5 Nursing Diagnosis for Glomerulonephritis: Complete Care Plan, Interventions, and Examples
Glomerulonephritis is a kidney disorder characterized by inflammation of the glomeruli, the microscopic structures found inside the kidneys that function as filters. These glomeruli play a crucial role in maintaining homeostasis by removing excess fluids, electrolytes, and metabolic waste products from the bloodstream. When these structures become inflamed or damaged, kidney function declines, resulting in abnormalities in urine composition, fluid balance, and blood pressure regulation.
Glomerulonephritis is a significant cause of chronic kidney disease (CKD) and end-stage renal failure worldwide. According to recent epidemiological studies, glomerulonephritis contributes to approximately 10% of cases of kidney failure globally, making it a critical illness requiring early detection, proper management, and comprehensive nursing care.
Understanding Glomerulonephritis
Glomerulonephritis may develop due to bacterial infections (such as streptococcal infection), viral infections (Hepatitis B, Hepatitis C, HIV), autoimmune reactions (lupus nephritis), or systemic diseases that affect kidney perfusion. When the immune system identifies certain antigens in the body, it produces antibodies that can mistakenly attack the glomeruli, causing inflammation and structural injury.
Types of Glomerulonephritis
Glomerulonephritis is generally grouped into two classifications based on the onset and progression of inflammation:
- Acute Glomerulonephritis (AGN): A sudden inflammatory reaction causing abrupt symptoms such as hematuria (blood in urine), edema, hypertension, and oliguria. It frequently follows infections like streptococcal pharyngitis.
- Chronic Glomerulonephritis (CGN): A long-standing inflammation that gradually deteriorates kidney function. It may result from unresolved acute glomerulonephritis or occur spontaneously without an identifiable cause. Over time, it leads to irreversible kidney damage and renal failure.
Both forms of glomerulonephritis can significantly affect the patient's quality of life and, if left untreated, may progress to life-threatening complications such as heart failure, pulmonary edema, and uremia.
Signs and Symptoms of Glomerulonephritis
The clinical manifestations vary depending on whether the condition is acute or chronic. However, the following symptoms are commonly observed:
- Hematuria: Pink or cola-colored urine caused by red blood cells leaking into the urine.
- Proteinuria: Frothy urine due to excessive protein loss.
- Hypertension: Increased blood pressure resulting from fluid retention and renin-angiotensin system activation.
- Generalized edema: Swelling of the face, hands, legs, and abdomen (ascites).
- Fatigue and weakness: Often due to anemia and impaired kidney filtration.
Early recognition of these signs is essential for nurses and healthcare providers to prevent worsening renal damage.
Complications of Glomerulonephritis
Without appropriate treatment, glomerulonephritis can lead to serious systemic complications:
- Oliguria to Anuria: Significantly decreased urine production, which may last 2–3 days or more due to reduced glomerular filtration.
- Hypertensive Encephalopathy: Severe hypertension may cause neurological symptoms such as headache, vomiting, seizures, and vision disturbances resulting from cerebral edema.
- Circulatory Disorders: Dyspnea, orthopnea, pulmonary crackles, cardiomegaly, and congestive heart failure due to fluid overload and persistent hypertension.
- Anemia: Reduced erythropoietin production and diluted blood concentration (hemodilution) lead to fatigue and weakness.
These complications highlight the importance of effective nursing care, continuous monitoring, and early interventions to prevent irreversible kidney damage.
5 Nursing Diagnosis for Glomerulonephritis
The following nursing diagnoses are commonly used for patients with glomerulonephritis based on NANDA International standards. Each diagnosis includes related factors, signs and symptoms, recommended nursing interventions, and expected outcomes.
1. Ineffective Tissue Perfusion
Related to: water retention, elevated blood pressure, hypernatremia, and decreased renal filtration.
Evidenced by: altered mental status, edema, oliguria, hypertension, decreased peripheral pulses.
Nursing Interventions
- Monitor vital signs including blood pressure and heart rate regularly.
- Assess urine output and daily weight to evaluate fluid retention.
- Provide a low-sodium diet to reduce fluid accumulation.
- Administer prescribed antihypertensives and diuretics.
- Elevate lower extremities to improve venous return.
Expected Outcomes
- Patient demonstrates stable perfusion indicated by normal blood pressure and adequate urine output.
- Reduced edema and improved renal function.
2. Risk for Imbalanced Fluid Volume
Related to: oliguria, impaired kidney function, and decreased glomerular filtration rate.
Nursing Interventions
- Monitor intake and output strictly.
- Assess for electrolyte imbalance, particularly potassium and sodium levels.
- Educate patients to avoid high-sodium foods.
- Prepare for dialysis if fluid retention becomes severe.
Expected Outcomes
- Patient maintains balanced fluid levels.
- No signs of fluid overload such as crackles, edema, or dyspnea.
3. Risk for Imbalanced Nutrition: Less Than Body Requirements
Related to: anorexia, nausea, altered metabolic needs, and dietary restrictions.
Nursing Interventions
- Offer small, frequent meals rich in calories and low in sodium and protein.
- Consult a dietitian for individualized nutrition plans.
- Monitor hemoglobin and hematocrit levels for anemia.
- Encourage fluid restriction if needed.
Expected Outcomes
- The patient maintains adequate nutritional status.
- Improved energy levels and stable laboratory results.
4. Activity Intolerance
Related to: fatigue, anemia, edema, and impaired oxygen transport.
Nursing Interventions
- Assess activity tolerance using a fatigue scale.
- Encourage rest between activities.
- Provide assistance with activities of daily living (ADLs).
- Administer iron supplements if ordered.
Expected Outcomes
- The patient performs physical activities without excessive fatigue.
- Improved stamina and reduced weakness.
5. Risk for Disturbed Sleep Pattern
Related to: immobilization, discomfort, fluid retention, and nocturia.
Nursing Interventions
- Encourage a bedtime routine and limit daytime naps.
- Administer analgesics before bedtime to relieve discomfort.
- Reduce fluid intake in the evening to minimize nocturia.
- Provide a calm environment conducive to sleep.
Expected Outcomes
- The patient reports improved sleep quality.
- Better alertness and functional performance during the day.
Conclusion
Glomerulonephritis is a complex kidney disorder requiring comprehensive nursing assessment and targeted interventions. Through accurate nursing diagnoses, nurses can develop individualized care plans that address the physiological and psychological needs of the patient. Proper monitoring, patient education, lifestyle modification, and early treatment are essential to prevent progression to chronic kidney disease and improve overall patient outcomes.
Understanding the etiology, symptoms, and complications of glomerulonephritis helps health professionals provide holistic and evidence-based care. With the right nursing interventions, patients can achieve optimal functioning, improved comfort, and a higher quality of life.
References
- NANDA International. Nursing Diagnoses: Definitions and Classification 2021–2023. Thieme; 2021.
- Couser WG. Glomerulonephritis. Lancet. 1999;353(9143):1509–1515.
- Jha V, Garcia-Garcia G. Chronic kidney disease: global dimension and perspectives. Lancet. 2013;382(9888):260–272.
- National Kidney Foundation. Glomerulonephritis: Causes, Symptoms, and Treatment. NKF; 2022.
