Acute Glomerulonephritis Patients

What is the normal lab value for Urine Specific Gravity?

1.01-1.03

What is the normal lab value for serum PHOSPHORUS?

2.4-4.1 mg/dL

What is the normal lab value for Urine Potassium?

25-100 mEq/L/day

What is the normal lab value for Urine pH?

4.8-7.5

Which best describes acute glomerulonephritis? a. Occurs after a urinary tract infection b. Occurs after a streptococcal infection c. Associated with renal vascular disorders d. Associated with structural anomalies of genitourinary tract

B ~ Acute glomerulonephritis is an immune-complex disease that occurs after a streptococcal infection with certain strains of the group A -hemolytic streptococcus. Acute glomerulonephritis usually follows streptococcal pharyngitis and is not associated with renal vascular disorders or genitourinary tract structural anomalies.

TRUE or FALSE: Poststreptococcal glomerulonephritis is a type of NEPHROTIC SYNDROME, which means there is the leakage of BOTH red blood cells and protein from the inflamed glomerulus into the filtrate. A ~ True B ~ False

B ~ False ~ Poststreptococcal glomerulonephritis is a type of NEPHRITIC (not nephrOtic) SYNDROME, which means there is the leakage of BOTH red blood cells and protein from the inflamed glomerulus into the filtrate. In Nephrotic Syndrome, there is only leakage of PROTEIN (not red blood cells) into the filtrate.

While providing care to a pediatric patient with acute glomerulonephritis, you note the urine output to be 10 mL/hr. The patient weighs 30 lbs. As the nurse, you will want to limit what type of foods from the patient's diet? A. Calcium-rich foods B. Potassium-rich foods C. Purine -rich foods D. None of the above because the patient's urinary output is normal based on the patient's weight.

B ~ This patient is experiencing OLIGURIA (low urinary output). The patient weighs 30 lbs. which is 13.6 kg (30/2.2= 13.6). Remember a normal urinary output for a pediatric patient should be 1 mL/kg/hr. Based on the patient's weight, their urinary output is 10 mL/hr...it should be 13.6 mL/hr. Therefore, the patient is at high risk for retaining POTASSIUM due to decreased renal function. The nurse should limit foods high in potassium.

A child is admitted with acute glomerulonephritis. The nurse should expect the urinalysis during this acute phase to show: a. bacteriuria, hematuria. b. hematuria, proteinuria. c. bacteriuria, increased specific gravity. d. proteinuria, decreased specific gravity.

B ~ Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes in specific gravity are not usually present during the acute phase.

What are the normal Creatinine Clearance values?

Men 107-139 mL/min Women 87-107 mL/min

What is the normal lab value for serum ALBUMIN?

3.5-5.5 g/dL

What is the Normal Osmolality of Urine?

300-900 mOsm/kg

What is the normal lab value for Urine Sodium?

40-220 mEq/day

What is the normal lab value for Urine RBCs?

<4 RBC/HPF

List the GFR rates in the different stages of renal failure.

Stage 1 = <90 mL/min Stage 2 = <60 mL/min Stage 3 = <45 mL/min Stage 4 = <30 mL/min Stage 5 = <15 mL/min

Which patient below is at MOST RISK for developing acute glomerulonephritis? A. A 3 year old male who has a positive ASO titer. B. A 5 year old male who is recovering from an appendectomy. C. An 18 year old male who is diagnosed with HIV. D. A 6 year old female newly diagnosed with measles.

A ~ An ASO (antistreptolysin) titer is a test used to diagnose strep infections. Remember strep infections increase, especially in the pediatric population, the risk of developing AGN. Patients in options B, C, and D are not at risk for this.

What is the normal lab value for Serum Creatinine?

0.6-1.2 mg/dL

Which of the following are NOT a sign and symptom of acute glomerulonephritis (poststreptococcal)? (SATA) A. Hypotension B. Increased Glomerular filtration rate C. Cola-colored urine D. Massive proteinuria E. Elevated BUN and creatinine F. Mild swelling in the face or eyes

A, B, D ~ The patient with AGN may experience HYPERtension (not hypotension), DECREASED glomerular filtration rate (NOT increased), MILD (not massive) proteinuria. Massive proteinuria is a classic sign and symptom in Nephrotic Syndrome which doesn't present with hematuria. Options C, E, and F can be present in AGN.

A school-age child is admitted to the hospital with acute glomerulonephritis and oliguria. Which dietary menu items should be allowed for this child? (SATA) a. Apples b. Bananas c. Cheese d. Carrot sticks e. Strawberries

A, D, E ~ Moderate sodium restriction and even fluid restriction may be instituted for children with acute glomerulonephritis. Foods with substantial amounts of potassium are generally restricted during the period of oliguria. Apples, carrot sticks, and strawberries would be items low in sodium and allowed. Bananas are high in potassium and cheese is high in sodium. Those items would be restricted.

