Glomerulonephritis | Med-Surg Nursing Lecture

Are you confused about glomerulonephritis in nursing school? Or maybe you're not even sure where to even start with it? Because to be honest, learning about the kidneys can really feel overwhelming sometimes, right? Well, don't worry, friends. I've got you covered. In this video, we are going to dive into the pathophysiology of glomerulonephritis. What it is, the signs and symptoms for it, what you need to assess for, and the nursing interventions as well, so you will be able to pass your nursing school exams. Let's dive in. Hello. Hello, my friend. My name is Christina Rafano, and welcome to the Nursing school show, where we walk you through how to pass nursing school step by step. Now hit that subscribe button and click the notification bell and let's dive in. So what exactly is glomerulonephritis other than a big scary word? So let's break it down. So that is not as scary. So acute means that it happens fast. Glomerulo is referring to the glomerulo glomerulus, part of the nephron. Neph meaning nephron. And the itis is inflammation. So there is sudden inflammation of the glomerulus. So that's all it means, glomerulonephritis. So what is the glomerulus? The glomerulus is the garbage man of the kidney. Now we'll call him garbage man glomerulus. So here's what happens. The blood takes all of the garbage from the body as it circulates. It takes all the garbage that it wants to get rid of. Things uric acid, urea, creatinine, extra electrolytes, things like that. And it gives it to garbage man glomerulus in the kidney to take all of that garbage away and send it out into the urine. So garbage man glomerulus takes all of that blood from your body and it filters out all of that garbage and the waste and sends it into the urine. So we know that acute glomerulonephritis just means inflammation of garbage man glomerulus. And it's most often caused by an infection that happens somewhere else in the body. It can be especially strep throat. Now, strep throat is the number one cause of acute glomerulonephritis. So let's think through this. So when you have an infection, there are pathogens inside the body that the body needs to get rid of. And to do this, it produces something called antibodies. And Antibodies are these little Y shaped guys that attack and stick to these pathogens. So your antibodies are actually going up to the pathogens and grabbing onto them so that they, they can't hurt you. Now this creates large complexes with all of those pathogens and the antibodies all stuck together. And now here is your glomerulus sitting in your kidney, ready to filter through all of the blood. And just imagine this large pathogen antibody complex moving through this little tiny glomerulus. Now as it moves through the glomerulus in the blood, it gets stuck and it causes inflammation. So just imagine that all of these pathogen antibody complexes are really rubbing against the inside of the glomeruli. And when things rub together for too long, things get inflamed. And that is exactly what's happening here with glomerulonephritis. This inflammation damages garbage man glomerulus. He can't do his job as the garbage man anymore, so he stops working and he can't get rid of all of the body's garbage and the waste. Now let's take it one step further. When the blood isn't getting filtered, then all of that waste and all that garbage really fill up in the blood. Things like, like we said before, uric acid, urea, creatinine, and extra electroly lights that really you don't need. You don't want that in your blood in excess. Then imagine that you put your trash outside every week, but the garbage man never came. You would have a lot of trash right in your house. So that's what's happening here with glomerulonephritis. The blood is getting filled with a lot of trash and waste products because garbage man glomerulus can't take out the trash. Now I know that pathophysiology can be a lot to learn, but don't worry, I have a free cheat sheet for you that walks you through some really, really, really amazing study tips to help you learn things faster in nursing school. It's called the nursing school Study checklist. And I will put a link down below in the description box for you to check that out after you watch this video. Alright, so now that we know what is happening inside the body, the pathophysiology of glomerulonephritis, we can talk about the signs and symptoms. So during acute glomerulonephritis, there are lots of those, like we said, pathogen antibody complexes that are rubbing against the inside of the glomeruli and causing inflammation and damage. So the Glomerulus is actually damaged. Now, thinking of it this way, the major signs and symptoms that you would see in a patient with acute glomerulonephritis are things like hematuria, blood in the urine, fever, fluid overload, edema, hypertension, perhaps neurological changes in oliguria. So let's dive into each one of these and explain them, and we'll talk about why each one of them happens so that you can actually remember all of them. Remember, we're not just memorizing a list of signs and symptoms. We're gonna critically think through it all. So let's do it. So with acute glomerulonephritis, we usually have blood in the urine. Now, this is called hematuria. And it can look reddish, brownish, or actually like a Coca Cola is how some people describe it to look like. So it doesn't necessarily need to look bright red like we usually think of when we of blood. It could also be that kind of brown or dark like color, like Coca Cola. Now, this is caused by all of that damage in the inflammation in the glomerulus. The glomerulus is actually letting blood leak out of the body through the urine because it's damaged. So it makes sense that we