Glomerulonephritis Nursing Diagnosis and Nursing Care Plan

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Glomerulonephritis Nursing Care Plans Diagnosis and Interventions

Glomerulonephritis NCLEX Review and Nursing Care Plans

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.
    • Immune disorders. Lupus is an inflammatory disease that is long-term and can affect different parts of the body, including the kidneys.
    • Vascular disorders. Vasculitis, or the disorder of the blood vessels, may also lead to glomerulonephritis.
    • 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.

Glomerulonephritis Nursing Diagnosis

Nursing Care Plan 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.

Glomerulonephritis Nursing 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.

Nursing Care Plan Glomerulonephritis 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.

Glomerulonephritis Nursing 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.

Nursing Care Plan Glomerulonephritis 3

Impaired Renal Perfusion

Nursing Diagnosis: Impaired Renal Perfusion related to glomerular malfunction secondary to glomerulonephritis as evidenced by increased BUN, creatinine and uric acid levels, anuria, oliguria, edema, hypertension, pulmonary congestion, and hematuria.

Desired Outcomes

  • The patient will demonstrate participation in his/her preferred treatment regimen.
  • The patient will demonstrate changes in lifestyle and behavior to prevent the occurrence of complications.
Acute Glomerulonephritis Nursing InterventionsRationale
Establish rapport with the patient and caregiver.This is to encourage cooperation of both the patient and caregiver.
Keep track of the patient’s vital signs and keep a record of them. Monitor the patient’s vital signs every 4 hours. Careful monitoring of the patient’s BP is required. This provides baseline data which can be used as a reference value along the course of the disease. Increased blood pressure may further exacerbate kidney damage. Damage to the glomeruli prevents salt and fluid from being emptied, which can cause an increase in heart rate and blood pressure.
Examine the patient’s overall health.This provides baseline data which can be used as a reference value along the course of the disease. This sets a baseline against which clinical interventions and outcomes can be measured. Examine the patient’s lungs for any unusual breath noises. Examine edema in the periorbital and dependent areas (+1–+4).
Determine the elements that affect an individual’s circumstance, as well as situations that can affect the entire physical system.To determine the elements that cause and contribute to the disease.
Take note of the characteristics of your urine and measure the specific gravity of the patient’s urine.To check for hematuria, proteinuria, and kidney disease.
Determine the patient’s regular voiding pattern and compare it to your current condition. Take note of the pain’s presence, intensity, and length.It’s possible that the discomfort is coming from the afflicted organ.
Review laboratory results such as BUN and creatinine levels, albumin levels, glomerular filtration rate, as well as mentation status.Increased BUN and creatinine levels have been linked to changes in mentation.
Monitor blood pressure and determine the patient’s normal range.GFR can cause rennin to increase and blood pressure to rise.
Keep an eye out for any signs of dependent generalized edema.To determine the extent of impairment of kidney function
Measure your urine output on a regular basis and weigh yourself every day.To determine the perfusion and function of the kidneys. This encourages a balance between the patient’s intake and output. Dependent edema may be a sign of decreased production of less than 400 mL every 24-hour period. Every day, weigh the patient at the same time on the same scale; a weight gain of more than 0.5kg per day indicates fluid retention. Changes in urine characteristics should be noted: black, foamy appearance, and hematuria.
Investigate for the presence of protein and blood in the urine using urine dipstick and urinalysis, as indicated by the physician.Keep track of how much protein is excreted in the urine. Protein levels in the blood will drop, but protein levels in the urine will rise. Classic signs of glomerulonephritis are hematuria and proteinuria.
Provide calorie restriction as directed while maintaining a healthy diet.Calories are needed to support the body’s needs, while protein restriction helps to keep BUN in check.
Encourage people to talk about their feelings about the prognosis or the long-term effects of the discussion.To reduce his anxiety about his health and correct his misconceptions about it.
Identify essential lifestyle adjustments and aid the client in incorporating disease management into their ADLs.To enhance health and prevent complications from worsening. Encourage to adopt healthy ways of life and dietary knowledge such as:

Provide regular, modest meals.

As needed, restrict fluids.

Reduce your sodium and protein intake.

Encourage physical activity in order to maintain a healthy weight.

