Nursing 4 Lecture 4 Polycystic Kidney Disease

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ncappadonia
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Nursing 4 Lecture 4 Polycystic Kidney Disease
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2012-02-03 01:28:40
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Nursing 4 Lecture 4 Polycystic Kidney Disease
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  1. Pathophysiology (Adults)
    • -More common in whites than any other races
    • -Men and Women have equal chances of inheriting

    -Inherited disorder in which fluid-filled cysts develop in the nephrons

    -Kidney function is replaced with non-functioning cysts that look like clusters of grapes

    -Kidneys become very large, possibly 2 to 3 times its nomal size which can displace other organs causing pain

    -Fluid filled cysts are at an increased risk for infection, rupture, and bleeding

    **Control of blood pressure is TOP priority to prevent further kidney damage
  2. Key Features Include:
    (Adults)
    • -Abdominal or flank pain
    • -Hypertension
    • -Nocturia (peeing at night)
    • -Increased abdominal girth
    • -Constipation
    • -Bloody or cloudy urine (infection)
    • -Bright-red cola colored urine (cyst ruptures)
    • -Kidney stones

    *Pain is often the first manifestation
  3. Uremic Problems:
    -Urine biproducts in blood

    • -Anorexia
    • -Nausea and vomiting
    • -Pruritis
    • -Fatigue
  4. Assessment: Patient History (Adults)
    • -Parents or others in family w/ PKD?
    • -Constipation?
    • -Abdominal discomfort?
    • -Change in urine color or frequency?
    • -High blood pressure?
    • -Headaches?
    • -Family hx from a sudden death of stroke?
  5. Assessment: Physical/Clinical Manifestations (Adult)
    • -Pain is often the FIRST manifestation
    • -Distended abdomen is common
    • -Dull aching pain caused by increased kidney size or by infection of a cyst
    • -Sharp intermittent pain occurs when a cyst ruptures
    • -Bright red or cola colored urine= cyst ruptured
    • -Cloudy or foul smelling urine w/ dysuria--> infection suspected
    • -Nocturia is an early manifestation and occurs due to decreased urine concentrating ability
    • -As renal function declines theres increased HTN, edema, uremic problems (anorexia, N/V, pruritis, and fatigue)
    • -Berry Aneurysms
  6. Intracranial Verry Aneurysm
    -AKA saccular aneurysm

    • -Sac like outpouching in a cerebral blood vessel
    • -Once a berry aneurysm has formed it is very likely to rupture- causing a stroke
    • -SERIOUS MEDICAL EMERGENCY, and should be treated ASAP
  7. Assessment: Psychosocial (Adults)
    • -Has seen this happen to other family members
    • -Parent may have died with this disease
    • -May be concerned for their children also
  8. Assessment: Diagnostic (Adults)
    • -UA shows proteinuria once the glomeruli are involved
    • -Hematuria may be gross or microscopic
    • -As kidney function declines: Serum creatine and BUN rise BUT creatinine clearance decreases
    • -Changes in kidney handling of sodium may cause either sodium losses or sodium retention

    -Diagnostic Tests: renal sonography, CT, MRI
  9. Interventions: Acute and Chronic Pain (Adults)
    • -Drug therapy and complementary approaches
    • -NSAIDS used cautiously because of the tendency to decrease renal blood flow
    • -Aspirin containing compounds are avoided due to risk of bleeding
    • -If pain is from infection antibiotics are prescribed
    • -*Bactrim, Septra, Trimpex or Cipro are prescribed because they enter the cyst wall
    • -Monitor serum creatinine because antibiotics can be nephrotoxic
    • -Apply dry heat to abdomin or flank area
    • -If pain is severe cysts can be reduced by needle aspiration and drainage
    • -Teach relaxation and comfort for using deep breathing, guided imagery, etc.

    OVERALL GOAL: patient self management
  10. Interventions: Constipation (Adult)
    • -Teach to maintain adequate fluid intake
    • -Increasing dietary fiber when fluid intake is greater than 2500 mL/24 hr
    • -Exercise regularly
    • -may need to advise about the use of laxatives and bulk agents including careful use of laxatives to prevent chronic constipation
    • -Bowel management might change, particularly if renal failure also develops
  11. Interventions: Hypertension and Renal Failure (Adult)
    • -Restrict sodium to help control BP, may need antihypertensive and antidiuretic drugs
    • -Teach to measure and record BP
    • -Teach to monitor daily weights
    • -Low sodium diet is often prescribed however some pts may have salt wasting and should not follow a sodium restricted diet
    • -Protein may be restrictued to slow the development of kidney failure
    • -Work with the nutritionalist and help the patient to understand the importance of diet planning

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