Nursing Care Plan (NCP) for Glomerulonephritis

Understanding Glomerulonephritis:
- Define and comprehend the pathophysiology and etiology of glomerulonephritis.
- Recognize the signs and symptoms associated with glomerulonephritis.
Assessment Skills:
- Develop proficiency in conducting a thorough nursing assessment for patients with glomerulonephritis.
- Identify key assessment parameters, including physical examination findings and relevant laboratory results.
Care Planning and Implementation:
- Formulate a comprehensive nursing care plan based on the individualized needs of a patient with glomerulonephritis.
- Implement evidence-based nursing interventions to address symptoms and contribute to the management of glomerulonephritis.
Monitoring and Evaluation:
- Establish criteria for monitoring the patient’s response to treatment and adjusting the care plan accordingly.
- Utilize evaluation methods to assess the effectiveness of nursing interventions and overall patient outcomes.
Patient Education:
- Educate patients and their families about glomerulonephritis, including its causes, treatment options, and strategies for managing symptoms.
- Promote patient understanding of the importance of adherence to prescribed medications and lifestyle modifications.

Pathophysiology of Glomerulonephritis

Immune Complex Deposition:
- Glomerulonephritis often begins with the deposition of immune complexes in the glomerular basement membrane, triggering an inflammatory response.
Inflammation and Cellular Infiltration:
- The immune complexes activate complement cascades and attract inflammatory cells, leading to inflammation within the glomeruli.
Glomerular Damage:
- Inflammation results in damage to the glomerular capillaries, impairing their ability to filter blood effectively.
Decreased Filtration Rate:
- Reduced glomerular filtration rate (GFR) occurs due to increased permeability and loss of selectivity, leading to proteinuria and hematuria.
Renal Dysfunction:
- Prolonged inflammation and glomerular damage contribute to renal dysfunction, manifesting as decreased urine output, hypertension, and electrolyte imbalances.

Etiology of Glomerulonephritis

Immunological Causes:
- Often, glomerulonephritis is triggered by immunological factors, such as infections (streptococcal, viral) that lead to the formation of immune complexes.
Autoimmune Disorders:
- Conditions like systemic lupus erythematosus (SLE) and other autoimmune diseases can contribute to glomerulonephritis by initiating an immune response against renal tissues.
Genetic Predisposition:
- Some individuals may have a genetic predisposition to glomerulonephritis, increasing their susceptibility to the disease.
Exposure to Toxins:
- Certain toxins, drugs, and environmental exposures can damage the glomeruli and contribute to the development of glomerulonephritis.
Systemic Inflammatory Diseases:
- Diseases with systemic inflammation, such as vasculitis, can affect the glomeruli and contribute to the development of glomerulonephritis.

Desired Outcome for Glomerulonephritis

Resolution of Symptoms:
- Achieve relief from symptoms such as hematuria, proteinuria, hypertension, and edema.
Normalization of Renal Function:
- Restore and maintain normal renal function, as evidenced by stabilized or improved glomerular filtration rate (GFR) and serum creatinine levels.
Prevention of Complications:
- Prevent complications associated with glomerulonephritis, such as fluid and electrolyte imbalances, infections, and cardiovascular issues.
Control of Blood Pressure:
- Maintain blood pressure within the target range to prevent further renal damage and cardiovascular complications.
Patient Education and Empowerment:
- Provide education to the patient about the condition, treatment plan, and lifestyle modifications to empower them to actively participate in the management of their health.

Glomerulonephritis Nursing Care Plan

Subjective Data:

Puffiness of face in mornings
Urinating less frequently
Shortness of breath
Cough
Fatigue
Change in weight (recent/significant)

Objective Data:

Hematuria / proteinuria
Hyper/hypotension
Bubbly / foamy urine
Dark colored urine

