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9/1/2016

PolycystickidneydiseaseFlashcards|Quizlet

Polycystic kidney disease

21 terms by Bonecrawler

Overview

Growth of multiple, bilateral, grapelike


clusters of fluid-lled cysts in the kidneys
May progress slowly even after symptoms
of renal insuciency appear
Adult form, which has an insidious onset but
usually becomes obvious between ages 30
and 50, has autosomal dominant
inheritance
Usually fatal within 4 years of uremic
symptom onset, unless dialysis begins
Carries a widely varying prognosis in adults
Also known as PKD and autosomal
dominant polycystic kidney disease
(ADPKD)

Overview-Pathophysiology

Cysts enlarge the kidneys, leading to


thickening of the basement membranes in
the tubules, macrophage inltration,
neovascularization, brosis, and cystic
dilation of the renal tubules, and ultimately
resulting in the compression and eventual
replacement of functioning renal tissue.
(See Polycystic kidney.)
Renal deterioration results.
The condition progresses relentlessly to
fatal uremia.

Overview-Causes

Autosomal dominant form inherited as an


autosomal dominant trait (ADPKD),
aecting the short arm of chromosome 16
and the long arm of chromosome 4
Acquired (more than one-half of patients
receiving dialysis for more than 3 years)

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Overview-Incidence

The disease aects both sexes equally, with


a slight increase in severity of the disease in
men.
Autosomal dominant form accounts for 6%
to 10% of all cases of end-stage renal
disease in the United States.
The usual age of onset for the autosomal
form typically ranges from age 20 to 40.

Overview-Complications

Cyst rupture
Hepatic failure
Cerebral aneurysm, subarachnoid
hemorrhage
Diverticula
Mitral valve prolapse
Metabolic abnormalities
Renal calculi
Renal failure
Respiratory failure
Heart failure
Recurrent hematuria
Life-threatening retroperitoneal bleeding

Assessment-History

Family history
Polyuria
Urinary tract infections
Headaches
Pain in back or flank area
Gross hematuria
Abdominal pain, usually worsened on
exertion and eased by lying down

Assessment-Physical Findings

Hypertension
Microscopic or gross hematuria
Increased abdominal girth
Signs of an enlarging kidney mass
Grossly enlarged kidneys (in advanced
stages)
Uremic fetor
Pallor

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Diagnostic Test Results-Laboratory

Urinalysis may show hematuria, bacteriuria,


or proteinuria.
Creatinine clearance test results may show
renal insuciency or failure.
Hematocrit may be elevated.
Serum albumin levels may be decreased.
Serum electrolyte levels may reveal
hyponatremia, hyperkalemia,
hyperphosphatemia, or hypocalcemia.

Diagnostic Test Results-Imaging

Excretory or retrograde urography reveals


enlarged kidneys, with pelvic elongation,
flattening of the calyces, and indentations
caused by cysts.
Magnetic resonance imaging (preferred
test) shows multiple areas of cystic
damage.

Treatment-General

Monitoring of renal function


Dialysis; renal replacement therapy
Transcutaneous electrical nerve stimulation
(TENS) and hypnotherapy for chronic pain

Treatment-Diet

Low-sodium
Fluid management based on degree of
renal dysfunction

Treatment-Activity

As tolerated in early stages


Avoidance of contact sports with advanced
disease
Exercise to manage hypertension

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Treatment-Medications

Analgesics, such as opioids, transcutaneous


opioid patches, or perinephric injection of
local anesthetics, for pain relief
Antibiotics, such as ciprofloxacin
hydrochloride, levofloxacin, or
trimethoprim-sulfamethoxazole for urinary
tract infection
Antihypertensive agents, such as
angiotensin-converting enzyme (ACE)
inhibitors (captopril, enalapril, or lisinopril)
or angiotensin receptor blockers (losartan
potassium, irbesartan, or candesartan
cilexetil), for hypertension
Diuretics, such as furosemide, to treat
hypertension and renal calculi
Electrolyte replacements, such as calcium
carbonate, and phosphate binders to
reduce phosphorus load in renal failure.

