Prioritized Nursing Diagnosis: Glomerulonephritis -- with rationale

Glomerulonephritis

Ryan, a 6-year-old boy from Sta. Mesa has been admitted to the Pediatric Unit with fever, chills and generalized edema, ascites, tenderness of the costovertebral angle (CVA) and flank pain. Je jas smokey (cola-colored) urine that contains red cells casts and traces of blood.
“Masakit ang ulo ko,” as stated by Ryan, when you had your rounds. Body malaise was complained also by Ryan. 
Around 21 days prior to the hospitalization, the client was diagnosed with a beta-hemolytic streptococcal infection of respiratory system. 
The client’s physician has now confirmed that he has developed acute poststreptococcal glomerulonephritis (APSGN).
Laboratory results:
Urinalysis: presence of RBC; 3.0 gm/day of protein
Blood exam: increase creatinine, increase BUN, decrease hemoglobin, hypoalbuminemia and hyperlipidemia
Vital signs: BP of 140/90 mmHg, HR 130 bpm; RR 28 cpm; Temp- 37.8 C
Management: Kidney biopsy will be scheduled. Penicillin and Costicosteroids were ordered. Loop diuretics and Anti-hypertensive will be started also. Client placed on decreased CHON, restricted Na.

Pertinent Data	Nursing Diagnosis	Rank	Justification
·         6 year old male ·         (+) Fever ·         (+) Chills ·         (+) Generalized edema ·         (+) Ascites ·         Tenderness of costovertebral angle ·         Flank pain ·         Cola-colored urine with red call casts and traces of blood ·         Headache ·         Body malaise ·         (+) Beta haemolytic streptococcal infection of the respiratory system ·         (+) Hematuria ·         (+) Proteinuria ·         Increased creatinine ·         Increased BUN ·         Decreased Hemoglobin ·         Hypoalbuminemia ·         Hyperlipidemia ·         BP : 140/90 mmHg ·         HR 130 bpm ·         RR 28 cpm ·         Hyperthermia 37.8	Increased fluid volume related to decreased oncotic pressure and water retention	1	This is the prioritized problem because a further increase in the fluid volume decreases the intravascular volume which decreases the blood volume subsequently. This increase in blood volume causes all the rest of the following problems that we have identified.
	Decreased cardiac output related to aldosterone release secondary to juxtoglomerular cell release of renin	2	This is the second priority because it is caused by our first problem, which is the increased fluid volume from the loss of albumin and decreased oncotic pressure. Decreased cardiac output also causes decreased perfusion to the organs.
	Decreased tissue perfusion related to vasoconstriction secondary to aldosterone release	3	Decreased tissue perfusion is the third priority because it is caused by the decrease in cardiac output thus also decreasing the systemic blood flow to the entire system.
	Hyperthermia related to foreign body detection	4	This is the fourth problem because uncontrolled hyperthermia may induce fatal results. The client had hyperthermia as the body is trying to restore homeostasis which is done by the release of pyrogens.
	Risk for infection related to loss of immunosurveilance secondary to loss of plasmin	5	This is the last priority because the risk for infection merely needs proper monitoring, maintenance and utmost care in the usage of the aseptic technique. The client is immunosuppressed mainly because of the loss of plasmin which is needed for immunosurveilance.