Davao Doctors College, Inc.

Gen. Malvar St., Davao City

Nursing Program

Nursing Management of a Patient with

Acute Glomerulonephritis

A Case Study Presented to the Nursing Clinical Instructors

of Davao Doctors College, Inc.

In Partial Fulfillment of the Requirements in

NRG 404 and 405

Cristal, March Karen; Cruz,Kimberly; Dulong, Joanna; Gabutan,

Vivian Shane; Galedo, Melanie; Gudelos, Arlyn; Iñigo,

Lyra; Jesuro, Vanessa Mae;Kanashiro, Kristi

Noelle; Siason, Christianne Joy

January 2022
 TABLE OF CONTENTS

Objectives 1
Brief Description of the Case 2
Patient Profile 3
i. Biographic Data 3
ii. Clinical Data 3
iii. Past Health History 3
iv. Present Health History 4
v. Family History 4
Health Assessment 4
Diagnostic and Laboratory results 5
i. Electrocardiogram 5
ii. Ultrasound 7
iii. Kidney Biopsy 8
iv. Hemo Glucose Test 10
v. Chest X-ray 12
vi. ABG analysis 13
vii. CBC 14
viii. Serum Creatinine 16
ix. Serum Electrolytes 16
x. Urinalysis 17
xi. Stool Exam, xii: BUN 19, 20
Test Result Relation to Patient Condition 21
Nursing Responsibilities 26
i. Electrocardiogram 26
ii. Ultrasound and Kidney Biopsy 27
iii. Complete Blood Count 28
iv. Serum Electrolytes 29
v. HGT and ABG 31
vi. Urinalysis 32
References 34
 GENERAL OBJECTIVES

The Group 1 of 4th year nursing students, section 14-A of Davao Doctors College,
presented a case related to Kidney Disorder focusing on the acute glomerulonephritis ,
and have discussed the client’s care and management. Furthermore, the students
attained the following;

SPECIFIC OBJECTIVES

a. Provided a comprehensive assessment of the patient;

b. Have interpreted the diagnostic procedure done and they were able to identify its
relevance and purpose to the case of the patient;

c. Have listed the important nursing consideration of every procedure performed for the
patient from beginning until the end of the test.

d. Provided relationship between the results from the test to the condition of the patient.

e. Identified nursing responsibilities relevant to the results of the tests.

f. Presented the case analysis to the panelist effectively.

1
 BRIEF DESCRIPTION OF THE CASE

Patient Bianca, 36- yrs. old, Filipina Female was brought to the emergency room
with complaints of blood in the urine, generalized edema and feeling of fatigue. She
was diagnosed with diabetes and hypertension when she was 34 years old. She stated
that she was extra careful during the start of the pandemic and would always take
ibuprofen (NSAID) when she feels something out of sort. She has been doing this
practice for almost 2 years now.

Kidney disorders are associated with decreased quality of life, increased health
care expenditures, and premature death. Untreated kidney disease can result in end-
stage kidney disease (ESKD), which is the final stage of CKD ESKD results in retention
of uremic waste products and the need for renal replacement therapies, dialysis, or
kidney transplantation (Center for Disease Control and Prevention (CDC), 2014).

Acute glomerulonephritis is an example of kidney disorders. It is the inflammation

and subsequent damage of the glomeruli leading to hematuria, proteinuria, and
azotemia; it may be caused by primary renal disease or systemic conditions.
Glomerulonephritis is also defined as the inflammation of the glomerular capillaries
(Hinkle & Cheever, 2018). The glomerular filtration rate is decreased, leading to
activation of the renin-aldosterone system and subsequent salt and water retention,
resulting in edema and hypertension. Acute glomerulonephritis requires prompt
diagnosis, as it can rapidly progress to permanent kidney disease if left undiagnosed.
Glomerulonephritis is the third most common cause of end-stage renal disease,
following diabetes mellitus and hypertension, and is responsible for about 15% of cases
of end-stage renal disease. Acute glomerulonephritis progresses to chronic
glomerulonephritis in about 30% of adults. The emergency physician must consider
acute glomerulonephritis in the differential diagnosis for patients that present with
hypertension, hematuria, proteinuria, peripheral edema, and/or acute pulmonary
edema.

Acute post streptococcal glomerulonephritis (PSGN) is considered the typical

form of acute glomerulonephritis, but the incidence of PSGN has fallen in the United
States and other developed countries, while glomerulonephritis associated with
staphylococcal infection has risen because of the increase in antibiotic-resistant
Staphylococcus aureus infections (Brown & Sinert, 2021). However, with the patient’s
case, chronic use of NSAIDs is the most prominent and possible cause of this problem.
In the United States non-steroidal anti-inflammatory drugs (NSAID) are freely available
over-the-counter. Because of the adverse effects on the kidneys and the popularity of
these drugs, unregulated use of NSAIDs is an under recognized and potentially
dangerous problem. Heavy or long-term use of some of these medicines, such as
ibuprofen, naproxen, and higher dose aspirin, can cause chronic kidney disease known

2
as chronic interstitial nephritis. NSAIDs disrupt the compensatory vasodilation response
of renal prostaglandins to vasoconstrictor hormones released by the body. Inhibition of
renal prostaglandins results in acute deterioration of renal function after ingestion of
NSAIDs (Dixit, et al. 2010).

Glomerulonephritis remain as the leading cause of end-stage kidney disease in

Southeast Asia and around the world (Hizon, 2019). Kidney diseases, especially End
Stage Renal Disease (ESRD), are already the 7th leading cause of death among the
Filipinos. One Filipino develops chronic renal failure every hour or about 120 Filipinos
per million populations per year.

