Glomerulonephritis
is the inflammation of the glomerulus it can be caused by an acute post-streptococcal or be chronic in the end stage of the glomerular disorder which is slow progressive destruction and decline in renal function
Hallmark signs of Nephrotic Syndrome
Proteinuria +3 to +4/frothy urine
Severe edema = anasarca (Full body edema)
Hypovolemic
Hematuria
Anorexia
HYPOtension
Fatigue
oliguria
Nephrotic Syndrome URINE Labs
Protein (+3 to +4)
Hyperalbuminuria
Elevated specific gravity
Microscopic hematuria
Nephrotic Syndrome BLOOD Labs
Hypoalbuminemia: <2.5
Increased Hgb/Hct, platelets
Elevated cholesterol/trig
Medical Management NS
Corticosteroids – prednisone
Immunosuppressant - if relapses
IV albumin
Diuretics
ACE inhibitors
Vaccinations
Potential Problems NS
Risk for skin breakdown
Infection potential
Risk for dehydration
Fluid retention
Poor nutritional intake
Altered Body Image
Anxiety
Diet/Nutrition NS
Strict I+O’s; daily weights
Fluid restriction
Salt restrictions
Increase protein in diet 1-2 g/kg/day
Adequate Potassium intake (diuretics use)
Nursing Interventions NS
Monitor edema and ascites (abdominal girth)
Monitor lab data
Meticulous skin care
Rest; diversional activities
Pain management if needed
Emotional support
Monitor for complications
Infection Control NS
hand hygiene
antibiotic prophylaxis
monitor for signs of infection
minimize exposure to communicable diseases
Skin Care NS
frequent turning and positioning
skin hygiene (bathing, lotions)
elevation of edematous areas
Complications of NS
hypovolemic shock
respiratory compromise
hypercoagulability
Prednisone Therapy
2-3 months to induce remission
Goals – diuresis and significant drop (less than 1+) in urine protein
Tapering
Tapering of total mg occurs slowly
Discharge Teaching
Medications
Skin care
Nutrition
Infection prevention
Activity limitations
Follow-up with MD/nephrologist
Types of Glomerulonephritic
Acute – poststreptococcal*
(Most common type)
Chronic
Acute Poststreptococcal Glomerulonephritis (APSGN)
Streptococcus
Immune complexes inflame glomerulus
Damage to capillary walls causes larger molecules (proteins) to pass into urine
Ineffective filtration causes enlarged kidneys with sodium, water, and waste retention
Edema
APSGN S/S
Tea/smoky/cola-colored urine
Edema – periorbital
Oliguria
HYPERtension
Fatigue/malaise
Fever
Diagnostic Test APSGN
Urinalysis
Hematuria (microscopic to gross)
Proteinuria (1-2+)
Blood
CMP (↑BUN/Cr; ↑K)
CBC (↑WBC; ↓Hgb/Hct)
Positive ASO or ADB titer
Renal biopsy
Glomerulonephritis Medication
Antihypertensives
ACE inhibitors
if severe HTN – hydralazine
Diuretics
Antibiotics
Nursing Interventions APSGN
Preventing consequences of fluid excess
Provide adequate rest
Maintain skin integrity
Maintain nutritional status
Relieve anxiety
Monitor for complications
Discharge Teaching APSGN
Medications
Monitor BP
Obtain urinalyses
Follow up with nephrologist
Dietary restrictions
Activity restrictions
Patient Education on Corticosteroids
Monitor growth (Growth suppression)
Monitor BP (Hypertension)
Monitor for Hyperglycemia
Don’t abruptly stop it
Infection control
no live vax
Delays wound healing