Treatment-Surgery

Kidney transplantation
Surgical drainage for cystic abscess or
retroperitoneal bleeding

Nursing Considerations-Nursing Diagnoses

Acute pain
Chronic pain
Decient fluid volume
Fatigue
Impaired urinary elimination
Ineective coping
Risk for ineective renal perfusion
Risk for infection
Risk for injury

Nursing Considerations-Expected
Outcomes

report feelings of increased comfort


identify measures to address chronic pain
maintain fluid balance
verbalize the importance of balancing
activity with adequate rest periods
demonstrate skill in managing the urinary
elimination problem
demonstrate adaptive coping behaviors
exhibit adequate renal function
remain free from signs and symptoms of
infection
avoid or minimize complications.

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Nursing Considerations-Nursing
Interventions

Give prescribed drugs, including ACE


inhibitors to control hypertension; if giving
diuretics, obtain specimens for serum
electrolyte levels, especially potassium,
which may be decreased.
Provide comfort measures, including opioid
analgesics; assist the patient with relaxation
techniques and the use of TENS.
Provide fluids and foods based on the
patient's condition, encourage increased
fluids if the patient has a urinary tract
infection, and restrict fluids if the patient
has renal failure.
Provide supportive care to minimize
symptoms.
Obtain specimens for urinalysis and culture
and sensitivity as ordered to evaluate for
hematuria, proteinuria, and infection; obtain
specimens for laboratory tests, such as
electrolyte levels, as ordered.
Individualize patient care, as appropriate
Allow the patient to verbalize his feelings
and concerns, especially related to
possible progression of the disease and
renal failure; provide support and
guidance.
Prepare the patient for dialysis or renal
replacement therapy as indicated.
Encourage the parents of a child with the
infantile form to obtain genetic counseling.
Prepare the patient and his family for
possible renal transplant or surgery.

Nursing Considerations-Monitoring

Renal function
Urinary elimination, including urine color
and characteristics
Fluid balance and hydration
Electrolyte balance
Vital signs, especially blood pressure
Pain level and relief
Laboratory test results (urine and blood
specimens)
Access site for dialysis if appropriate
Eectiveness of therapy and dialysis

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Nursing Considerations-Associated Nursing


Procedures

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Blood pressure assessment


Clean-catch (midstream) urine collection,
female
Clean-catch (midstream) urine collection,
male
Continuous ambulatory peritoneal dialysis
(CAPD)
Continuous renal replacement therapy
(CRRT)
Health history interview and physical
assessment
Hemodialysis, arteriovenous access
Hemodialysis, double-lumen catheter
Intake and output assessment
Nutritional screening
Oral drug administration
Postoperative care
Preoperative care
Preparing a patient for urologic surgery, OR
Pulse assessment
Venipuncture
Weight measurement

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Patient Teaching-General

disorder, underlying cause, diagnosis, and


treatment, including medication therapy
and possible dialysis or transplantation
prescribed drug therapy, including the drug
name(s), dosage(s), frequency of
administration, and duration of therapy
possible adverse eects of therapy, such as
hypokalemia with diuretic therapy and GI
upset with ACE inhibitors
follow-up with the practitioner for severe
or recurring headaches
signs and symptoms of urinary tract
infection and renal calculi and the need to
notify the practitioner immediately if any
occur
signs and symptoms of electrolyte
imbalances and the need to notify the
practitioner if any occur
importance of blood pressure control and
adhering to medication therapy
use of analgesics and possible sedative
eects if opioid agents are used and how
to use opioid patches if prescribed
how to use TENS or hypnotherapy for
chronic pain control
that disorder is slowly progressive, and that
dialysis or transplantation may be needed
dialysis procedure, technique, and
frequency, if indicated, and care of the
access site.
ongoing need for follow-up and laboratory
testing to evaluate disease progress,
including ultrasonography every 1 to 2
years.

Patient Teaching-Discharge Planning

Refer the patient and his family to


community and social services for support.

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