PATIENT PROFILE

i. Biographic data

Name : Bianca

Age : 36 years old

Gender : Female

ii. Clinical data

Chief Complaint : Blood in the urine; generalized edema; feeling

of fatigue

Vital signs upon admission Results

Blood Pressure 180/100 mmHg

Heart Rate 90 bpm

Respiratory rate 12 cpm

iii. Past health history

She was diagnosed with Diabetes and Hypertension when she was 34 years old.
She always takes Ibuprofen (NSAID) when she feels something out of sort. She has
been doing this practice for almost 2 years now.

3
 iv. Present health history

Patient was brought to the emergency room with complaints of blood in the
urine, generalized edema and feeling of fatigue.

v. Family History

Both of her parents were diagnosed with Diabetes and Hypertension in their
40’s.

HEALTH ASSESSMENT

General Assessment
A 36 yr old Filipina Female was brought to the emergency room with complaints
of blood in the urine, generalized edema and feeling of fatigue.

Skin
Her skin looks a bit pale and is a bit shinny due to the edema.

EENT/Mouth
Her eyes look normal. Her nose, ears, and throat are normal. No palpable
masses were noted.

Cardiovascular System
Her RR IS 12cpm. Her heart rate is 90bpm with a blood pressure of
180/100mmHg. Her pulse is strong and bounding. Capillary refill time was 3 seconds.

Respiratory System
No signs of nasal flaring or difficulty of breathing. Her trachea is located midline.

Gastrointestinal System
Her abdomen is swollen.

Genitourinary System
Her urine output is only 25ml/hour and complains of blood in the urine.

Neurological System
Patient appears to be anxious. Her GCS is 15/15, E-4, V-6,M-5.

4
 DIAGNOSTIC AND LABORATORY RESULTS AND NURSING CONSIDERATIONS

PROCEDURE NORMAL RESULTS PRETEST INTRATEST POST-TEST

RANGE
Electrocardiogram HR: Elevation of T 1. Educate patient 1. Place patient 1.After the test
-It is a medical test that detects 60-100 bpm wave the importance of in supine slowly remove
cardiac (heart) abnormalities by the procedure and position or the patches or
measuring the electrical activity PR interval: why is it Semi-fowlers use alcohol pad
generated by the heart as it 0.12-0.20s conducted. position. to avoid hurting
contracts. The machine that records QRS: 2.Inform as well 2.Once in the patient.
the patient’s ECG is called an 0.6-0.10s the patient that position assess 2.Educate patient
ST segment: some patches will the skin. It that there is no
electrocardiograph. ECGs from a
0.32-0.42 also be placed in should be dry, possible side
healthy hearts have a characteristic T wave: area that is hairless, and oil effect in regard to
shapes and manner. Any 1.0 mm to + sensitive. free. the procedure
irregularity in the heart rhythm or 5.0 mm in 3.Explain that the 3.Place the 10 unless the patient
damage to the heart muscle can height. test is painless electrodes on is allergic to the
change the electrical activity of the and takes 5-10 the inner aspect pads refer to the
heart affecting the shape of the minutes. of the wrists, on nurses or health
ECG. 4. Assess patient the medical care provider if
The procedure is relevant to the for any metallic aspect of the rashes were
patient case because patients with objects within the lower legs, and observed.
suspected acute glomerulonephritis examination field on the chest to 3.Assess patient
can lead to hypertension, heart which may hinder have a clear if there is a
organ perspective of current chest pain
failure and pulmonary edema
visualization or the heart’s or fatigue after
primarily due to sodium retention
cause alteration of activity. the procedure.
leading to fluid overload as results. 4.Instruct
evidenced by the suppression of the 5.Instruct patient patient to
renin-angiotensin aldosterone to empty the minimize any
(RAAS) system thus doing this bladder prior to movement
procedure help to determine how performing the during the
severe it already affects the heart. procedure. procedure for it

5
 6. Instruct patient might alter the
Reference: to minimize ECG results.
movement during 5.Press the
Ihm C. (2015). Hypertension in the procedure for START button
Chronic Glomerulonephritis. it might alter the and input any
Electrolytes & Blood Pressure. ECG results. required
information.
https://doi.org/10.5049/ebp.2015.13
6. Make sure
.2.41 that all leads
are represented
ECG-test-Better Health Channel. in the tracing. If
(2020). Vic.gov.au. not, determine
https://www.betterhealth.vic.gov.au/ which electrode
health has come
/conditionsandtreatments/ecg-test loose, reattach
it, and restart
Cables and Sensors. (2017). 12- the tracing.
Lead ECG Placement Guide with 7.Instruct
Illustrations | Cables and Sensors. patient to
breath normally.
Cables and Sensors.
8. Observe the
https://www.cablesandsensors.com/
strips properly
pages/ while until done.
12-lead-ecg-placement-guide-with-
illustrations#5

Jane, D. (2020).
Electrocardiography (ECG). Nursing
Crib.
https://nursingcrib.com/medical-
laboratory-diagnostic-
test/electrocardiography-ecg/

