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
Assessment: Daily weight
an increase in sodium and water retention may result in weight gain
Assessment: Lab values
- hemoglobin/hematocrit
- plasma creatinine level/ BUN
- plasma sodium level
- plasma potassium level
- plasma calcium level
- plasma phosphorous level
- urinalysis/ urine cultures
Assessment: Hemoglobin/ hematocrit
anemia is associated with chronic renal disease because of the decreased production of erythropoietin, a protein produced in the kidneys necessary for red blood cell (RBC) production
Assessment: plasma creatinine level/ blood urea nitrogen (BUN)
impairment in renal function may affect the renal clearance of waste waste products
-evidence in renal clearance is seen as an elevation in serum creatinine and BUN levels
Assessment: plasma sodium level
patients with PKD may retain sodium, which causes fluid retention and predisposes the patient to hypertension, fluid overload, and heart failure
Assessment: plasma potassium level
patients with PKD may have an elevated potassium level as a result of the impaired renal elimination of potassium
Assessment: plasma calcium level
patients with PKD may have a low calcium level because of renal damage impairing the conversion of vitamin D to its active form, which allows the GI absorption of calcium from the diet
Assessment: Plasma phosphorus level
may have elevated phosphorus levels because of impaired renal clearance of phosphates
Assessment: urinalysis/ urine cultures
patients with PKD are at high risk for UTIs due to the compression of the tissue by the cysts impairing elimination
-careful monitoring of the clinical manifestations of a UTI is necessary to ensure prompt treatment and avoid the ascension of the infection to the renal structures
Nursing Actions
- diet modifications consistent with impaired renal function, specifically low potassium, phosphorus, protein, and sodium
- fluid restriction
- administer anti-hypertensive agents ordered
- administer antibiotics as ordered
- administer pain medications as ordered
Actions: diet modifications consistent with impaired renal function, specifically low potassium, phosphorus, protein, and sodium
diet modification is essential to prevent severe complications from eating foods high in protein, potassium, and phosphorus that the kidneys cannot excrete adequately
-excess sodium intake can cause fluid retention
Actions: fluid restriction
excess fluid intake may not be excreted, and fluid overload and heart failure may occur
Actions: administer anti-hypertensives
uncontrolled hypertension is a significant complication of PKD because of the damage to the renal tissue by the enlarged cyst that compresses the surrounding tissue, reducing perfusion to the tissues
-complying with prescribed anti-hypertensive agents is required for patients with PKD to reduce elevated blood pressure, which is a risk factor for heart disease and stroke
Actions: administer antibiotics as ordered
to control the spread of a UTI up to the renal system
Actions: administer pain medication as ordered
necessary to manage pain associated with PKD
Nursing Teachings
- report manifestations of infection
- follow prescribed dietary restrictions
- follow prescribed anti-hypertensive therapy
- follow prescribed antibiotics for diagnosed UTIs
Teaching: Immediately report clinical manifestations of infection
patients with PKD are at high risk for UTIs due to the compression of the tissues by the cysts impairing elimination
-prompt attention is necessary to halt the spread of infection to renal tissue
Teaching: follow prescribed dietary restrictions
to avoid serious metabolic complications that are associated with renal failure
Evaluating Care outcomes
goal is to prevent complications
- comply with prescribed medications such as anti-hypertensives to maintain normal blood pressure and the use of antibiotics to treat UTI is essential to the treatment plan for PKD
- diets restricting sodium, potassium, fluid, and phosphorus are necessary if renal failure is present
- vital signs within reasonable limits and the absence of infection are indicative of maintaining health for patients with PKD
