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Kaiser Ann Pajulas, USRN
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Nursing Care and Pathophysiology of Glomerulonephritis

Nursing Care and Pathophysiology of Glomerulonephritis

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Included In This Lesson

Study Tools
Outline
ADPIE Related Lessons
Transcript
Additional Lessons

Study Tools For Nursing Care and Pathophysiology of Glomerulonephritis

Management of Glomerulonephritis (Mnemonic)
Glomerulonephritis Pathochart (Cheatsheet)
Abdominal Pain – Assessment (Cheatsheet)
Glomerulus (Image)
Cloudy Urine in UTI (Image)
Plasmapheresis Machine (Image)
Cystoscopy (Image)
Glomerulonephritis Assessment (Picmonic)
Acute Glomerulonephritis Interventions (Picmonic)
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Outline

Overview

  1. Inflammatory disorder of the glomerulus caused by an immunological reaction
Pathophysiology
Injury to the glomerulus occurs by infections, drugs, toxins, vascular disorders, or diseases such as diabetes and lupus. The glomerular membrane is inflamed and disturbed. This disturbance increases the permeability of the membrane and increases the chance to lose substances through the urine.
Nursing Points

General

  1. Predisposing factors
    1. Upper respiratory infection
    2. Skin infection
    3. Systemic Lupus Erythematosus (SLE)
  2. Leads to impaired kidney function
    1. ↓ Filtration of toxins out of blood
    2. ↓ Regulation of fluid, electrolytes
    3. ↓ Regulation of acid-base balance

Assessment

  1. Fever
  2. Cloudy urine (pyuria)
  3. Azotemia
    1. Anorexia, N/V
    2. Fatigue / Malaise
    3. ↑ BUN / Creatinine
  4. ↓ Creatinine clearance (CrCl)
  5. ↓ Glomerular Filtration Rate (GFR)
  6. ↓ Uptake and excretion of dye with renal scan
    1. Due to ↓ GFR
  7. HTN due to water retention
  8. Hematuria – RBC in urine
  9. Hypoalbuminemia and Proteinuria – especially with associated Nephrotic Syndrome

Therapeutic Management

  1. Hemodialysis
  2. Plasmapheresis
    1. Removal of harmful antibodies from plasma
    2. Decreases autoimmune response
  3. Dietary changes
    1. Protein restriction
    2. Decrease sodium and potassium
  4. Diuretics

Nursing Concepts

  1. Fluid & Electrolytes
    1. Monitor daily weights
    2. Strict I&O
    3. Monitor electrolytes and treat or replace as needed
  2. Elimination
    1. Potty plan if administering diuretics
    2. Peri care
    3. Monitor urine output for quality and quantity
  3. Infection Control
    1. Monitor for s/s infection (HR, temp, WBC, pyuria)
    2. Hand hygiene

Patient Education

  1. Dietary restrictions
  2. Infection control precautions to prevent recurrence
  3. Purpose and process for dialysis or plasmapheresis

 

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ADPIE Related Lessons

Related Nursing Process (ADPIE) Lessons for Nursing Care and Pathophysiology of Glomerulonephritis