6
ULTRASOUND 9-12 cm long, POSITIVE 1. Ensure consent 1.Place patient 1. After the test
4-5 cm wide, GLOMERU- is obtained prior in supine clean the residue
It is a medical test that uses high
3-4 cm thick LONEPRITIS the procedure. position or of the gel in the
high-frequency sound waves to
No right/left lateral; client’s lower
capture live images from the inside 2. Promote
inflammation decubitus abdomen using
of the body. The images can privacy of the
Noted. position soft cloth.
provide valuable information and patient until the
helped diagnose the causes of pain, procedure is 2. Help patient 2. Educate
swelling and infection in the body's done. is repositioning. patient that there
internal organs and to examine an is no possible
3. Educate patient 3.Instruct
unborn child (fetus) in pregnant side effect in
the importance of patient that she
women. In infants. It also helps regards to the
the procedure and may feel mild
guide biopsies, diagnose heart procedure.
why is it pressure from
conditions, and assess damage
conducted. the transducer. 3. Educate
after a heart attack. Ultrasound is
patient that the
safe, noninvasive, and does not use 4. Inform as well 4.Instruct
results will be
radiation. the patient that patient to listen
analyzed or
that the test is to physician
This kind of procedure is often the interpreted by the
first test to do to examine the noninvasive and instruction
physician.
kidneys and this is indicated to the does not use during the
patient because the patient showed radiation and procedures
signs and symptoms of oliguria, won’t require such as holding
generalized edema, blood in urine, sedating that breaths
fatigue and hypertension that can he/she should feel intermittently
be seen to a patient having a no discomfort. during the
possible kidney problem. Thus, this exam.
kind of procedure can help to 5.Inform patient
assess and identify if there is a that foods, fluids, 5.Instruct
problem in the kidney structures and ordered patient to say if
such as tumor, abscesses, medications are any discomfort
obstructions, fluid collection and not restricted prior is felt during the
infection within or around the procedure.

7
kidneys as well have a good to this test.
visualization for the biopsy.
6. Explain that the
Reference: test will take
approximately 30-
RSNA, A. (2020). General 60 minutes to
Ultrasound. Radiologyinfo.org. complete.
https://www.radiologyinfo.org/en
/info/genus.Ultrasoundimaginusess 7. Educate patient
oundwaves,(fetus)pregnantwomen. that a conductive
gel paste or gel
which is cold will
Frothingham, S. (2021). What to be applied to
Know About Kidney Ultrasounds. his/her back and
Healthline; Healthline Media. flank to allow
https://www.healthline.com/health/ki sound
dney-ultrasound transmission.
8. Instruct patient
Unfried A. (2018). Renal to minimize
Procedures: Nursing Protocols & movement during
Patient Management.Study.com. the procedure.
https://study.com/academy/lesson/r 9. Instruct patient
enal-procedures- nursing-protocols- to empty the
patient-management.html bladder prior to
performing the
procedure.

KIDNEY BIOPSY Normal GLOMERULO- 1. Ensure consent 1. Place patient 1. After the test
kidney NEPHRITIS is obtained prior in supine let patient lie on
-A kidney biopsy is a procedure that structure and the procedure. position on the her back for few
involves taking a small piece of tissue.

8
kidney tissue for examination using 2. Ensure that examination hours.
a microscope. The kidney tissue blood test was table.
2.Take Vital
was then sent in the lab and be done and relay to
2.Remind signs:
examined by a pathologist—a the physician prior
patient to
doctor who specializes in to the procedure. -Every 15 min for
remain calm
diagnosing diseases. A kidney To prevent risky 1hr
throughout the
tissue sample can show biopsy.
procedure and -Every30 min for
inflammation, scarring, infection, or
3. Hold one unit of minimize 2hrs
unusual deposits of a protein called
blood with client moving.
immunoglobulin. -Every 1hr to next
blood type as per
3. Ensure pack morning
A kidney biopsy is performed to the doctor’s order.
of RBC is
case of the patient in order to -Every 4h to next
4. Educate patient already
evaluate some alerting symptoms
the importance of prepared in the morning.
manifest by her and as well to
remaining NPO room. 3. Monitor pain
identify the kidney disease and how
for 6hrs except assessment.
severe it is. 4.Give
medication.
sedatives 4. Monitor patient
4. Ask for history through the IV. for bleeding or
Reference: of bleeding any signs and
5.Once in
disorder. symptoms of
Giorgi, A. (2018). Renal Biopsy. position assist
infections.
Healthline; Healthline Media. 5. Ask patient if the physician.
https://www.healthline.com/health/r he/she ingested 5. Instruct patient
6.Observe
enal-biopsy any medication that she is under
patient for any
prior to the complication NPO for 4hrs.
Cattran D. (2022). Kidney Biopsy |
procedures such that may arise.
NIDDK. National Institute of
as aspirin or
Diabetes and Digestive and Kidney
warfarin.
Diseases.
https://www.niddk.nih.gov/health- 6. Obtain Vital
information/diagnostic-tests/kidney- Sign.

9
biopsy 7. Monitor Blood
Glucose level.
8. Educate patient
the importance of
the procedure.
9. Insert an IV line
into the vein to
give fluids and
medication,
including
sedatives.
10. Have a strict
control of blood
pressure of the
patient to reduce
bleeding risk.
Hemo Glucose Test 80-110 mg/dL 140 mg/dL 1.Before 1. Position 1. Apply pressure
beginning the client in semi- or ask the patient
Blood glucose test is a blood test (H)
procedure, upright position to apply pressure,
that screens for diabetes by
determine if there or upright in to the puncture
measuring the level of glucose
are any condition chair. site.
(sugar) in a person’s blood. It is
present that could
often used to help diagnose and 2.Encourage 2.Assist patient to
affect the reading
monitor diabetes. the patient to
a comfortable
such as if the
keep their
position and ask
This procedure is indicated to the patient is fasting
hands warm if she have any
patient due to she was diagnosed or has done
question in
with diabetes 2 years ago and eating. 3. Educate
regards to the
having such disorder is one of the patient that she
2. Assess the procedure.
risk factors that may cause possible may feel a little
patient for signs
organ problem such as filtration in pressure made 3. Instruct patient

