Nursing Care Plan for Clien with

Glomerulonephritis

By :
Rodianson Tuah
2014
 Preface
Acute glomerulonephritis is an inflammation of
the glomeruli, bundles of tiny vessels inside the
kidneys. The damaged glomeruli cannot
effectively filter waste products and excess
water from the bloodstream to make urine. The
kidneys appear enlarged, fatty, and congested.
 Definition
Acute glomerulonephritis is an inflammatory
disease of both kidneys predominantly affecting
children from ages two to 12. Chronic
glomerulonephritis can develop over a period of
10-20 years and is most often associated with
other systemic disease, including diabetes,
malaria, hepatitis, or systemic lupus
erythematosus.
 Causes and Symptoms
Acute glomerulonephritis most often follows a
streptococcal infection of the throat or skin. In
children, it is most often associated with an upper
respiratory infection, tonsillitis, or scarlet fever.
Kidney symptoms usually begin two to three weeks
after the initial infection. Exposure to certain paints,
glue or other organic solvents may also be the
causative agent. It is thought that the kidney is
damaged with exposure to the toxins that are
excreted into the urine.
Mild glomerulonephritis may produce no symptoms, and diagnosis is
made with laboratory studies of the urine and blood. Individuals with
more severe cases of the disease may exhibit:
1. Fatigue
2. nausea and vomiting
3. shortness of breath
4. disturbed vision
5. high blood pressure
6. swelling, especially noted in the face, hands, feet, and ankles
7. blood and protein in the urine, resulting in a smoky or slightly red
appearance

The individual with chronic glomerulonephritis may discover their

condition with a routine physical exam revealing high blood pressure,
or an eye exam showing vascular or hemorrhagic changes. The kidneys
may be reduced to as little as one-fifth their normal size, consisting
largely of fibrous tissues.
 Diagnosis
Diagnosis of glomerulonephritis is established based on
medical history, combined with laboratory studies. A
"dipstick" test of urine will reveal increased protein levels.
A 24 hour urine collection allows measurement of the
excretion of proteins and creatinine. Creatinine clearance
from the bloodstream by the kidneys is considered an
index of the glomerular filtration rate. Blood studies may
reveal a low blood count, and may also be checked for
the presence of a streptococcal antibody titer(a
sophisticated blood test indicating presence of
streptococcal infection). A kidney biopsy may also be
performed, using ultrasound to guide the needle for
obtaining the specimen
 Treatment
The main objectives in the treatment of acute glomerulonephritis are to:
1. Decrease the damage to the glomeruli
2. Decrease the metabolic demands on the kidneys
3. Improve kidney function