would see that blood in the urine, right, meaning hematuria. Now, they may also have a fever, which is defined as a temperature of above 100.54 degrees Fahrenheit, or 38 degrees Celsius. Now, this can be caused by the inflammation in the kidneys, but it can also be caused by the original infection, or like original strep infection that caused the glomerulonephritis in the first place. And then excess fluid or fluid overload is another symptom that you will probably see. Now, this is because that damaged glomeruli in the kidney, right, they're letting proteins spill out into the urine. There's a lot of holes in there, letting proteins spill out into the urine. And proteins usually hold water into the blood. So now, when there's less protein in the blood to hold onto that water, the water will leak out into the surrounding tissues, and it causes swelling or edema. So the patient might have swelling, maybe around their eyes. Now, this is called periorbital edema, or they might have swelling in other places, like their feet. Now, this fluid overload can also cause hypertension, and hypertension can cause neurological changes. So you might see things like dizziness and a headache, maybe because the brain just isn't getting as much blood as it needs because of that elevated blood pressure, that hypertension. So all of those symptoms are very much related to all of that protein in the urine. The glomerulus is damaged, so it lets that protein leak out. And then when there's less protein in the blood, there's nothing for the water to hold, hold on to. So edema happens, which then leads to hypertension, which then can lead to those neurological changes. Now, to top that all off, that hypertension then prevents the kidneys from getting enough blood as they need, right? So they stop making as much urine, which is called oliguria. Now, oliguria means, it simply means that the patient is making only a little bit of urine. So simply because of that hypertension, the blood vessels are constricted, the kidneys aren't getting as much blood as they need. They can't make as much urine as they need to. All right, so those are the primary signs and symptoms that you will see in most of your patients with acute glomerulonephritis and that you need to know for your nursing school exams. So remember, hematuria, fever, fluid overload, edema, hypertension, there's a neurological changes, and of course, oliguria. Now, if you're a nursing SOS member, of course, be sure to log into your dashboard and you can download the study guide that we have for you all about this acute glomerul, acute glomerulonephritis, so that you can remember all of these signs and symptoms as you study. It's going to be a really, really good resource for you to help you remember all of these things as you study and prepare for your lecture exams. And if you're not a nursing SOS member yet, be sure to join the wait list so that you can join next time enrollment opens. Now, I'm going to put the link to all the details down below in the description box for you now, because we know what is happening inside the body now with acute glomerulonephritis, we know what symptoms might happen because of that pathophysiology. So now, as always, we are going to learn what we need to assess for as the nurse. So these things might show up on your nursing school exams, so be sure to pay attention. So we are going to learn the critical thinking and the why behind all of this. Because understanding the why will help you actually remember these assessments and the interventions. So let's talk about the why behind each one of these. All right, so your priority assessment for a patient with acute glomerulonephritis is, of course, to assess for fluid overload. Now, that sounds kind of weird. Why would fluid overload be a top priority for us to look for in this. In this disorder? And why would it be the first thing that your nursing school exams would test you on? Well, we know that acute glomerulonephritis is inflammation of the glomerulus in the kidney. And we know that inflammation causes capillary leak, which basically just means that fluid from the little capillaries in. In the body is seeping out into the tissue. So patients with capillary leak, and especially patients with any kind of kidney damage who aren't able to get rid of fluid as much as they should, they're at a risk for fluid overload because all of that fluid from the capillaries is now leaking out into the body tissues and the kidneys. They're holding on to too much fluid, so there's going to be fluid buildup in the body. Now, why does this matter? We know that fluid overload comes packed with a lot of problems, things like edema, pulmonary congestions, respiratory congestion, and heart failure. So pulmonary edema and acute heart failure should be at the top of your mind, because that is what can really be fatal for your patients. So check for edema, check for shortness of breath, crackles in the lungs, checking the respirations, check for hypertension and additional heart sound called the S3 heart sound, which means that they have a little extra heart sound at the end of their regular heartbeat. Now, you'll also need to make sure to weigh them every 24 hours. Take daily weights to get an accurate assessment of fluid volume changes. Now, weight is the most sensitive indicator for a patient's fluid status. You will always need to check their weight daily when you are dealing with a patient with fluid issues, especially fluid overload. So make sure you assess their vital signs, especially their blood pressure and their heart rate. Check their respirations as well to make sure that they are staying stable. Also, your patient may or may not have signs of an infection. Remember back to how glomerulonephritis starts