Polycystic Kidney Disease

A client diagnosed with polycystic kidney disease has been taught about the treatment plan for this disease. The nurse determines that the client needs additional teaching if the client states that the treatment plan includes: 1. Genetic counseling. 2. Sodium restriction. 3. Increased water intake. 4. Antihypertensive medications.

2. Individuals with polycystic kidney disease seem to waste rather than retain sodium. Thus, they need increased sodium and water intake. Aggressive control of hypertension is essential. Genetic counseling is advisable because of the hereditary nature of the disease.

Which of the following nursing interventions is appropriate in providing care for an adult patient with newly diagnosed adult onset polycystic kidney disease (PKD)? a) Help the patient cope with the rapid progression of the disease. b) Suggest genetic counseling resources for the children of the patient. c) Expect the patient to have polyuria and poor concentration ability of the kidneys. d) Implement appropriate measures for the patient's deafness and blindness in addition to the renal problems.

Answer: b PKD is one of the most common genetic diseases. The adult form of PKD may range from a relatively mild disease to one that progresses to chronic kidney disease. Polyuria, deafness, and blindness are not associated with PKD.

A 30 year old client has just been diagnosed with polycystic kidney disease. The nurse would expect to develop a plan of care based on which of the following nursing diagnoses? a. Excess fluid volume related to impaired renal function. b. Fluid volume deficit related to impaired renal function. c. Infection related to obstructed urinary drainage. d. Knowledge deficit related to end stage renal disease.

C Rationale: The client with polycystic disease would have the potential to develop renal failure, hypertension and urinary tract infections. Renal failure develops by age 60-70. Hypertension tract infections occur due to cysts obstructing urinary drainage.

Which of the following statements made by a client with polycystic kidney disease indicates that the desired outcome has been met? 1. "I know these drugs will make the cysts disappear." 2. "The development of renal failure with this disease is very rare." 3. "I will have my family seek genetic counseling and screening." 4. "I sure am glad that hemodialysis will shrink the cysts."

3 Adult polycystic kidney disease is an autosomal-dominant disorder, and the client should be advised to have family members screened for the disease. The management of clients with polycystic kidney disease is mainly supportive. Eventually, clients with this disease require dialysis or transplantation. The core issue of the question is knowledge that this disorder has a genetic basis. Use nursing knowledge and the process of elimination to make a selection.

The nurse has taught the client with polycistic kidney disease about management of the disorder and prevention and recognition of complications. The nurse determines that the client understands the instructions if the client states that there is no reason to be concerned about: 1. Burning on urination. 2. A temperature of 100.6F 3. New-onset shortness of breath. 4. A blood pressure of 105/68 mmHg

4. The client with polycystic kidney disease should report any signs and symptoms of urinary tract infection so that treatment may begin promptly. Lowered blood pressure is not a complication of polycystic kidney disease, and it is an expected effect of antihypertensive therapy. The client would be concerned about increases in blood pressure because control of hypertension is essential. The client may experience heart failure as a result of hypertension, and thus any symptoms of heart failure, such as shortness of breath, are also a concern.

The nurse is giving the client with polycystic kidney disease instructions for replacing the elements that are lost in the urine as a result of impaired kidney function. The nurse instructs the client to increase the intake of which of the following in the diet? a) sodium and water b) sodium and potassium c) water and phosphorus d) calcium and phosphorus

A - Clients with polycystic kidney disease waste sodium rather than retain it and therefore require an increase in sodium and water in the diet. Potassium, calcium, and phosphorus need no special attention.

A client newly diagnosed with polycystic kidney disease has just finished speaking with the physician about the disorder. The client asks the nurse to explain again what the most serious complication of the disorder might be. In formulating a response, the nurse incorporates the understanding that the most serious complication is: a) diabetes insipidus b) end-stage renal disease (ESRD) c) chronic urinary tract infection (UTI) d) syndrome of inappropriate antidiuretic hormone (SIADH) secretion

B - The most serious complication of polycystic kidney disease is ESRD, which would be managed with dialysis or transplant. There is no reliable way to predict who will ultimately progress to ESRD. Chronic UTIs are the most common complication because of the altered anatomy of the kidney and from development of resistant strains of bacteria. Diabetes insipidus and SIADH secretion are unrelated disorders.

A nurse is caring for a hospitalized client with polycystic kidney disease who has intravenous pyelography (IVP). The nurse monitors which specific item in the postprocedure period? a) lung sounds b) groin area c) carotid pulse rate d) intake and output

D - IVP is used to visualize the kidneys, ureters, and bladder for evaluation of structure and excretory function. Contrast medium is injected intravenously (usually in a vein located in the antecubital area) to visualize the renal parenchyma, collecting system, ureter, and bladder, using multiple x-ray films. This diagnostic test detects renal masses and cysts, ureteral obstruction, retroperitoneal tumors, renal trauma, and other urinary tract abnormalities. The nurse monitors urinary output and renal function for 24 to 48 hours after the test in order to recognize a nephrotoxic response to the contrast medium. Options A, B, and C are unrelated to this procedure.