• Bedrest helps in maintaining adequate blood flow to the kidney. If residual

infection is suspected, antibiotic therapy may be needed. In the presence of fluid
overload, diuretics may be used to increase output with urination. Iron and
vitamin supplements may be ordered if anemia develops, and antihypertensives, if
high blood pressure accompanies the illness. In order to rest the kidney during the
acute phase, decreased sodium and protein intake may be recommended. The
amount of protein allowed is dependent upon the amount lost in the urine, and
the requirements of the individual patient. Sodium limitations depend on the
amount of edema present. Fluid restrictions are adjusted according to the
patient's urinary output and body weight.
• An accurate daily record of the patient's weight, fluid intake and urinary output
assist in estimating kidney function. The patient must be watched for signs of
complications and recurrent infection. As edema is reduced and the urine
becomes free of protein and red blood cells, the patient is allowed to increase
activity. A woman who has had glomerulonephritis requires special medical
attention during pregnancy
 Prognosis
In acute glomerulonephritis, symptoms usually
subside in two weeks to several months, with
90% of children recovering without
complications and adults recovering more
slowly. Chronic glomerulonephritis is a disease
that tends to progress slowly, so that there are
no symptoms until the kidneys can no longer
function. The resultant renal failure may require
dialysis or kidney transplant.
 Prevention
Prevention of glomerulonephritis is best
accomplished by avoiding upper respiratory
infections, as well as other acute and chronic
infections, especially those of a streptococcal origin.
Cultures of the infection site, usually the throat,
should be obtained and antibiotic sensibility of the
offending organism determined. Prompt medical
assessment for necessary antibiotic therapy should
be sought when infection is suspected. The use of
prophylactic immunizations is recommended as
appropriate.
Glomerulonephritis adalah peradangan dan
kerusakan pada alat penyaring darah sekaligus
kapiler ginjal (glomerulus) (Sandra M. Nettina,
2001).
Glomerulonephritis adalah sindrom yang ditandai
oleh peradangan dari glomerulus diikuti
pembentukan beberapa antigen (Barbara Engram,
1999).
Glomerulonephritis akut adalah istilah yang sering
secara luas digunakan yang mengacu pada
sekelompok penyakit ginjal dimana inflamasi terjadi
di glomerulus (Brunner & Suddarth, 2001).
 ETIOLOGI
a. Kuman streptococcus
b. Berhubungan dengan penyakit autoimun lain
c. Reaksi obat.
d. Bakteri.
e. Virus.
 Manifestasi Klinik
1. Faringitis atau tonsilitis
2. Demam
3. Sakit kepala
4. Malaise
5. Nyeri panggul
6. Hipertensi
7. Anoreksia
8. Muntah
9. Edema akut
10. Oliguria, proteinuria, dan urine berwarna cokelat.
 Penatalaksanaan
a. Modifikasi diet:
- Pembatasan cairan dan natrium.
- Pembatasan protein bila BUN sangat
meningkat.
b. Farmakoterapi
- Terapi imunosupresif seperti agen sitoksit dan
steroid untuk glomerulonefritis progresif cepat.
- Diuretik, terutama diuretik loop seperti
furosemid (lasix), dan bumex.
- Dialisis, untuk penyakit ginjal tahap akhir.
 Komplikasi
a. Hipertensi.
b. Dekopensasi jantung.
c. GGA (Gagal Ginjal Akut)
 Diagnostik
a. Urinalisis (UA).
b. Laju filtrasi glomerulus (LFG)
c. Nitrogen urea darah (BUN) dan kreatinin
serum
d. Pielogram intravena (PIV)
e. Biopsi ginjal
f. Titer antistrepsomisin O (ASO).
 Asuhan Keperawatan
Pengkajian :
Aktivitas/istirahat :
Keletihan, kelemahan, malaise
Perubahan pola tidur
Sirkulasi :
Hipertensi
Integritas Ego :
Marah, sensitif, perubahan kepribadian.
Eliminasi :
Perubahan pola berkemih, disuria, urien keruh,
proteinuria, hematuria.Riwayat ISK (+)
Makanan dan Cairan :
Anoreksia, hiperkalemi, penampilan tak
bertenaga.
Neurosensori :
Sakit kepala, irritabilitas
kram otot/kejang
Nyeri dan ketidaknyamanan :
Nyeri tubuh, sakit kepala, perilaku berhati-hati
dan gelisah.
Pernafasan :
Takipnoe, dispnoe saat terjadi peningkatan suhu
tubuh.
Keamanan :
Perhatikan adanya reaksi seperti demam (sepsis
dan dehidrasi, risiko komplikasi
 Pembelajaran keluarga
Riwayat ISK, penyakit keganasan.
Pola kebersihan diri
Riwayat paparan zat berbahaya.
 Masalah Kep yang lazim terjadi
1. Perubahan pola eliminasi urine
2. Perubahan nutrisi kurang dari kebutuhan
tubuh berhubungan dengan anoreksia.
3. Nyeri berhubungan dengan infeksi pada
ginjal.
4. Defisit pengetahuan
PRIORITAS KEPERAWATAN :
1. Tanda infeksi dan peradangan teratasi
2. Mencegah komplikasi.
3. Memberikan dukungan emosi utk klien
4. Memberikan informasi tentang penyakit/prognosis dan
kebutuhan pengobatan.

TUJUAN PEMULANGAN :
1. Pola perkemihan normal
2. Komplikasi dicegah/minimal
3. Menerima/menyadari keadaannya.
4. Proses penyakit , prognosis dan program pengobatan dipahami.