Glomerulonephritis Nursing Care Plan
Glomerular inflammation with hematuria and edema; BP control and fluid limits.
Quick answer
A Glomerulonephritis nursing care plan centers on control blood pressure and prevent hypertensive encephalopathy and seizures; manage fluid overload and monitor for pulmonary edema and heart failure; monitor renal function and electrolytes, especially potassium. Priority nursing diagnoses are Excess fluid volume, Impaired urinary elimination, Fatigue. The plan below gives assessment cues, measurable goals, 5 intervention sets with rationales, and patient teaching.
Overview
Glomerulonephritis is inflammation of the glomeruli, most commonly post-infectious in children following a group A streptococcal throat or skin infection about 1–3 weeks earlier. Immune complexes deposit in the glomerular basement membrane and trigger inflammation that reduces filtration surface area. The result is the nephritic picture: hematuria producing tea-, cola- or smoky-colored urine, mild to moderate proteinuria, oliguria, edema and hypertension from sodium and water retention.
Distinguishing it from nephrotic syndrome clarifies the whole plan. Nephritic disease features gross hematuria and hypertension with modest protein loss and periorbital edema; nephrotic disease features massive proteinuria with hypoalbuminemia and profound generalized edema. Most post-infectious cases in children resolve completely within weeks, though microscopic hematuria can persist for months. The two dangers during the acute phase are hypertensive encephalopathy and fluid overload with heart failure, so blood pressure, daily weight and strict intake and output are the core nursing measures.
Key numbers to know
Classic history
Streptococcal pharyngitis or impetigo 1–3 weeks before onset; elevated ASO titer and low serum complement C3.
Urine
Tea-colored or cola-colored with red cell casts — casts confirm a glomerular source of bleeding.
Nephritic vs nephrotic
Nephritic: hematuria + hypertension, mild proteinuria. Nephrotic: massive proteinuria + hypoalbuminemia + severe edema.
Biggest acute risks
Hypertensive encephalopathy — headache, vomiting, visual change, seizure — and circulatory overload.
Prognosis
Most children recover fully; microscopic hematuria may persist for months and needs monitoring, not alarm.
Nursing priorities
- Control blood pressure and prevent hypertensive encephalopathy and seizures.
- Manage fluid overload and monitor for pulmonary edema and heart failure.
- Monitor renal function and electrolytes, especially potassium.
- Restrict sodium, fluid and, when indicated, protein and potassium.
- Detect and treat residual or recurrent infection.
- Balance rest with a gradual return to activity and reassure the family about prognosis.
Nursing assessment
Subjective data
- Report of dark, brown, tea- or cola-colored urine
- Puffiness around the eyes, worse in the morning
- Headache, malaise, anorexia, nausea and lethargy
- Flank or abdominal discomfort
- History of sore throat or skin infection in the previous few weeks
- Visual disturbance or vomiting suggesting severe hypertension
Objective data
- Hypertension, sometimes marked, with headache and irritability
- Periorbital edema on waking, progressing to dependent and generalized edema
- Decreased urine output, dark urine with proteinuria and red cell casts on microscopy
- Weight gain over baseline and rising abdominal girth
- Elevated BUN and creatinine, hyperkalemia, metabolic acidosis, mild anemia
- Elevated ASO titer and depressed serum complement C3
- Crackles, gallop rhythm, jugular distention or dyspnea with circulatory overload
- Seizure activity, visual change or altered consciousness in hypertensive encephalopathy
Related factors
- Immune complex deposition and glomerular inflammation reducing filtration
- Sodium and water retention from decreased glomerular filtration rate
- Increased intravascular volume raising blood pressure
- Recent streptococcal or other infection
- Impaired excretion of potassium, nitrogenous waste and acid
Key nursing diagnoses
Goals and expected outcomes
- The client will maintain blood pressure within the target range for age with no neurologic symptoms.
- The client will show resolving edema and return to baseline weight with adequate urine output.