with the body's immune response response with antibodies that are all clumped together with the pathogens. Right? And it's causing blockages in that glomeruli and inflammation in the glomeruli. So you'll especially want to ask if they've had strep throat or if they've had a sore throat recently, because that is one of the top causes of acute glomerulonephritis of course, you'll need to assess their urine color, the odor and the amount of urine they're producing. So most often with glomerulonephritis, there will be blood in the urine, so it will be darker than normal, might be brown, or it can actually look like Coca Cola. Also, ask them if they have been urinating less frequently lately. Since the glomeruli are responsible for making urine, there will be less urine production when the glomeruli are damaged. You should also be looking at their mental status and their energy level because if their kidneys really aren't functioning properly to be able to balance out those electrolytes and get toxins out of the body, they might have mental status changes. So you might see things like confusion and disorientation. Now with glomerulonephritis, there are going to be changes in lab values as well. All right, so the kidneys are responsible for removing toxins and really balancing out electrolytes in the body. So when the kidney is messed up, I want you to always be thinking fluid and electrolytes. And the number one electrolyte that we're worried about in a patient with kidney issues is potassium. A normal potassium level is between a 3.5 to 5 milli equivalents per liter. That's 3.5 to 5. And if potassium levels rise in the body too much, it affects the heart's electrical system and it can cause life threatening cardiac arrhythmias, meaning death. So you should always know your patient's potassium level, especially if they have any kidney issues or kidney damage. Now, another lab volume you'll need to check is their urinalysis. Now you may also likely see hematuria, meaning that there's blood in the urine and a red blood cell casts. Now this tells you that there's bleeding from the kidney. Normally there is no hemoglobin or no red blood cell casts in the urine and there should be less than five red blood cells in each high power field. You may also see proteinuria, meaning that they have more than 20 milligrams per deciliter of in their urine and they might have decreased albumin levels in the blood. So proteins are those larger molecules and they don't pass through healthy kidneys. But if the kidneys become damaged, like we said, they get holes packed inside of them from those antibody complexes so the proteins can really fit inside the holes. They pass, pass out through into the urine. So when we see protein in their urine and decreased albumin levels in the Blood, we say they are really losing protein out of their kidneys. So their kidneys must have those holes in them, right? That is not good. So protein in the urine means holy kidneys. Holes in the kidneys, which means kidney damage. Now, the next lab value you'll need to look for is their glomerular filtration rate, or their GFR for short. Now, this is the amount of blood that the glomerulus can filter in one minute. And if you remember from the path of physiology back at the beginning of this video, we call the glomerulus, garbage man glomerulus. His job is to take out all of the garbage from the body, all of that waste from the blood. So the glomerulus filters the blood, all of the blood gets rid of all the waste from it. Now, normally garbage Manglomerelis can filter 60-120 ML of blood per minute. Now, anything less than that is not normal and could indicate kidney damage. So if your patient's GFR, if their glomerular filtration rate is less than 60 milliliters per minute, we know that garbage man glomerulus, the glomeruli isn't doing his job well, so he might be damaged. Then the last lab value we're going to look at are the blood urea nitrogen level, or the BUN for short, and the creatinine level. Now, these are your primary kidney lab values. So anytime you suspect damage to the kidney, you should always check, always be thinking both the BUN and the creatinine. Now, it is one thing to say that you would check the BUN and creatinine, but let's make sure that we take it one step further to know why we are going to check these. So here's how this works. Urea nitrogen and creatinine, these two things are some of those waste products that garbage man chlomerulis. The glomeruli that he normally gets rid of, he needs to get rid of those. But if he's damaged the blood urea nitrogen level, the BUN and the creatinine, the creatinine level will probably be elevated because garbage main glomeruli is not able to get rid of them. So, so if garbage manglomerulus is damaged, he can't filter that bun and creatinine from the blood. So the bun and creatinine levels will be increased. A normal BU1 level is between 7-20mg per deciliter and a normal creatinine level is 0.6 to 1.2mg per deciliter. So if you see those levels much higher than that, it might be because garbage mang glomerulus is damaged, which means, unfortunately, that the kidney is damaged. Now, we've gone over what glomerulonephritis is, the pathophysiology, what's happening inside the body with it, what the signs and symptoms are, including the lab values that you have to look for, what you will be assessing for. Now, let's talk about our main nursing interventions for our patients with acute glomerulonephritis. Now, our main goal is to reduce fluid overload and edema. And we want to help the blood circulate through the kidneys to keep them functioning and to really keep electrolyte levels and their lab values within a normal range. So there are four nursing interventions that you will need to do in