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Outline
Overview
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
- Auscultate lungs, noting any adventitious breath sounds
- Assess periorbital and dependent edema (+1 – +4)
- Monitor vital signs
- Insert indwelling urinary catheter as necessary
- 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
- Elevate extremities
- 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
- Administer medications as indicated
- Diuretics
- Antihypertensives
- Electrolyte supplements
- 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
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