Question

Polycystic Kidney Disease (PKD)

A 30-year-old white male patient comes to the clinic reporting dull, aching abdominal and flank pain. He reports nocturia and a family history of autosomal dominant PKD. He reports no known personal health problems, although he was instructed to monitor his blood pressure at home and he admits to “not doing so well with that.”

Today his blood pressure is 130/90 mm Hg; pulse is 72 and regular; respirations 12/min, and temperature is 98.8° F.

1. What additional information should the nurse elicit during the interview?
2. What are the key features of PKD?
3. Describe the causes of pain for patients with PKD.
4. What are typical findings of a urinalysis in a patient with PKD?
5. What are the causes of hypertension and kidney ischemia in a patient with PKD?
6. What is the risk involved with other organs and tissues in the progression of PKD?
7. Patients with PKD often have other tissue involvement. List several of the complications that can be present.
8. Identify priority nursing care needs for the patient with PKD.
9. What would the nurse include in the teaching plan for this patient?

Answer 1

1. While taking the history of the patients we should include :-

a) Demographic profile - in which patients name ,age, sex ,marital status , nationality , occupation , education etc are taken .

b) Chief complaints -in which patient is asked to tell the about the complaints he have :-

- dull ,aching abdominal and flank pain

- nocturia

c) History of present illness - in which patient is asked to describe the whole scenario ,when the complaints started ,teh did he when to any hospital ,had any investigation and treatment and then when did he reached here , was he referred or came himself .

d) History of past illness - any history of disease in past till present day like typhoid ,cholera pneumonia etc ,any allergies he have , any medications taken in the past or being taken .

e) Family history - we ask for any family history of any disease in the family and the number of family members in the family and make the family tree mentioning the patient with disease The patient tells about the family history of autosomal dominant polycystic kidney disease .

f) Socioeconomic status - in which we ask about the family income , the facilities available where he resides like water facility , electricity facility, waste disposal facility etc .

g) On examination:-

-we check the vital signs of the patient(temperature,BP,HR,RR,SPO2 and pain assessment)

Pain assessment using visual analogue scale and according to the reading treatment is provided for pain management.

- do the physical examination including inspection , auscultation, palpation and percussion

h) plan of treatment is made including bthe investigation to be done on the basis of history and assessment of clinical manifestations.

2. The key features of PKD are :-

- abdominal or flank pain

- hypertension

- nocturia

- increased abdominal girth

- constipation

- bloody or cloudy urine

- kidney stones

3. The pain in PKD patients is both acute and chronic . Pain occurs in lower back ,abdomen ,head ,legs and chest . Cyst hemorrhage , nephrolithiasis and urinary tract infection are the causes for acute pain but the exact cause of chronic pain can not be determined. Chronic pain related to cyst may be caused due to traction of renal pedicle, distension of capsule and compression of nearby structures like blood vessels and cause lack of blood supply and pain develops .

4.Typical findings of a urinalysis done in a patient with PKD:-

Urinalysis is non specific , but it will show urine protein or blood in urine .

Colour - yellow

Specific gravity -1.010

pH - 7

Blood -3+

Protein - 2+

Glucose - negative

Leukocyte esterase - negative

Nirates - negative