A patient with early-stage glomerulonephritis is being educated on dietary modifications. Which of the following dietary changes is most appropriate to help manage their condition?

B) Reduce sodium intake to prevent fluid retention

A) Increase protein intake to promote healing

B) Reduce sodium intake to prevent fluid retention

C) Increase potassium intake to improve kidney function

D) Reduce calcium intake to prevent kidney stones

A patient with a history of kidney dysfunction reports new symptoms of occasional fatigue and mild ankle swelling. The nurse notes trace edema in the ankles and a slight increase in serum creatinine. What is the most appropriate initial nursing action?

B) Encourage the patient to rest and elevate her legs.

A) Advise the patient to increase fluid intake.

B) Encourage the patient to rest and elevate her legs.

C) Notify the physician immediately.

D) Reassure the patient that these symptoms are normal.

A patient with a history of mild kidney dysfunction presents with new symptoms of occasional fatigue and mild ankle swelling. Which of the following nursing interventions is most appropriate to prioritize in this situation?

B) Educate the patient on reducing sodium intake to help manage swelling.

A) Encourage the patient to increase fluid intake to flush out the kidneys.

B) Educate the patient on reducing sodium intake to help manage swelling.

C) Advise the patient to rest more frequently to reduce fatigue.

D) Suggest the patient monitor blood pressure daily to detect hypertension.

When managing a patient with mild renal impairment and edema, which dietary recommendation is most appropriate?

B) Restrict sodium intake to manage fluid retention

A) Increase protein intake to promote kidney function

B) Restrict sodium intake to manage fluid retention

C) Increase potassium intake to prevent electrolyte imbalance

D) Increase fluid intake to promote diuresis

What is the primary purpose of initiating a low-dose diuretic in the management of this patient?

A) To increase urine output and reduce fluid retention

B) To enhance kidney function and increase eGFR

C) To lower blood pressure and prevent hypertension

D) To correct electrolyte imbalance in the body

What is the most likely reason for the decrease in the patient's ankle edema and weight following the adjustment in her diuretic dosage?

A) Improved blood pressure control

C) Enhanced dietary modifications

A patient on diuretics has shown improvement in symptoms, including a decrease in ankle edema and headaches, with stable renal function. Which vital sign finding in this scenario indicates an effective response to the treatment plan?

A) Blood pressure of 122/80 mmHg

B) Heart rate of 72 beats per minute

C) Serum potassium level of 3.7 mEq/L

Glomerulonephritis - Nursing Case Study

Pathophysiology

• Primary mechanism: Immune Complex Deposition

Immune complexes form in response to infections or other triggers and deposit in the glomeruli, leading to inflammation and damage.

• Secondary mechanism: Inflammatory Response

The deposition activates the immune system, causing inflammation. This disrupts the glomerular filtration barrier, leading to proteinuria and hematuria.

• Key complication: Reduced Kidney Function

Inflammation and damage to the glomeruli can impair kidney function, causing fluid retention and hypertension, which are clinically significant for patient care.

Patient Profile

Demographics:

25-year-old female, university student

History:

• Key past medical history: No significant past medical history

• Current medications: None

• Allergies: None

Current Presentation:

• Chief complaint: Mild swelling in the ankles

• Key symptoms: Slight hematuria, mild proteinuria, fatigue

• Vital signs: Blood pressure 120/80 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F (37°C)

Section 1

New Diagnostic Results:

Following the initial presentation, the healthcare team ordered a series of laboratory tests to further evaluate the patient's renal function and confirm the diagnosis of glomerulonephritis. The urinalysis revealed the presence of red blood cell casts, confirming the diagnosis and indicating glomerular inflammation. Blood tests showed a slight elevation in serum creatinine at 1.2 mg/dL (normal range: 0.6-1.1 mg/dL for women), suggesting mild impairment in kidney function. The estimated glomerular filtration rate (eGFR) was calculated to be 85 mL/min/1.73m², which is on the lower end of normal, indicating early-stage kidney dysfunction.

Complement levels, specifically C3, were slightly decreased, supporting the theory of immune complex deposition as the underlying mechanism. An antistreptolysin O (ASO) titer was also elevated, indicating a recent streptococcal infection that could have triggered the immune response leading to glomerulonephritis. This connection between the infection and the immune-mediated kidney damage provides a clear focus for treatment and monitoring strategies.

These diagnostic results reinforce the initial clinical impression of early-stage glomerulonephritis with minor complications. The slight decrease in kidney function, as evidenced by the serum creatinine and eGFR, highlights the need for close monitoring and possibly initiating conservative management strategies. Education on symptom monitoring, dietary modifications to reduce protein and sodium intake, and the importance of follow-up appointments will be essential components of her care plan. This clear understanding of her condition paves the way for evaluating her response to interventions in the next phase of care.

Section 2

Change in Patient Status

A week after initiating the conservative management plan, the patient returned for a follow-up visit. During this appointment, the nurse conducted a thorough assessment to evaluate any changes in the patient's condition. The patient reported feeling generally well but mentioned experiencing occasional fatigue and mild swelling in her ankles, particularly in the evenings. These symptoms were new since her last visit and warranted further investigation.

