Jenna Cohen Exam 5 Study Guide Renal and Urological Disorders Glomerulonephritis it s an immune process causes GFR to decrease unique renal disease renal function closed its not an infection Renal Disease Kidney Filter Working Infections blockage No Filter problem Not in Renal Failure Can Take Fluids Diseases like Infections Pyelonephritis Cystitis Blockage Renal Calculi Prostate Hypertrophy Kidney Filter NOT Working Problems with filter decreased output NO Output Renal Failure Fluid Restrictions Diseases like Renal Failure Acute and Chronic Glomerulonephritis Nephrotic Syndrome Physiology Acute Glomerulonephritis Immune complexes trapped in glomerular capillary loop Obstruction edema and vasospasm all that inflammation causes an antibody reaction and we end up with inflammation of the capillary walls Antigen antibody reaction from infectious agent strep and activate WBCs inflammation of capillary wall usually from group a hemolytic strep Physiology Glomerulonephritis Immune Disease Antibody antigen Description Antibody antigen disease as a result of Group A beta hemolytic causes inflammation of glomerular capillaries usually following streptococcal infection o Immune complexes develop and become trapped in the glomerular capillary loop o Causes swelling and decreases the glomerular filtration rate GFR ability to remove waste and excess fluids Etiology o Acute Primary infection with Group A beta hemolytic streptococcal infection o Renal clinical findings occurs 10 21 days after original infection o Most recover completely recurrence may occur o Chronic Progressive destruction of glomeruli can cause a lot of renal damage over years Risk Factors o Systemic Lupus Erythematosus o Vascular Injury Hypertension o Metabolic Disease DM o Nephrotoxic Drugs o Excessive High Protein and Sodium o Older Adults Increased risk for chronic renal failure already have decreased GFR Assessment Glomerulonephritis Labs o Renal Function BUN 100 200mg dL significant changes to BUN and Creatinine serum Creatinine 6 mg dL Creatinine Clearance Glomerular filtration rate GFR o Electrolytes K Na phosphate albumin o Urinalysis Tea colored urine from cell debris Proteinuria most significant indicator of glomerular injury Hematuria specific gravity o Anti streptolysin Titer ASO positive for presence of streptococcal antibodies o Erythrocyte sedimentation rate ESR inflammation o WBC Diagnostic Tests o X ray of Kidney Ureter o KUB o Renal Ultrasound o Throat Culture R O streptococcus infection o Chest X ray Identify pulmonary complications cardiac enlargement pulmonary edema o Dialysis In severe cases may need to remove urea and nitrogenous waste o Therapeutic Procedures Plasmapheresis filters out antibodies First Priority Interventions Plasmapheresis Filters antibodies from circulating blood by removing plasma helps remove some of the antibodies from the circulating blood having antibody reaction then remove these Need to monitor o Weight before and after make sure no FVD at risk for hypovolemia o Monitor for hypovolemia o Signs of decreased calcium tetany o Signs of infection Teaching Moment A client is admitted with glomerulonephritis has just undergone plasmapheresis What clinical findings would be a priority to report to the healthcare provider a BP 136 85 is now 149 90 b Specific gravity 1 032 high which indicated FVD but look at early signs c HR was 82 bpm is now 105 bpm increased HR hypovolemia d Urine output was 85mL hr is now 70mL hr Assessment Acute Glomerulonephritis RENAL Renal Symptoms GFR urine urine coffee tea colored oliguria dysuria hematuria proteinuria electrolyte imbalance Edema from Fluid Volume Excess periorbital edema around the eyes lower extremities ascites distended neck veins adventitious lung sounds SOB glomerulonephritis worry about too much fluid volume Note B P due to increase extracellular fluid RR fluid in lungs dyspnea orthopnea Temp with acute AGN because of infection o Neuro status Adults Changes in level of consciousness children behavior changes Appetite anorexia diet restrictions acute stage important to let them rest don t want to do too much activity let the body heel Lethargic activity irritable pale in color Teaching Moment A client is admitted with glomerulonephritis What clinical findings would be a priority to report to the healthcare provider a BUN of 150mg dl Creatinine clearance decreased 50ml min normal 80 140ml min creatinine is going down BUN is expected b Urinalysis results of proteinuria and specific gravity 1 047 expected finding c Shortness of breath RR 24 rales bilaterally in the lower lobes on auscultation fluid volume excess expected but this is more important bc we need some diuretics mainly d Anorexia and nausea and complaint of headache Analysis Glomerulonephritis Fluid Volume Balance Nutrition always an issue when we have infection Pain Infection First Priority Interventions Glomerulonephritis FILTER F Fluid balance Monitor I O BP Check proteinuria specific gravity and color of urine weigh client daily if has hypertension check blood pressure q 2 to 4 hours Daily weights specific gravity urine color watch bp Infection antibiotic therapy if cultures are positive When client does not feel well then he she will restrict own activity Educate client on how to prevent UTI and infection precautions Lethargic limit activity and encourage rest To protect from infections Educate client family how to prevent UTIs respiratory infections diet fluid needs and medication therapy Teach how to dipstick urine to monitor for protein Evaluate serum K levels first sign of improvement is them getting back on feet and an increase in GFR Reassure and provide comfort to client and or family Review progress Many times the fist sign of improvement is an increase in the urine output that may progress to profuse diuresis PRIORITY for FVE weight lab values important to listen to lung sounds need to watch sodium intake where sodium goes water goes so don t add additional sodium salt and then have more problems with fluid volume restrict protein in order to lower their renal issues azotemia is high BUN and creatinine watch protein when these levels are up can get flank pain infection going on want to see what the organism is but may need to do cultures Teaching Moment The nurse is caring for the client with Glomerulonephritis Which of the following are appropriate nursing interventions Select all that apply a Administer penicillin on time as ordered Probably use broad spectrum