A nurse is caring for a client with autosomal dominant polyc… | 마이메르시 MyMerci
Adult Health
문제

A nurse is caring for a client with autosomal dominant polycystic kidney disease (ADPKD). Which nursing intervention is most appropriate to help prevent complications associated with this condition?

해설
Blood pressure control is critical in ADPKD to slow disease progression and prevent cardiovascular complications. Other options are not recommended as they may worsen outcomes.

심화 해설

Core Nursing Explanation Key Concept Analysis: This question assesses the priority nursing intervention for managing Autosomal Dominant Polycystic Kidney Disease (ADPKD). ADPKD is characterized by the growth of numerous cysts in the kidneys, leading to progressive kidney enlargement, hypertension (HTN), and eventual decline in renal function. The pathophysiology involves cyst expansion, which compresses normal kidney tissue and activates the renin-angiotensin-aldosterone system (RAAS), causing secondary hypertension. Uncontrolled hypertension is the single most important modifiable factor that accelerates the decline of Glomerular Filtration Rate (GFR) and increases the risk of cardiovascular complications, which are the leading cause of death in ADPKD.

Answer Rationale: Key Point! The most appropriate nursing intervention is to Monitor and control blood pressure within target range. Aggressive blood pressure control (typically targeting

임상 시나리오

Nursing Clinical Practice Guide Clinical Scenario: You are assigned to Mr. Johnson, a 45-year-old male newly diagnosed with ADPKD during a family screening after his father died of renal failure. His current BP is 148/92 mmHg. He reports occasional dull flank pain but is otherwise asymptomatic. He asks, "What can I do to keep my kidneys working as long as possible?"

Nursing Intervention Strategy:
  1. Assessment: Obtain a thorough history (family history is key). Perform a physical assessment, focusing on BP measurement in both arms, abdominal palpation for enlarged kidneys (may be ballotable), and auscultation for renal bruits. Review labs: serum creatinine, eGFR, urinalysis for protein/blood.
  2. Nursing Diagnosis: Risk for Decreased Cardiac Output related to hypertension; Deficient Knowledge regarding disease management and complication prevention.
  3. Planning & Implementation:
    • BP Management: Educate on home BP monitoring. Collaborate with the provider to initiate or titrate an ACEI/ARB. Teach the importance of strict adherence.
    • Lifestyle Education: Teach a low-sodium diet (140/90) – take medication as prescribed, rest, re-check, call provider if persistently high.
      ACEI/ARB Administration Points: - Administer as ordered, often once daily. - Monitor for first-dose hypotension, especially in volume-depleted patients. Advise to take at bedtime if dizziness occurs. - Educate about the importance of continuing even if feeling well, as the renoprotective effect is long-term.
      A Word from Your Senior Nurse "Managing ADPKD is a marathon, not a sprint. As a nurse, you are the coach. Your most powerful tool is patient education. When a patient understands that controlling their blood pressure today directly impacts whether they'll need dialysis in 10 or 20 years, it empowers them. On the NCLEX, they're testing if you see the big picture – not just the diseased kidney, but the whole person and the modifiable factors that change their trajectory. Remember: In chronic disease nursing, the priority is often the intervention that slows progression and prevents complications. Keep that lens on, and you'll ace these questions."

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