10
the kidney. This is were also done and symptoms of by needle. call and inform us
to check if the patient is suitable to hyperglycemia or nurses if she
4. Ask patient if
undergo any invasive procedure. hypoglycemia to feels
she has a
correlate data to uncomfortable
preferred finger
pursue action due after the
site to be used.
to an onset of procedure.
symptoms. 5. Cleanse the
4. Document the
site with an results and
3. Determine if the
alcohol swab related
test require
for 30 seconds assessment
special timing
and allow it to findings.
before or after
Reference: dry. Perform the
meals according
skin puncture
Mathew, T. K., & Prasanna Tadi. to doctor’s order.
with the lancet,
(2021). Blood Glucose Monitoring. 4. Gather supplies using a quick,
Nih.gov; StatPearls Publishing. before proceeding deliberate
https://www.ncbi.nlm.nih.gov/books/ to client’s room. motion against
NBK555976/ the patient’s
5. Explain the
Cattran D. (2022). Kidney Biopsy | skin.
importance ofthe
NIDDK. National Institute of procedure andthe 6. Gently
Diabetes and Digestive and Kidney process to the squeeze above
Diseases. patient. the site and
https://www.niddk.nih.gov/health- wipe away the
information/diagnostic-tests/kidney- 6. Have the
first drop of
biopsy patient wash its
hands with soap blood with
For, R. (2021). Checklist for Blood and warm water. gauze, transfer
Glucose Monitoring. the second drop
Pressbooks.pub; Pressbooks. of blood.
https://wtcs.pressbooks.pub/nursing
skills/chapter/19-8-checklist-for-

11
blood-glucose-monitoring/

Chest X-ray Normal lung No sign of 1.Before 1.Guide patient 1. After images
structure and Pleural beginning the in proper are taken, guide
-A chest X-ray is an imaging test no fluid Effusion procedure, ask if position. patient to room to
that uses X-rays to look at the accumulation. patient is pregnant provide the
structures and organs in the chest. 2. Encourage
or suspected of appropriate
It can help the healthcare provider the patient to
being pregnant. clothing.
to see how well the lungs and heart listen to the
are working. Because certain heart 2. Assess the instruction of 2. Provide
problems can cause changes in the patient’s ability to the radiologist comfort by
hold her breath during the providing privacy.
lungs such as fluid accumulation or
and educate that procedure.
air surrounding the lung. The image 3.Educate patient
this may need
helps the doctor determine whether that result will
later on during the take time and
a patient may have heart problems, procedures. only the doctor
a collapsed lung, pneumonia,
3. Instruct patient will see the result
broken ribs, emphysema, cancer or in order to help
any of several other conditions. It that presence of
her condition.
can also use to see fractures, metallic object
within the area of
postoperative changes such as
examination is
tubes to see if position correctly.
prohibited and
This procedure is indicated to the must be left in the
patient because having fluid room.
retention is one of the seen 4. Explain the
symptoms if kidney problems were importance of the
evident and is seen in the client’s procedure and the
condition. It can cause swelling in process to the
arms, legs, high blood pressure or patient.
fluid in the lungs thus, having this

12
procedure can help see if our 5. Educate that
patient may have fluid in the lungs patient the need
to prevent worsening her condition to remove the
and manage immediately. underclothing to
ensure accuracy
of the results and
Reference: proper gown will
be provided.
Jean, B. (2021). Acute
Glomerulonephritis in the ED: 6. Provide Privacy
to the patient.
Practice Essentials, Emergency
Department Care. Medscape.com;
Medscape.
https://emedicine.medscape.com/ar
ticle/777272-overview
Martin P. (2019). Chest X-ray
(Chest Radiography) Nurse Study
Guide. Nurseslabs.
https://nurseslabs.com/chest-x-ray/

ABG ANALYSIS pH PH- 7.25 (L) Obtain syringe Usual site is the Apply direct
An arterial blood gases (ABG) test 7.35-7.45 pCO2- with heparin, radial artery. pressure on site
measures the acidity (pH) and the 45mmhg rubber stopper, Perform Allen’s for 5-10 minutes,
levels of oxygen and carbon dioxide pCO2 HCO3- container with ice Test send specimen
in the blood from an artery. This test 35-45 mmhg 177mmol/L (L) with occluded
is used to find out how well your SaO2-95% needle on ice.
lungs are able to move oxygen into paO2 Metabolic
the blood and remove carbon 80-100 mmhg acidosis,
dioxide from the blood. Acid Base Partially

13
Disorders (ABDs) are commonly HCO3 Compensated
encountered in Kidney Disease 22-26 mEq/L
patients. Timely and correct
analysis of Arterial Blood Gases Base excess
(ABG) is critical for the diagnosis, -2 to +2
treatment and prediction of outcome
of the patients O2
saturation
95-98%
COMPLETE BLOOD COUNT WBC (4.0- 5.7 obtain syringe, Cubital vein is Place a direct
The CBC can evaluate your overall 10.5) tourniquet, vial commonly used pressure on the
health and detect a variety of with appropriate for venipuncture site and observe
diseases and conditions, such as RBC (4.10- 5.27 anticoagulant for bleeding.
infections, anemia and leukemia. A 5.160) Label the vial with
decrease in the hematocrit may necessary
indicate a dilutional anemia. When Hemoglobin 8.0 (L) information.
your kidneys are damaged, they (12.5-17.0)
produce less erythropoietin (EPO),
a hormone that signals your bone Hematocrit 30.2 (L)
marrow—the spongy tissue inside (36.0-50.0)
most of your bones—to make red
blood cells. With less EPO, your MCV 84
body makes fewer red blood cells, (80-90)
and less oxygen is delivered to your
organs and tissues. MCH 29.2
(27.0-34.0)

MCHC 34.9
(32.0-36.0)

RDW 13.7
(11.7-15.0)

14
Plaetelets 268
(140-415)

Neutrophils 47
(40-74)

Lymphs 46
(14-46)

Monocytes 6
(4-13)

Eos 1
(0-7)

Basos 0
(0-3)

Neutrophils 2.6
(1.8-7.8)

Lymphs 2.6
(0.7-4.5)

Monocytes 0.4
(0.1-1.0)

Eosinophil 0.1
(0.0-0.4)

Baso 0.0
(0.0-0.2)

15
 Immature 0
(0-1)

Gran 0.0
(0.0-0.1)
IG (Abs)

