4 Acute Glomerulonephritis Nursing Care Plans

Acute glomerulonephritis usually shows up as a school-age child with puffy eyes, tea-colored urine, a climbing blood pressure, and dropping urine output. Your job is to pull off the excess fluid, keep that pressure controlled, protect the kidneys while the inflammation runs its course, and clear the streptococcal infection that most often started it.

What is Acute Glomerulonephritis?

Acute glomerulonephritis (AGN) is glomerular injury that alters renal function. The classic picture is gross hematuria, mild proteinuria, edema (usually periorbital), hypertension, and oliguria.

It comes in two forms. Primary AGN, the more common type, follows a group A beta-hemolytic streptococcal infection. It is an immune-complex disease: antigen-antibody complexes form during the strep infection, lodge in the glomerular membrane, and drive inflammation 8 to 14 days after the infection starts. Secondary AGN is tied to autoimmune conditions such as systemic lupus erythematosus, hemolytic uremic syndrome, sickle cell disease, and Henoch-Schönlein purpura.

AGN peaks in the early school-age child, around 6 to 7 years. Onset is usually abrupt and self-limiting, though hematuria and proteinuria can persist. The injured glomeruli drop the filtration rate, so water and sodium are retained. Plasma and interstitial volumes expand, producing edema, circulatory congestion, and hypervolemia. Hypertension follows; plasma renin activity is low during the acute phase, so the pressure is thought to be volume-driven.

Nursing Care Plans and Management

Care centers on moving excess fluid out through urination, keeping activity within tolerance, preventing infection, and heading off complications.

Nursing Problem Priorities

• Fluid and electrolyte balance
• Blood pressure control
• Renal function monitoring
• Reducing renal inflammation and injury
• Infection prevention
• Symptom management (pain, edema)
• Patient and family education and selfcare

Nursing Assessment

Assess for the following subjective and objective data:

• Azotemia
• Altered electrolytes
• Crackles and pleural effusion
• Decreased urinary output
• Dependent and periorbital edema, facial puffiness
• Moderate blood pressure increases
• Intake greater than output
• Weight gain

The underlying problem is loss of the kidney's regulatory control over water and electrolytes as renal function fails.

Nursing Goals

The child will reach a normal fluid balance: no edema, vital signs within normal limits, and balanced intake and output.

Nursing Interventions and Actions

1. Managing Excess Fluid Volume and Swelling

Inflamed kidneys lose their grip on fluid and electrolyte balance, so volume backs up and the child swells. The work here is to track that volume closely and move it out.

1. Monitor vital signs every 4 hours and report significant changes. Gives you a baseline to track changes against and to judge whether therapy is working.

2. Auscultate breath sounds for crackles. Watch for increased work of breathing, cough, and nasal flaring. Crackles signal fluid backing up into the lungs.

3. Weigh the child daily on the same scale at the same time, and measure intake and output accurately. Weight gain tracks fluid retention, and accurate intake and output tells you where the balance sits.

4. Measure and record abdominal girth daily. Edema collects in the abdomen and can grow as the condition progresses.

5. Hold the child to the ordered fluid restriction. How much fluid is allowed depends on how well the kidneys are working.

6. Reposition the child every 2 hours and elevate edematous limbs in bed or in a chair. Repositioning takes pressure off dependent areas, and elevation drains fluid away by gravity.

7. Give diuretics as prescribed. Drops plasma volume and edema by driving diuresis.

8. Teach the child and family about AGN: its signs and symptoms, the workup, and the treatment plan. Understanding the disease improves compliance with the regimen.

9. Refer to a dietitian for a meal plan low in sodium, potassium, and protein that works in foods the child likes. Diet is central to controlling symptoms, holding nutrition, and managing the disease.

2. Enhancing Tolerance to Activity

These children tire easily from the anemia of reduced erythropoietin and from bed rest. Build activity back gradually, matched to what the child can handle.

1. Assess weakness, fatigue, and how well the child moves in bed and plays. Tells you the energy reserves during the acute phase and whether bed rest still applies.

2. Enforce bed rest during the acute stage and disturb the child only when needed. Conserves energy and limits the waste load the kidneys have to clear.

3. Schedule care in blocks and build in rest periods in a quiet room. Protects rest and cuts down stimulation and fatigue.

4. Offer quiet play, reading, TV, and games as symptoms ease. Gives diversion with minimal energy cost.

5. Explain the reason for activity restriction to the child and parents, and stress rest after any activity or ambulation. Helps them buy into conserving energy so recovery moves along.

3. Promoting Safety and Minimizing Injury

Failing kidneys let waste, electrolytes, and blood pressure climb, and that is where the danger sits. Watch the pressure and the neuro status closely.

1. Check blood pressure, pulse, and respirations every 4 hours. Move to every 1 hour if diastolic runs over 90, or if tachycardia, tachypnea, or dyspnea appear. Severe hypertension can tip into encephalopathy, and rising pulse and respirations point to heart failure and pulmonary edema.

2. Track intake and output, the extent of edema, urine output, headache, pallor, and electrolytes. These are the early signs of renal failure.

3. Watch for lethargy, irritability, and restlessness tied to hypertension, and give anticonvulsants if ordered. Cerebral changes from hypertension can trigger seizures, so set up safety precautions.

4. Match activity and rest to the child's energy, and increase activity as the condition allows. Prevents fatigue through the acute phase and convalescence.

5. During the acute phase, keep sodium, potassium, and protein low and push carbohydrates and fats for calories, as ordered. Limits potassium during oliguria, sodium with edema, and protein if oliguria drags on, while still feeding the child.

6. Limit fluids to urine output plus insensible losses, as ordered. Keeps you from adding to the fluid load while the kidneys are damaged.

7. Tell parents to report weight gain, hematuria with falling urine output, headache, and anorexia. Lets you step in early before renal damage worsens.

8. Give a written list of foods to include and avoid within the sodium, potassium, and protein limits. Keeps the child nourished while the disease resolves.

9. Give antihypertensives, diuretics, and cardiac glycosides as ordered, and watch for the intended effect. Treats the complications of more severe renal impairment.

10. Reinforce the need for followup care. Keeps the child monitored for chronic renal disease or a persistent streptococcal infection.

4. Reinforcing Infection Control

Glomerular inflammation and a weakened immune response leave these children open to infection, more so on dialysis, after invasive procedures, or on immunosuppressants. Stay on top of the strep source and basic infection control.

1. Assess for fever, chills, sore throat, and cough, whether new or recurring. Points to a lingering streptococcal infection.

2. Obtain a throat culture for analysis and sensitivities. Identifies the streptococcal organism and which antibiotic it responds to.

3. Dispose of used tissues and articles properly. Stops transmission to others and reinfection.

4. Give antibiotics to the child, and to family members if ordered. Kills the organism by blocking cell wall synthesis and limits spread within the family.

5. Stress finishing the full course of antibiotics. Prevents a resistant super-infection.

6. Teach the child and family handwashing after sneezing or coughing. Stops the spread of disease.

7. Keep the child away from anyone with an upper respiratory infection. A susceptible child catches respiratory infections easily.

8. Tell parents to call the provider for fever, cough, or sore throat. Flags infection early so you can intervene.