Assess Lessons
General Assessment (Physical assessment)
Assess Lessons
Genitourinary (GU) Assessment
Assess Lessons
Fluid Volume Overload
Assess Lessons
Fluid Shifts (Ascites) (Pleural Effusion)
Assess Lessons
Fluid Pressures
Assess Lessons
Fluid Compartments
Assess Lessons
Intake and Output (I&O)
Assess Lessons
Adult Vital Signs (VS)
Diagnose Lessons
Blood Urea Nitrogen (BUN) Lab Values
Diagnose Lessons
Creatinine (Cr) Lab Values
Diagnose Lessons
Glomerular Filtration Rate (GFR)
Diagnose Lessons
Urinalysis (UA)
Diagnose Lessons
Metabolic Acidosis (interpretation and nursing diagnosis)
Diagnose Lessons
ABG (Arterial Blood Gas) Interpretation-The Basics
Diagnose Lessons
ABGs Nursing Normal Lab Values
Diagnose Lessons
Calcium-Ca (Hypercalcemia, Hypocalcemia)
Diagnose Lessons
Phosphorus-Phos
Diagnose Lessons
Anion Gap
Diagnose Lessons
Base Excess & Deficit
Diagnose Lessons
Albumin Lab Values
Diagnose Lessons
Potassium-K (Hyperkalemia, Hypokalemia)
Diagnose Lessons
Sodium-Na (Hypernatremia, Hyponatremia)
Diagnose Lessons
Creatinine Clearance Lab Values
Implement Lessons
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Implement Lessons
Furosemide (Lasix) Nursing Considerations
Implement Lessons
Specialty Diets (Nutrition)
Implement Lessons
Nutrition (Diet) in Disease
Implement Lessons
Hemodialysis (Renal Dialysis)
Supplemental Lessons
Nursing Care Plan (NCP) for Glomerulonephritis
Supplemental Lessons
Management of Glomerulonephritis Nursing Mnemonic (Please Help Deliver Diuretics)

Transcript

In this lesson, we’re gonna talk about glomerulonephritis. As you can deduce from the name, this is inflammation (that’s the -itis) of the glomerulus in the kidneys (remember nephro means kidneys).
Remember from anatomy that the glomerulus is the little tuft of capillaries that sits in Bowman’s Capsule and filters the blood into the nephron. So it forces the blood through the capillary walls like a strainer, that fluid gets collected in this tubule and goes through the nephron to be excreted as urine. So glomerulonephritis is inflammation of this glomerulus caused by some sort of immune reaction. Common predisposing factors are respiratory or skin infections or autoimmune diseases like Lupus. These things cause an immune response in our systems that can come here into the nephron and damage the glomerulus. If this gets all inflamed and swollen, it’s going to really struggle to filter the blood like it should.

So we essentially see that the kidneys stop doing what they’re supposed to do. If the blood can’t get into the nephron – we can’t filter the toxins out. We also can’t regulate our fluid and electrolytes if that fluid isn’t available to us in the nephron. Our kidneys will also struggle to retain that bicarb buffer for acid-base balance.

So, in addition to seeing those signs of infection because of the inflammation, like fever and increased WBC’s, we also see evidence of impaired kidney function. The azotemia causes anorexia, nausea, vomiting, and malaise. The retention of water and sodium can cause hypertension and signs of volume overload. And something else we see is that the kidneys aren’t uptaking or excreting dye on scans – that’s because it’s not being filtered through the glomerulus. So, what do we see in our lab values? Well first and foremost, obviously, we see a decreased glomerular filtration rate. I’ve said this before and I’ll say it again – the GFR is the Number One indicator of kidney function – we will still see increased BUN and Creatinine, but since they’re not always specific, looking at that GFR gives us an even better picture of what’s happening to the kidneys. We’ll also possibly see hematuria, which is blood in the urine because of this damage to the glomerulus, and we can also see leakage of protein into the urine. We talked about this in the lesson about nephrotic syndrome – when protein leaks into the urine, we see hypoalbuminemia, which further contributes to that edema and volume overload. And then because we lose that bicarb buffer, we’ll see metabolic acidosis – that’s a pH less than 7.35 and HCO3- less than 22.