SERUM CREATININE Women 6 mg/dL (H) obtain syringe, Cubital vein is Place a direct
A creatinine test, also called a 0.6-1.1mg/dL tourniquet, vial commonly used pressure on the
serum creatinine test, is a way for with appropriate for venipuncture site and observe
Men anticoagulant for bleeding.
doctors to measure how well your
0.7-1.3mg/dL Label the vial with
kidneys are working. Creatinine is a necessary
waste product from the normal information.
breakdown of muscle tissue. As
your body makes it, it's filtered
through your kidneys and expelled
in urine. Your kidneys' ability to
handle creatinine is called the
creatinine clearance rate, and this
helps estimate how fast blood is
moving through your kidneys, called
the glomerular filtration rate (GFR).
SERUM ELECTROLYTES- Sodium 145mEq/L obtain syringe, Cubital vein is Place a direct
Also known as an electrolyte panel, 135-147 tourniquet, vial commonly used pressure on the
is a blood test that measures the mmol/L with appropriate for venipuncture site and observe
anticoagulant for bleeding.
levels of the body’s main
Potassium 6.5mEq/L (H) Label the vial with
electrolytes (sodium, potassium, 3.5-5.2 necessary
chloride, bicarbonate—they conduct mmol/L information.
electrical impulses in the body).
Chlorine 95mEq/L

16
 96-106
mEq/L

Phosphorus 3.5mEq/L
2.8 to 4.5
mg/dL

Magnesium 1.5mEq/L
1.7-2.2 mg/dL
URINALYSIS/UA Color: Yellow Appearance: -Inform the patient -Observe -Transport
A urinalysis is a simple test done tea colored about the standard specimen to the
that looks at a small sample of your Appearance: (presence of procedure precaution laboratory for
urine. This test is done for several Clear blood) urinalysis when handling processing and
urine analysis
reasons like to check for the overall
Specific Glucose: 3+ -Give the patient a specimens.
health-might be part of the routine gravity: clean and dry/ -Follow up results
medical exam, pre-op preparations 1.001-1.035 Occult blood: sterile specimen -Cover all and relay to the
or used for screening for a variety of (+) positive container. specimens physician and
disease (kidney and urinary tract); pH: tightly, label attach a copy of
to diagnose a medical condition- 5.0-8.0 Protein: 5+ -Instruct patient properly (with the results to the
may be requested to help diagnose on how to get a patient’s patient’s chart.
Glucose: RBC: 5+ clean-mid stream surname and
the signs and symptoms
negative catch sample initials, time and
experienced by a patient; to monitor (allow a few date,
a medical condition- a regular urine Bilirubin: amount of urine medications
testing is requested to monitor negative and catch taken) and send
condition and treatment midstream urine immediately to
Ketone: directly into the the laboratory
negative container)
- If the
Occult specimen
blood: cannot be
negative delivered to the

17
 laboratory or
Protein: tested within
negative one hour it
should be
Nitrite: refrigerated or
Negative have an
appropriate
Leukocyte preservative
Esterase: - added.

Urine
microscopic
WBC: <= 5
WBC/HPF

RBC: <= 2
RBC/HPF

Squamous
epithelial:
<=5 HPF

Bacteria:
none seen
/HPF

Crystals:
none seen
/HPF

Casts: none
seen /HPF

18
 Yeast: none
seen /HPF

Appearance: Occult blood: -Inform patient -A peanut size -Instruct patient

solid and negative about the of stool is for proper
formed procedure needed. handwashing.
-Observe
Color: -Assess patient’s standard -Instruct patient
Brown level of comfort precaution to resume
and give a stool while handling activities and diet
Epithelial specimen stool specimen unless
cells: few to container (sterile contraindicated
moderate or clean) -Securely cover
specimen
Fecal - Instruct patient properly, label
fat:<7g/24ho that only peanut properly and
urs size of stool is send to the
needed laboratory for
Leukocytes analysis
(WBC):
negative

Occult
blood:
negative

Reducing
substance:
negative

Trypsin: 2+

19
 to 4+

BLOOD UREA NITROGEN (BUN) 10-20 mg/dl 25 mg/dl (H) -Inform the patient Assist patient -Instruct patient
TEST about the while drawing to apply direct
A blood urea nitrogen (BUN) test procedure, that blood pressure on the
reveals important information about blood will be (Apply site.
the status of the kidneys. BUN test drawn for this tourniquet and
procedure. instruct patient -Educate patient
measures the amount of urea
to close the fist, that there may be
nitrogen that is in the blood. -Refer to medical cubital vein is some throbbing
Nitrogen comes from the waste technologist for commonly used or slight bruising
product urea. Urea is made when scheduling for and this soon will
protein is broken down in the body (Prepare the venipuncture, go away
necessary release the
equipment for tourniquet, -Document
venipuncture and insert the procedure and
drawing if blood: syringe into the wait for results.
syringe, vial) Relay results to
tourniquet, vial the physician.
with correct -Label the vial
anticoagulant) properly.

20
TEST RESULTS IN RELATION TO THE PATIENT’S CONDITION

21
1. 12-Leads Electrocardiogram shows This test result of elevated T wave would primarily relate to the
elevated T wave patient’s condition of having high level of potassium in the blood.
Early indication of hyperkalemia is a peaked T wave.

Reference:
Lederer, E. (2020). What do ECG findings indicate in hyperkalemia
(high serum potassium level)? (2021, October 17). Medscape.
https://www.medscape.com/answers/240903-11014/what-do-ecg-
findings-indicate-in-hyperkalemia-high-serum-potassium-level

2. Chest X-ray shows no sign of This test result of a normal chest x-ray would mean that the
pleural effusion condition, mainly the disease progression of the patient has not yet
exacerbated in other organs such as the lungs since most common
manifestation of complication in the lungs include the fluid build-up
brought about by the Acute Glomerulonephritis. This is mainly
evident with the patient’s normal respiratory assessment which
include, no nasal flaring, no difficulty of breathing, and a respiratory
rate of 12cpm.

