Acute Glomerulonephritis (AGN) is a kidney condition characterized by inflammation of the glomeruli, which are tiny filters in the kidneys. This nursing diagnosis focuses on identifying symptoms, preventing complications, and managing the condition effectively through appropriate nursing interventions.
Causes (Related to)
Acute Glomerulonephritis can develop due to various factors that affect kidney function:
- Post-streptococcal infection (most common cause)
- Autoimmune conditions
- Systemic diseases such as:
- Lupus
- Diabetes
- Goodpasture’s syndrome
- IgA nephropathy
- Contributing factors include:
- Recent strep throat or skin infection
- Genetic predisposition
- Immune system disorders
- Environmental toxins
Signs and Symptoms (As evidenced by)
Acute Glomerulonephritis presents with distinctive signs and symptoms that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient reports)
- Fatigue and weakness
- Decreased urine output
- Tea or cola-colored urine
- Lower back pain
- Facial puffiness
- Joint pain
- Shortness of breath
- Decreased appetite
Objective: (Nurse assesses)
- Elevated blood pressure
- Peripheral edema
- Decreased urine output
- Abnormal urinalysis showing:
- Proteinuria
- Hematuria
- Red blood cell casts
- Elevated BUN and creatinine levels
- Decreased glomerular filtration rate (GFR)
Expected Outcomes
The following outcomes indicate successful management of AGN:
- The patient will maintain normal blood pressure
- The patient will demonstrate improved kidney function
- The patient will maintain a fluid-electrolyte balance
- Edema will decrease
- The patient will avoid complications
- The patient will understand dietary restrictions
- The patient will comply with prescribed medications
Nursing Assessment
Monitor Vital Signs
- Check blood pressure frequently
- Monitor heart rate and rhythm
- Assess respiratory status
- Document temperature changes
Assess Fluid Status
- Monitor intake and output
- Measure daily weights
- Check for edema
- Assess skin turgor
- Evaluate mucous membranes
Monitor Kidney Function
- Track urine output
- Note urine characteristics
- Monitor lab values
- Assess for complications
Evaluate Cardiovascular Status
- Monitor for hypertension
- Check for signs of heart failure
- Assess peripheral circulation
- Document edema levels
Review Risk Factors
- Document recent infections
- Note chronic conditions
- Review family history
- Check medication history
Nursing Care Plans
Nursing Care Plan 1: Excess Fluid Volume
Nursing Diagnosis Statement:
Excess Fluid Volume related to decreased glomerular filtration rate as evidenced by peripheral edema, elevated blood pressure, and decreased urine output.
Related Factors:
- Impaired kidney function
- Sodium and water retention
- Decreased cardiac output
- Altered regulatory mechanisms
Nursing Interventions and Rationales:
- Monitor daily weights and trend changes
Rationale: Rapid weight gain indicates fluid retention - Assess edema and document characteristics
Rationale: Indicates the severity of fluid overload - Maintain fluid restrictions as ordered
Rationale: Prevents further fluid overload - Monitor vital signs, especially blood pressure
Rationale: Indicates cardiovascular status and fluid volume status
Desired Outcomes:
- The patient will demonstrate decreased edema
- The patient will maintain a stable weight
- The patient will comply with fluid restrictions
- Blood pressure will stabilize within the normal range
Nursing Care Plan 2: Decreased Cardiac Output
Nursing Diagnosis Statement:
Decreased Cardiac Output related to increased afterload secondary to fluid volume excess as evidenced by hypertension and tachycardia.
Related Factors:
- Fluid volume overload
- Increased systemic vascular resistance
- Altered contractility
- Electrolyte imbalances
Nursing Interventions and Rationales:
- Monitor cardiovascular status
Rationale: Early detection of complications - Administer prescribed medications
Rationale: Manages hypertension and supports cardiac function - Position patient to optimize cardiac function
Rationale: Reduces cardiac workload
Desired Outcomes:
- The patient will maintain stable cardiac output
- Blood pressure will normalize
- The patient will report decreased dyspnea
- Heart rate will remain within normal limits
Nursing Care Plan 3: Risk for Impaired Skin Integrity
Nursing Diagnosis Statement:
Risk for Impaired Skin Integrity related to edema and altered circulation as evidenced by tissue swelling and compromised blood flow.
Related Factors:
- Fluid volume excess
- Decreased peripheral circulation
- Altered nutrition
- Limited mobility
Nursing Interventions and Rationales:
- Assess skin condition regularly
Rationale: Early detection of breakdown - Implement pressure relief measures
Rationale: Prevents skin breakdown - Maintain proper skin hygiene
Rationale: Reduces risk of infection
Desired Outcomes:
- The patient will maintain skin integrity
- The patient will demonstrate proper skincare
- Edema will decrease
- Circulation will improve
Nursing Care Plan 4: Knowledge Deficit
Nursing Diagnosis Statement:
Knowledge Deficit related to lack of information about disease process and management as evidenced by questions about condition and verbalized misconceptions.
Related Factors:
- Lack of exposure to information
- Misinterpretation of information
- Unfamiliarity with medical resources
- The complexity of the healthcare system
Nursing Interventions and Rationales:
- Provide disease-specific education
Rationale: Improves understanding and compliance - Teach medication management
Rationale: Ensures proper treatment adherence - Instruct on dietary modifications
Rationale: Supports kidney function
Desired Outcomes:
- The patient will verbalize understanding of the condition
- The patient will demonstrate medication compliance
- The patient will follow dietary restrictions
- The patient will recognize warning signs
Nursing Care Plan 5: Activity Intolerance
Nursing Diagnosis Statement:
Activity Intolerance related to fatigue and fluid volume overload as evidenced by excessive fatigue and dyspnea with activity.
Related Factors:
- Decreased oxygen delivery
- Fluid volume excess
- Weakness
- Altered cardiac output
Nursing Interventions and Rationales:
- Assess activity tolerance
Rationale: Determines appropriate activity level - Plan activities with rest periods
Rationale: Prevents exhaustion - Assist with mobility as needed
Rationale: Ensures safety and prevents falls
Desired Outcomes:
- The patient will demonstrate improved activity tolerance
- The patient will maintain energy conservation
- The patient will participate in a progressive activity
- The patient will avoid complications
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Bonner, R. W., Moreno, V., & Jain, K. (2024). Infection-Associated Glomerulonephritis. Advances in Kidney Disease and Health, 31(3), 246-254. https://doi.org/10.1053/j.akdh.2024.01.001
- Chadban SJ, Atkins RC. Glomerulonephritis. Lancet. 2005 May 21-27;365(9473):1797-806. doi: 10.1016/S0140-6736(05)66583-X. PMID: 15910953.
- Keskinyan VS, Lattanza B, Reid-Adam J. Glomerulonephritis. Pediatr Rev. 2023 Sep 1;44(9):498-512. doi: 10.1542/pir.2021-005259. PMID: 37653138.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
