Chronic Glomerulonephritis

Description:

 Characterized by inflammation of the glomeruli.

 Usually remains undetected until the progressive phase which is usually irreversible.

Risk factors

 Diabetes
 Cardiovascular Disease
 Family history of kidney disease
 Obesity
 Older age
 Smoking

Sign and Symptom

 Hematuria
 Edema
 Oliguria
 Hypertension
 Nephrotic syndrome
 Proteinuria

Diagnostic Tests

 Urine Test
o might show red blood cells and red cell casts in your urine, an indicator of possible
damage to the glomeruli.
o might also show white blood cells, a common indicator of infection or inflammation, and
increased protein, which can indicate nephron damage.
 Blood Test
o provide information about kidney damage and impairment of the glomeruli by
measuring levels of waste products, such as creatinine and blood urea nitrogen.
 Kidney Biopsy
o involves using a special needle to extract small pieces of kidney tissue for microscopic
examination to help determine the cause of the inflammation.
o A kidney biopsy is almost always necessary to confirm a diagnosis of glomerulonephritis.
 CT Scan
o Detect and monitor diseases and conditions such as cancer, heart disease, lung
nodules and liver masses

Anatomy

 The kidneys lie on either side of the spine in the retroperitoneal space between the
parietal peritoneum and the posterior abdominal wall.
 The left kidney is located at about the T12 to L3 vertebrae, whereas the right is lower
due to slight displacement by the liver.
 They are about 11–14 cm in length, 6 cm wide, and 4 cm thick.
 Each kidney weighs about 125–175 g in males and 115–155 g in females.

Pathophysiology

The majority of the glomeruli are affected. Depending on the stageof the disease, they
may present different degress or hyalinization. The hyaline is an amorphous material,
pink.homogenous, resulted from combination of plasma proteins, increased mesangial matrix and
collagen. Totally hyanilised glomeruli are atrophic (smaller), lacking capillaries, hence these glomeruli
are non-functional.
Nursing Diagnosis

1. Ineffective breathing pattern related to the inflammatory process.

2. Altered urinary elimination related to decreased bladder capacity or irritation secondary to
infection
3. Excess fluid volume related to a decrease in regulatory mechanisms (renal failure) with the
potential of water
4. Risk for infection related to a decrease in the immunological defense
5. Imbalanced Nutrition Less than body requirements related to anorexia, nausea, vomiting.

NCP

Assessment Diagnosis Planning Intervention Rationale Evaluation

Chronic Excess fluid Restrict 1. Monitor the During The patient
Glomerulonephritis volume the fluid intake dialysis health
related to a patient of the sessions, status will
decrease in from patient fluid can getting any
regulatory taking a 2. Promote build up worse
mechanisms lot of emptying in the because of
(renal fluids. the bladder body of limiting the
failure) with the fluid
the potential patient intake.
of water that may
lead to
shortness
of breath.

Assessment Diagnosis Planning Intervention Rationale Evaluation

Chronic Altered Monitor 1. Monitor To
Glomerulonephritis urinary the input the intake monitor
elimination and fluid of the the renal
related to output of patient. activity of
decreased the 2. Insert the
bladder patient. catheter patient.
capacity or for better
irritation monitoring
secondary 3. Monitor
to infection the
amount
and color
of the
urine.

Assessment Diagnosis Planning Intervention Rationale Evaluation

Chronic Ineffective Assess 1. Monitor To know if the The patient
Glomerulonephritis breathing cardiopulmo the patient is doesn’t
pattern nary system patient’ having any have any
related to by s vital cardiopulmona problem
the auscultating sign ry problems. with his/her
inflammatory the heart and 2. Monitor breathing.
process. the lungs. the
breathin
g of the
patient
3. Listen
for
friction
rub and
pulmon
ary
cracks if
present.
 Nursing Management/ Intervention

1. Monitor vital signs. Always maintain a reasonable blood pressure.

2. Monitor laboratory results. For the nurse and patient to know what actions they must do to
improve the patient’s health status.
3. Evaluate patient’s status. The patient might be getting anxious because of the procedure.
Make sure to explain every procedure to avoid confusion on the patient.
4. Health teachings. Teach the patient on how to maintain a good health status. Promote a
healthy lifestyle and healthy diet for the patient.

