Glomerulonephritis

Glomerulonephritis Nursing Diagnosis Interventions and Care Plans

Glomerulonephritis NCLEX Review Care Plans

Nursing Study Guide: Glomerulonephritis

Glomerulonephritis is a medical condition wherein the small filters of the kidneys called glomeruli become inflamed.

The glomeruli are responsible for the removal of waste, excess fluid, and excess electrolytes from the bloodstream into urine.

There are two types of glomerulonephritis: acute, which occurs suddenly and/or lasts for less than 6 months, and chronic, which progresses slowly and lasts for more than 6 months.

Glomerulonephritis, if left untreated, can cause severe damage to the kidneys, and can result to their failure to function properly.

This condition can happen as a part of another disease like diabetes or lupus.

Signs and Symptoms of Glomerulonephritis

  • Hematuria – blood in urine; appears pink or brown-colored urine indicating presence of red blood cells
  • Proteinuria – presence of protein in the urine; may appear foamy
  • Azotemia – increased presence of waste products such as creatinine and blood urea nitrogen (BUN) in the blood
  • Hypertension or high blood pressure
  • Swelling or edema – indicates fluid retention that is usually seen in the face, hands, feet and abdomen
  • Weight gain

Causes and Risk Factors of Glomerulonephritis

  1. Infections. Glomerulonephritis can occur after recovering from a step throat infection. It can also happen when a patient has a viral infection such as HIV, or a bacterial infection, such as endocarditis.
    1. Immune disorders. Lupus is an inflammatory disease that is long-term and can affect different parts of the body, including the kidneys.
    1. Vascular disorders. Vasculitis, or the disorder of the blood vessels, may also lead to glomerulonephritis.
    1. Risk factors. Having hypertension can damage the ability of the kidneys to filter the blood. Poorly controlled diabetes can lead to diabetic nephropathy, which is the damage of the kidneys due to both high blood pressure levels and high glucose levels. Glomerulonephritis can also be inherited – a condition known as Alport syndrome. Having lung cancer, leukemia, or myeloma increases the risk for developing glomerulonephritis.

Complications of Glomerulonephritis

  1. Chronic kidney disease (CKD). Losing the ability to filter blood can result to the development of CKD, and the patient may need a kidney transplant or long-term dialysis in order to live.
  2. Acute Kidney Failure. Chronic glomerulonephritis can result to the inability of the kidneys to function at all, accumulating a huge amount of waste products in them. Dialysis may be required to reverse this acute kidney failure.
  3. Nephrotic syndrome. Protein is excreted in high amounts due to the damage in the glomeruli. This means that the amount of protein in the blood is reduced. The symptoms of this syndrome include hypercholesterolemia (high cholesterol levels), and edema of the abdomen, feet, and face, especially the eyelids.

Diagnosis of Glomerulonephritis

  • Blood test – to perform kidney function tests, which include measuring the levels of blood waste products like blood urea nitrogen (BUN) and creatinine
  • Urinalysis – to check for the presence of protein and red blood cells in the urine, which may indicate damage of the glomeruli
  • Imaging – kidney Xray, ultrasound and/or CT scan, to visualize the kidneys and check for the extent of damage
  • Kidney biopsy – to collect samples of kidney tissues in order to identify the cause of kidney inflammation

Treatment for Glomerulonephritis

  1. Blood pressure and fluid volume control. One of the most common causes of glomerulonephritis is hypertension or high blood pressure, therefore it needs to be controlled effectively. The physician may prescribe angiotensin-converting enzyme inhibitors (ACE) inhibitors, or angiotensin receptor blockers (ARBs). Diuretics may also be given to reduce plasma volume and treat edema.
  2. Corticosteroids or plasmapheresis. If the glomerulonephritis is caused by an immune disorder, then corticosteroids can help reduce the inflammation. Another option is to remove the antibodies from the patient’s plasma, a procedure known as plasmapheresis.
  3. Dietary changes. The dietitian may advise to reduce the salt, protein, and potassium in the patient’s diet.
  4. Dialysis or Kidney Transplant. If severe or chronic glomerulonephritis results to end-stage kidney disease, the patient may need a kidney transplant or a long-term dialysis treatment to filter the blood.

Nursing Care Plans for Glomerulonephritis

  1. Nursing Diagnosis: Excess Fluid Volume related to decreased renal function secondary to glomerulonephritis, as evidenced by facial and leg edema, azotemia, proteinuria, weight gain, and blood pressure level of 190/100

Desired Outcome: The patient will demonstrate a normal fluid balance with vital signs within normal range and absence of edema, proteinuria, and azotemia.

InterventionsRationales
Monitor vital signs every 4 hours, especially the patient’s blood pressure level.High blood pressure contributes to kidney damage.  
Monitor the urine for presence of protein and blood in the urine using urine dipstick and urinalysis, as ordered by the physician.Proteinuria and hematuria are classic signs of glomerulonephritis.
Administer antihypertensives, diuretics, and/or corticosteroids as prescribed.Antihypertensives – to control the blood pressure Corticosteroids- to reduce inflammation of the glomeruli in the kidneys Diuretics – to reduce edema and plasma volume
Encourage the patient to elevate the legs as often as possible.To reduce the swelling of the legs
Place the patient in fluid restriction, as ordered by the physician. Monitor the input and output (I&O) strictly using a daily chart.To encourage a balance between the patient’s intake/input and output.

2. Nursing Diagnosis: Activity Intolerance related to anemia and edema secondary to glomerulonephritis as evidenced by fatigue, HB level of 82, overwhelming lack of energy, swollen feet, unsteady gait, and verbalization of tiredness

Desired Outcome: The patient will demonstrate alternate periods of desired activities and rest/sleep.

InterventionsRationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try. Ensure that the exercise is safe to perform during the patient’s current stage of glomerulonephritis.To create a baseline of activity levels and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with rest and sleep.To gradually increase the patient’s tolerance to physical activity.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
Encourage the next of kin, relative, or caregiver of the patient to participate in his/her care, such as monitoring hydration and diet, and activities of daily living where the patient require a helping hand.Glomerulonephritis may cause fatigue and exhaustion of the patient, so it is best to have the partner or a caregiver beside him/her at all times and ensure her safety and assist him/ her to perform activities of daily living.

Other Nursing Diagnoses:

  • Risk for Kidney Injury
  • Risk for Infection
  • Deficient Knowledge

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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