Polycystic Kidney Disease/PKD (Exam 3)

Question 1

PKD Patho

Answer 1

hereditary, genetic kidney disorder; fluid filled cysts develop in nephrons (autosomal recessive, more severe cysts present at birth with death occurring early childhood; autosomal dominant, most common, cysts begin to multiply at age 30)

growing cysts damage nephron (glomerular and tubular membranes) reducing kidney function and causing HTN*

cysts may occur in other tissues, such as the liver or blood vessels

Question 2

Growing Cysts (PKD)

Answer 2

cysts don’t filter blood; kidney failure will occur over time

cysts are also at higher risk of infection, kidney stones, rupture and bleeding

each cystic kidney may enlarge x2-3 times causing discomfort, paint, and organ displacement

Question 3

PKD S/S

Answer 3

pain (flank, abdominal)
distended abdomen
enlarged, tender kidney on palpation
changes in urine, including hematuria, clarity, odor
changes in pattern of urination including nocturia
dysuria
VS changes (HTN, fever)
edema
uremic symptoms (n/v, pruritis, fatigue)
emotional responses (anger, resentment, futility, sadness, or anxiety related to chronicity or inheritable condition)

Question 4

PKD Risk Factors

Answer 4

caucasian
family history

Question 5

PKD Labs and Diagnostics

Answer 5

urinalysis with findings of proteinuria and hematuria

urine C&S if infection is suspected

serum BUN/Cr to assess kidney function, creatinine clearance

renal sonography, CT scan, or MRI to assess the presence and size of cysts

Question 6

PKD Meds

Answer 6

analgesics for comfort; use NSAIDs cautiously

antibiotics like trimethoprim/sulfamethoxazole TMP-SMX (Bactrim, Septra) or ciprofloxacin (Cipro) if a cyst infection is causing discomfort

nitrofurantoin

fosfomycin

Question 7

PKD Procedures

Answer 7

needle aspiration of cysts

Question 8

PKD Nursing Care

Answer 8

HTN control and fluid management (major priority!!) antihypertensive agents, diuretics as ordered, daily weights

pain management (apply dry heat to abdomen or flank; teach relaxation or distraction techniques to self manage pain and discomfort)

infection prevention
constipation prevention associated with fluid restriction and intestinal tract displacement from cysts with fiber intake and regular activity

diet therapy to slow progression of kidney injury with fluid, Na, and protein restrictions

provide counseling, support and teaching to health maintenance to promote self management