Acute Glomerulonephritis Nursing Care

Acute Glomerulonephritis (AGN)

• An immune complex disease that occurs after a streptococcal infection (Betahemolytic streptococci)
• Etiology: Previous acute bacterial infection (pharyngitis, impetigo)
• Clinical Manifestations:
  • Hematuria (dark red or brown urine)
  • Oliguria
  • Weight gain
  • Pallor, Irritability, Fatigue
  • Mild to moderate elevated BP
  • Urine analysis reveals protein, RBC’s, WBC’s
• Diagnostic Evaluation:
  • Urine testing
  • Elevated BUN & Creatinine
  • Serum studies (antibody, complement, C-reactive protein, erythrocyte sedimentation rate, WBC, +ASO titer)
  • Throat culture
  • History of antecedent strep infection
• Nursing Diagnosis and Planning:
  • Risk for Imbalanced Fluid Volume related to retention of sodium and fluid and dietary fluid restriction
  • Risk for Activity Intolerance related to fatigue
  • Risk for Impaired Skin Integrity related to edema and decreased activity
  • Imbalanced Nutrition: Less Than Body Requirements related to diet restrictions
  • Anxiety related to insufficient knowledge about disease process or hospitalization
• Nursing Interventions:
  • Monitor vital signs, fluid balance, and behavior
  • Assess child’s appearance; check for signs of edema
  • Possible fluid restriction
  • Provide frequent rest periods
  • Teaching points: importance of finishing medications as ordered, findings of recurrence

Nephrotic Syndrome

• A kidney disorder characterized by proteinuria, hypoalbuminemia, and edema
• Can be classified as primary or secondary
• Primary nephrotic syndrome results from a disorder within the glomerulus of the kidney and is the most common type seen in children
• Management:
  • Encourage fluids to reduce fever and dilute the concentration of the urine
  • Administer I.V. fluids if necessary

Urinary Tract Infections (UTIs)

• Clinical Manifestations:
  • Fever
  • Anorexia and general malaise
  • Urinary frequency, urgency, dysuria
  • Nocturnal enuresis
  • Foul odor or change in the appearance of urine
  • Abdominal or suprapubic pain (more common in upper tract disease)
  • Tenderness over one or both kidneys
  • Irritability
  • Vomiting
  • Failure to thrive (FTT) in infancy
• Prevention:
  • Practice perineal hygiene: wipe from front to back
  • Avoid tight clothing or diapers; wear cotton panties rather than nylon
  • Check for vaginitis or pinworms, especially if child scratches between legs
  • Avoid “holding” urine
  • Lactobacillus bacteria found in probiotic yogurt can produce lactic acid, which lowers the pH of the urinary tract, making it difficult for pathogenic bacteria to grow
• Nursing Interventions:
  • Promoting Urinary Elimination:
    • Obtain a clean urine specimen for urinalysis or culture
    • Provide fluids to help the child void
    • Perform catheterization, if necessary, to obtain a sterile specimen
    • Send urine to the laboratory immediately or refrigerate to avoid a falsely high bacterial count
    • Administer antibiotics as ordered by the health care provider (after specimen has been obtained for culture)
  • Maintaining Comfort and Providing Symptomatic Relief:
    • Administer analgesics and antipyretics as ordered
    • Maintain child on bed rest while febrile