HISTORY. Question the patient or parents about an untreated respiratory tract infection that has occurred in the last 1 to 3 weeks. Ask the patient about the medical history to identify any multisystem diseases. Because patients often describe a history of weight gain and edema of the hands and face, ask the patient if his or her rings are tighter than usual. Some patients may also describe decreased urine volume, changes in urine color (dark, smoky), increased fatigue and activity intolerance, muscle and joint achiness, shortness of breath, and orthop-nea. Elderly patients' symptoms may be more vague and nonspecific, such as achiness and nausea.

PHYSICAL EXAMINATION. Note any signs of fluid retention, such as edema in the face and hands. As you speak to the patient, you may notice dyspnea and labored breathing. Inspect the neck veins to determine if engorgement is present. The patient's urine output is usually

376 Glomerulonephritis, Acute decreased and is often dark or even coffee colored. When you auscultate the patient's heart and lungs, you may hear basilar crackles and an S3 heart sound. Most patients have an elevated arterial pressure. Weigh the patient each day, and monitor abdominal girth. Provide ongoing monitoring for visual changes, vomiting, adventitious breath sounds, abdominal distension, and seizure activity. These signs and symptoms indicate the potential onset of the complications and need to be reported to the physician.

PSYCHOSOCIAL. Patients and families may be anxious about changes in the patient's appearance, an uncertain prognosis, and the possibility of lifestyle changes. Older children and adults may be concerned about their appearance. Assess the patient's and family's coping mechanisms, support systems, and stress levels.

Diagnostic Highlights


Normal Result

Abnormality with Condition



100-140 mL/min

50 mL/min

Damaged glomerulus no longer


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