A child is being discharged from the emergency with a diagnosis of acute glomerulonephritis. Which of the following measures would a nurse include in the home care plan?

1. A

   Restrict fluid intake

2. B

   Weigh daily

3. C

   Maintain strict bed rest

4. D

   Limit visitors

Appeared in: AIIMS Bhatinda NO - 2019

Explanation

• The primary pathophysiology of acute glomerulonephritis (AGN) involves fluid and sodium retention due to decreased glomerular filtration.
• Daily weight measurement is the most sensitive and accurate non-invasive method to monitor changes in a child's fluid status at home.
• A sudden increase in weight is the earliest indicator of worsening fluid retention, signaling the need for potential changes in treatment, such as diuretics or stricter fluid/sodium limits.
• This monitoring is a fundamental nursing instruction for home care to prevent complications like severe hypertension and fluid overload.

Why Other Options Were Wrong

• Option A: Fluid restriction is a therapeutic intervention, not a routine monitoring measure. It is only implemented if the child has significant edema or oliguria (low urine output) and must be prescribed by a physician.
• Option C: Strict bed rest is an outdated practice for AGN. It does not improve renal recovery and increases the risk of complications such as thromboembolism, muscle atrophy, and boredom in a child.
• Option D: Limiting visitors is an infection control measure. While AGN is often post-infectious (e.g., post-streptococcal), the nephritis itself is not contagious. This measure is not relevant to managing the primary problems of fluid retention and hypertension.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Home care management for pediatric acute glomerulonephritis in acute care settings.
• A key nursing role is educating the family on the correct procedure for daily weights: use the same scale, at the same time each day (preferably in the morning after voiding), with the child wearing the same amount of clothing.
• Nurses must provide clear parameters for when to contact the healthcare provider, such as a weight gain of more than 0.5 kg (about 1 lb) in a single day.
• This monitoring empowers the family to be active participants in the child's care and allows for early intervention before complications become severe.

How to Approach the Question

• First, identify the core pathophysiology of the diagnosis provided: Acute Glomerulonephritis (AGN) causes fluid and sodium retention.
• Next, analyze the question's focus, which is on 'home care plan' measures after discharge. This points towards monitoring and family education.
• Evaluate each option to determine which one best addresses the primary problem of fluid retention. Differentiate between monitoring actions (gathering data) and therapeutic interventions (treating the problem).
• Weighing daily is a key monitoring action. Fluid restriction is a therapeutic intervention. Bed rest is an activity-level instruction. Limiting visitors is an infection-control measure.
• Select the option that represents the most fundamental and universally applicable monitoring strategy for the disease's main complication. In this case, tracking fluid status via daily weight is paramount.

Concept Tested & Keywords

• Concept Tested: Home care management for pediatric acute glomerulonephritis.
• Stem keywords: child, discharged, acute glomerulonephritis, home care plan
• Lead-in keywords: include
• Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
• Clinical cues: The care setting changes urgency, monitoring level, and the expected nursing action.

Question ID

QRuZHN8Xn_PFIB95CI4Xrs

Copy ID

Reference Book

E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 2 (pp 239-476 of 713) p. 200-202

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 1 p. 142-144