Week 13: Chp 62: Acute Glomerulonephritis Flashcards
What is glomerulonephritis?
inflammation of the glomeruli of the kidney within the Bowman’s capsule of the kidney triggered by an immunological mechanism
-can be acute or chronic
Risk factors
infections such as recent strep infections, immune disease infections such as lupus, vasculitis, hypertension, and diabetes
What is glomerulonephritis caused by?
autoimmune disorders such as Goodpasture’s syndrome or lupus, vasculitis (blood vessel inflammation), or an infection such as Streptococcus
How does acute glomerulonephritis occur?
develops acutely, typically as a result of a complication from an infection, and can be found in patients across the lifespan
How does chronic glomerulonephritis occur?
may be genetic
- can be from the same causes of acute glomerulonephritis
- develops more slowly with fewer symptoms and may result in irreversible damage
- may result from unresolved acute glomerulonephritis
Two types of antibody-induce immunological conditions affecting the glomerulus in glomerulonephritis, which are?
-Type 1 and Type 2
>both result in accumulation of antigens, antibodies, and complement in the glomeruli and GBM, which ultimately results in injury to the glomerular membrane and a decrease in effective filtration through the glomeruli
-there is an overall decrease in the glomerular filtration rate (GFR) and an increase in permeability to larger-size proteins
Type 1 antibody induced immunological condition
the antibodies produced are specific for antigens within the glomeruli and glomerulus basement membrane (GBM)
-as a result of that interaction, immunoglobulins and complement are deposited along the basement membrane
Type 2 antibody immunological condition
the antibodies react to antigens not specific to the glomerulus but still deposit immune complexes along the GBM
What happens to the glomerular filtration rate in glomerulonephritis?
a decrease in the glomerular filtration rate (GFR) and an increase in permeability to larger-size proteins
What is the etiological process in glomerulonephritis?
A. tubular necrosis caused by bacteria and antibody reactions
B. deposition of immunological complexes and complement along the GBM
C. deposition of bacteria and immunological complements within the loop of Henle
D. destruction of proteolytic enzymes contained in the GBM
B. deposition of immunological complexes and complement along the GBM
Clinical Manifestations in glomerulonephritis
as a result of increased permeability, protein and blood are seen in the urine as well as WBCs and casts
- patients present edematous, with decreased urine output and hypertension
- BUN and creatinine are elevated
Diagnostics of glomerulonephritis
-complete medical history and physical examination —laboratory tests; urinalysis, CBC and differential, serum chemistries
What would a urinalysis reveal?
presence of WBCs, RBCs, proteins, and casts
what would a CBC and differential reveal?
increased WBCs
What would a serum chemistry reveal?
increased serum BUN and creatinine level
Would albumin and complement levels be decreased or increased?
decreased albumin and complement levels
-decreased complement indicates an immune-mediated response
Treatment
based on the cause of the disease and symptom management
-medications and supportive care
Medications
focus on antibiotic treatment; Penicillin for post-streptococcal glomerulonephritis if the infection is actively present
- diuretics and other anti-hypertensives to treat hypertension
- corticosteroids not always recommended but may be used to modulate the inflammatory response triggered by an immunological mechanism
Supportive care treatments
- The edema is treated with the restriction of sodium and fluids
- If BUN is elevated, reductions in dietary protein to reduce the buildup of metabolic waste
- plasmapheresis
- rest
Supportive Care treatments: Plasmapheresis
reduce the immune-triggered inflammation
-is an extracorporeal separation of the blood components to filter out immune complexes created as a part of the immunological response; the filtered plasma is discarded while the red blood cells and a replacement colloid such as donor plasma are returned to the patient
Assessment and Analysis: clinical manifestations is based on what?
are present because of the damage of the GBM
- hematuria
- oliguria
- periorbital edema
- peripheral edema of the lower extremities
- generalized body edema
- ascites
- abdominal or flank pain
- hypertension
Nursing Diagnoses
- impaired urinary elimination r/t effects of damage to the glomerular membrane
- ineffective therapeutic regimen management r/t the lack of knowledge regarding the treatment regimen
Nursing Assessments
- vital signs
- daily weights
- intake and output
- measuring abdominal girth or extremity size
- skin condition
- monitor dietary intake
- lab analysis; RFTs, WBC count, urinalysis
Assessments: Vital signs
hypertension is a common finding because of fluid retention associated with glomerulonephritis
-hypertension is a risk factor for cardiovascular disease, stroke, and renal failure
Assessments: Daily weights
weight gain is associated with sodium and water retention
Assessments: intake and output
is essential is assessing the accumulation of fluids
- increases in fluid retention can develop because of the potential sodium retention associated with renal impairment
- fluid retention is a risk factor for elevated blood pressure and heart failure
Assessments: measuring abdominal girth or extremity size
important in assessing fluid retention
-fluids tend to pool in dependent areas such as the abdomen or extremities
Assessments: Skin condition
edema can increase the risk of skin breakdown
Assessments: monitor dietary intake
a patient with glomerulonephritis has the potential for malnourishment from the excessive loss of protein in the urine because of the damage of the glomeruli
- excess sodium intake can cause fluid retention, resulting in elevated blood pressure and heart failure
- protein intake may need to be limited if the BUN is elevated and there are no signs of malnutrition
Assessment: Renal Function Tests (RFT)
BUN/creatinine should be monitored to track renal function
Assessment: WBC count
elevations indicate infection
Assessment: Urinalysis
protein and RBCs can be found in the urine because of damage in the GBM
Nursing Actions
- administer anti-hypertensives as prescribed
- administer corticosteroids as ordered
- maintain low to moderate protein diet
- dietary sodium and fluid restriction
Actions: administer anti-hypertensives as prescribed
diuretics are used to combat sodium and fluid retention
-other anti-hypertensives such as ACE inhibitors may be prescribed to control blood pressure adequately
Actions: administer corticosteroids as ordered
may be indicated to modulate the inflammatory response triggered by the immunological mechanism
Actions: maintain a low to moderate protein diet
care must be taken to limit protein intake if the BUN is elevated, but a low to moderate protein diet may be needed to treat protein loss through the urine
Actions: dietary sodium and fluid restriction
necessary to prevent fluid retention, which can cause elevated blood pressure and heart failure
Nursing Teachings
- overview of the disease process
- prescribed medications
- dietary restrictions
- avoid infections
Evaluating Care outcomes
based on improvements in kidney function and the symptoms associated with glomerulonephritis
- monitoring serum BUN, creatinine, and electrolytes is important in assessing the condition of the patient
- patient teaching can be evaluated by the patients verbalization of information regarding the condition
A well-managed patient
has a blood pressure within normal limits, no edema, and renal function within normal limits
