Week 13: Chp 62: Acute Glomerulonephritis

Question 1

What is glomerulonephritis?

Answer 1

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

Question 2

Risk factors

Answer 2

infections such as recent strep infections, immune disease infections such as lupus, vasculitis, hypertension, and diabetes

Question 3

What is glomerulonephritis caused by?

Answer 3

autoimmune disorders such as Goodpasture’s syndrome or lupus, vasculitis (blood vessel inflammation), or an infection such as Streptococcus

Question 4

How does acute glomerulonephritis occur?

Answer 4

develops acutely, typically as a result of a complication from an infection, and can be found in patients across the lifespan

Question 5

How does chronic glomerulonephritis occur?

Answer 5

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

Question 6

Two types of antibody-induce immunological conditions affecting the glomerulus in glomerulonephritis, which are?

Answer 6

-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

Question 7

Type 1 antibody induced immunological condition

Answer 7

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

Question 8

Type 2 antibody immunological condition

Answer 8

the antibodies react to antigens not specific to the glomerulus but still deposit immune complexes along the GBM

Question 9

What happens to the glomerular filtration rate in glomerulonephritis?

Answer 9

a decrease in the glomerular filtration rate (GFR) and an increase in permeability to larger-size proteins

Question 10

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

Answer 10

B. deposition of immunological complexes and complement along the GBM

Question 11

Clinical Manifestations in glomerulonephritis

Answer 11

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

Question 12

Diagnostics of glomerulonephritis

Answer 12

-complete medical history and physical examination —laboratory tests; urinalysis, CBC and differential, serum chemistries

Question 13

What would a urinalysis reveal?

Answer 13

presence of WBCs, RBCs, proteins, and casts

Question 14

what would a CBC and differential reveal?

Answer 14

increased WBCs

Question 15

What would a serum chemistry reveal?

Answer 15

increased serum BUN and creatinine level

Question 16

Would albumin and complement levels be decreased or increased?

Answer 16

decreased albumin and complement levels

-decreased complement indicates an immune-mediated response

Question 17

Treatment

Answer 17

based on the cause of the disease and symptom management

-medications and supportive care

Question 18

Medications

Answer 18

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

Question 19

Supportive care treatments

Answer 19

• 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

Question 20

Supportive Care treatments: Plasmapheresis

Answer 20

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

Question 21

Assessment and Analysis: clinical manifestations is based on what?

Answer 21

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

Question 22

Nursing Diagnoses

Answer 22

• 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

Question 23

Nursing Assessments

Answer 23

• vital signs
• daily weights
• intake and output
• measuring abdominal girth or extremity size
• skin condition
• monitor dietary intake
• lab analysis; RFTs, WBC count, urinalysis

Question 24

Assessments: Vital signs

Answer 24

hypertension is a common finding because of fluid retention associated with glomerulonephritis
-hypertension is a risk factor for cardiovascular disease, stroke, and renal failure

Question 25

Assessments: Daily weights

Answer 25

weight gain is associated with sodium and water retention

Question 26

Assessments: intake and output

Answer 26

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

Question 27

Assessments: measuring abdominal girth or extremity size

Answer 27

important in assessing fluid retention

-fluids tend to pool in dependent areas such as the abdomen or extremities

Question 28

Assessments: Skin condition

Answer 28

edema can increase the risk of skin breakdown

Question 29

Assessments: monitor dietary intake

Answer 29

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

Question 30

Assessment: Renal Function Tests (RFT)

Answer 30

BUN/creatinine should be monitored to track renal function

Question 31

Assessment: WBC count

Answer 31

elevations indicate infection

Question 32

Assessment: Urinalysis

Answer 32

protein and RBCs can be found in the urine because of damage in the GBM

Question 33

Nursing Actions

Answer 33

• administer anti-hypertensives as prescribed
• administer corticosteroids as ordered
• maintain low to moderate protein diet
• dietary sodium and fluid restriction

Question 34

Actions: administer anti-hypertensives as prescribed

Answer 34

diuretics are used to combat sodium and fluid retention

-other anti-hypertensives such as ACE inhibitors may be prescribed to control blood pressure adequately

Question 35

Actions: administer corticosteroids as ordered

Answer 35

may be indicated to modulate the inflammatory response triggered by the immunological mechanism

Question 36

Actions: maintain a low to moderate protein diet

Answer 36

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

Question 37

Actions: dietary sodium and fluid restriction

Answer 37

necessary to prevent fluid retention, which can cause elevated blood pressure and heart failure

Question 38

Nursing Teachings

Answer 38

• overview of the disease process
• prescribed medications
• dietary restrictions
• avoid infections

Question 39

Evaluating Care outcomes

Answer 39

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

Question 40

A well-managed patient

Answer 40

has a blood pressure within normal limits, no edema, and renal function within normal limits