Nursing 4 Lecture 4 Glomerulonephritis

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Nursing 4 Lecture 4 Glomerulonephritis
2012-02-04 17:06:32

Nursing 4 Lecture 4 Glomerulonephritis
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  1. Glomerulonephritis
    -Immunologic renal disorder

    • -Can start in the kidney or as a result of other health problems, the glomeruli are usually injured
    • -For diseases that start in the kidney, a genetic basis and immune problem are common
    • -Systemic diseases and infections can have renal effects and cause glomeruli injury
    • -Diseases that can cause glomeruli injury include Systemic Lupus and diabetic nephropathy
    • -Each disease or syndrome has a specific effect, but their glomerular effects are caused by damage to the glomeruli and result in proteinuria, hematuria, decreased GFR, edema, and HTN
  2. Pathophysiology: Acute Glomerulonephritis
    • -An infection usually occurs before renal manifestations
    • -Onset of sx are usually 10 days from the time of infection
    • -Patients usually recover completley and quickly
    • -Most causes are infectious or from other systemic diseases
  3. AGN: Assessment- History
    • -Ask about recent infections, particularly of skin or upper respiratory tract
    • -Ask about recent travel for possible exposure to viruses, bacteria, fungi, or parasites
    • -Ask about any recent invasive procedures or systemic diseases (ex. systemic lupus)
  4. AGN: Assessment- Physical/Clinical Manifestations
    • -Areas of edema
    • -Fluid overload
    • -SOB
    • -Lung sounds for crackles
    • -Neck vein distention
    • -Any changes in urine pattern or color
    • -Urine color is often described as smokey, reddish brown, rusty, or cola-colored
    • -Take BP and compare it w/ the baseline because mild to moderate HTN often occurs as a result of the sodium and fluid retention
    • -Fatigue, anorexia, n/v if uremia is present from kidney failure
  5. AGN: Assessment- Laboratory
    • UA:
    • -Shows hematuria (RBC's) and proteinuria

    • -GFR may be decreased to 50 mL/min
    • -BUN is usually increased
    • -The protein excretion rate may be increased from 500mg to 3 grams/24 hour period
    • -Serum albumin levels are decreased because the protein is lost in the urine
  6. AGN: Assessment- Other Diagnostic Testing
    Possibly a Renal Biopsy to provide a precise diagnosis of the condition
  7. Collaborative Care: Management of Infection
    • -Antibiotic therapy
    • -PCN, Emycin, or Azithromycin are prescribed for patients caused by strep infection (also can be prescribed to people with close contact to prevent the spread)
    • -Stress personal hygiene and basic infection control principles
    • -Teach importance of completing the entire regimen of antibiotics
  8. Collaborative Care: Prevention of Complications
    • -For pts with fluid overload, HTN, and edema diuretics and water restriction are prescribed
    • -Antihypertensive drugs may be prescribed
    • -Usual fluid allowance is equal to the urine output plus 500 to 600 mL
    • -Pts with oliguria usually have increased levels of potassium and BUN
    • -Potassium and protein intake may be restricted to prevent hyperkalemia and uremia
  9. Collaborative Care: Dialysis
    • -N/V or anorexia indicate uremia is present
    • -Dialysis is necessary if uremia of fluid volume cannot be controlled
  10. Collaborative Care: Plasmapheresis
    -Removal and filtering of plasma to eliminate antibodies also may be attempted
  11. Collaborative Care: Patient Education
    • -Daily weights
    • -Daily blood pressure
    • -Dietary and fluid restrictions
    • -How to detect fluid retention

    **Oliguria= urine output between 100 and 400 mL in 24 hours
  12. Pathophysiology: Chronic Glomerulonephritis
    -Develops over a period of 20 to 30 years

    *ALWAYS leads to kidney failure
  13. Chronic Glomerulonephritis: Assessment
    • -Nocturia is very common
    • -Assess for uremic sx such as slurred speech, ataxia (unsteady gait), tremors, or asterixis (flapping tremor of the fingers or the inability to maintain a fixed posture with the arms extended and wrists hyperextended)
    • -Urine output decreases but appears normal
    • -UA shows protein (usually less than 2grams in a 24 hour period)
    • -Specific gravity is fixed at 1.010
    • -GFR is low
    • -Serum creatinine is elevated
    • -BUN is increased
    • -Decreased kidney function causes abnormal electroyte levels
    • -Sodium retention is common but plasma dilation from excess fluid can result in a falsely normal sodium level or a low reading
    • -When oliguria occurs potassium is not excreted, hyperkalemia occurs, hyperphosphatemia develops
    • -Acidosis develops from hydrogen ion retention and loss of bicarb
  14. Chronic Glomerulonephritis: Interventions
    **Slowing the progression of the disease and preventing complications

    • Diet Changes:
    • -Dietary restrictions on salt, fluids, and protein may be recommended to help control high blood pressure or kidney failure

    Dialysis or kidney transplantation may be necessary to control sx of kidney failure and to sustain life