Nursing Assessment for Glomerulonephritis

Patient History:
- Gather information on the patient’s medical history, including any previous episodes of glomerulonephritis, kidney disease, or other relevant conditions.
Symptom Assessment:
- Evaluate and document symptoms such as hematuria, proteinuria, edema, hypertension, and changes in urinary habits.
Vital Signs Monitoring:
- Regularly monitor blood pressure to assess for hypertension, a common complication of glomerulonephritis.
Fluid and Electrolyte Balance:
- Assess fluid status and monitor for signs of fluid overload or dehydration. Keep a close watch on electrolyte levels, especially potassium.
Laboratory Tests:
- Conduct and analyze laboratory tests, including complete blood count (CBC), renal function tests (serum creatinine, blood urea nitrogen), urinalysis, and immunological tests to aid in diagnosis and ongoing monitoring.
Dietary Assessment:
- Evaluate the patient’s dietary habits, paying attention to sodium and protein intake. Collaborate with a dietitian for appropriate dietary modifications.
Medication Review:
- Review the patient’s current medications, including prescribed medications for glomerulonephritis, and assess for any potential interactions or adverse effects.
Psychosocial Assessment:
- Assess the patient’s emotional well-being, coping mechanisms, and support system. Chronic kidney conditions can impact the patient’s mental health, so addressing psychosocial aspects is essential.

Implementation for Glomerulonephritis

Pharmacological Management:
- Administer prescribed medications as directed, including antibiotics for bacterial infections, diuretics to manage fluid overload, and antihypertensive agents to control blood pressure.
Fluid and Electrolyte Balance:
- Monitor and regulate fluid intake to maintain a balance and prevent complications such as edema or dehydration. Adjust sodium and potassium intake as needed.
Dietary Modifications:
- Collaborate with a dietitian to implement dietary changes, focusing on reducing protein and sodium intake. Provide education on the importance of adhering to dietary restrictions.
Blood Pressure Management:
- Implement measures to control hypertension, such as medication adherence, lifestyle modifications, and regular monitoring of blood pressure. Educate the patient on the significance of blood pressure management.
Patient Education:
- Educate the patient on the importance of adherence to the treatment plan, including medications, dietary restrictions, and follow-up appointments. Provide information on recognizing and reporting symptoms of worsening kidney function.

Nursing Interventions and Rationales

Perform head-to-toe assessment

To establish a baseline by which to measure interventions and outcomes

Auscultate lungs, noting any adventitious breath sounds
Assess periorbital and dependent edema (+1 – +4)

Monitor vital signs

Damage to the glomeruli prevent the emptying of sodium and fluid and can raise the heart rate and blood pressure.

Insert indwelling urinary catheter as necessary

Provides a more accurate method of measuring output. If catheter is contraindicated,, provide urinary hat for toilet to measure urine.

Monitor fluid balance
- I & O
- Daily weights
- Evaluate edema

Measure for decreased output <400 mL/24 hr period may be evident by dependent edema
Daily weights at the same time on the same scale each day, >0.5kg/day is indicative of fluid retention
Note changes in characteristics of urine: dark, frothy appearance, hematuria

Elevate extremities

Provide elevation for feet and ankles or arms as necessary to allow gravity to assist in reducing edema. There may be a gain of up to 10lbs of fluid before pitting is noticed

Monitor diagnostic testing: Evaluate electrolyte levels
- Calcium
- Sodium
- Magnesium
- Potassium
Monitor renal function labs
- BUN, Creatinine
- Albumin
- Glomerular Filtration Rate (GFR)
Kidney biopsy, as indicated

Electrolyte imbalances can lead to muscle weakness or spasticity and affect cardiac output.

Monitor the amount of protein lost in the urine. Serum protein levels will be decreased, while urine protein levels will be elevated.

A kidney biopsy may be required, especially if patient is diabetic

Administer medications as indicated
- Diuretics
- Antihypertensives
- Electrolyte supplements

An acute attack of glomerulonephritis may clear on its own. Depending on severity of symptoms and progression of disease, diuretics are often given to remove excess fluid, antihypertensives to manage blood pressure caused by fluid retention and electrolyte supplements such as calcium or potassium to maintain homeostasis

Encourage healthy lifestyle and nutritional education

Offer small, frequent meals
Restrict fluids as necessary
Limit sodium and protein intake
Encourage exercise to maintain a healthy weight
Control blood sugar (diabetic patients)
Quit smoking

Evaluation for Glomerulonephritis

Symptom Monitoring:
- Regularly assess and document the patient’s symptoms, including changes in urine output, presence of edema, and blood pressure levels. Evaluate if symptoms have improved or worsened.
Laboratory Parameters:
- Analyze laboratory results, including serum creatinine, blood urea nitrogen (BUN), and urine analysis. Compare current values with baseline measurements to determine the effectiveness of the treatment in maintaining kidney function.
Blood Pressure Control:
- Evaluate the success of blood pressure management by comparing current blood pressure readings with target levels. Adjust antihypertensive medications if needed to maintain optimal blood pressure control.
Dietary Adherence:
- Assess the patient’s adherence to dietary restrictions and modifications. Collaborate with a dietitian to review dietary choices and ensure compliance with prescribed dietary recommendations.
Patient Education Impact:
- Measure the patient’s understanding of the condition, treatment plan, and self-management strategies. Evaluate whether education interventions have been effective in empowering the patient to actively participate in their care.

