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Patient Centered Care 3 > Inflammation: Nephritis Exemplar > Flashcards

Inflammation: Nephritis Exemplar Flashcards

1
Q

Define nephritis

A

Inflammation of the kidneys

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2
Q

What is glomerulonephritis?

A

Inflammation of the glomerular capillary membrane

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3
Q

What is acute postinfectious glomerulonephritis?

A

Inflammation of the glomerular capillary membrane in response to a strep infection in the skin or pharynx or staph, pneumococcus, or Coxsackievirus

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4
Q

What is chronic glomerulonephritis?

A

the end stage of other glomerular disorders such as rapidly progressive glomerulonephritis, lupus nephritis, and diabetic nephropathy

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5
Q

What are the characteristics of chronic glomerulonephritis?

A
  1. destruction of the glomeruli
  2. gradual decline in renal function
  3. kidneys decrease in size and their surfaces become granular or roughened
  4. entire nephrons are eventually lost
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6
Q

What is Goodpasture syndrome?

A

A rare autoimmune disorder of unknown etiology that is characterized by formation of antibodies to the glomerular basement membrane

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7
Q

What three things typically are the cause of Glomerulonephritis?

A
  1. infection
  2. Diabetes mellitus
  3. SLE
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8
Q

What are the risk factors for nephritis?

A
  1. diabetes mellitus
  2. hypertension
  3. infections
  4. drug abuse
  5. prematurity
  6. trauma
  7. family history of kidney disease
  8. SLE (Systemic Lupus erythema)
  9. Sickle cell anemia
  10. AIDS
  11. Congestive heart failure
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9
Q

What are the most common clinical manifestations of acute glomerulonephritis?

A
  1. flank or midabdominal pain
  2. irritability
  3. malaise
  4. fever
  5. hematuria
  6. mild periorbital edema
  7. hypertension
  8. evidence of azotemia
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10
Q

What diagnostic tests are typically done for nephritis?

A
  1. Throat or skin cultures
  2. Antistreptolysin O titer
  3. KUB
  4. Kidney scan
  5. Biopsy
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11
Q

What diagnostic tests check for kidney function?

A
  1. BUN
  2. Creatinine
  3. serum electrolytes urinalysis
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12
Q

What is the pharmacologic treatment for edema and mild to moderate hypertension related to nephritis?

A

diuretics and sodium restriction

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13
Q

What drugs are used for postinfection glomerulonephritis to get rid of the remaining bacteria?

A

Antibiotics (Do not give nephrotoxic antibiotics such as aminoglycosides and some cephalosporins)

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14
Q

What pharmacologic therapy is used for rapid progressing glomerulonephritis, Goodpasture syndrome, and exacerbations of SLE?

A

Aggressive immunosuppressive therapy

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15
Q

What are ACE inhibitors used for with regards to nephritis?

A

They are used to reduce protein loss associated with nephrotic syndrome

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16
Q

How are fluid requirements determined for someone with nephritis?

A
  1. monitoring urinary output
  2. daily weight
  3. Monitoring BP
  4. Monitoring Serum electrolytes
17
Q

What is the typical sodium restriction for someone who has edema because of nephrotic syndrome?

A

1-2 g per day

18
Q

What dietary restrictions may be put in place if azotemia is present?

A

protein restriction

Complete proteins should still be used (milk, eggs, cheese, meats fish, soy)

Incomplete proteins should be taken out such as bread, cereals, grain, legumes, seeds, and nuts

19
Q

What is Plasmapheresis?

A

Plasma exchange therapy which is used to remove damaging antibodies from the plasma mostly for people with rapid progressive glomerulonephritis and Goodpasture syndrome

20
Q

What is required for nephritis during the acute phase?

A

Bed rest

21
Q

How would a nurse prevent infection for a patient with nephritis?

A
  1. Monitor for signs of infection
  2. Avoid or minimize invasive procedures
  3. Instruct the family and patient in good hand hygiene
  4. Limit visitors and screen for upper respiratory infections
  5. screen family member for the presence of streptococcal infection
22
Q

Some patients with nephritis are on anti-inflammatory medications like glucocorticosteroids. What do these drugs often do if there is an infection?

A

They can mask the signs of an infection

23
Q

What are the signs that someone might have if they are on immunosuppressant anti-inflammatory drugs?

A
  1. tachycardia
  2. lethargy
  3. confusion
24
Q

How would a nurse protect skin integrity with someone who has nephritis?

A
  1. Pad bony prominences
  2. Make sure the patient’s bed is free of crumbs
  3. keep sheets tight and free of wrinkles
25
Q

How would a nurse monitor and maintain fluid volume balance for someone with nephritis?