Reference:
Rull, G. (2018, June 16). Glomerulonephritis. Causes, Symptoms and
Treatment | Patient. https://patient.info/kidney-urinary-
tract/glomerulonephritis-leaflet

3. Ultrasound of the Kidney shows This test result indicates that the patient has an existing
Positive Glomerulonephritis inflammation in the glomeruli or the tiny filtrations located in the
kidneys. The patient is also developing signs and symptoms
4.Kidney Biopsy shows accustomed with the manifestations of this disease like the
Glomerulonephritis generalized edema, hematuria, and fatigue. In addition, it is most
likely caused by the chronic use of Non-steroidal anti-inflammatory
drugs of the patient for 2 years. NSAIDS would then cause the
blockage of prostaglandins which are the natural chemicals that
dilate blood vessels and allow oxygen to reach the kidneys to keep
them alive and healthy. This is also counter-regulatory by means of
regulating and working interdependently with the vasoconstrictor
systems in the local areas of the kidneys which include angiotension
II, norepinephrine, vasopressin, and endothelin.

However, when these prostaglandins are blocked, it would cause a

decrease renal blood flow as there will be not enough
prostaglandins to dilate the blood vessels to allow the blood to pass
through the kidneys. As a compound effect, the glomerular
filtration rate (GFR) would also decrease as there would be less
blood to be filtered. When this continues to happen, there would be

22

5. Complete Blood Count –
Hgb: 8.0 (LOW)
HCT: 30.2 (LOW)
6. Serum Electrolytes
 Potassium: 6.5mEq/L (HIGH),
 Creatinine: 6mg/dL ( HIGH)
 BUN: 25mg/dL ( HIGH),
 Cholesterol: 200mg/dL (HIGH),
 Triglycerides: 150mg/dL
(HIGH)
 HDL: 60mg/dL (LOW)
 LDL: 150mg/dL (HIGH)
insufficient blood supply resulting to decreased oxygen supply in the
cells and tissues of the kidneys, particularly this glomeruli leading to
a damage or injury to this area of the kidney. When there is injury
and damage, it is the body’s defense mechanism to protect the body
against infection and further injury by means of an inflammatory
process. In spite of that, when the inflammation and damage
progresses, that’s where a disease develops either acute or chronic
such as what the patient experiences – the Acute
Glomerulonephritis.
Reference:
Roberts, S. M., MD. (2021, June 11). Do NSAIDs Cause Kidney Injury?
Ochsner Health System. https://blog.ochsner.org/articles/do-nsaids-
cause-kidney-injury
This result of low hemoglobin and hematocrit indicates that the
patient’s kidney damage is progressing and is now affecting the
production of erythropoietin. This is clearly manifested with the
patient feeling weak and tired as it can be also a sign of anemia.
Reference:
Anemia in Chronic Kidney Disease. (2022, January 12). National
Institute of Diabetes and Digestive and Kidney Diseases.
https://www.niddk.nih.gov/health-information/kidney-
disease/anemia
High potassium would primarily relate to the patient’s condition of
chronic use of NSAIDS. Because of this, as mentioned, prostaglandin
is blocked causing the retention of the potassium resulting to
hyperkalemia.
Creatinine and BUN is also high since the inflammation causes the
immune cells to congest at the site thereby resulting for the waste
not to be filtered properly and building up in the blood. This is
evident as the patient manifest fatigue and tiredness.
Cholesterol, Triglycerides and LDL are slightly increased and the HDL
is slightly decreased because of the existing kidney damage that
alters the cholesterol level. In addition, inflammation can cause bad
(LDL) cholesterol to stick around in the body thus making it elevated.
Reference:
Roberts, S. M., MD. (2021, June 11). Do NSAIDs Cause Kidney Injury?
23

7. Urinalysis
Appearance: Tea-colored, presence of
blood, Glucose (3+), Occult blood (+),
Protein (5+)
8. HGT – 140mg/dL (HIGH)
Ochsner Health System. https://blog.ochsner.org/articles/do-nsaids-
cause-kidney-injury
This test result relates to the patient’s condition of having acute
glomerulonephritis because this disease manifests hematuria and
proteinuria in its early progression. This is originated with the
inflamed glomerular area which caused the increased permeability
in the barriers. This allows the red blood cells and protein to be
included in the filtration along with the waste products to be
excreted in the urine. Thereby causing presence of blood, protein,
and a tea-colored appearance of urine..
A positive 3 glucose result in the urine is mainly because of the
elevated blood glucose level of the patient which is related to the
Diabetes Mellitus in which the patient was diagnosed with.
Reference:
Rull, G. (2018, June 16). Glomerulonephritis. Causes, Symptoms and
Treatment | Patient. https://patient.info/kidney-urinary-
tract/glomerulonephritis-leaflet
This test result of high HGT would primarily relate to the patient’s
condition because the patient is diagnosed with Diabetes Mellitus at
age 34. This would mean that the blood glucose levels has elevated
due to the said existing disease and has not been controlled.
However high blood glucose can affect the acute kidney disease that
the patient is currently experiencing if not treated promptly. This
can lead to an elevated blood pressure thereby causing damage to
the blood vessels located in the kidneys.
Reference:
Diabetic Kidney Disease. (2022, January 12). National Institute of
Diabetes and Digestive and Kidney Diseases.
https://www.niddk.nih.gov/health-
information/diabetes/overview/preventing-problems/diabetic-
kidney-disease
24
9. ABG – This result mainly reiterates that the patient is experiencing damage
pH: 7.25 in the kidneys. Because of this damage, kidneys can’t remove
PCO2: 45mmHg enough acid resulting it to build-up in the blood leading to metabolic
HCO3: 27mmol/L acidosis.
SAO2: 95
Reference:
Interpretation: Metabolic Acidosis, Facts about Metabolic Acidosis and Chronic Kidney Disease. (2019,
Partially Compensated September 4). National Kidney Foundation.
https://www.kidney.org/atoz/content/facts-about-metabolic-
acidosis-and-chronic-kidney-disease
10. Stool Exam – (-) Occult Blood This test result of negative occult blood in stool indicates that there
is no bleeding problem in the lower gastrointestinal tract of the
patient. This means that the patient did not suffer from GI bleeding
and problems despite the chronic use of NSAIDs.