So, our goal for management of these patients is to decrease that inflammatory process and prevent complications like permanent kidney damage, which can lead to CKD. So we give corticosteroids to decrease inflammation. We can also do dialysis to support kidney function until we’ve addressed the source of the problem. We also do something called plasmapheresis. This is a plasmapheresis machine here. It works sort of like dialysis, except the goal is to remove harmful antibodies from the plasma. This is helpful because we know that glomerulonephritis can be caused by immune responses – if we can get those harmful antibodies out, we can stop that immune response. We also want to put some restrictions on their diet including protein, fluids, potassium, and sodium. We know kidney failure comes with hyperkalemia, so we restrict potassium intake. We restrict fluids, protein, and sodium, because we want to try to avoid further retention of fluid and volume overload. And finally we’re going to measure their intake and output and measure daily weights to see if they’re retaining fluid. Remember that 1 kg of body weight equals 1 L of fluid retained!

So, our priority nursing concepts for a patient with glomerulonephritis are, obviously, fluid & electrolytes and elimination, as well as infection control because we want to address the source of the inflammation and prevent any further urinary tract infections. Check out the care plan attached to this lesson to see more detailed nursing interventions and rationales.

Let’s recap quickly. Glomerulonephritis is inflammation of the glomerulus caused by some sort of immune or infectious process. This means that our kidneys will not be functioning appropriately – we see a decreased GFR, azotemia, and volume overload. We want to decrease the inflammatory process and stop the immune response that’s causing the problem. All the while, we want to support the kidneys and prevent long-term complications like chronic kidney disease.

That’s it for glomerulonephritis, make sure you check out all the resources attached to this lesson to learn more. Now, go out and be your best selves today. And, as always, happy nursing!

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Kaiser Ann Pajulas, USRN

Concepts Covered:

  • Basics of Sociology
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Study Plan Lessons

