Module 7 Renal Ignatavicius & Workman 7th ch70 pg1518, ch71 pg1537
1. Polycystic Kidney Disease pg1518
A. Pathophysiology
a. an inherited disorder in which fluid-filled cysts develop in the
nephrons; Cysts develop anywhere in the nephron as a result of
abnormal kidney cell division; Incidence ...
Module 7 Renal Ignatavicius & Workman 7th ch70 pg1518, ch71 pg1537
1. Polycystic Kidney Disease pg1518
A. Pathophysiology
a. an inherited disorder in which fluid-filled cysts develop in the
nephrons; Cysts develop anywhere in the nephron as a result of
abnormal kidney cell division; Incidence of cerebral aneurysms
(berry aneurysms) is higher in clients with PKD—screen early.
Assess for headaches with our without visual disturbances; only
definitive Tx dialysis & kidney transplant
i. Dominant form, few nephrons have cyst until person
reaches 30s
ii. Recessive from, 100% of nephron have cyst from birth
b. (saunders) Cyst formation and hypertrophy of the kidneys,
which leads to cystic rupture, infection, formation of scar
tissue, and damaged nephron
i. The ultimate result of this disease is chronic kidney
disease
ii. 2 types:
1. Infantile polycystic disease: An inherited autosomal
recessive trait that results in the death of the infant
within a few months after birth
2. Adult polycystic disease: An autosomal dominant
trait that manifests between 30 and 40 years of
age and results in end-stage kidney disease
B. Clinical Manifestations
a. Pain is often the first manifestation (abdominal (distended
common) or flank pain); Nocturia (the need to urinate
excessively at night) is an early manifestation, , hypertension,
increased abdominal girth, constipation, bloodier cloudy urine
(rupture), kidney stones; pay attention to headaches
b. (saunders) Often asymptomatic until the age of 30 to 40 years;
Flank, lumbar, or abdominal pain that worsens with activity and
is relieved when lying down; Fever and chills; Recurrent
urinary tract infections; Hematuria (rupture), proteinuria,
pyuria; Calculi; Hypertension; Palpable abdominal masses and
enlarged kidneys; Increased abdominal girt
C. Treatment
a. include pain management and prevention of infection,
constipation, hypertension, and chronic kidney disease
b. pain: NSAIDs used cautiously cause reduce kidney blood flow;
ASA avoided risk of bleed; antibiotics
trimethoprim/sulfamethoxazole (Bactrim, Septra, Trimpex) or
ciprofloxacin (Cipro) are prescribed; low Na diet
i. Apply dry heat to the abdomen or flank to promote
comfort when kidney cysts are infected; Teach the
, patient methods of relaxation and comfort using deep
breathing, guided imagery, or other strategies.
c. Constipation: Teach patient w/ adequate urine output to
prevent constipation by maintaining adequate fluid intake,
increasing dietary fiber when fluid intake is more than
2500mL/24hr, and exercising regularly.
d. HTN: done FIRST urge the patient to drink at least 2L of fluid
per day to prevent dehydration; Restricting sodium intake may
help control blood pressure.
i. Drugs: Antihypertensive agents include angiotensin-
converting enzyme (ACE) inhibitors, calcium channel
blockers, beta blockers, and vasodilators; diuretics
1. Teach the patient and family how to measure and
record blood pressure.
e. (saunders) Monitor for gross hematuria, which indicates cyst
rupture; Increase Na and H2O intake because sodium loss
rather than retention occurs; Provide bed rest if ruptured cysts
and bleeding occur; Prepare the client for percutaneous cyst
puncture for relief of obstruction or for draining an abscess;
Administer antihypertensives PRN; Prevent and/or treat urinary
tract infections; Prepare the client for dialysis or renal
transplantation; Encourage genetic counseling
2. Kidney Disorders: Review A&P of Kidney
A. Hydroureter, Hydronephrosis, Urethral Stricture
1) Pathophysiology
a. Hydronephrosis: kidney enlarges due to kidney obstruction
b. Hydroureter: ureter enlarges due to obstruction of ureter
c. Urethral stricture: obstruction causes bladder distension
2) clinical manifestations
a. Known kidney/urologic disorders; Hx UTI; ask about recent
flank/abd pain; chills, fever, malaise, abd pain, bladder
distension,
3) nursing considerations
a. Assess amount of drainage in collection bag
b. If urine expected to drain, assess amount of drain hrly for
first 24hrs
c. If pt has back pain and drainage amount decrease, tube
may b clogged/dislodged
d. Monitor site for leaking urine/blood
e. Red ting first 12-24hrs after procedure and gradually clear
up
f. Notify dr if drainage stops/decreases, becomes cloudy/ foul
smelling, nephrostomy site leaks blood/urine, pt has back
pain
B. Glomerulonephritis, Pyelonephritis
1) Pathophysiology
, a. Pyelonephritis is either the presence of active organisms in
the kidney or the effects of kidney infections. Acute
pyelonephritis is the active bacterial infection, whereas
chronic pyelonephritis results from repeated or continued
upper urinary tract infections or the effects of such
infections.
