Glomerolonephritis -Inflammation of the glomerulus -this may be brought by immunologic processes that result in inflammatory and proliferative changes

-it can be acute or chronic -usually manifested by either neoplastic or nephroticsyndrome Classification describes it: 1. 2. 3. Extent of damage (diffuse or focal) Initial cause of disorder (SLE, systemic sclerosis, streptococcal infxn) Extent of changes (minimal or widespread)

Med MGT of glomerulonephritis: Goal: -eliminate antigens -alter immune balance -inhibit or alleviate inflammation Treatment is typically on an outpatient basis Treatment: Plasmapheresis removes the circulating specific antibody or mediators of the inflammatory response -Large volumes of client s plasma are clinically removed and replaced with fresh frozen plasma through a continuous flow blood cell separator Cortecosteroids& immunosuppressive agents -administered in conjunction with plasma pharesis to minimize inflammation Antibiotic therapy penicillin for strep.Infxn Multiple Myeloma -malignancy of the plasma B cells characterized by infiltration of the cells into the bone marrow, which leads to destruction of bone marrow cells, destruction of the bone cortex & the secretion by the cells of the monoclonal paraprotein. Etiology neoplastic proliferation of the B cells Risk Factors: -increase in incidence in some families -ionizing radiation -occupational chemical exposure -incidence is 4:100,000 people -men are affected twice as often as women -usually develops at age 40 -accounts for 1% of all malignancies PATHO

Nephrotic Syndrome set of clinical manifestation caused by protein wasting s/t diffuse glomerular damage. Manifestations: -proteinuria -Hypoalbuminemia -edema Causes: DM, Hepa B, Syphilis, Carcinoma, Leukemia, Preeclampsia Predisposing factors: Allergic rxn to drugs, renalucin thrombosis, sickle cell dse, heart failure Goal of Care: 1. 2. 3. Heal the leaking glomerular basement membrane Stop ___ of protein on the urine Break the cycle of edema

Intervention: 1. 2. 3. Maintaining fluid and electrolyte balance Reducing inflammation Minimizing protein loss

NSG considerations: unless hyponatremic fluids are not usually restricted 1. 2. 3. 4. 5. 6. 7. 8. 9. Monitor daily weight Girth measurements I & O determination Mild sodium restriction Potassium may be restricted Skin care Prevent thrombosis Minimize protein loss 24hr urine collection 1.5g/kg/24hr

HX teachings: 1. 2. 3. Take prescribe meds regularly Follow prescribed diet Report changes in hx status: -increasing edema -reduced urine output -weight gain -respiratory distress -signs of infection

4. Bed rest is imposed on severe edema 5. Proper nutrition 6. teach prevention of infxn Nephretic Syndrome: -refer to a set of clinical manifestations that include hematuria & at least one of the following -oliguria (urine output < 400mL/24hrs -hypertension -decreased GFR Treatment: 1. 2. Mgt of underlying dse Symptomatic tx of BP & uremia

Clinical Manifestations: -skeletal systems (pelvis, spine, ribs) -most common presenting complaints: Bone -hypercalcemia -renal stones -hyperurecemia -bleeding -carpal tunnel syndrome Diagnostics Examinations: -radiographic studies of the bone -bone marrow biopsy -blood exam (CBC, plasma electrophoresis) -urine examination

MED MGT: -no cure for multiple myeloma -median survival in 3 yrs -early recognition and treatment of complications -clients who are asymptomatic are carefully monitored until the disease progresses -hospitalization is required to many of pain and treatment of complications -clients who are asymptomatic are carefully monitored until the disease progresses -hospitalization is required to management of pain & treatment of complications MGT: 1. Suppress bone marrow -Chemotherapy (melphalan& prednisone) given orally 47 days without contrast well tolerated & has 50-60% response rate. -Chemo may continue for 1-2 yr but condition recurs when d/c 2. Reduce Ca levels -corticosteroids & hydration are used to reduce serum Ca levels (Pamidronate Sodium (aredia)), etidonate disodium (Didronel) Treatment Complications: -pallative radiotherapy of myeloma lesions -NSAID s (acetaminophen) for pain -antiemetics& stool softeners NSG MGT: 1. 2. 3. 4. 5. 6. 7. 8. 9. I&O Blood study results Weight Monitor Ca level Caution when moving Monitor mental status Side rails & light restraints Teach family to institute safety measures & need for assistive devices @ home _______ to deal with the eventual fatal outcome.