Nursing Care Plan (NCP) for Glomerulonephritis

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Outline

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)

 

  • Monitor vital signs

 

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

 

  • Elevate extremities

 

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

Writing a Nursing Care Plan (NCP) for Glomerulonephritis

A Nursing Care Plan (NCP) for Glomerulonephritis starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Hey guys, let’s take a look at the care plan for glomerulonephritis. In this lesson, we’ll briefly take a look at the pathophysiology and etiology of glomerulonephritis. Also, we’ll look at subjective and objective data and nursing interventions and rationales. 

 

So glomerulonephritis is defined as a group of diseases that causes inflammation and injury to the part of the kidney that filters blood, which are the 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. Acute glomerulonephritis develops as a complication following streptococcal infection of the throat or skin, although this is rare. Bacterial infections, such as endocarditis and strep throat and viral infections, such as HIV, hepatitis B and C may result in an inflammation of the glomeruli within the kidneys. Immune diseases, such as lupus or good pasture syndrome are also thought to lead to this issue. The chronic form of the disease is thought to be hereditary, but may occur months or years following an acute attack of the disease. The desired outcome is increased homeostasis, stable weight and blood pressure, and being free from edema. 

 

Okay, let’s take a look at some of the subjective and objective data that your patient with this issue may present with. Remember subjective data are going to be things that are based on your patient’s opinions or feelings like puffiness of the face in the morning, urinating less frequently, shortness of breath, cough, fatigue, and recent significant change in weight. 

 

Objective or measurable data may include hematuria, proteinuria, hyper, or hypotension, bubbly or foamy urine, and dark colored urine.

 

Let’s take a look at some of the nursing interventions important when caring for a patient with glomerulonephritis. Perform a head to toe assessment,  so a baseline can be established to which interventions and outcomes can be measured. Auscultate the lungs, noting any adventitious breath sounds and measure dependent and periorbital edema from plus one, to plus four. Monitoring vital signs is critical, as damage to the glomeruli prevents the emptying of sodium and fluid, and can raise the heart rate and blood pressure. Insert an indwelling catheter as necessary as this will provide a more accurate method of measuring output. If a catheter is contra-indicated, be sure to provide a urinary hat for the toilet to measure urine. It is critical to monitor fluid balance in these patients. Measure for decreased output, less than 400 ml’s in a 24 hour period, which may be evident by dependent edema. Measure daily weights at the same time each day on the same scale. Greater than five kilos per day is indicative of fluid retention. Note changes in the characteristics of the urine, including dark urine, frothy appearance or hematuria. Provide elevation of the feet, ankles and arms as necessary to allow gravity to assist in reducing edema. There may be a gain of up to 10 pounds of fluid before pitting is noticed, okay? Monitor diagnostic testing, including electrolyte levels, calcium, sodium, magnesium, and potassium. Electrolyte imbalances can lead to muscle weakness or spasticity and affect cardiac output. Monitor renal function labs, including bun, creatinine, albumin, and GFR, which is the glomerular filtration rate. Monitor the amount of protein, which is lost in the urine. Serum protein levels will be decreased while urine protein levels will be elevated. Also, a kidney biopsy may be required, especially if the patient is diabetic. 

When considering medications, sometimes glomerulonephritis will clear on its own, so it’s important to know that depending on the severity of the 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 like potassium or calcium to maintain homeostasis. Finally guys, encourage a healthy lifestyle and for nutritional education, offer small and frequent meals. Restrict fluids as necessary, limit sodium and also protein intake. Encourage exercise to maintain a healthy weight, control blood sugar in diabetic patients and of course, encourage smoking cessation. 

 

Okay. Here is a look at the completed care plans for glomerulonephritis. We love you guys. Now, go out and be your best self today and as always, happy nursing!

 

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