and congested. € . € More than half of patients with IgA nephropathy (the most common type of primary glomerulonephritis) have an elevated serum IgA and a normal complement level.Assessment kidneys become large. swollen.

Some patients become severely uremic within weeks and require dialysis for survival. after a period of apparent recovery. Others.€ If the patient improves. insidiously develop chronic glomerulonephritis. the amount of urine increases and the urinary protein and sediment diminish. .

Physiology/Pathophysiology Antigen (group A beta-hemolytic streptococcus) Antigen-antibody product Deposition of antigen±antibody complex in glomerulus Increased production of epithelial cells lining the glomerulus Leukocytes infiltrate the glomerulus Thickening of the glomerular filtration membrane Scarring and loss of glomerular filtration membrane Decreased glomerular filtration rate (GFR) .

proteinuria hematuria Alteration in sodium excretion Edema and hypertention .

5 nursing diagnosis excess Fluid Volume may be related to failure of regulatory mechanism (inflammation of glomerular membrane inhibiting filtration) € acute Pain may be related to effects of circulating toxins and edema/distention of renal capsule. € imbalanced Nutrition: less than body requirements may be related to anorexia and dietary restrictions € .

€ € deficient Diversional Activity may be related to treatment modality/restrictions. and malaise. malnutrition. . fatigue. chronic illness. risk for disproportionate Growth: risk factors may include infection.

Medical Management € Management consists primarily of treating symptoms. . penicillin is the agent of choice. Corticosteroids and immunosuppressant medications may be prescribed for patients with rapidly progressive acute glomerulonephritis. If residual streptococcal infection is suspected. attempting to preserve kidney function. but in most cases of poststreptococcal acute glomerulonephritis. however. these medications are of no value and may actually worsen the fluid retention and hypertension. other antibiotic agents may be prescribed. and treating complications promptly. Pharmacologic therapy depends on the cause of acute glomerulonephritis.

edema. Loop diuretic medications and antihypertensive agents may be prescribed to control hypertension. .€ Dietary protein is restricted when renal insufficiency and nitrogen retention (elevated BUN) develop. Prolonged bed rest has little value and does not alter long-term outcomes. Sodium is restricted when the patient has hypertension. and heart failure.

In a hospital setting.Nursing Management € Although most patients with acute uncomplicated glomerulonephritis are treated as outpatients. . Insensible fluid loss through the respiratory and GI tracts (500 to 1. Intake and output are carefully measured and recorded. Fluids are given according to the patient¶s fluid losses and daily body weight.000 mL) is considered when estimating fluid loss. carbohydrates are given liberally to provide energy and reduce the catabolism of protein. nursing care is important no matter what the setting.

Other nursing interventions focus primarily on patient education for safe and effective self-care at home. and some patients may go on to develop chronic glomerulonephritis. Proteinuria and microscopic hematuria may persist for many months. .€ Diuresis begins about 1 week after the onset of symptoms with a decrease in edema and blood pressure.

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