Acute glomerulonephritis

V. Pathophysiology Predisposing Factors Age: 5-10 years old Gender: Male Precipitating Factors B- hemolytic Streptococci Post infection Poor intake of vitamin rich food

Streptococcal Infection

Microorganism circulate in the blood stream

Deposition of antigen-antibody complex glomerulus

Acute inflammation and damage within the nephrons including the glomerulus

proliferation of endothelial cell lining of the glomerular capillary

leukocytes infiltration of the glomerulus

thickening of the glomerular filtration membrane

scarring and loss of glomerular filtration membrane

decrease glomerular filtration rate

Signs and Symptoms G.U. System Oliguria Hematuria Proteinuria Albuminuria G.I System Vomiting Abdominal pain Anorexia Musculoskeletal System Backpain Weakness Fatigue Respiratory system Tachypnea Dyspnea Circulatory system Decreased rbc Increased potassium Increased sodium Cardiovascular system Increased heart rate Increased blood pressure Integumentary system Skin flushing Edema Diaphoresis

VI. Nursing Management

1.Review fluid and diet restrictions.

2.measure and record intake and output.

3.Instruct patient to schedule follow-up evaluations of blood pressure, urinalysis for protein, and BUN and creatinine studies to determine if disease has worsened. 4.Instruct patient to notify physician if infection or symptoms of renal failure occur: fatigue, nausea, vomiting, diminishing urinary output. 5.Refer to home care nurse as indicated for assessment and detection of early symptoms and follow-up evaluations.y Provide low salt, low sodium, low potassium and high protein diet. The goal of treatment is to stop the ongoing inflammation and lessen the degree of scarring that ensues. Depending on the diagnosis, there are different treatment strategies.Often the treatment warrants a regimen of immunosuppressive drugs to limit the immunesystems activity. This decreases the degree of inflammation and subsequent irreversiblescarring. VII.Nursing Care Plan The 5 prioritized Nursing Care Plan infection related to altered immune response Acute Pain related to inflammation of the glomerulus Fluid volume excess related to failure of regulatory mechanism risk for decreased cardiac output related to decrease peripheral vascular resistance secondary to hypertension tertiary to AGN ineffective breathing pattern related to compensatory mechanism

IV. Diagnostic Tests Urinalysis One of the most revealing test of the kidney functions is also one of the simplest : urinalysis. For best results, specimen collected should be fresh because that stands at room temperature for any length of time changes composition. A chemical reagent strip can be used to detect glucose, protein, and occult blood and to measure pH. Patients with acute glomerulonephritis (AGN) have an active urinary sediment. This means that signs of active kidney inflammation can be detected when the urine is examined under the microscope. Such signs include red blood cells, white blood cells, proteinuria (blood proteins in the urine), and "casts" of cells that have leaked through the glomeruli and have reached the tubule, where they develop into cylindrical forms. Results:

Hematuria

Proteinuria

Albuminuria

Creatinine Clearance Rate Glomerular Filtration Rate is the rate of which substances are filtered from the blood to the urine. It is measured by the amount creatinine (the breakdown product of creatinine from muscle contraction) excreted in 24 hours urine sample. This is known as a creatinine clearance test. A venous blood sample is taken

during the 24-hour period and compared with the urine findings. A normal creatinine clearanceis 100 mL/min. a normal urine creatinine levels is 0.7 to 1.5 mg/100 mL; serum creatine rarely exceeds 1 mg/dL. Blood Studies A blood urea nitrogen (BUN) test measures the level of urea in blood and is used to assess glomerular function, or how well the kidneys can clear this from the blood-stream. However, this level may not increase until approximately 50% of glomerular are destroyed, because the remaining glomeruli can increase in size and function to accommodate urine production. A normal value is 5 to 20 mg/100 mL. X-Ray Studies A plain flat-plate abdominal x-ray film can provide information about the size andcontour of the kidneys. This x-ray may be referred to as aKUB (kidney, ureters,and bladder). kidney biopsy is essential to establish a diagnosis of AGN, determine the cause, and create an effective treatment plan