Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Inherited disorder; fluid-filled cysts develop in nephrons
 Symptoms:
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Abdominal or flank pain
Hypertension
Nocturia
Increased abdominal girth
Constipation
Bloody or cloudy urine
Kidney stones
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 Patient history
 Physical assessment/clinical manifestations
 Psychosocial assessment
 What is the impact of this disease, as an inherited disorder?
 Diagnostic assessment
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 Acute and chronic pain
 Constipation
 Hypertension and renal failure
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Problems of urine outflow obstruction
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 Urologic
 Radiologic
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 Bacterial infection in kidney and renal pelvis (upper
urinary tract)
 Acute symptoms:
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Fever, chills, tachycardia, tachypnea
Flank, back, or loin pain
Abdominal discomfort
Turning, nausea and vomiting, urgency, frequency, nocturia
General malaise or fatigue
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
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Hypertension
Inability to conserve sodium
Decreased concentrating ability
Development of hyperkalemia and acidosis
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Manifestations
Preventative measures
Treatment
Priority collaboration
Assessment of treatment (for ef ficacy)
Teaching needs
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Patient assessment
 Connection with sore throat?
 Proteinuria
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Physical assessment
Clinical manifestations
Laboratory assessment
Other diagnostic tests
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Management of infection
Prevention of complications
Dialysis
Plasmapheresis
Patient education
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 Develops over period of 20 to 30 years or longer
 Assessment
 Interventions:
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Slowing progression, preventing complications
Diet changes
Fluid intake
Drug therapy
Dialysis, transplantation
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 Condition of increased glomerular permeability; allows
larger molecules to pass through the membrane into
urine and be excreted
 Severe loss of protein into urine, edema formation, and
decreased plasma albumin levels
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Treatment:
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Immunosuppressive agents
ACE inhibitors
Heparin
Diet changes
Mild diuretics
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 Thickening in nephron blood vessels; results in narrowing
of vessel lumen
 Occurs with all types of hypertension, atherosclerosis,
diabetes mellitus
 Collaborative management —control high blood pressure,
preserve kidney function
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Processes af fecting renal arteries; may severely narrow
lumen, greatly reduce blood flow to kidneys
 Assessment
 Priority goals for care
 Interventions
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 Microvascular complication of type 1 or type 2 diabetes
 First manifestation: persistent albuminuria
 Priority goals in prevention of ESKD
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 Adenocarcinoma of kidney
 Paraneoplastic syndromes:
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Anemia
Erythrocytosis
Hypercalcemia
Liver dysfunction
Increased sedimentation rate
Hypertension
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Patient history
Physical assessment/clinical manifestations
Diagnostic assessment
Nonsurgical management
Surgical management
“Cues” for readiness for teaching
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Minor injuries—contusions, small lacerations
 Major injuries—lacerations to cortex, medulla, or
branches of renal artery
 Collaborative management
 Nonsurgical management—drug therapy, fluid therapy
 Surgical management—nephrectomy or partial
nephrectomy
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
A 35-year-old patient is admitted to the ED with fever,
chills, and severe right flank pain. His heart rate is
112/min and respiration rate is 32/min. He was recently
treated for a urinary tract infection. Assessment reveals
tenderness of the right costovertebral angle (CVA).
1.
2.
What diagnosis does the nurse expect?
What laboratory tests does the nurse anticipate?
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The patient is diagnosed with possible acute
pyelonephritis and is admitted to the acute
medical unit.
What is the nurse’s priority concern on admission?
A. Potential for infection
B. Acute pain
C. Activity intolerance
D. Insufficient knowledge
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Which orders and interventions should be
implemented for the priority patient problem on
admission to the unit? (Select all that apply.)
A. Administer analgesics as ordered.
B. Assess patient pain level often.
C. Send a daily urinalysis to the laboratory.
D. Administer nitrofurantoin (Macrodantin) 50 mg
with meals and at bedtime.
E. Encourage 2 to 3 L of fluid intake per day.
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Which imaging test would the nurse expect to be ordered
for this patient?
A.
B.
C.
D.
Abdominal CT scan
Thoracic MRI
Abdominal x-ray
IV urography
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Two days later during morning assessment, the patient
expresses embarrassment about his illness. He says that
he did not take all of the antibiotics prescribed to treat his
UTI 2 weeks ago.
What is the nurse’s best response?
A.
B.
C.
D.
“You should always take antibiotics as prescribed.”
“Do you realize that when you don’t take your
antibiotics, superbugs can develop?”
“Why did you choose not to take all of your
medication?”
“Can you tell me more about why you didn’t take all of
your antibiotics?”
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28
The older adult patient with acute
glomerulonephritis is often misdiagnosed with:
Cerebrovascular accident
B. Transient ischemic attack
C. Aortic aneurysm
D. Congestive heart failure
A.
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Which assessment parameter requires immediate
attention in a patient with polycystic kidney
disease?
Fever
B. Hypertension
C. Tachycardia
D. Urine output less than 30 cc/hour
A.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
What percentage of patients with end -stage kidney
disease treated by dialysis or kidney transplant
have diabetes mellitus?
A.
B.
C.
D.
12%
28%
44%
57%
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