References

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Transcript

Hey guys, let’s take a look at the care plan for glomerulonephritis. In this lesson, we’ll briefly take a look at the pathophysiology and etiology of glomerulonephritis. Also, we’ll look at subjective and objective data and nursing interventions and rationales.

So glomerulonephritis is defined as a group of diseases that causes inflammation and injury to the part of the kidney that filters blood, which are the glomeruli. When the kidneys are injured or inflamed, they are unable to remove waste and extra fluid in the body. Prolonged disease may lead to kidney failure. Acute glomerulonephritis develops as a complication following streptococcal infection of the throat or skin, although this is rare. Bacterial infections, such as endocarditis and strep throat and viral infections, such as HIV, hepatitis B and C may result in an inflammation of the glomeruli within the kidneys. Immune diseases, such as lupus or good pasture syndrome are also thought to lead to this issue. The chronic form of the disease is thought to be hereditary, but may occur months or years following an acute attack of the disease. The desired outcome is increased homeostasis, stable weight and blood pressure, and being free from edema.

Okay, let’s take a look at some of the subjective and objective data that your patient with this issue may present with. Remember subjective data are going to be things that are based on your patient’s opinions or feelings like puffiness of the face in the morning, urinating less frequently, shortness of breath, cough, fatigue, and recent significant change in weight.

Objective or measurable data may include hematuria, proteinuria, hyper, or hypotension, bubbly or foamy urine, and dark colored urine.

Let’s take a look at some of the nursing interventions important when caring for a patient with glomerulonephritis. Perform a head to toe assessment, so a baseline can be established to which interventions and outcomes can be measured. Auscultate the lungs, noting any adventitious breath sounds and measure dependent and periorbital edema from plus one, to plus four. Monitoring vital signs is critical, as damage to the glomeruli prevents the emptying of sodium and fluid, and can raise the heart rate and blood pressure. Insert an indwelling catheter as necessary as this will provide a more accurate method of measuring output. If a catheter is contra-indicated, be sure to provide a urinary hat for the toilet to measure urine. It is critical to monitor fluid balance in these patients. Measure for decreased output, less than 400 ml’s in a 24 hour period, which may be evident by dependent edema. Measure daily weights at the same time each day on the same scale. Greater than five kilos per day is indicative of fluid retention. Note changes in the characteristics of the urine, including dark urine, frothy appearance or hematuria. Provide elevation of the feet, ankles and arms as necessary to allow gravity to assist in reducing edema. There may be a gain of up to 10 pounds of fluid before pitting is noticed, okay? Monitor diagnostic testing, including electrolyte levels, calcium, sodium, magnesium, and potassium. Electrolyte imbalances can lead to muscle weakness or spasticity and affect cardiac output. Monitor renal function labs, including bun, creatinine, albumin, and GFR, which is the glomerular filtration rate. Monitor the amount of protein, which is lost in the urine. Serum protein levels will be decreased while urine protein levels will be elevated. Also, a kidney biopsy may be required, especially if the patient is diabetic.

When considering medications, sometimes glomerulonephritis will clear on its own, so it’s important to know that depending on the severity of the symptoms and progression of disease, diuretics are often given to remove excess fluid, antihypertensives to manage blood pressure caused by fluid retention, and electrolyte supplements like potassium or calcium to maintain homeostasis. Finally guys, encourage a healthy lifestyle and for nutritional education, offer small and frequent meals. Restrict fluids as necessary, limit sodium and also protein intake. Encourage exercise to maintain a healthy weight, control blood sugar in diabetic patients and of course, encourage smoking cessation.

Okay. Here is a look at the completed care plans for glomerulonephritis. We love you guys. Now, go out and be your best self today and as always, happy nursing!

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