- The client will maintain electrolytes and renal indices trending toward normal.
- The client will remain free of seizures, pulmonary edema and heart failure.
- The client will adhere to prescribed sodium, fluid and dietary restrictions.
- The client and family will describe follow-up urine testing and the need to treat future strep infections promptly.
Nursing interventions and rationales
1. Blood pressure and neurologic monitoring
- Measure blood pressure at least every 4 hours during the acute phase using a correctly sized cuff, and more often if elevated or if antihypertensives are being titrated.
- Assess for hypertensive encephalopathy — headache, blurred vision, vomiting, irritability, drowsiness, seizure — and report any of these immediately.
- Give antihypertensives and diuretics exactly as ordered and document the response; monitor for hypotension after dosing.
- Institute seizure precautions with padded rails, the bed low, and suction and oxygen available for children with markedly elevated pressures.
- Provide a quiet environment with dim lighting and clustered care to limit stimulation.
2. Fluid balance and edema management
- Weigh daily at the same time on the same scale in the same clothing — the most sensitive indicator of fluid change.
- Maintain strict intake and output records including all oral, IV and irrigant volumes and every void.
- Assess edema location and severity each shift, measure abdominal girth if ascites is present, and inspect the periorbital area on waking.
- Enforce the prescribed fluid restriction, dividing the daily allowance across shifts and providing ice chips, mouth care and hard candy for thirst.
- Auscultate lungs and heart each shift for crackles, gallop and increasing respiratory rate signaling overload.
- Document urine color and volume each void and note the transition from tea-colored to clear as recovery progresses.
3. Renal function, electrolytes and infection
- Monitor BUN, creatinine, electrolytes, complement and urinalysis as ordered and report rising potassium or worsening azotemia.
- Watch for hyperkalemia — peaked T waves, arrhythmia, muscle weakness — and restrict dietary potassium when indicated.
- Give the full course of antibiotics when residual streptococcal infection is present, and ensure household contacts are evaluated if indicated.
- Assess temperature and other infection signs; the child is at risk during immobility and reduced intake.
- Avoid nephrotoxic medications including NSAIDs and review all drugs for renal dosing.
- Support dialysis when severe azotemia, hyperkalemia or refractory overload occurs.
4. Nutrition and activity
- Provide a sodium-restricted diet during hypertension and edema, and explain that most sodium comes from processed foods rather than the salt shaker.
- Restrict potassium and protein only when specifically prescribed for elevated levels or azotemia; otherwise provide adequate calories to prevent catabolism.
- Offer small, frequent, appealing meals during anorexia and involve the child in food choices within limits.
- Encourage rest during the acute hypertensive and edematous phase, then a graded return to normal activity as blood pressure normalizes and urine clears — prolonged bed rest is neither necessary nor beneficial.
- Provide quiet age-appropriate diversion during activity limitation to reduce restlessness.
5. Education, reassurance and follow-up
- Reassure the family that most children with post-infectious glomerulonephritis recover completely, while explaining the need for follow-up.
- Teach that microscopic hematuria may persist for months and does not mean the illness is returning if blood pressure and function are normal.
- Teach home blood pressure monitoring where appropriate and the importance of reporting persistent elevation.
- Stress prompt evaluation and full antibiotic treatment of future sore throats and skin infections.
- Arrange follow-up urinalysis, blood pressure checks and renal function testing and explain the schedule concretely.
- Review return criteria: decreased urine output, returning dark urine, swelling, headache, vomiting or visual change.
Patient and family teaching
- Watch and report decreased urination, returning dark or tea-colored urine, or new swelling around the eyes.
- Report headache, vomiting or blurred vision immediately — these can mean dangerously high blood pressure.
- Follow the low-sodium diet and fluid limit while swelling and high blood pressure persist.
- Weigh at the same time each day and keep a record for the follow-up visit.
- Take every dose of prescribed antibiotics and blood pressure medication as directed.