Keep your blood sugar in check (diabetic patients)

Give up smoking.
Examine the emotional/psychological elements that are affecting the patient’s current predicament.  It’s possible that stress or despair is causing the symptoms to worsen. Stress or sadness may exacerbate the symptoms of a disease, or depression may be the outcome of forced inactivity.
Small, frequent, and readily digestible meals should be provided to the patient.Reduced gastric motility might make digestion and absorption more difficult. Small, frequent meals may help with digestion and absorption of nutrients. avoid abdominal ache.
Set a reasonable activity goal with the patient.Increase commitments to improving optical results.
Provide details on encouraging signals of progress, such as improved vital signs and circulation.To give someone encouragement.
Assist with physiologic issues. Maintain a calm demeanor but admit to any concerns if the client or caregiver asks.When the client or caregiver is dealing with a lot of activities or stress, being honest can be reassuring.
Examine the patient’s/expectations.To establish personal objectives.
Give the patient information that shows their improvement on a daily/weekly basis.To keep your motivation going.
Encourage the patient to keep a good attitude and, if necessary, use relaxation techniques such as guided imagery.To improve one’s sense of well-being.
As directed, provide medicine. Administer antihypertensives, diuretics, and/or corticosteroids as indicated by the physician.For a quicker recovery. It is utilized to treat the medical state of the patient. Antihypertensive drugs aid in controlling blood pressure. Corticosteroids decrease the inflammation of the glomeruli in kidneys. Diuretics aid in decreasing edema and plasma volume. An acute glomerulonephritis attack may resolve on its own. Diuretics are commonly used to eliminate excess fluid, antihypertensives to reduce blood pressure caused by fluid retention, and electrolyte supplements such as calcium or potassium to maintain homeostasis, depending on the severity of symptoms and disease development.
Instruct the patient to raise his/her legs as often as possible. This allows gravity to assist in lowering edema by elevating the feet, ankles, or arms as needed. Before pitting appears, there may be a fluid gain of up to 10 pounds.
Practice measures to improve overall health. Maintain the patient in fluid restriction, as indicated by the physician.To encourage people to be healthy.

Nursing Care Plan Glomerulonephritis 4

Risk for Injury  

Nursing Diagnosis: Risk for Injury related to impaired renal function secondary to glomerulonephritis

Desired Outcomes: 

  • The patient will demonstrate normal blood pressure (i.e., within the normal range according to age)
  • The child will demonstrate absence of headache and a calm disposition.
Acute Glomerulonephritis Nursing InterventionsRationale
Every 4 hours, check the patient’s blood pressure (BP), pulse, and respiratory rate. Monitor the patient’s BP every 1 hour if diastolic BP is more than 90 mmHg. Monitor the patient’s pulse and respirations every 1 hour if dyspnea, tachycardia, or tachypnea is present.This provides information about potentially harmful effects of hypertension, including encephalopathy, pulse, and respiration changes that occur with heart failure and pulmonary edema.
Evaluate alterations in intake and output of the patient. Evaluate also for the presence and extent of edema, headache, pallor, and decreased urinary output. Assess also the patient’s electrolyte levels (i.e., calcium, sodium, magnesium, potassium).This will reveal signs and symptoms of possible renal failure. Early detection and management can lead to better prognosis. Electrolyte imbalances can cause muscle weakness and stiffness, as well as a reduction in cardiac output.
Employ an indwelling urinary catheter if necessary.This allows for a more accurate measurement of urine production. If a catheter isn’t an option, a urinary helmet for the toilet can be used to quantify urine.
Antihypertensive and diuretic medications should be given.As directed, administer cardiac glycoside treatment; monitor for therapeutic impact. In the presence of a more severe renal impairment, it provides treatment for complications.
Observe behavior changes linked with hypertension, such as lethargy, irritability, and restlessness, and provide anticonvulsants if necessary.The presence of seizure activity as a result of brain alterations necessitates the use of safety precautions.
During the acute phase of acute glomerulonephritis, encourage low-sodium, low-potassium, and low-protein diets; instruct to increase carbohydrate and fat consumption (just during the acute phase of AGN), as required.Provides nourishment during the acute period, including potassium restrictions during oliguria, sodium restrictions when edema is present, and protein restrictions if oliguria is protracted.
Limit fluid intake as directed; allow intake of urine and insensible losses.In the case of renal impairment, this prevents increased fluid retention and edema.
Inform parents that any weight gain, hematuria with decreased urine output, headaches, or anorexia should be reported.Allows for immediate intervention in the event of serious renal injury.
Teach parents about dietary inclusion and restriction, and provide them a list of foods to consume and avoid that are within sodium, potassium, and protein limits.While the sickness is being treated, it provides sustenance.
Allow activity/rest periods as needed by energy and tiredness; gradually increase as needed by condition.During the acute and convalescent stages of the disease, it prevents weariness and conserves energy.
Parents should be reminded of the need for follow-up monitoring and care.Ensures that the child is being monitored for chronic renal disease or infection on a regular basis (i.e. streptococcal infection that persists).

