Polycystic Kidney

Formation of cysts in the cortex and medulla. Etiology Genetic Symptoms appear between the age of 30-40 years old Pathophysiology
1.Cysts contain fluid

2.Kidney enlarge, compress and become unfunctioning .

3.Maybe accompanied by hepatic fibrosis.

4.Renal- nephrone the primary area suffered for the damage.

5.Cycts develop in the glomerulus or tubules.

6.Cycts detrays of membrane in glomerulus and tubules.

7.Tubular reabsorption and tubules secretion malfunctions Clinical Manifestation Hypertension Hematuria Urinary tract infection (UTI) Pain in the lumbar region Enlarged kidneys Increase abdominal girth and swelling Diagnostic test Urine analysia- present proteinuria, hematuria, or bacteruria Urine c&s Serum creatinine, BUSE Ultrasound / CT scan/ MRI

IVP (intravenous pyelogram)- is an x-ray examination of the kidney , ureters and urinary bladder that uses iodinated contrast material injected into veins.

Surgical Management Nephrectomy - To remove the kidney Surgery to drain the cysts Nursing Management Pain due to disease process Goal reduce the pain Intervention : 1. Rest and assist patient in ADL 2. Give analgesic as prescribed e.g acetaminophen 3. Assist doctor collecting blood specimen 4. Perform hot compress if complaint abdomen discomfort 5. Teach patient to do deep breathing exercise 6. Diversional therapy 7. Advise high fiber, drink plenty of water to avoid constipation. 1. 2. 3. 4. 5. Excessive fluid volume related to renal dysfunction Goal: fluid normal limit Intervention: Reduce contain of sodium in the diet -( to retain the water) Serve anti-hypertensive drugs e.g metaprolol, beta-blocker. Serve diuretic drug e.g frusemide (lasix)-( to reduce body fluid) Monitor fluid intake and record in I/O chart Daily weight- to identify symptom of dehydration.

Health education Monitor blood pressure everyday Continue anti-hypertensive drug as prescribed by doctor Reduce intake of Salt in the diet Drink plenty of water Eat diet contain high fiber diet- ( to prevent constipation ) Care of genitalia area- ( to reduce risk of UTI) See doctor if symptom occur. Eg smelly urine, hematuria, headache or blurred vision. Summary Formation of cysts in the cortex and medulla It can damaged in the kidney tissue It can cause failure and need to do dialysis
Surgical management involved nephrectomy.

Renal trauma
Variety of traumatic injuries as a result of violent erime, increased speed in transport or sport. Etiology Blunt trauma (fall & accident) Penetrating trauma (gunshot or sharp object) Classification according to types 1. Minor- contusion, minor laceration and hematoma 2. Major- Major laceration, rupture of capsule of renal. 3. Critical- multiple and severe laceration, renal pedicle injury (rupture of artery and veins) Clinical manifestation Hematuria Flank pain Weakness/lethargic Nausea and vomiting Loss of weight Palpation (abdominal mass) Shock (severe or multiple injuries) cold sweat Diagnostic test Urinalysis Hemoglobin, hematocrit and WBC Intravenous urography Renal arteriography CT scan Management Minor injuries CRIB ( complete rest in bed, no need operation) Observe the urine- hematuria, amount and record in the I/O chart Start on intravenous infusion Give antibiotic as ordered- control injection Closed observation the vital sign and level of consciousness to identified symptoms bleeding e.g: blodd pressure , body temperature and respiration. Prepared for operation. Major injuries Same as minor Need operation Critical injuries Prepare for operation nephrectomy

Nursing intervention Restore fluid volume IV fluid and electrolyte replacement Plasma volume expanders suck as albumin or dextrin Frequent (hourly/half hourly) monitoring vital signs (if patient got hypovolumic, the BP will drop ) Hourly urine output Health education Instruct patient on safety measure such as: Wearing seat belt Wearing protective clothes for contact sport Avoiding excessive vehicle speeds.

Nursing preparation for patient who will undergo for procedure intravenous pyelogram (IVP)
1. 2. 3. 4. 5. 6. 7. 8. 9. The nurse must instruct the patient not to eat or drink anything after midnight on the day of the test Preparations will involve the use of laxatives and in some cases, enema to cleanse the bowel Ensure the patient signed the consent for the procedure as an approval Assess renal anal fluid status, including serum osmdality, creatinine and blood urea nitrogen (BUN) levels. Notify the physician of any abnormal values. Obtain baseline vital signs and record in the patients file as documentation. Assess the knowledge and understanding of the patient towards the procedure, clarifying information as needed. The nurse will inform the patient to wear a hospital gown before the procedure If the patient is a women, the nurse should clarify if they are pregnant or not and inform the physician and xray technologist if there is any possibility that they are pregnant Ask the patient about allergy to seafood, iodine or radiologic contrast dye. Notify physician or radiologist if allergies are known.

Nursing care, pre-operative & postoperative care of patient with nephrectomy Pre-operative care 1. Assess the knowledge and understanding of the patient towards the surgery, clarifying information as needed 2. Ensure the patient knows which side of kidney will be removed 3. Make sure the patient signed the consent form as an approval for the surgery] 4. Pre-operative teaching about postoperative expectations reduces anxiety for the patient and family during the early postoperative period. 5. Inform the patient not to eat or drink anything after midnight on the day of the test 6. Inform to the patient that they can still survive even it they have one kidney left. 7. Advice the patient to pray according to their beliefs and culture to reduce anxiety 8. Obtain vital sign as a baseline and record in the patients file as documentation. Post operative care 1. Take vital sign for the patient in order to assess any internal bleeding 2. Frequently assess urine colour, amount and character, noting any hematuria, pyuria or sediment. 3. Promptly report oliguria and anuria as well as changes in urine colour or clarity 4. Note the placement, status and drainage from urethral catheters, stents, nephrectomy tubes or drains 5. Maintain gravity drainage: irrigate only as ordered. Maintaining drainage tube patency is vital to prevent potential hydronephrosis. Bright bleeding or unexpected drainage may indicate a surgical complication. 6. Support the grieving process and adjustment to the loss of a kidney. Loss of major organ leads to a body image change and grieve response 7. Administer analgesic medication as prescribe by the doctor to reduce postoperative pain. 8. Instruct the patient to inform if the pain persists in order to proceed further investigations 9. Instruct the patient to report if sign and symptoms to the nurse, including clinical manisfestation of urinary tract infection (UTI)-( dyuria, frequency and urgency of micturation, cloudy, malodorous urine) or systemic infection (fever, general, malaise, fatigue) redness, swelling or drainage from the catheter. 10. Encourage the patient to walk after surgery as it encourages early return bowel function. Promotes effective breathing, mobilizes secretion and prevents stiffness of joints and relieves pressure. 11. Plantar extension or flexion exercises- instruct the patient to begin with pointing his toes towards the foot side of the bed. Then point the toes up toward his face. Repeat this simple exercise at least 100 times an hours while awake.