- Have any future sore throat checked and treated fully — untreated strep is what started this.
- Keep follow-up urine and blood pressure checks; microscopic blood in the urine can persist for months and still be normal recovery.
How to build this plan
- 1Assess the patient. Collect subjective and objective data through interview, physical assessment, labs and chart review. Complete, accurate data is the foundation of every later step.
- 2Analyze and cluster the data. Group related cues, compare them with normal findings, and identify patterns that point to actual or potential problems.
- 3Formulate nursing diagnoses. Write the problem statement using a recognized diagnostic label plus related factors and evidence (problem related to cause as evidenced by signs).
- 4Set priorities. Rank diagnoses as high, medium or low using ABCs, Maslow's hierarchy and the patient's own stated priorities. Life-threatening problems come first.
- 5Establish goals and outcomes. Write SMART, patient-centered outcomes: specific, measurable, attainable, realistic and time-bound (short-term and long-term).
- 6Select nursing interventions. Choose independent, dependent and collaborative actions that are safe, evidence-based and matched to the outcome.
- 7Provide rationales. State the scientific reason each intervention works. Rationales are what turn a task list into clinical reasoning.
- 8Evaluate the plan. Compare the patient's actual response with the expected outcome: met, partially met or not met — then continue, revise or discontinue.
- 9Document and communicate. Record the plan and the patient's response in the health record so the whole team works from the same information.
Summarized for study use. Always follow your school's or facility's approved care plan format and current clinical policy.
Practice Glomerulonephritis questions
These concepts are tested on the ATI proctored exams below — every set has answers and rationales.
More Urinary & Renal care plans
Plans that share these nursing diagnoses
Care plan writing guides
Common questions
What are the nursing diagnoses for Glomerulonephritis?
Priority nursing diagnoses for Glomerulonephritis: Excess fluid volume; Impaired urinary elimination; Fatigue.
What are the nursing interventions for Glomerulonephritis?
Measure blood pressure at least every 4 hours during the acute phase using a correctly sized cuff, and more often if elevated or if antihypertensives are being titrated. Assess for hypertensive encephalopathy — headache, blurred vision, vomiting, irritability, drowsiness, seizure — and report any of these immediately. Give antihypertensives and diuretics exactly as ordered and document the response; monitor for hypotension after dosing. Institute seizure precautions with padded rails, the bed low, and suction and oxygen available for children with markedly elevated pressures. Provide a quiet environment with dim lighting and clustered care to limit stimulation. Weigh daily at the same time on the same scale in the same clothing — the most sensitive indicator of fluid change.
What are the nursing care goals for Glomerulonephritis?
The client will maintain blood pressure within the target range for age with no neurologic symptoms. The client will show resolving edema and return to baseline weight with adequate urine output. The client will maintain electrolytes and renal indices trending toward normal. The client will remain free of seizures, pulmonary edema and heart failure. The client will adhere to prescribed sodium, fluid and dietary restrictions. The client and family will describe follow-up urine testing and the need to treat future strep infections promptly.
What should you assess in a patient with Glomerulonephritis?
Report of dark, brown, tea- or cola-colored urine; Puffiness around the eyes, worse in the morning; Headache, malaise, anorexia, nausea and lethargy; Flank or abdominal discomfort; History of sore throat or skin infection in the previous few weeks; Visual disturbance or vomiting suggesting severe hypertension; Hypertension, sometimes marked, with headache and irritability; Periorbital edema on waking, progressing to dependent and generalized edema; Decreased urine output, dark urine with proteinuria and red cell casts on microscopy; Weight gain over baseline and rising abdominal girth; Elevated BUN and creatinine, hyperkalemia, metabolic acidosis, mild anemia; Elevated ASO titer and depressed serum complement C3; Crackles, gallop rhythm, jugular distention or dyspnea with circulatory overload; Seizure activity, visual change or altered consciousness in hypertensive encephalopathy