order to help accomplish this. You'll want to monitor their activity, maintain diet restrictions, prevent other infections, and then, of course, continue activity assessing them. So let's talk about each of these four things. So the first is to monitor their activity. You'll need to keep your patient on bed rest until they don't have really any more blood in their urine. And once their edema is under control, after all of that is gone, they should start to move around and then increase their activity. Another thing you'll do is to maintain diet restrictions. Their doctor might prescribe a sodium and a fluid restriction and possibly even a protein restriction, too. We know that edema is caused by too much fluid in the body tissues, and this can happen because of either too much sodium and water. Now, think about water and sodium. They're BFFs. Wherever sodium goes, water will follow. So when there is a lot of sodium, there's also going to be a of lot a lot of water. Now, normal kidneys usually regulate sodium and water levels just fine. And when your patient has kidney issues, they're just not able to really balance their sodium and their water levels well. So that is why edema can occur, because there is just too much sodium and water in the body, because the kidneys just cannot get rid of it. So your patients may need a sodium and a fluid restriction to prevent even more edema. They might also need to be on a protein restriction if they have protein in their urine. So usually there is no protein in the urine. If they do have protein in their urine, that means that those large protein molecules that they're going through those holes in the kidneys causing damage and then allowing the proteins to then spill out into the urine. So your patient might need a fluid restriction to prevent more damage. And finally, they might be on a potassium restriction to keep that potassium level from getting too high. Like we said, if the patient's kidneys are damaged, just like sodium and water, they won't be able to really get rid of the potassium that they need to get rid of. And this can cause that potassium level to rise in the body, which can be really, really dangerous, like we said, lead to those cardiac electrical issues. So you will be keeping a close eye on their intake and their output to make sure that they're not holding on to too much fluid. So make sure to document all of the fluid that they're getting. Coffee, water, tea, IVs, anything. Make sure that there is a urine hat in the toilet as well so that you can measure their urine output after the urine. You'll also need to make sure that the nursing staff is following their fluid restriction. It's pretty easy for a patient to slip over that fluid restriction, especially when there are so many nurses working with them each day. So make sure that you are always really accurately tracking how much fluid your patient is getting and then making sure that you don't go over that limit. That's going to be really important for them. You'll need to check their blood pressure regularly to make sure that they're not too hypertensive if they have a lot of that fluid buildup. And then make sure that their blood pressure isn't too low as well, especially if they're receiving a diuretic medication, which would diuretics would cause them to lose a lot of fluid, a lot of water. You'll need to do a lung and a cardiac assessment to check for signs of pulmonary edema or heart failure. So look for things like crackles in the lungs, shortness of breath. Look for hypertension or high blood pressure edema. Look for an S3 heart sound, which is the extra heart sound at the end of a normal heartbeat. And you will always need to assess their urine. So we already talked about tracking their urine output, but you will also need to look at the urine color and make a note of if any, it smells kind of funny at all. And you may also need to check for hidden protein in their urine and hidden blood using a dipstick. Okay, I know that was a lot of info to go through. Great job, my friend. You are now fully ready to not only take care of a patient with acute glomerulonephritis but you are also ready to ace your nursing school exam that comes your way on it. Now. Of course there's three ways that I can help you more through nursing School. Number one, be sure to download the Nursing School Study checklist that I have for you that walks you through step by step how to study in Nursing school. And be sure to check out our Nursing School boxes that we have available for you. They are packed with resources to really help you learn things faster and pass your exams. And of course if you want me to come alongside your nursing school journey and hold your hand throughout nursing school, you know that I am 100% here for that. Don't miss out on joining the Nursing SOS Membership community. It is filled with step by step nursing lectures to help you understand everything faster. So for Med Surg and for your other nursing school classes so you'll be more prepared for your nursing school exams and you will also be able to have more of a life in nursing school. The links to all of those things are down below in the description box and if you like this video, be sure to hit that like button. Leave a comment below to let me know that you loved it and share it with a nursing school friend who might also need help with Med Surg and Acute glomerulonephritis for Nursing school. And of course hit that subscribe button and click the notification bell so you never miss a video. And click on one of these videos right over here so you can keep rocking Nursing school. And as always my friend, go become the nurse that God created only you to be. And I'll catch you next time on the Nursing School show. Take care. Bye bye.