b. Glomerulonephritis: Acute symptoms is about 10 days from
the time of infection. Usually, patients recover quickly and
completely from acute GN. Chronic develops over 20 to 30
years or even longer. The exact onset of the disorder is
rarely identified
2) clinical manifestations
a. Pyelonephritis
i. Acute: active bacterial infection
1. Fever; chills; tachy & tachypnea; flank, back,
loin pain; tender costovertebral angle; abd,
discomfort; N/V; burning, urgency, freq of
urination; nocturia
ii. Chronic: repeated infections causing progressive
inflammation & scarring
1. HTN; inability to conserve Na; decrease urine
concentration ability; tendency to develop
hyperkalemia & acidosis
b. Glomerulonephritis
i. Acute: skin lesions, edema of face, eyelids, hands,
fluid overload and circulatory congestion, shortness of
breath, crackles, JV D, smoky reddish brown rusty or
cola colored urine, dysuria, oliguria, mild to moderate
hypertension, fatigue, anorexia, nausea/vomiting
ii. chronic: systemic circulation overload, crackles, S3
heart sounds, edema of foot, ankle, Shin, sacrum, JV
D, slurred speech, ataxia, tremors, asterixis (flapping
tremor of the fingers or inability to maintain a fixed
posture with arms extended and risk hyperextended),
yellowish color, texture, bruises, rashes, eruptions
3) nursing considerations
a. pyelo
i. Meds
1. Opioid analgesics, morphine sulfate, &
morphine: moderate-sever pain
2. Antibiotics
a. Mild – mod pyelo tx at home for 14 days
w/ antiinfective
i. Trimethoprim,
sulfamethoxazole/trimethoprim
, ii. Quinolone antibiotic: ciprofloxacin
levofloxacin
1. Stress the importance of
completing the drug therapy
as directed.
ii. Surgery
1. Pyelolithotomy: remove large stone from kidney
2. Nephrolithotomy: remove kidney when all else
failed
3. Ureteroplasty: repair ureter or ureteral
reimplantation (preserves kidney functions &
eliminates infections
b. Glomerulonephritis
i. Acute: antibiotic therapy. Penicillin, erythromycin, or
azithromycin is prescribed for GN caused by
streptococcal infection
1. Check for allergies before giving; Stress personal
hygiene and basic infection control principles
(e.g., handwashing) to prevent spread of the
organism
2. Teach completing entire course of the prescribed
antibiotic
3. diuretics and a sodium and water restriction are
prescribed; antiHTN
ii. Chronic: Management consists of diet changes, fluid
intake sufficient to prevent reduced blood flow volume
to the kidneys, and drug therapy to control the
problems from uremia.
1. Eventually requiring dialysis or transplantation
C. Nephrotic Syndrome
1) Pathophysiology
a. is a condition of increased glomerular permeability that
allows larger molecules to pass through the membrane into
the urine and then be excreted
2) clinical manifestations
a. Main feature severe proteinuria (more than 3.5g of protein
in 24hrs)
b. Edema (anasarca)
c. Increased risk of infection
d. Hyperlipidemia
e. Hypoalbuminemia (Low serum albumin levels)
f. Reduced kidney function; increased coagulation
3) nursing considerations
a. Assess hydration status (vascular dehydration is common)
D. Degenerative disorders
a. Nephrosclerosis
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