SECOND YEAR BSC. NURSING NOTES 
SUBJECT:MEDICAL NURSING INCLUDING PATHOLOGY 

Glomerulonephritis is a group of diseases that injure the part of the kidney that filters blood (called glomeruli). Other terms you may hear used are nephritis and nephrotic syndrome. When the kidney is injured, it cannot get rid of wastes and extra fluid in the body.

🔆DEFINITION

Glomerulonephritis is a kidney condition that involves damage or inflammation to the glomeruli. 

🔆ETIOLOGY AND RISK FACTORS

  • Streptococcal infection of the throat or skin
  • Hereditary disease
  • Immune disease such as SLE
  • Diabetes
  • High blood pressure
  • Vasculitis(Inflammation of the blood vessels) 
  • Viruses(HIV, Hep B and Hep C) 
  • Endocarditis(Infection of the valve of the heart) 
🔆TYPES OF GLOMERULONEPHRITIS

1. Chronic Glomerulonephritis

2.Acute Glomerulonephritis


1.Acute Glomerulonephritis

-Begins suddenly 

-It occurs after 5-21 days of streptococcal infection

2.Chronic Glomerulonephritis

-Develops gradually over several years. It occurs after the acute phase

🔆PATHOPHYSIOLOGY

         Due to any etiological factors

                                  ⬇️

    Release of antigen substance into the circulation

                                  ⬇️

                Formation of antibody

                                  ⬇️

       Formation of antigen and antibody    complex in the glomerulus

                                  ⬇️

                Inflammatory response

                                  ⬇️

       Proliferation of epithelial cells lining  the glomerulus

                                  ⬇️

       Leukocytes infiltration of the glomerulus 

                                 ⬇️

       Thickening of the glomerulus filtration  membrane

                                 ⬇️

        Scarring and loss of glomerulus  filtration membrane

                                 ⬇️

      Decrease GFR and glomerulus plasma  flow

                                 ⬇️

       Retention of sodium and water

                                 ⬇️

             Edema and hypertension

🔆 CLINICAL MANIFESTATION

  • Flank pain
  • Foamy urine
  • Cola color or diluted iced tea color urine
  • Hematuria
  • Oliguria
  • Dysuria
  • Fatigue to anemia and kidney failure
  • Hypertension
  • Fluid retention
🔆DIAGNOSTIC EVALUATION

  • History collection
  • Physical examination
  • Urinalysis
  • Biopsy
  • IVP
  • Blood test
  • USG
🔆MANAGEMENT 

  • Treatment depends on the cause of the disorder, type and severity of the symptoms
  • High blood pressure may be hard to control.Controlling the blood pressure usually the most important part of the treatment
  • Dialysis
  • Medication

    -Diuretics 

    -Immunosuppressents

    -Anti hypertensive

  • Lifestyle changes
  1. Sodium and water restrictions
  2. Potassium, phosphorus, magnesium              restriction
  3.  Maintain a healthy weight through the         diet and exercise

  • Physiotherapy treatment
  • Patient Education 
  1. Lymphatic massage to reduce the                   edema
  2. Breathing exercise 
  3. Endurance exercise such as walking

🔆COMPLICATIONS

  • Acute and chronic renal failure
  • Nephrotic Syndrome
  • Hypertension
  • Electrolyte imbalance
  • Pulmonary edema
  • CHF due to fluid overload
🔆NURSING MANAGEMENT

  • NURSING DIAGNOSIS:Acute pain related to inflammation of renal cortex as evidenced by facial expressions and verbalization of patient
  • GOAL:Reduce pain
  • INTERVENTIONS:
  1.   Assess the onset, duration, location, severity and intensity
  2. Provide comfort device, quiet environment and calm activities
  3. Encourage use of relaxation techniques
  4. Provide diversion therapy
  5. Administer analgesics as per Dr' order