A 5 year old male is admitted with acute glomerulonephritis. On assessment, you note mild edema predominately in the face and tea-colored urine. The patient's blood pressure is 165/110, heart rate 95, oxygen saturation 98% on room air, and temperature 98.9 'F. In your nursing care plan, what nursing interventions will you include in this patient's plan of care? (SATA) A. Initiate and maintain a high sodium diet daily. B. Monitor intake and output hourly. C. Encourage patient to ambulate every 2 hours while awake. D. Assess color of urine after every void. E. Weigh patient every daily on a standing scale. F. Encourage the patient to consume 4 L of fluid per day.

B, D, E ~ Patients with acute glomerulonephritis experience proteinuria and hematuria. In addition, they may experience mild edema (mainly in the face/eyes), hypertension, and in severe cases renal failure/oliguria. Therefore, it is very important the nurse monitors intake and output every hour, assesses color of urine, and weighs the patient every day on a standing scale. Option A is wrong because the patient should be consuming a LOW (not high) sodium diet. Option C is wrong because the patient should maintain bed rest until recovered due to experiencing hypertension. Option F is wrong because the patient will be on a fluid restriction...4 L is a lot of fluid to consume. It is generally 2 L or less of fluids per day.

The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching? a. You will need to decrease the number of calories in your child's diet. b. Your child's diet will need an increased amount of protein. c. You will need to avoid adding salt to your child's food. d. Your child's diet will consist of low-fat, low-carbohydrate foods.

C ~ For most children, a regular diet is allowed, but it should contain no added salt. The child should be offered a regular diet with favorite foods. Severe sodium restrictions are not indicated.

Which is the most appropriate nursing diagnosis for the child with acute glomerulonephritis? a. Risk for Injury related to malignant process and treatment b. Fluid Volume Deficit related to excessive losses c. Fluid Volume Excess related to decreased plasma filtration d. Fluid Volume Excess related to fluid accumulation in tissues and third spaces

C ~ Glomerulonephritis has a decreased filtration of plasma, which results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. No malignant process is involved in acute glomerulonephritis. A fluid volume excess is found. The fluid accumulation is secondary to the decreased plasma filtration.

A patient who is experiencing poststreptococcal glomerulonephritis has edema mainly in the face and around the eyes. As the nurse, you know to expect the edema to be more prominent during the? A. Evening B. Afternoon C. Morning D. Bedtime

C ~ Patients will experience the most prominent swelling in the face in the morning when they awake. This is a common finding with kidney disorders. The skin of the eyes is fragile, folded, and pocketed which makes it easier for fluid to collect around the eyes. In addition, this is where the swelling looks more noticeable.

The nurse notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of: a. poor appetite. b. increased potassium intake. c. reduction of edema. d. restriction to bed rest.

C ~ This amount of weight loss in this period is a result of the improvement of renal function and mobilization of edema fluid. Poor appetite and bed rest would not result in a weight loss of 8 pounds in 4 days. Foods with substantial amounts of potassium are avoided until renal function is normalized.

A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse's best response should be that the: a. blood pressure will stabilize. b. the child will have more energy. c. urine will be free of protein. d. urinary output will increase.

D ~ An increase in urinary output may signal resolution of the acute glomerulonephritis. If blood pressure is elevated, stabilization usually occurs with the improvement in renal function. The child having more energy and the urine being free of protein are related to the improvement in urinary output.

What is the normal Glomerular Filtration Rate (GFR)?

Men >130 mL/min/m2 Women >120 mL/min/m2

Within the past month, the admission rate of patients with poststreptococcal glomerulonephritis has doubled on your unit. You are proving an in-service to your colleagues about this condition. Which statement is CORRECT about this condition? A. "This condition tends to present 6 months after a strep infection of the throat or skin." B. "It is important the patient consumes a diet rich in potassium based foods due to the risk of hypokalemia." C. "Patients are less likely to experience hematuria with this condition." D. "This condition is not caused by the streptococcal bacteria attacking the glomerulus, but by the immune system's response to the bacteria by creating an antigen-antibody complex which inflames the glomerulus."

D ~ This is the only correct statement. Option A is wrong because this condition tends to present 10-14 days (not 6 months) after a strep infection of the throat or skin. Option B is wrong because the patient is at risk for HYPERkalemia (not HYPOkalemia) especially if low urinary output is present. Option C if wrong because patients with this conditon will experience hematuria which is a hallmark of this condition.