Nursing Considerations & Diagnoses

Nursing Considerations

As we've discussed in previous posts, PKD is a disease characterized by multiple cysts in the kidneys.  The cysts damage or destroy the healthy tissue surrounding them.  Doctors are responsible for deciding how to treat the disease, while nurses are responsible for the direct care of the patient.  As nurses some of our top concerns are:

 

 

• Acute Pain
• Could have many causes including kidney stone formation, urinary blockage or infection

 

• Fluid volume excess 
• Cysts damage the kidney and reduce their ability to filter blood and create urine resulting in a potential overload of fluid in the body

 

• Altered renal perfusion
• Cysts damage healthy kidney tissue, including the blood vessels within the kidneys, changing the way blood flows through the kidney.  Reduced blood flow further damages the kidneys. 

 

• Altered nutrition: less than body requirements 
•  Patients with PKD may be placed on a restricted diet that results in inadequate intake.  

• Impaired urinary elimination 
• The kidneys lose their ability to filter urine, or a cyst may block urinary flow.  Additionally, bladder and urinary tract infections are common and will also impact elimination.

 

• Risk for infection 
• UTIs, bladder and kidney infections are all common symptoms of PKD

 

Diagnosis:	Fluid Volume Excess
Related To:	Decreased Kidney Function
As evidenced by:	Swelling, reduced urine output, weight gain, shortness of breath, distended jugular vein
Nursing Interventions:	-Monitor intake and output -Monitor patient’s weight -Educate patient about when to call the doctor -Listen to lungs -Observe and rate swelling -Review labs to check for electrolyte imbalance -Restrict fluid and sodium intake if ordered
Outcomes:	-Patient will be able to identify signs & symptoms of fluid volume excess -Patient will maintain adequate intake & output -Patient will remain at a stable fluid volume

All info from:

5 Chronic Renal Failure Nursing Care Plans - Nurseslabs. (2011, December 21). Retrieved February 26, 2015, from http://nurseslabs.com/chronic-renal-failure-nursing-care-plans/

Back pain image:

http://img4.hostingpics.net/pics/656303kidneystonestreatment5.jpg

PKD: How Can Nurses Help?

PKD: How Can Nurses Help?

 

The treatment of Polycystic Kidney Disease is mostly about managing the symptoms. Nurses can do a lot to help with this! For PKD patients we want to monitor fluids, manage pain, and keep the kidneys as healthy as possible for as long as possible.  We also want to treat related conditions, such as kidney or urinary tract conditions as soon as possible to prevent further damaging the kidneys. 

 There are many common symptoms of PKD including pain, high blood pressure and fluid retention.  Nurses can work in tandem with patients to manage these symptoms.

Symptom or Concern	Nursing Interventions
Infection (UTI, kidney cyst infection, etc)	Administer antibiotics as prescribed, manage associated pain, monitor vitals for signs of infection, monitor lab values
Pain	Pain management with non-NSAID medications as ordered, heating pads, comfort measures such as visiting with the patient, listening to music
Kidney Stones	Encourage fluid intake, manage pain, monitor urine for the passage of the stone and blood in the urine
High Blood Pressure	Provide patient education on exercise, encourage a low sodium diet, administer anti-hypertensives as ordered
Fluid Retention	Administer diuretics as ordered, encourage a low salt diet

 

In an outpatient setting, it's important for the nurse to let the patient know when they should contact their doctor. The following signs warrant a call to the doctor:

-Blood in the urine

-Increasing or unusual flank pain

-Swelling of the extremities

-Decreased urine output

-Fever, lethargy, malaise, generally feeling of being unwell which could indicate infection

If the patient has a severe headache they should call 911 immediately as PKD is associated with an increased risk of aneurysms.

Patient education is also important when talking about the treatment options as the disease progresses. For example, most patients will undergo hemodialysis instead of peritoneal dialysis.  Nurses should be familiar with both and be able to explain the procedure to patients and families.  Many people with PKD also will undergo a kidney transplant, understanding the procedure and the outcomes, including the need for lifelong immunosuppresant medications. 

The Dialysis Nurse

Many patients with PKD progress to End Stage Renal Disease and rely on dialysis to take the place of their failing kidneys.  The dialysis nurse accesses the dialysis catheter under sterile conditions and hooks the patient up to the dialysis machine.  The nurse is also responsible for monitoring the patient during dialysis, as well as weighing the patient before and after.

Image of nurse & patient: http://blog.soliant.com/wp-content/uploads/Nurse1.jpg 

Info from: Polycystic kidney disease. (n.d.). Retrieved February 19, 2015, from http://www.mayoclinic.org/diseases-conditions/polycystic-kidney-disease/basics/definition/con-20028831