principles apply to ANH, atrionatriuretic hormone. We'll talk about that but it also encourages the body to get rid of a lot of fluid because it responds when the volumes in your heart tell you "Whoah, whoah, whoah, whoah, whoah we've got too much on board. So when ANH is released, that will work on the kidneys so you end up letting go of extra water. Now the 3rd one, if you study cardiovascular medications, this is going to look very familiar to you. So, renin, angiotensin, aldosterone system. This is a system that maintains your blood pressure in 2 ways. When you end up with a body senses "Hey, we need more here. It puts out renin, can exit angiotensin. You know all these things the end product is angiotensin II which is a potent vasoconstrictor and you end up with aldosterone which tells your body to hang on to sodium and to water. Now that was just a quick review. I want you to hear that once before we go through each of these 3 areas in detail. So you're ready to go? Let's back up a little bit. Remember we're talking about the 3 major areas that a normal aging kidney experiences. We talked about structure and function. Now we're looking at the hormones that are changing in normal aging. We're going to look at ADH, ANH, and the RAAS. So, here is a quick chart just to kind of give you a feel for where we're heading. As a person ages, as Jose has aged successfully, his antidiuretic hormone levels are going to be decreased. Okay, so what I want you to do is right next to that arrow, what does that do to Jose's volume of urine? If he has less ADH, is his urine increased the amount or decreased? Now with atrial natriuretic hormone, ANH, fs increased as we age, what impact does that have on an older person's amount of urine? Remember, predicting and if you're not sure what the answer is if you make yourself kind of jump through that mental gymnastics of answering the question, this information is going to stick much better. Now lastly, renin.

    04:07 Right? We've got the RAAS. See that 3rd box, you have less of that as you age. So what do you think is going to happen to the urine output? Is it going to increase? Or is it going to decrease? Alright, so write yourself a note if you need to pause the video for a second but I promise you the act of predicting, the act of trying to think through things rather than just listening to us talking is really what's going to help you be successful.

    04:38 So let's take a deeper dive into ADH. What do those 3 letter stand for? Right.

    04:45 Antidiuretic hormone. Now, I've got picture, a pretty cool picture here, of the brain.

    04:51 You see where the pituitary gland is. Now, it's a tiny little gland but it's really, really bossy. Right? It controls a lot of things. It's like a uhm, I don't know, like a little 2-year-old that runs the whole household with a finger, does some pretty amazing things. Now it's not exactly an attractive gland as you see it there, but we're going to talk about the posterior pituitary. That's where ADH comes from. You have an anterior pituitary which you see there in gray, we don't have it labeled for you but that's what it is.

    05:21 This is the posterior pituitary. So it's little, but it is mighty and this is where antidiuretic hormone comes from. Now, what does this do when it's released in the body? What happens way down in your kidneys? Now let's reorient where you are. So see back here you see you have the kidneys with the adrenal glands on top. Right? We've got the blood vessels in the middle. Then you have a ureter coming from each kidney down to the bladder. Right? Then the bladder empties into the urethra where it exits your body.

    06:00 So here's where we are. We're looking at what happens with ADH in this part of your body and your renal system. So, we've got that little circle of the kidney there to remind you now we're going to like totally zoom in on what this is. So, we go way, way, way, way, way, way in. You see there at the beginning the circle with almost looks like a little antennae. There's a really blood supply coming in. That is the tangle of capillaries that we call the glomerulus in Bowman's capsule. Now blood will enter through there.

    06:32 It will filter and decisions are made throughout those tubules as to what the body will reabsorb and what the body will get rid of. Now one thing I'd love for you to write down is water follows sodium. Okay, water follows sodium. Or as my students know I always say wherever sodium goes, water follows. Okay, so keep that in mind. That's why we're talking about "Ooohhh if I reabsorb sodium, then my body is going to reabsorb extra water.

    07:05 That means I'm hanging onto it instead of peeing it out. Because at the end of our little thing there, if you trace that from your Bowman's capsule all the way around to the end that's going to end up dumping out into your bladder and out of your body. That's what that section is. ADH is against that process happening. So, look what we made for you. So you can see what happens when ADH. Right? We've got things going through the body. ADH, see those little buggers go out "phew." What they're going to do is they're going to go to the sites and they're going to make sure that water is not excreted but we hang on to it because it is against diuresis. So, one of the hormonal changes that are normal as you age is do you have more ADH or less ADH? I hope you said less, but if you didn't, no problem. That is the answer, you have less ADH. So, the amount of volume that you're going to have to put out of your body as I age is it going to be more than when I was younger or less? Well if I have less ADH, that means I have less hormone that's against diuresing so I'm going to be pro-diuresing. I'm going to put out much more urine than I did when I was younger.


    About the Lecture

    The lecture Regulatory Hormonal Changes (Nursing) by Prof. Lawes is from the course Assessment of the Geriatric Patient: Renal System (Nursing).


    Included Quiz Questions

    1. Atrial natriuretic hormone
    2. Antidiuretic hormone
    3. Renin-angiotensin-aldosterone system
    4. Oxytocin
    1. Atrial natriuretic hormone
    2. Antidiuretic hormone
    3. Renin-angiotensin-aldosterone system
    4. Testosterone
    1. Posterior pituitary gland
    2. Adrenal gland
    3. Thymus
    4. Pancreas
    1. A decrease in antidiuretic hormone with age
    2. An increase in antidiuretic hormone with age
    3. An increase in the renin-angiotensin-aldosterone system with age
    4. A decrease in the renin-angiotensin-aldosterone system with age

    Author of lecture Regulatory Hormonal Changes (Nursing)

     Prof. Lawes

    Prof. Lawes


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