A
  1. monitor VS
  2. fluid and electrolyte status
  3. intake and output (including IV infusions)
  4. monitor the degree of ascites by measuring abdominal girth
  5. document urine specific gravity
  6. Maintain fluid restriction as ordered
26
Q

How would a nurse prevent unnecessary fatigue?

A
  1. schedule activities and procedures to provide adequate rest and energy conservation
  2. assist with ADLs
  3. Reduce energy demands with frequent small meals and short periods of activity
  4. Limit the number of visitors and visit length
  5. Discuss with the patient and family the relationship between fatigue and the disease process
27
Q

What effect can fatigue and muscle weakness have on a person that has nephritis?

A

it can limit physical and social activities

28
Q

What can interfere with role function with someone who has nephritis?

A

Malaise, nausea, mental status changes because of azotemia

29
Q

What effect can periorbital edema have on a patient with nephritis?

A

It can affect their self-esteem and lead to isolation

30
Q

How can a nurse promote healthy self-esteem with someone who has nephritis?

A
  1. Encourage patient self-care and participation in decision making
  2. Support coping skills
  3. Discuss the effect of the disease and treatments on roles and relationships
  4. Help the patient and family develop a plan for alternative behaviors and relationships, encouraging the patient to maintain usual roles to the extent possible.
31
Q

What is pyelonephritis?

A

Inflammation of the kidneys from an infection coming up from the ureters

32
Q

An 8-year-old boy and his father visit the pediatrician’s office with reports of a sudden onset of abdominal pain and reddish-brown urine. A urinalysis shows 4+ protein. On taking the boy’s health history, the nurse learns that he had strep throat a little over a week ago. Which condition should the nurse suspect?

  1. Acute glomerulonephritis
  2. Kidney agenesis
  3. Polycystic kidney
  4. Nephrosis
A

The correct answer is: Acute glomerulonephritis

Glomerulonephritis, inflammation of the glomeruli of the kidney, is most common in children between the ages of 5 and 10 years. The child typically has a history of a recent streptococcal respiratory infection (within 7 to 14 days). Symptoms are as described above.

Kidney agenesis (absence of kidneys) and polycystic kidneys (formation of large, fluid-filled cysts in the place of normal kidney tissue) are serious congenital conditions that would likely be discovered either in utero or shortly after birth, not conditions that would appear acutely in an 8-year-old.
Nephrosis is altered glomerular permeability apparently due to an autoimmune process or a T-lymphocyte dysfunction that results in fusion of the glomeruli membrane surfaces, which, in turn, leading to abnormal loss of protein in the urine. The highest incidence is at 3 years of age, and it occurs more often in boys than in girls. In addition to proteinuria, a major symptom of nephrosis is edema, which is absent in this case.
33
Q

A child diagnosed with acute glomerulonephritis will most likely have a history of:

  1. Recent illness such as strep throat
  2. A sibling diagnosed with the same disease
  3. Hemorrhage or history of bruising easily
  4. Hearing loss with impaired speech development
A

The correct answer is: recent illness such as strep throat.

Symptoms of acute glomerulonephritis often appear 1 to 3 weeks after the onset of a streptococcal infection such as strep throat. The causative agent is group B hemolytic streptococcus. The treatment for glomerulonephritis includes maintaining fluid volume and managing hypertension.

Glomerulonephritis is not contagious so the child would not have acquired it from a sibling.
Glomerulonephritis only affects the kidney so hemorrhage, bruising, hearing loss, or speech development would not be associated with the disease.

34
Q

Which of the following is a term used to describe excessive nitrogenous waste in the blood, as seen in acute glomerulonephritis?

  1. Azotemia
  2. Proteinuria
  3. Hematuria
  4. Bacteremia
A

The correct answer is: Azotemia

The primary presenting features of acute glomerulonephritis are hematuria, edema, azotemia (excessive nitrogenous wastes in the blood), and proteinuria (>3 to 5 g/day).

Bacteremia is excessive bacteria in the blood.

35
Q

A client is admitted with glomerulonephritis. Which psychosocial problems could likely affect this client?

  1. Altered sexuality patterns related to prolonged hospitalization
  2. Impaired physical mobility related to bone reabsorption
  3. Anxiety related to poorly functioning kidneys and body image disturbance
  4. Altered breathing patterns related to dehydration
A

The correct answer is: anxiety related to poorly functioning kidneys and body image disturbance

Developing a problem with the kidneys may cause anxiety about poor kidney function, especially if the condition becomes a chronic one.

Altered sexuality is not a primary concern at this time,
impaired physical mobility and altered breathing patterns are physical problems, not psychological.

Patient Centered Care 3 (19 decks)

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