Nursing Care Plans

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 and nursing diagnosis 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 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.

Activity Intolerance

Activity Intolerance: Insufficient physiologic or physiological energy to endure or complete required or desired activity.

May be related to

Anemia
Bed rest

Possibly evidenced by

Expressed weakness and fatigue
Lethargy

Desired Outcomes

Child will progress to increased tolerance for an activity.

Nursing Interventions	Rationale
Assess the level of weakness and fatigue, ability to move about in bed and engage in play activities.	Provides data about energy reserves during the acute stage of the disease and recognition of bed rest status.
Encourage bed rest during the acute stage, disturb only when needed.	Conserves energy and limits the production of waste materials which increases the work of the kidneys.
Schedule care and provide rest periods after any activity in a quiet environment.	Provides adequate rest and reduces stimuli and fatigue.
Provide for quiet play, reading, TV, games as symptoms subside.	Provides diversion, stimulation and requires minimal energy expenditures.
Explain to the child and parents the purpose of activity restriction.	Promotes understanding of the need to conserve energy and rest to help in recovery.
Inform parents and child about the importance of rest after ambulation or any activity.	Avoids fatigue and conserves energy during recovery.
Instruct parents and child to rest when feeling tired.	Prevents fatigue and promotes recovery.

Risk for Injury

Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources, which may compromise health.

May be related to

Impaired renal function

Possibly evidenced by

[not applicable]

Desired Outcomes

Child’s blood pressure will be normal within the range of the child.
Child will experience an absence of headache and will appear calm.

Nursing Interventions	Rationale
Assess blood pressure, pulse, respirations every 4 hours (monitor BP every 1 hour if diastolic is more than 90, pulse and respirations every 1 hour if tachycardia, tachypnea or dyspnea present).	Provides information about the dangerous effect of hypertension which may result in encephalopathy, pulse, and respiration that change with heart failure and pulmonary edema.
Assess changes in intake and output, extent of edema, decreased urinary output, headache, pallor, electrolyte balance.	Reveals signs and symptoms of possible renal failure.
Administer antihypertensives, diuretic therapy, cardiac glycoside as ordered; Observe for therapeutic effect.	Provides treatment for complications if a more severe renal impairment is present.
Observe behavior changes including lethargy, irritability, restlessness associated with hypertension and administer anticonvulsives if ordered.	Indicates need for safety precautions associated with seizure activity as a result of cerebral changes.
Encourage foods low in sodium, potassium, and protein during the acute phase of AGN; Instruct to increase intake of food high in carbohydrates and fats (only during the acute phase of AGN), as ordered.	Provides nutrition during the acute period with the limitation of potassium during oliguria, sodium with the presence of edema, protein limitation if oliguria is prolonged.
Limit fluids as ordered; allow intake of the amount lost via urine and insensible losses.	Avoids additional fluid retention and edema in the presence of renal damage.
Inform parents to report any weight gain, hematuria with decreased urine output, complaints of headache and anorexia.	Provides for a prompt intervention to prevent severe renal damage.
Teach parents regarding dietary inclusion and restriction; provide a list of foods to include and avoid that comply with sodium, potassium, protein allowances.	Provides nourishment while the disease is being resolved.
Encourage to allow activity/rest periods as energy and fatigue require; progressively increase as condition warrants.	Prevents fatigue and conserves energy during the acute stage and convalescence.
Reinforce to parents the need for follow-up care and supervision.	Ensures ongoing monitoring of child for chronic renal disease or infection. persistent streptococcal

Risk for Infection

Risk for Infection: At increased risk for being invaded by pathogenic organisms.

May be related to

Chronic disease

Possibly evidenced by

[not applicable]

Desired Outcomes

Child will not experience a sore throat.
Child’s throat cultures will be negative.

Nursing Interventions	Rationale
Assess temperature, chills, sore throat, cough (presence or recurrence).	Reveals persistence of streptococcal infection.
Obtain throat culture for analysis and sensitivities.	Identifies streptococcal microorganism and sensitivity to specific antibiotic therapy.
Administer antibiotic therapy to the child and to family members if ordered.	Destroys microbial agents by preventing cell wall synthesis and prevents transmission to family members.
Provide proper disposal of used tissues and articles.	Prevents transmission of microorganisms to others or reinfection.
Instruct parents about the importance of taking the full course of antibiotic therapy.	Promotes parental understanding and prevents the development of super-infection.
Instruct child and family to do handwashing after sneezing/coughing and to properly disposed used tissues.	Prevents transfer of disease.
Instruct parents to avoid exposure of the child to others with an existing upper respiratory infection.	Avoids respiratory infections in the susceptible child.
Instruct parents to notify health care provider if fever, cough, sore throat is present.	Indicates infection and provides for early intervention.