4 Acute Glomerulonephritis Nursing Care Plans

August 8, 2018

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

Here are four (4) nursing care plans (NCP) for Acute Glomerulonephritis:

Excess Fluid Volume

Excess Fluid Volume: Increased isotonic fluid retention.

May be related to

Decrease in regulatory mechanisms (renal failure) with the potential of water.

Possibly evidenced by

Azotemia
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

Desired Outcomes

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.

Nursing Interventions	Rationale
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 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 child to do position changes every 2 hours.	Frequent position change lessens pressure on body parts and prevents 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 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.