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 and nursing diagnosis for Acute Glomerulonephritis:
Excess Fluid Volume
Nursing Diagnosis
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 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 Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses as reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of it’s evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions show how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
See also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
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
I for one as one of the Med-Surgical Nurses feel so much inspired and have benefited a lot from Paul’s work