Nursing Care Plan Glomerulonephritis 5

Risk for Infection

Nursing Diagnosis: Risk for Infection related to chronic disease secondary to glomerulonephritis

Desired Outcomes: 

  • The patient will demonstrate absence of sore throat as evidenced by negative throat cultures.
  • The patient will not experience signs and symptoms of infection.
Acute Glomerulonephritis Nursing InterventionsRationale
Check for fever, chills, a sore throat, and a cough (presence or recurrence).  The persistence of streptococcal infection is revealed.
Obtain a throat culture for sensitivity testing and analysis.Detects the streptococcal bacteria and its sensitivity to antibiotic treatment. The most effective treatment is determined by confirming the infection and identifying the exact organism. Note: A number of antibacterial  medications necessitate dose or timing changes , usually a period of time during which renal clearance is impaired.
If antibiotic therapy is prescribed, give it to the child and any family members.By limiting cell wall production, it destroys microbial agents and prevents transmission to family members.
Monitor the patient’s vital signs.Although sepsis can occur without a febrile reaction, a fever of more than 100.4°F (38.0°C) with increased pulse and respirations is indicative of an elevated metabolic rate caused by an inflammatory disease.
Dispose of used tissues and articles properly.Prevents germ transfer to others or reinfection.
Instruct parents on the necessity of completing the entire antibiotic treatment.Encourages parental knowledge and protects against the spread of superinfection.
Encourage the patient and staff to practice good handwashing. This decreases the risk of cross-contamination.
Invasive operations, instrumentation, and manipulation should be avoided at all costs. If possible, avoid indwelling catheters When handling IV and invasive lines, use aseptic technique. Change dressings in accordance with procedure. The presence of edema and purulent discharge should be noted.Limits the amount of microorganisms that enters the body. Sepsis can be avoided if an infection is detected and treated early.
Ensure that catheters are cleaned on a regular basis and that perianal care is rigorous. Close the urine drainage system and remove the indwelling catheter as quickly as feasible.This decreases the occurrence of bacterial colonization and risk of developing ascending urinary tract infection.
Encourage deep breathing, coughing, and position changes on a regular basis.Reduces the risk of developing lung infections by preventing atelectasis and mobilizing secretions. Coughing prevents infection by effectively expectorating mucus buildup. Maintaining the patient in an upright position and frequent position changes prevent the pooling of mucus, thereby preventing infection.
Evaluate the patient’s skin integrity.Secondary infections can be acquired from excoriations due to scratching.
Monitor the patient’s laboratory studies (e.g., white blood cell count with differential)Although an increase in WBCs may indicate a widespread infection, Leukocytosis is a common symptom of glomerulonephritis and may indicate renal inflammation or damage. Infection is indicated by a change in the differential to the left.
Maintain a suction machine near the patient’s bedside. If the patient is unable to independently cough out the secretions, manual suctioning may be necessary to avoid the pooling of mucus in the airway. 
Evaluate regularly the patient’s stoma and surrounding skin for exudates, change in color, erythema, and crusting lesions. Friction brought about by tracheostomy tube and mucus can cause irritation of the stoma and surrounding skin. These factors create a suitable nidus for bacterial infection. 

More Glomerulonephritis Nursing Diagnosis

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. (2022). 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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