Medical Surgical Management

Drug analysis

Drug Order Indication Mechanism Side Adverse Contra- Nursing

of Action Effects Effects indications Responsibilities

Generic Headache, Hypotension -Pregnancy ● Monitor BP and

Name: Moderate Direct- anorexia, ,Palpitations -Renal pulse frequently
Hydralazine to severe acting nausea, Conjunctivitis, Failure during initial dose
-oral hypertensi peripheral vomiting, Tachycardia, -Breast adjustment and
Brand on (with a arteriolar diarrhea, Headache, Feeding periodically
Name: diuretic). vasodilator. palpitations Peripheral -Stroke during therapy.
Apresoline Unlabele Therapeuti , edema, -Hyper ● Monitor
Classificati d Use(s): c Effect(s): tachycardia Vascular sensitivity frequency of
on: HF Lowering of , angina collapse, prescription refills
Antihyperte unrespons BP in pectoris. Peripheral to determine
nsive ive to hypertensiv neuropathy, adherence.
Route: conventio e patients Anorexia, ● Lab Test
OP nal and Diarrhea, Considerations:
Dosage: therapy decreased Nausea, Monitor CBC,
 10mg with afterload in Vomiting, electrolytes, LE
 25mg digoxin patients Psychotic cell prep, and
 50mg and with HF. reaction, ANA titer prior to
 100m diuretics. Agranulocytosi and periodically
g s, during prolonged
Leukopenia, therapy.
Hepatotoxicity, ● May cause a
Chest pain, positive direct
Dyspnea, Coombs’ test
Nasal result.
congestion,
Paralytic ileus,
Dysurea,
Thrombocytop
enia,
Peripheral
neuritis,
Rheumatoid
arthritis,
Agranulocytosi
s,
Arthralgia, SLE
syndrome

Drug Order Indication Mechanism Side Adverse Contra- Nursing

of Action Effects Effects indications Responsibilities

Generic -Treatment Edema- Headache, , Injection site -Pregnancy -Assess fluid

Name: of the associated nausea, reaction -Renal status throughout
Ethacrynic edema with CHF, vomiting, Failure therapy. Monitor
Acid associated hepatic diarrhea, Hyperuricemia -acute daily weight,
Brand with cirrhosis, palpitations. kidney intake and output
Name: congestive renal tachycardia, Gout failure ratios, amount
Edecrin heart dysfunction, angina -Hyper and location of
Classificati failure, malignancy, pectoris, Hypotension Sensitivity edema, lung
on: cirrhosis of & hearing -low blood sounds, skin
Antihyperte the liver, pulmonary problems, Hypokalemia pressure turgor, and
nsive and renal edema weight loss mucous
Route: disease, Electrolyte membranes.
OP including abnormalities
Dosage: the -Assess patient
 25mg nephrotic Short-term Hyperglycemia for anorexia,
syndrome. use in /hypoglycemia muscle
children weakness,
-Short-term (other than Hyperlipidemia numbness,
manageme infants) with tingling,
nt of ascites congenital Ototoxicity paresthesia,
due to heart confusion, and
malignancy, disease or Tinnitus excessive thirst.
idiopathic nephrotic Notify health care
edema, and syndrome Photosensitivit professional
lymphedem y promptly if these
a. signs of
Muscle cramps electrolyte
-Short-term Use when imbalance occur.
manageme fluid Dizziness
nt of retention
hospitalized refractory to Confusion
pediatric thiazides, or
patients, with Headache
other than impaired
infants, with renal Nausea/vomiti
congenital function ng
heart
disease or Anorexia
the
nephrotic Dysphagia
syndrome.
Diarrhea
-Intra
venous Pancreatitis
SODIUM
EDECRIN Agranulocytosi
is indicated s
when a
rapid onset Neutropenia
of diuresis
is desired, Thrombocytop
e.g., in enia
acute
pulmonary Hematuria
edema, or
when
gastrointesti
nal
absorption
is impaired
or oral
medication
is not
practicable.
Discharge planning’

References