Question

B. GLOMERULONEPHRITIS

A patient with cleft lip and bronchial asthma was brought to the emergency department with chief complaint of low-grade fever, puffiness of the face and eyes in the morning, +2 edema on both feet, and tea-colored urine. Urinalysis revealed numerous RBC and certain degree of proteinuria and Antistreptolysin-O titer reaches more than 300 todd units. The doctor came up with the diagnosis of Acute Glomerulonephritis (AGN).

Answer the following questions:
1. What history-taking question should be asked by the nurse to strengthen the diagnosis of AGN?

2. Explain the pathophysiological tracing on the development of AGN.

3. The doctor ordered hydrocortisone TIV, create a drug study specifying the following:
a. Drug classification
b. Mechanism of action
c. Indication (*for the case of the patient mentioned above)
d. Contraindication
e. Side effects
f. Nursing Considerations

Answer 1

1) •past history should be taken by the nurse, that the patient was suffering from cleft lip and bronchial asthma.

• Then nurse should collect history if the patient is suffering from puffiness in face, eye, edema of both feet.

• History should be taken about elimination pattern of the patient, if the patient is suffering from proteinuria, hematuria (cola colour urine). Which indicates acute glomerulonephritis.

2) Pathophysiology-

Due to etiological factors, an immune response is produced by the formation of antigen- antibody complex . These complexs travel through the circulation, get trapped in the glomerulus and active an inflammatory response in the glomerular basement membrane. That damages glomerular capillaries and reduce the size of the capillary lumen. That decreases glomerular filtration rate. Sodium and fluid retention occurs, that causes edema. Injury to the capillary walls increases the permeability and proteinuria occurs.

3)a.Drug classification.

Group- short acting Glucocorticoid.

b.Mechanism of action-

Hydrocortisone induces a protein called lipocortin which inhibits phospholipase A2 and it also stabilized lysosomal membrane to prevent release of inflammatory mediators. In this way anti inflammatory response occurs.

c.Indication- AGN is an inflammatory disease, hydrocortisone is used to reduce inflammation and improve renal function.

d.Contra indication- Hypersensitivity to this product, GI obstruction.

e.Side effect-

a.CNS- Seizure, drowsiness, dizziness.

b.CV- palpitations, tachycardia.

c. GU- dysuria, urinary retention.

d. GI- nausea, vomiting.

f. Nursing consideration.

1. Assess- pain, CNS changes, vital signs, bowel, urinary elimination pattern. Physical examination. Urine analysis. Allergic reaction.

2. Evaluates- Therapeutic response improve renal function, decrease information.

3. Teach patient family.

• to report any symptoms of CNS change, allergy.

•to report abdominal pain, black tarry stool because of GI bleeding.

• Not to discontinue abruptly.

•to report immediately a change in vision.