Lab Panels – The Basics and What YOU Need to Know 2 – Live Tutoring Archive
Fundamentals Course Introduction
Legal & Ethical Issues in ER
Nursing Care and Pathophysiology of Osteoporosis
2nd Degree AV Heart Block Type 1 (Mobitz I, Wenckebach)
2nd Degree AV Heart Block Type 2 (Mobitz II)
3rd Degree AV Heart Block (Complete Heart Block)
6 Rights of Medication Administration
Abdomen (Abdominal) Assessment
Abortion in Nursing: Spontaneous, Induced, and Missed
Abruptio Placentae (Placental abruption)
Abuse
Access to Care
ACE (angiotensin-converting enzyme) Inhibitors
Acute Bronchitis
Acute Confusion
Acute Otitis Media (AOM)
Addicted Newborn
Admissions, Discharges, and Transfers
Advance Directives
Advanced Cardiovascular Life Support (ACLS)
Aggressive & Violent Patients
Airway Suctioning
Albumin Lab Values
Alcohol Withdrawal (Addiction)
Alkylating Agents
Alveoli & Atelectasis
Ammonia (NH3) Lab Values
Amputation
Amputation Concept Map
Anemia in Pregnancy
Anesthetic Agents
Aneurysm & Dissection
Angiotensin Receptor Blockers
Antepartum Testing
Anti Tumor Antibiotics
Anti-Infective – Aminoglycosides
Anti-Infective – Antifungals
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Antidiabetic Agents
Antimetabolites
Antineoplastics
Anxiety
Appendicitis
Applying for Jobs
Artificial Airways
Asthma
Asthma Concept Map
Attention Deficit Hyperactivity Disorder (ADHD)
Atypical Antipsychotics
Autism Spectrum Disorders
Avoiding Alarm Fatigue
Babies by Term
Barriers to Health Assessment
Base Excess & Deficit
Basic Operations
Be a Mix Tape (Rewind and Fast-Forward)
Bed Bath
Benzodiazepines
Betamethasone and Dexamethasone
Betamethasone and Dexamethasone in Pregnancy
Bladder Cancer
Blood Cultures
Blood Transfusions (Administration)
Blunt Abdominal Trauma
Blunt Chest Trauma
Blunt Thoracic Trauma
Body Image Changes Throughout Development
Body System Assessments
Bone Cancer (Osteosarcoma, Chondrosarcoma, and Ewing Sarcoma)
Bowel Elimination
Bowel Obstruction Concept Map
Brain Death v. Comatose
Brain Tumors
Breast Cancer
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Brief CPR (Cardiopulmonary Resuscitation) Overview
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Calculating Heart Rate
Can You Draw It
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Cardiovascular Angiography
Care Plan Review (Addresses Patient Considerations) for Certified Perioperative Nurse (CNOR)
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Communicating With Providers
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Community Health Course Introduction
Community Health Nursing Theories
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Congestive Heart Failure Concept Map
Conjunctivitis
Connections
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Continuous Renal Replacement Therapy (CRRT, dialysis)
COPD Concept Map
Coronary Artery Disease Concept Map
Corticosteroids
Crash Cart
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Critical Thinking
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Crush Injuries
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Day in the Life of a Postpartum Nurse
Day in the Life of an Operating Room Nurse
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Defects of Decreased Pulmonary Blood Flow
Defects of Increased Pulmonary Blood Flow
Degree Restrictions in Career Growth
Delegation
Depression
Depression Concept Map
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Diabetes Management
Different Dressings
Digestive Terminology
Diploma vs ADN vs BSN vs Bridge
Discharge (DC) Teaching After Surgery
Disseminated Intravascular Coagulation (DIC)
Dissociative Disorders
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Documentation Basics
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Dysrhythmias Labs
Eating Disorders (Anorexia Nervosa, Bulimia Nervosa)
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Erikson’s Theory of Psychosocial Development
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Fall and Injury Prevention
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Forensic Nurse
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Grief and Loss
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How to Write a Nursing Care Plan
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Newborn Physical Exam