Reference:
Managing the Adverse Effects of NSAIDs. (2011, September 28).
Medscape. https://www.medscape.com/viewarticle/750226_3

25
 NURSING RESPONSIBILITIES

Laboratory test
Laboratory test result Nursing Responsibilities
ordered

1. Monitor the patient’s electrolyte levels specifically

potassium levels.
R: The patient’s potassium levels is elevated thereby possibly
causing the elevation of T waves in the ECG tracing. Careful
monitoring is advised to immediately address possible
occurrence of myocardial infarction.

2. Assess and monitor patient’s heart rate, blood pressure,

and respiratory status.
Shows elevation of T-wave R: Changes in these vital signs may suggest further
complications.

3. Educate patient about some dietary modifications.

ECG - R: It is advisable to lower intake of cholesterol, potassium
Electrocardiogram containing foods and to have moderate intake also of protein.
This is to aid in preventing occurrence of heart problems and
decreasing the damage of the kidneys.

4. Administer potassium-excreting diuretics as prescribed.

R: This type of mediations can help lower the potassium
levels in the body thereby and to further lessen the
progression of the elevated T waves in the ECG.

5. Prepare administration of IV calcium gluconate, as per

doctor’s orders.
R: High levels of potassium in the body can be fatal to the
patient. This type of medication is considered to be the first-
line agent used to treat severe hyperkalemia. Therefore,
careful monitoring of potassium levels and ECG changes are

26
 advised.

1. Administer diuretics and antihypertensive medications

as prescribed.
R: Since the patient has generalized edema, giving diuretics
can decrease the plasma volume and edema thru diuresis.
Positive glomerulonephritis
An addition, antihypertensive medications may also aid since
the patient is hypertensive, this medication can provide a
vasodilatory effect which helps in reducing water retention.

2. Assess for the patient’s current status, which includes;

evaluating edema, checking intake and output, and vital
signs, especially the patient’s respiratory rate and blood
Ultrasound and pressure.
Kidney Biopsy R: Evaluating edema is necessary in order to monitor for the
effectiveness of the given medications. Pulmonary
congestion may also occur of edema is not thoroughly
monitored. Intake and output is important to know
progressing condition via glomerular filtration. As edema
exists, there is an increase probability that it may accumulate
in the lungs, blood pressure taking is also indicated for the
reason that, high blood pressure is one of the common factor
that contributes to occurrence of edema.

3. Elevate the patient’s extremities with pillows when at

rest or at lying position. You may also assist the patient

27
 in changing position every 2 hours.
R: Provide elevation for feet and ankles or arms as
necessary to allow gravity to assist in reducing edema.
Frequent position change lessens pressure on body parts
and prevents the accumulation of fluid in the dependent
areas.

4. Monitor the patient’s electrolyte levels and renal function

lab results.
R: Since patient has an edema, electrolyte imbalances occur
which can lead to muscle weakness or spasticity and affect
cardiac output. Monitoring also for renal function results can
help you aid in the possible occurrence of kidney failure.

5. Refer to a dietician for a consultation to develop a meal

plan low in sodium, potassium, and protein that includes
preferred foods as allowed. Also, maintain fluid
restrictions as indicated.
R: A proper diet plays a vital part in controlling the symptoms,
maintaining nutrition and in the management of the disease.
Since patient has edema, fluid must be controlled.

1. Assist the client in developing a schedule for daily

Abnormal results:
Complete Blood
 Hemoglobin – 8.0 g/dL
Count
 Hematocrit – 30.2
2. Provide supplemental oxygen therapy as needed.
activity and rest. Stress the importance of frequent rest
periods.
R: Since the patient has a low count of RBC, there is a low
number also of RBC that circulates throughout the body
which causes fatigue.
R: Red blood cells are oxygen-carrying blood, with the low
number of RBC in the patient’s laboratory result, this means
that low oxygen is being carried out to supply the patient’s

28

Abnormal levels:
 Potassium – 6.5 mEq/L (↑)
 BUN – 25 mg/dl (↑)
 LDL-C – 150mg/dl (↑)
Serum Electrolytes
 Creatinine – 6 mg/dl (↑)
 Cholesterol – 200 mg/dl (↑)
 Triglyceride – 150 mg/dl (↑)
 HDL-C – 60mg/dl (↓)
demand (RR: 12 cpm).
3. Administer medications that can/may stimulate red blood
cells production as prescribed by the physician.
R: Erythropoietin aids in stimulating the production of red
blood cells in the bone marrow. With that, since the patient
has kidney problem, this lead to low production of RBC. With
these types of medications, it may increase the number of
RBC’s in the circulation decreasing the chances of doing
blood transfusion.
4. Encourage deep breathing techniques and administer
oxygen as prescribed.
R: Breathing exercises helps increase how much oxygen’s in
your blood and also helps in boosting the delivery of oxygen
to the different tissues of the body.
5. Monitor pulse oximetry and report O2 saturation <95%.
R: A low oxygen saturation indicates that there is inadequate
amount of oxygen thus, needing for supplementation of
oxygen.
1. Monitor heart rate and rhythm. Be aware that cardiac
arrest can occur.
R: Potassium excess depresses myocardial conduction.
Bradycardia can progress to cardiac fibrillation and arrest.
2. Monitor urine output.
R: Since patient has glomerulonephritis, potassium is
retained because of improper excretion. Potassium is
contraindicated if oliguria or anuria is present.
3. Administer diuretics as ordered.
29
 R: Diuretics can aid in reducing the potassium levels in the
body, since the kidneys are unable to excrete those excess
potassium. This may also help in reducing water retention
and reducing the risk for heart attack.

