The nurse is caring for a client in the emergency department.

Exhibits

A. Edema, noted as 2+ in the eyelids and hands with periorbital edema and jugular vein distention, is consistent with glomerulonephritis. Glomerulonephritis often causes fluid retention due to impaired glomerular filtration, leading to edema and jugular vein distention as the kidneys fail to excrete excess fluid. This aligns with the client’s elevated blood urea nitrogen (BUN) of 45 mg/dL and creatinine of 2.6 mg/dL, indicating renal dysfunction. Acute pyelonephritis, primarily an infectious process, typically does not cause significant edema unless complicated by severe systemic effects, which are not evident here.

B. Elevated blood pressure of 182/86 mm Hg is consistent with glomerulonephritis. Glomerulonephritis frequently leads to hypertension due to sodium and water retention from impaired renal function, activating the renin-angiotensin-aldosterone system. The client’s laboratory results showing renal impairment (elevated BUN and creatinine) support this. Acute pyelonephritis may cause transient blood pressure elevation due to pain or infection, but hypertension is less characteristic compared to glomerulonephritis.

C. Pain location, described as flank pain with painful urination, is consistent with acute pyelonephritis. Pyelonephritis typically presents with flank pain and dysuria due to bacterial infection of the renal pelvis, as supported by the client’s positive nitrite and leukocyte esterase in the urinalysis, indicating a urinary tract infection. The history of recent strep throat further suggests a possible post-infectious process, but glomerulonephritis typically presents with painless hematuria rather than localized flank pain.

D. Elevated respiratory rate of 26/min is consistent with glomerulonephritis. The client’s shortness of breath, bilateral crackles, and oxygen saturation of 90% suggest pulmonary edema, a complication of fluid overload from glomerulonephritis due to reduced glomerular filtration. This aligns with Maslow’s hierarchy of physiological needs, prioritizing oxygenation. Acute pyelonephritis does not typically cause respiratory distress unless sepsis develops, but the client’s stable heart rate (88/min) and absence of severe systemic signs make this less likely.

E. Decreased urinary output, reported as last urination yesterday afternoon with dark reddish-brown urine, is consistent with both acute pyelonephritis and glomerulonephritis. In pyelonephritis, reduced urine output and dark urine with blood (3+ on urinalysis) result from infection and inflammation causing hematuria. In glomerulonephritis, oliguria and dark reddish-brown urine (due to hematuria from glomerular damage) are common, supported by the client’s elevated BUN, creatinine, and turbid urine. Both conditions align with the client’s presentation, as reduced urine output reflects renal impairment in either case.