26 terms

Acute Glomerulonephritis

Medical-Sugical Nursing Patient-Centered Collaborative Care 7th Edition Author Ignatavicius Workman (pgs 1527-1528) Lone Star College North Harris, Nursing III
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Acute Glomerulonephritis is also known as
Acute Nephritic Syndrome
Pathophysiopogy of Acute Glomerulonephritis
An infection is most often the cause of Acute GN
Infections that cause Acute Glomerulonephritis
Group A beta-hemolytic-streptococcus bacteria;
Any bacterial, parasitic, fungal, or viral infection (potentially)
Primary Glomerular diseases and syndromes
Acute glomerulonephritis (Acute Nephritic Syndrome);
Rapidly progressive glomerulonephritis (RPGN);
Chronic glomerulonephritis;
Nephrotic syndrome;
Persistent, vague urinary abnormalities with few or no symptoms
Most forms of glomerulonephritis occur
with a collection of immune complexes in the glomeruli. These complexes trigger many inflammatory mediators, such as complement, white blood cells, and blood clotting proteins, which cause damage to kidney tissue
Actions that cause tissue injury to kidneys
damage to cell membranes,
local edema,
movement of WBCs to site of inflammation,
and platelet activation
Secondary Glomerular diseases and syndromes
Systemic Lupus Erythematosus (SLE);
Amyloidosis;
Diabetic glomerulopathy;
HIV-associated nephropathy;
Sickle-Cell disease
The onset of symptoms for GN
occur about 10 days from the time of infection.
Patients with Acute GN
normally recover quickly and completely
Results for glomerular injury
proteinuria;
hematuria;
decreased glomerular filtration rate;
edema;
hypertension
Immunologic changes injure what part of the nephron
glomeruli, interstitium, or tubules and the effect may be acute or chronic
Triggers for glomerular injury
exposure to bacteria, viruses, drugs, or other toxins
Actions that cause tissue injury
damage to cell membrane; local edema; movement of WBCs to site of inflammation; platelet activation
History for a patient with Acute Glomerulonephritis
Ask about recent infections (skin or upper respiratory); recent travel (possible exposure to viruses, bacteria, fungi, or parasites); recent illnesses, surgery, or invasive procedures (possible infection); any systemic diseases (Systemic Lupus Erythematosus -SLE)
Physical Assessment for a Patient with Acute Glomerulonephritis
Inspect Skin (lesions, recent incisions, body piercings);
Assess for edema (face, eyelids, hands, legs, present in 75% of pt's with Acute GN);
Assess for fluid overload and circulatory system (Na+ and fluid retention occurs with acute GN;
ascultate lung fields for crackles, ascultate heart for S3- gallop rhythm; check for jugular vien distension);
weigh the patient (to assess for fluid retention);
take Blood Pressure and compare to baseline BP (mild to moderate hypertension often occurs with Acute GN as result of fluid retention)
During physical assessment of a patient with Acute Glomerulonephritis, The nurse wants to ask
Ask patient if it is hard to breath; if they are short of breath;
Ask the patient about change in urineation pattern or color (microscopic blood causes urine to be smoky or cola color);
Ask the patient about dysuria or oliguria (unable or low urine output- 100 to 400 mL/day)
Uremia signs and symptoms from severe kidney impairment
Nausea;
Vomiting;
Anorexia;
Lack of energy;
Fatigue
Urinalysis laboratory assessment for a patient with Acute GN
Hematuria (RBCs),
Proteinuria (proteins),
Glomerular flitration rate (GFR) measured by 24 hr urine creatinine clearance may be decreased to 50 mL/min (normal 90-120 mL/min)
Blood Laboratory Assessment for a patient with Acute GN
Blood urea nitrogen (BUN) increased (older pt's it may be higher);
Protein excretion rate increased from 500 mg to 3 g/24 hrs
Serum albumin levels are decreased (because of proteinuria)
Other diagnostic assessments for Acute GN
Kidney biopsy (precise diagnosis of condition)
Interventions: managing infection in patients with Acute GN
Penicillin, erythromycin, or azithromycin is prescribed for acute GN caused by streptococcal infections
Patient teaching for managing infection in patients with Acute GN
Stress importance of personal hygine and basic infection control principles;
teach importance to take all antibiotics
Interventions: Preventing Complications for patients with Acute GN
Dieuretics and a sodium and water restriction are prescribed to patients with fluid overload, hypertension, and edema (antihypertensives may be used)
Interventions: Preventing Complications for patients with Acute GN and OLIGURIA
usually have increased potassium and BUN; so, K+ and protein may be restricted to prevent hyperkalemia and uremia as a result of increased BUN.
Interventions: Preventing Complications for patients with Acute GN and UREMIC SYMPTOMS or FLUID VOLUME EXCESS CANNOT BE CONTROLED
Dialysis or Plasmapheresis (removal and filtering of the plasma to eliminate antibodies)
Inerventions: Preparing for self-management for a patient with Acute GN
Teach patient and family about prescribed drugs (dosage, schedule, potential side effects);
Teach methods for detecting fluid retention;
Ensure they understand fluid or dietary restrictions;
Teach them to weigh theirself and take BP at the same time every day to monitor for fluid retention
Teach them to notify the doctor if sudden increase in BP or weight
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