Week 13: Chp 62: Polycystic Kidney Disease Flashcards
What is polycystic kidney disease?
a progressive kidney disorder causing excessive growth of fluid-filled cysts in the kidneys, often leading to complications over time
- a genetic disorder that manifests in the cortex and medulla of both kidneys and appears as large, thin -walled, fluid-filled cysts
- 2 forms: childhood and adult
What is PKD caused by?
caused by an autosomal-recessive disorder, and its course is rapid and progressive, leading to severe lung and liver dysfunction and end-stage renal disease (ESRD), causing death during infancy and childhood
The nurse recognizes that genetic counseling is appropriate for which patient?
A. a child with frequent UTIs
B. an adult with frequent UTIs
C. an adult with autosomal-dominant polycystic kidney disease
D. an adult with metastatic renal cancer
C. an adult with autosomal-dominant polycystic kidney disease
How do Cysts Develop?
as a result of repeated cell division process within the renal tubule known as a cystogenic process that occurs many times over the life of a patient with PKD
- progressive expansion causes emerging cysts to separate from the parent tubule, leaving an isolated sac; the cysts become large and compress the surrounding tissue, destroying the underlying renal tissue
- the compression of the underlying tissue reduces the blood flow and subsequent nutrient supply to the renal tissues, which are highly sensitive to reduced blood flow and nutrients
Clinical manifestations of PKD
none in the early stage
- symptoms become apparent as the cysts enlarge
- first symptoms is hypertension as a result of damage to the surrounding renal structures caused by the enlargement of cysts
- hematuria also occurs because of the rupture of the cysts
- may complain of lower back or flank pain, headaches, or pain in the abdominal area
- manifest manifestations of a UTI such as urinary frequency, or urinary calculi (stones) that cause severe pain as a result of obstruction to urinary flow
Physical on examination on palpation may reveal what?
bilaterally enlarged kidneys, increased abdominal girth, and costovertebral angle tenderness
This disease can lead to what other disease?
end-stage renal disease (ESRD)
How to diagnose PKD
based on clinical manifestations and patient and family history
- laboratory tests
- imaging studies
Laboratory tests used to diagnose PKD
a urinalysis to reveal blood (hematuria) or bacteria in the urine
Definitive Diagnosis is determined by what?
abdominal ultrasound, magnetic resonance imaging (MRI), IV pyelogram (IVP), or computed tomography (CT)
-a renal ultrasound can also assist in the visualization of cysts and is less invasive and less expensive
Diagnostic imaging can reveal other complications related to PKD such as?
cysts on the liver and other abdominal organs
A nurse understands that which diagnostic study is most specific in identifying PKD? A. abdominal x-ray B. serum creatinine level C. urinalysis D. computed tomography scan
D. Computed tomography scan (CT)
Treatment for PKD
hemodialysis (HD) or peritoneal dialysis
- other goals include: managing UTIs, pain, and hypertension
- lifestyle changes such as proper diet, exercise, and smoking cessation
Managing UTIs
require regular checkups and immediate treatment as the clinical manifestations of infection become evident
-antibiotics are necessary to control the spread of infection up to the kidneys
How can pain be managed?
- pain can be managed with nonnarcotic pain medications such as acetaminophen and opiate narcotic pain medications such as morphine
- severe pain may require nephrectomy as a palliative measure
How is hypertension managed?
medications such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers
What is the only curative measure?
renal transplant
Complications of PKD
severe hypertension, renal calculi, recurrent UTIs, hematuria, and heart valve abnormalities
- high risk for developing life-threatening aneurysms in the aorta or cerebral circulation
- lead to the development of cysts in the liver and the GI tract; cysts that form in the liver destroy surrounding tissues and impair the normal functioning of the liver in degrading waste products of digestion; cysts in the intestines can cause diverticulosis or an outpouching of the intestines
- most common complication is renal failure
Most common complication of PKD
renal failure
-characterized by the inability of the kidneys to remove waste products and excess fluid from the circulation
Assessment and analysis: clinical manifestations appear as a result of what?
as a result of enlargement and rupture of the cyst
- hypertension, hematuria, pain or heaviness in the back, abdomen, or flank area
- headaches
- UTI
- urinary calculi
- palpable, bilaterally enlarged kidneys
Nursing Diagnoses
- excess fluid volume r/t the inability of the kidneys to excrete fluid and excessive fluid intake
- risk for infection r/t alteration in urinary elimination patterns
- ineffective therapeutic regimen management r/t the lack of knowledge regarding the disease process
Nursing Interventions: Assessments
- vital signs
- oxygenation
- daily weight
- lab values
Assessments: Vital signs
increased temperature may be present because of infection
- hypertension is present because of changes in the renal tissue caused by the cysts
- increased heart rate may be present as a result of infection and pain
Assessment: Oxygenation
anemia (inadequate RBCs to carry oxygen to the tissues) associated with chronic kidney disease may impair oxygen exchange at the cellular level, which results in lower oxygen saturation