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NG Tube Medication Administration
Normal Sinus Rhythm
Nuclear Medicine
Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care and Pathophysiology for Anaphylaxis
Nursing Care and Pathophysiology for Anemia
Nursing Care and Pathophysiology for Appendicitis
Nursing Care and Pathophysiology for Arterial Disorders
Nursing Care and Pathophysiology for Asthma
Nursing Care and Pathophysiology for Chlamydia (STI)
Nursing Care and Pathophysiology for Cholecystitis
Nursing Care and Pathophysiology for Cirrhosis (Liver Disease, Hepatic encephalopathy, Portal Hypertension, Esophageal Varices)
Nursing Care and Pathophysiology for Crohn’s Disease
Nursing Care and Pathophysiology for Disseminated Intravascular Coagulation (DIC)
Nursing Care and Pathophysiology for Distributive Shock
Nursing Care and Pathophysiology for Diverticulosis – Diverticulitis
Nursing Care and Pathophysiology for Gonorrhea (STI)
Nursing Care and Pathophysiology for Gout
Nursing Care and Pathophysiology for Hashimoto’s Thyroiditis
Nursing Care and Pathophysiology for Hemorrhoids
Nursing Care and Pathophysiology for Herpes Simplex (HSV, STI)
Nursing Care and Pathophysiology for Herpes Zoster – Shingles
Nursing Care and Pathophysiology for Human Papilloma Virus (HPV STI)
Nursing Care and Pathophysiology for Hyperparathyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care and Pathophysiology for Inflammatory Bowel Disease (IBD)
Nursing Care and Pathophysiology for Influenza (Flu)
Nursing Care and Pathophysiology for Lyme Disease
Nursing Care and Pathophysiology for Male Infertility
Nursing Care and Pathophysiology for Meningitis
Nursing Care and Pathophysiology for Multiple Sclerosis (MS)
Nursing Care and Pathophysiology for Myasthenia Gravis
Nursing Care and Pathophysiology for Osteomyelitis
Nursing Care and Pathophysiology for Pancreatitis
Nursing Care and Pathophysiology for Parkinsons
Nursing Care and Pathophysiology for Pelvic Inflammatory Disease (PID)
Nursing Care and Pathophysiology for Peptic Ulcer Disease (PUD)
Nursing Care and Pathophysiology for Pneumothorax & Hemothorax
Nursing Care and Pathophysiology for Polycystic Ovarian Syndrome (PCOS)
Nursing Care and Pathophysiology for Pulmonary Embolism
Nursing Care and Pathophysiology for Rhabdomyolysis
Nursing Care and Pathophysiology for Scleroderma
Nursing Care and Pathophysiology for Seizure
Nursing Care and Pathophysiology for Sepsis
Nursing Care and Pathophysiology for Sickle Cell Anemia
Nursing Care and Pathophysiology for Syphilis (STI)
Nursing Care and Pathophysiology for Testicular Torsion
Nursing Care and Pathophysiology for Tuberculosis (TB)
Nursing Care and Pathophysiology of Acute Kidney (Renal) Injury (AKI)
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Nursing Care and Pathophysiology of Chronic Kidney (Renal) Disease (CKD)
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care and Pathophysiology of Glomerulonephritis
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Nephrotic Syndrome
Nursing Care and Pathophysiology of Osteoporosis
Nursing Care and Pathophysiology of Renal Calculi (Kidney Stones)
Nursing Care and Pathophysiology of Urinary Tract Infection (UTI)
Nursing Care Delivery Models
Nursing Care Plan (NCP) for Abortion, Spontaneous Abortion, Miscarriage
Nursing Care Plan (NCP) for Abruptio Placentae / Placental abruption
Nursing Care Plan (NCP) for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care Plan (NCP) for Anxiety
Nursing Care Plan (NCP) for Appendicitis
Nursing Care Plan (NCP) for Decreased Cardiac Output
Nursing Care Plan (NCP) for Gastroesophageal Reflux Disease (GERD)
Nursing Care Plan (NCP) for Glaucoma
Nursing Care Plan (NCP) for Hepatitis
Nursing Care Plan (NCP) for Herpes Zoster – Shingles
Nursing Care Plan (NCP) for Influenza
Nursing Care Plan (NCP) for Maternal-Fetal Dyad Using GTPAL
Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia
Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida
Nursing Care Plan (NCP) for Neutropenia
Nursing Care Plan (NCP) for Pediculosis Capitis / Head Lice
Nursing Care Plan (NCP) for Pericarditis
Nursing Care Plan (NCP) for Pneumonia
Nursing Care Plan (NCP) for Skull Fractures
Nursing Care Plan (NCP) for Somatic Symptom Disorder (SSD)
Nursing Care Plan (NCP) for Urinary Tract Infection (UTI)
Nursing Care Plan for (NCP) Autism Spectrum Disorder
