Acute glomerulonephritis (AGN) is an alteration in renal function caused by glomerular injury, which is characterized by the classic symptoms of gross hematuria, mild proteinuria, edema (usually periorbital), hypertension, and oliguria. AGN is also categorized as either: a primary disease, related with group A, beta-hemolytic streptococcal infection; or a secondary disease, associated with autoimmune diseases such as systemic lupus
erythematosus, hemolytic uremic syndrome, sickle cell disease, and Henoch’s chorea purpura.
Primary disease, the most common type of AGN is described as an immune-complex disease (or an antigen-antibody complex developed during the streptococcal infection which becomes entrapped in the glomerular membrane, causing inflammation for 8 to 14 days after the onset of this infection).
AGN is primarily observed in the early school-age child, with a peak age of onset of 6 to 7 years. The onset of the classic symptoms of AGN is usually abrupt, self-limiting (unpredictable), and prolonged hematuria and proteinuria may occur. AGN results in decreased glomerular filtration rate causing retention of water and sodium (edema); expanded plasma and interstitial fluid volumes that lead to circulatory congestion and edema (hypervolemia); hypertension (cause is unexplained; plasma renin activity is low during the acute phase, hypervolemia is suspected to be the cause).
Nursing Care Plans
Nursing care planning goals for the child with acute glomerulonephritis is directed toward the excretion of excess fluid through urination, participate in an activity within tolerance, preventing infection, and absence of complication
Excess Fluid Volume
May be related to
- Decrease in regulatory mechanisms (renal failure) with the potential of water.
Possibly evidenced by
- Altered electrolytes
- Crackles and pleural effusion
- Decreased urinary output
- Dependent edema
- Moderate blood pressure increases
- Intake greater than output
- Periorbital edema
- Pleural effusion
- Puffiness in the face
- Weight gain
- Child will have a normal fluid balance as evidenced by absence of edema, vital signs within the client normal limit, and balanced fluid intake and output.
|Monitor vital signs every 4 hours; notify any significant changes.||An assessment provides baseline information for monitoring changes and evaluating the effectiveness of therapy.|
|Auscultate breath sounds for the presence of crackles. Observe for increased work of breathing, cough, and nasal flaring.||Crackles upon auscultation indicate a fluid accumulation resulting in pulmonary congestion.|
|Weigh the child on the same scale at the same time daily. Monitor intake and output accurately.||Weight gain results from fluid retention; Accurate measurement of intake and output helps assess fluid balance.|
|Measure and record abdominal girth daily.||Edema normally observed in the abdomen which may increase as the condition progresses.|
|Administer diuretics as prescribed.||Decreases plasma volume and edema by causing diuresis.|
|Instruct parents to maintain fluid restrictions as indicated.||The amount of fluid allowed to take depends on the level of kidney function.|
|Assist the child to do position changes every 2 hours.||Frequent position change lessens pressure on body parts and prevents the accumulation of fluid in the dependent areas.|
|Elevate edematous body part while the child is in bed or sitting in a chair.||Helps move fluid away from dependent body parts through gravity.|
|Explain to the child (as appropriate) and family about acute glomerulonephritis, including its signs and symptoms, diagnostics, and management.||Provides an understanding of the disease which increases compliance with the treatment regimen.|
|Refer to a dietician for a consultation to develop a meal plan low in sodium, potassium, and protein that includes preferred foods as allowed.||A proper diet plays a vital part in controlling the symptoms, maintaining nutrition and in the management of the disease.|
Recommended nursing diagnosis and nursing care plan books and resources.
- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
- Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
- NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
- Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
- Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
- Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
- Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
- All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other care plans and nursing diagnoses related to reproductive and urinary system disorders:
- Acute Glomerulonephritis | 4 Care Plans
- Acute Renal Failure | 6 Care Plans
- Benign Prostatic Hyperplasia (BPH) | 5 Care Plans
- Chronic Renal Failure | 11 Care Plans
- Hemodialysis | 3 Care Plans
- Hysterectomy (TAHBSO) | 6 Care Plans
- Mastectomy | 14+ Care Plans
- Menopause | 6 Care Plans
- Nephrotic Syndrome | 5 Care Plans
- Peritoneal Dialysis | 6 Care Plans
- Prostatectomy | 6 Care Plans
- Urolithiasis (Renal Calculi) | 4 Care Plans
- Urinary Tract Infection | 4 Care Plans
- Vesicoureteral Reflux (VUR) | 5 Care Plans