Question

A 25 y/o white male complains of recurrent episodes of "bloody urine" that lasted for several days in conjunction with URI. He was well until the onset of the symptoms. On Physical examination (PE), he has marked pallor with slight palpebral edema. Urinanalysis (UA) showed proteinuria; red cell casts: gross hematuria; increased serum IGA Imaging and Gross pathology are unapplicable. Micropathology demonstrated focal glomerulonephritis involving only selected glomeruli with mesangial proliferation and segmental necrosis with crescents IGA deposits as well as some IgG, IgM and C3 on immunofluorescence.

2) Please design a short term care for the patient according to nursing protocols.

Answer 1

• Obtain complete physical examination.
• Monitor daily weight to have a measurable account on fluid accumulation.
• Monitor fluid intake and output every 4 hours to know progressing condition.
• Monitor BP (use same arm and properly fitting cuff) and PR hourly.
• Assess for adventitious breath sounds to know for possible progression in the lungs.
• Monitor lab values, especially protein level in urine, periodic urinalysis, urine culture and sensitivity as indicated.
• Maintain fluid restrictions and dietary restriction of sodium and protein.
• Elevate extremities with pillows when at rest or in lying position.
• Administer diuretics, antitypertensives - ACE (Angiotensin Converting Enzymes) and ARBs (Angiotensin Receptor Blockers) as ordered.
• Encourage ambulation and non-strenous exercises.
• Maintain clean and moist skin.
• Prevent infection by restricting contact with people having infections.
• Infuse IV albumin as ordered to compensate for protein loss.