4. Ensure the patient’s safety by putting the side rails up

always and not leaving the patient unattended.
R: With renal dysfunction, as creatinine and BUN levels
continue to rise, the patient is likely to experience fatigue,
muscle weakness.

5. Monitor heart rate and BP.

R: Tachycardia and hypertension can occur because of: (1)
failure of the kidneys to excrete urine, (2) excess fluid
resuscitation during efforts to treat hypovolemia and/or
hypotension or convert oliguric phase of renal failure, (3)
changes in the renin-angiotensin system.

6. Maintain patient’s skin integrity.

R: A patient with a high creatinine and BUN may complain of
itching skin and the nurse should assess the patient
frequently for signs of skin breakdown.

7. Refer to a dietician to implement dietary sodium, fat, and

cholesterol restrictions as indicated.
R: These restrictions can help manage fluid retention and,
with the associated hypertensive response, decrease
myocardial workload.

8. Discuss the necessity for decreased caloric intake and

limited fats, salt, and sugar as indicated.
R: Excessive salt intake expands the intravascular fluid
volume and may damage kidneys, which can further
aggravate hypertension. Restriction on salt intake and

30
 lowering intake of saturated fats and cholesterol helps in
reducing body weight.

1. Assess and monitor blood glucose level.

R: Monitoring is essential to the patient for the main reason
that she is diabetic. This also determines the need for
providing insulin and diabetic medications.

2. Refer the patient to dietician for dietary changes.

Abnormal levels: R: Modifications in the patient’s food intake will contribute
 HGT - 140 mg/dl stabilization of blood glucose levels.
 ABG
- pH – 7.25 (↓) 3. Administer insulin medications as directed.
- pCO2 – 45mmHg R: Insulin helps control blood glucose levels by signaling the
HGT and ABG - HCO3 – 17mmol/L (↓) liver and muscle and fat cells to take in glucose from the
- SaO2 – 95% blood. Insulin therefore helps cells to take in glucose to be
used for energy.
Metabolic Acidosis, Fully
Compensated 4. Assess LOC and note progressive changes in
neuromuscular status.
R: Decreased mental function, confusion, seizures,
weakness, flaccid paralysis can occur because of hypoxia
and hyperkalemia.

5. Monitor heart rate and rhythm.

R: Metabolic acidosis can cause changes in the ECG

31
 tracing. This may be manifested as brady dysrhythmias as
well as increased ventricular irritability such as fibrillation
(signs of hyperkalemia).

6. Observe for altered respiratory excursion, rate, and

depth.
R: Deep, rapid respirations (Kussmaul’s) may be noted as a
compensatory mechanism to eliminate excess acid; however,
as potassium shifts out of cell in an attempt to correct
acidosis, respirations may become depressed.

7. Assess skin temperature, color, capillary refill.

R: Evaluates circulatory status, tissue perfusion, effects of
hypotension.

8. Modify diet as indicated: low-protein, high-carbohydrate

diet in presence of renal failure.
R: Restriction of protein may be necessary to decrease
production of acid waste products, whereas addition of
complex carbohydrates will correct acid production from the
metabolism of fats.

1. Cleanse perineal area and keep dry. Provide catheter

care as appropriate.
Abnormal findings: R: Proper perineal hygiene decreases risk of skin irritation or
 Appearance – tea color breakdown and development of ascending infection.
Urinalysis  Occult blood - positive
 Protein – 5+ 2. Assess vital signs. Check for changes in mentation,
 RBC – 5+ hypertension, and peripheral or dependent edema.
Weigh daily. Maintain precise I&O record.
R: Kidney failure results in reduced fluid excretion and builds
up of toxic wastes. It may lead to complete renal shutdown.

32
3. Limit fluids as ordered; allow intake of the amount lost
via urine and insensible losses.
R: Avoids additional fluid retention and edema in the
presence of renal damage.

4. Educate the patient to avoid taking ibuprofen, naproxen,

acetaminophen (Tylenol), or similar medicines, unless
your doctor tells you to.
R: Patient already has a history of chronic use of NSAID
specifically ibuprofen, with that, it is best to educate
avoidance for the main reason that this may make the kidney
problem worse.

33
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Anemia in Chronic Kidney Disease. (2022, January 12). National Institute of Diabetes
and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-
information/kidney-disease/anemia

Brown, B.J., Sinert, R. (2021). Acute Glomerulonephritis in the ED.

https://emedicine.medscape.com/article/777272-overview

Cables and Sensors. (2017). 12-Lead ECG Placement Guide with Illustrations | Cables
and Sensors. Cables and Sensors. https://www.cablesandsensors.com/pages/
12-lead-ecg-placement-guide-with-illustrations#5

Cattran D. (2022). Kidney Biopsy | NIDDK. National Institute of Diabetes and Digestive
and Kidney Diseases. https://www.niddk.nih.gov/health-information/diagnostic-
tests/kidney-biopsy
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ECG-test-Better Health Channel. (2020). Vic.gov.au.

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ecg-test

Facts about Metabolic Acidosis and Chronic Kidney Disease. (2019, September 4).
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acidosis-and-chronic-kidney-disease

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Lederer, E. (2020). What do ECG findings indicate in hyperkalemia (high serum

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hyperkalemia-high-serum-potassium-level

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35
36