Reference no: EM133843806
Overview of Glomerulonephritis
Glomerulonephritis is an immunologic inflammatory process affecting the renal glomeruli, resulting from two different types of antibody-induced injury. In the first type, an unknown mechanism stimulates the development of autoantibodies specific for antigens within the glomerular basement membrane. In the second type of immune process, antibodies react with circulating nonglomerular antigens, such as bacterial products or viral agents, and are randomly deposited as immune complexes along the glomerular basement membrane. All forms of immune complex diseases are characterized by an accumulation of antigen, antibody, and complement in the glomeruli, which can result in inflammation and tissue injury. In most cases, recovery from the acute illness is complete. If progressive involvement occurs, the result is destruction of renal tissue and marked renal insufficiency.
Overview of Acute Kidney Injury
Acute kidney injury (AKI) is a clinical syndrome characterized by a rapid loss of kidney function. This loss is accompanied by a rise in serum creatinine and/or a reduction in urine output. The severity of dysfunction can range from a small increase in serum creatinine or reduction in urine output to the development of azotemia [an accumulation of nitrogenous waste products (urea nitrogen, creatinine) in the blood]. The multiple causes of AKI are categorized into prerenal (most common), intrarenal, and postrenal causes.
Interprofessional care of AKI is focused on eliminating the cause, managing the signs and symptoms, and preventing complications while the kidneys recover. Some individuals do not recover and progress to end-stage renal disease (ESRD).
Case Study
N.G. is a 21-year-old college student who is admitted to the hospital with a diagnosis of acute poststreptococcal glomerulonephritis. He was seen at the college's student health center because of swelling around his eyes and rusty-colored urine. His history based on medical records from the student health center indicates that he had a sore throat several weeks ago that he ignored because it resolved in 4 to 5 days. His past medical history is positive for type 1 diabetes mellitus since the age of 7. However, he has maintained excellent control of his serum glucose levels via intensive insulin therapy.
Before caring for N.G., you review his admission laboratory findings, which reveal gross hematuria, moderate proteinuria, and red blood cell (RBC) casts in the urine, a blood urea nitrogen (BUN) of 28 mg/dL (10 mmol/L), a creatinine of 1.4 mg/dL (123.8 mmol/L), a serum glucose level of 131 mg/dL, and decreased C3 and CH50 complement levels. An ASO (antistreptolysin O) titer was 240 Todd units. During the morning assessment of N.G., his vital signs are as follows: BP 154/98 mm Hg, heart rate 86 beats/min, respiratory rate 16 breaths/min, and temperature 98.8°F (37.1°C). He has periorbital edema and 2+ pitting edema of his ankles, and he denies any pain. His urinary output from the previous 8 hours was 200 mL.
Questions
1. Evaluate the results of diagnostic testing in a patient with acute glomerulonephritis.
2. Identify relevant assessment data for a patient with acute glomerulonephritis and acute kidney injury (AKI).
3. Describe interprofessional care of a patient with acute glomerulonephritis and AKI.
4. Discuss complications of AKI.
5. Develop a nursing care plan for a patient with AKI.
6. Prioritize nursing care of a patient undergoing hemodialysis.
7. Appropriately delegate nursing care of a patient who is undergoing hemodialysis.
8. Develop an individualized teaching plan for a patient with renal dysfunction.
9. Cite all references. References must be from a Medical Surgical Nursing Textbook with page numbers.