DIAGNOSIS

Ms. King develops the following nursing diagnoses for Mr.Chang. Excess fluid volume related to plasma protein deficit and sodium and water retention Risk for imbalanced nutrition: Less than body requirements related to anorexia Anxiety related to prescribed activity restriction Risk for ineffective therapeutic regimen management related to lack of information about glomerulonephritis and treatment

EXPECTED OUTCOMES
The expected outcomes are that Mr.Chang will: Maintain blood pressure within normal limits. Return to usual weight with no evidence of edema. Consume adequate calories following prescribed dietary limitations. Verbalize reduced anxiety regarding ability to continue studies. Demonstrate an understanding of acute glomerulonephritis and prescribed treatment regimen.

PLANNING AND IMPLEMENTATION

Ms. King plans the following nursing interventions for Mr.Chang. Vital signs every 4 hours; notify physician of significant changes. Weigh daily;intake and output every 8 hours. Schedule fluids allowing 650 mL on day shift, 450 mL on evening shift, and 100 mL on night shift. Arrange dietary consultation to plan a diet that includes preferred foods as allowed. Provide small meals with high-carbohydrate between-meal snacks. Encourage Mr.Chang to talk about his condition and its potential effects. Assist with problem solving and exploring options for maintaining studies. Enlist friends and family to listen and provide support. Teach Mr. Chang and his family about acute glomerulonephritis and prescribed treatment. Instruct in appropriate antibiotic use.

EVALUATION
Mr.Chang is released from the infirmary after 4 days.He decides to return to his parentshome for the 6 to 12 weeks of convalescence prescribed by his doctor.Mr. Changs renal function gradually returns to normal with no further azotemia and minimal proteinuria after 4 months.He verbalizes understanding of the relationship between the strep throat, his inappropriate use of antibiotics, and the glomerulonephritis. He says,I may not always remember to take every pill on time in the future, but I sure wont save them for the next time again!

Nursing ManagementAcute Glomerulonephritis

Patient assessment Maintain fluid balance Fluid and dietary restrictions Patient education Follow-up care

Imbalanced Nutrition: Less Than Body Requirements Interventions include: Dietary evaluation for: Protein Fluid Potassium Sodium Phosphorus

Vitamin supplementation

Excess Fluid Volume Interventions: Monitor clients intake and output. Promote fluid balance. Assess for manifestations of volume excess: Crackles in the bases of the lungs

Edema Distended neck veins

Drug therapy includes diuretics.