Vital signs were stable with a blood pressure reading of 128/82 mmHg, heart rate of 72 beats per minute, and a respiratory rate of 18 breaths per minute. However, the nurse observed trace edema in the patient's ankles during the physical examination. Given these findings, the healthcare team decided to repeat some lab tests to monitor the patient's renal function and electrolyte balance. The serum creatinine level had slightly increased to 1.3 mg/dL, and there was a mild reduction in eGFR to 80 mL/min/1.73m², indicating a marginal progression in kidney dysfunction. Urinalysis continued to show the presence of red blood cell casts but no significant increase in proteinuria.

These subtle changes in the patient's status suggest the importance of maintaining close surveillance and adherence to dietary and lifestyle modifications. The healthcare team discussed with the patient the importance of continuing to monitor her symptoms, managing her fluid intake, and attending regular follow-up appointments to ensure early detection and management of any further complications. The patient's journey now focuses on stabilizing her condition and preventing progression while maintaining her quality of life.

Section 3

In the weeks following the follow-up visit, the patient continued with her conservative management plan, which included a low-sodium diet, adequate hydration, and regular exercise. Despite these efforts, the patient noticed a gradual increase in the frequency of her fatigue and ankle swelling, prompting her to return for another evaluation. During this subsequent appointment, the nurse conducted a comprehensive assessment to understand the current state of the patient’s condition.

The nurse noted that the patient’s vital signs remained stable, with a blood pressure of 130/84 mmHg, heart rate of 74 beats per minute, and respiratory rate of 18 breaths per minute. However, the physical examination revealed a progression in the trace edema, now extending slightly above the ankles. The patient also reported a weight gain of two pounds since her last visit, which she attributed to the fluid retention. Recognizing the potential for developing complications, the healthcare team ordered repeat laboratory tests to reassess kidney function and electrolyte status.

The new lab results indicated that the serum creatinine level had increased further to 1.4 mg/dL, and the estimated glomerular filtration rate (eGFR) had decreased to 75 mL/min/1.73m², suggesting a mild but noticeable decline in renal function. Urinalysis showed the persistence of red blood cell casts with a slight increase in proteinuria. These findings underscored the importance of revisiting the patient’s management strategy. The healthcare team emphasized the need for the patient to adhere strictly to dietary modifications and to consider potential adjustments in her fluid intake to manage the edema effectively. They also discussed possibly initiating a low-dose diuretic to help alleviate the fluid retention and prevent further deterioration. The patient was reminded of the significance of regular follow-up visits to monitor her progress and to ensure timely intervention as needed.

Section 4

In the weeks following the adjustment of her management plan, the patient began taking a low-dose diuretic as prescribed and adhered more rigorously to dietary modifications. She reported a noticeable reduction in her ankle swelling and a slight improvement in her energy levels. However, during a routine follow-up visit, the nurse observed that the patient’s blood pressure had decreased slightly to 126/82 mmHg, while her heart rate remained stable at 72 beats per minute. Upon examination, the edema had reduced but was still present around the ankles. The patient expressed concern over experiencing mild headaches and occasional dizziness, which she had not reported in previous visits.

To evaluate these new symptoms, the healthcare team ordered additional laboratory tests. The results showed that while the serum creatinine level had stabilized at 1.3 mg/dL, the eGFR remained at 75 mL/min/1.73m², indicating no further decline in renal function. Electrolyte levels were within normal limits, but a slight drop in serum potassium to 3.5 mEq/L was noted, likely attributable to the diuretic therapy. The urinalysis continued to show red blood cell casts, but no significant increase in proteinuria was detected.

These findings suggested a positive response to the current interventions, although the minor complications of headaches and dizziness needed addressing. The healthcare team discussed the possibility of adjusting the diuretic dosage to alleviate these side effects while continuing to monitor the patient's progress closely. The patient was encouraged to keep track of her symptoms and maintain regular follow-up appointments to ensure any further complications could be promptly managed. This approach aimed to support the patient in maintaining stable renal function and preventing additional deterioration in her condition.

Section 5

In the weeks following the adjustment in her diuretic dosage, the patient continued to adhere to her dietary modifications and medication regimen. During her next follow-up visit, the nurse conducted a thorough assessment to evaluate the patient's response to the changes in her treatment plan. The patient's blood pressure was recorded at 122/80 mmHg, indicating a slight improvement from the previous reading. Her heart rate remained stable at 72 beats per minute, and her weight had decreased by two pounds, suggesting a reduction in fluid retention.

Upon physical examination, the nurse noted a further decrease in ankle edema, with only mild swelling remaining. The patient reported that her headaches had significantly subsided, and the episodes of dizziness had become infrequent. She expressed feeling more energetic and was pleased with the noticeable improvements in her symptoms. The healthcare team reviewed the recent laboratory results, which showed that the serum potassium level had increased slightly to 3.7 mEq/L, and the eGFR had remained stable at 75 mL/min/1.73m². The urinalysis continued to show red blood cell casts, but there was no increase in proteinuria, indicating stable renal function.

Given these positive developments, the healthcare team decided to maintain the current treatment plan while emphasizing the importance of ongoing monitoring. The patient was instructed to continue tracking her symptoms and was encouraged to engage in light physical activities as tolerated, which could further enhance her overall well-being. The team scheduled a follow-up appointment in four weeks to reassess her condition, ensuring that any emerging issues could be promptly addressed. This proactive management aimed to support her progress and prevent any potential complications from arising.