Pathophysiology
A group of diseases that cause inflammation and injury to the part of the kidneys that filters blood (glomeruli). When the kidneys are injured or inflamed, they are unable to remove waste and extra fluid in the body. Prolonged disease may lead to kidney failure.
Etiology
Most commonly, acute glomerulonephritis develops as a complication following streptococcal infection of the throat or skin (rare). Bacterial infections such as endocarditis and strep throat and viral infections such as HIV and hepatitis B and C may result in inflammation of the glomeruli within the kidneys. Immune diseases such as lupus, Goodpasture’s syndrome are also thought to lead to glomerulonephritis. The chronic form of the disease is thought to be hereditary, but may occur months or years following an acute attack of the disease.
Desired Outcome
Increased homeostasis, stable weight and blood pressure, free from edema
Glomerulonephritis Nursing Care Plan
Subjective Data:
- Puffiness of face in mornings
- Urinating less frequently
- Shortness of breath
- Cough
- Fatigue
- Change in weight (recent/significant)
Objective Data:
- Hematuria / proteinuria
- Hyper/hypotension
- Bubbly / foamy urine
- Dark colored urine
Nursing Interventions and Rationales
- Perform head-to-toe assessment
To establish a baseline by which to measure interventions and outcomes
- Auscultate lungs, noting any adventitious breath sounds
- Assess periorbital and dependent edema (+1 – +4)
Damage to the glomeruli prevent the emptying of sodium and fluid and can raise the heart rate and blood pressure.
- Insert indwelling urinary catheter as necessary
Provides a more accurate method of measuring output. If catheter is contraindicated,, provide urinary hat for toilet to measure urine.
- Monitor fluid balance
- I & O
- Daily weights
- Evaluate edema
- Measure for decreased output <400 mL/24 hr period may be evident by dependent edema
- Daily weights at the same time on the same scale each day, >0.5kg/day is indicative of fluid retention
- Note changes in characteristics of urine: dark, frothy appearance, hematuria
Provide elevation for feet and ankles or arms as necessary to allow gravity to assist in reducing edema. There may be a gain of up to 10lbs of fluid before pitting is noticed
- Monitor diagnostic testing:
Evaluate electrolyte levels
- Calcium
- Sodium
- Magnesium
- Potassium
Monitor renal function labs
- BUN, Creatinine
- Albumin
- Glomerular Filtration Rate (GFR)
Kidney biopsy, as indicated
Electrolyte imbalances can lead to muscle weakness or spasticity and affect cardiac output.
Monitor the amount of protein lost in the urine. Serum protein levels will be decreased, while urine protein levels will be elevated.
A kidney biopsy may be required, especially if patient is diabetic
- Administer medications as indicated
- Diuretics
- Antihypertensives
- Electrolyte supplements
An acute attack of glomerulonephritis may clear on its own. Depending on severity of symptoms and progression of disease, diuretics are often given to remove excess fluid, antihypertensives to manage blood pressure caused by fluid retention and electrolyte supplements such as calcium or potassium to maintain homeostasis
- Encourage healthy lifestyle and nutritional education
- Offer small, frequent meals
- Restrict fluids as necessary
- Limit sodium and protein intake
- Encourage exercise to maintain a healthy weight
- Control blood sugar (diabetic patients)
- Quit smoking
References
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nrsng.com/cornell