Nursing Process – Assess
Nursing Process – Diagnose
Nursing Process – Evaluate
Nutrition (Diet) in Disease
Nutrition Assessments
Nutrition in Pregnancy
Obstetrical Procedures
Obstructive Heart (Cardiac) Defects
Omphalocele
Oncology Important Points
Opioid Analgesics
Opioid Analgesics in Pregnancy
Order of Lab Draws
Osteosarcoma
Outline Question Method (Note taking)
Ovarian Cancer
Pain and Nonpharmacological Comfort Measures
Paranoid Disorders
Parasympatholytics (Anticholinergics) Nursing Considerations
Patient Positioning
Pediatric Advanced Life Support (PALS)
Pediatric Gastrointestinal Dysfunction – Diarrhea
Pediatric Oncology Basics
Pediculosis Capitis
Penetrating Abdominal Trauma
Penetrating Thoracic Trauma
Perioperative Nursing Roles
Peripheral Vascular Assessment
Peritoneal Dialysis (PD)
Personality Disorders
Pertussis – Whooping Cough
Pharmacology Course Introduction
Phenylketonuria
Phosphorus-Phos
Piaget’s Theory of Cognitive Development
Pill Crushing & Cutting
Pituitary Adenoma
Placenta Previa
Platelets (PLT) Lab Values
Pneumonia
Postpartum Discomforts
Postpartum Hematoma
Postpartum Hemorrhage (PPH)
Postpartum Physiological Maternal Changes
Potassium-K (Hyperkalemia, Hypokalemia)
PPE Donning & Doffing
Practice Settings
Precipitous Labor
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Preoperative (Preop) Nursing Priorities
Preoperative (Preop)Assessment
Pressure Line Management
Pressure Ulcers/Pressure injuries (Braden scale)
Preterm Labor
Prioritization
Prioritizing Assessments
Procedural Terminology
Process of Labor
Prostaglandins
Prostaglandins in Pregnancy
Provider Phone Calls
Psychiatry Terminology
Pulmonary Function Test
R – Real-Life
Radiation Cancer Treatment
Real-Life Experiences
Red Blood Cell (RBC) Lab Values
Renal (Kidney) Failure Labs
Reproductive Terminology
Resources for Lesson Creation
Respiratory Acidosis (interpretation and nursing interventions)
Respiratory Alkalosis
Restraints
Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Rh Immune Globulin (Rhogam)
Rh Immune Globulin in Pregnancy
Routine Neuro Assessments
Rubeola – Measles
Safety Checks
SBAR Communication
Schizophrenia
Scoliosis
Seizure Management in the ER
Selecting THE vein
Self Concept
Sensory Terminology
Sepsis Concept Map
Shift change and Patient handoff
Sickle Cell Anemia
Signs of Pregnancy (Presumptive, Probable, Positive)
Sinus Bradycardia
Sinus Tachycardia
Sodium-Na (Hypernatremia, Hyponatremia)
Somatoform
Spiking & Priming IV Bags
Spina Bifida – Neural Tube Defect (NTD)
Spinal Cord Injury
Spinal Precautions & Log Rolling
Start and End with the Linchpin
Sterile Gloves
Stoma Care (Colostomy bag)
Stomach Cancer (Gastric Cancer)
Stress and Crisis
Stroke (CVA) Management in the ER
Stroke Concept Map
Stroke Nursing Care (CVA)
Subinvolution
SubQ Injections
Sudden Infant Death Syndrome (SIDS)
Suicidal Behavior
Surgical Incisions & Drain Sites
Surgical Prep
Surgical Wound Classification Documentation for Certified Perioperative Nurse (CNOR)
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Systemic Lupus Erythematosus (SLE)
Tenet 2 Linchpins & Connections
Tenet 3 Why Behind the What
Tenet 4 Learner-Centered Talkabouts
Tension and Cluster Headaches
Testicular Cancer
The 5-Minute Assessment (Physical assessment)
The EKG (ECG) Graph
The Medical Team
Thinking Like a Nurse
Thoracentesis
Thorax and Lungs Assessment
Threatened/Spontaneous Abortion for Certified Emergency Nursing (CEN)
Thrombocytopenia
Thyroid Cancer
Time Management
Tocolytics
Tocolytics
Tonsillitis
Topical Medications
Total Bilirubin (T. Billi) Lab Values
Trach Care
Trach Suctioning
Transient Tachypnea of Newborn
Transition To Practice
Transition to Practice Course Introduction
Trauma Survey
Triage in the ER
Troponin I (cTNL) Lab Values
Types of Exercise
Types of Schizophrenia
Umbilical Hernia
Urinary Elimination
Using Aseptic Technique
Uterine Stimulants (Oxytocin, Pitocin)
Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations
Varicella – Chickenpox
Varicocele
Venous Disorders (Chronic venous insufficiency, Deep venous thrombosis/DVT)
Vent Alarms
Vitals (VS) and Assessment
Vomiting
What Guides Nurses Practice
What is CCMM?
White Blood Cell (WBC) Lab Values
Working night shift
Working with a Preceptor
Wound Care – Assessment
Wound Care – Dressing Change
Wound Care – Selecting a Dressing
Wound Care – Wound Drains