Goodpasture Syndrome: Diagnosis and Treatment (Nursing)

00:01 All right, o how do we diagnose this? Really unusual thing only happens rarely.

00:07 What are the ways that Healthcare Providers will diagnose this condition.

00:11 While they look at labs in the patient's risk factors.

00:14 They look at the patient's clinical assessment.

00:16 They look and see for signs of lung Hemorrhage or proteinuria or blood in their urine.

00:21 When they diagnosed it and they confirm it.

00:24 They noticed the presence of anti GBM antibody in the blood or in the kidney.

00:30 Now it takes a tissue biopsy to do that.

00:33 Okay. So here's a pretty good list, but I don't want to speak through it.

00:37 I want to go back because look at the role you play in this.

00:40 All right assessment of labs and patients risk factors.

00:43 You can get a lot of the patient's risk factors on a good patient history.

00:48 So when you're doing an admission assessment you want to make sure that you ask these types of questions you want to do a very thorough assessment on your patient.

00:56 Now you look for signs of lung Hemorrhage and proteinuria or blood in the urine.

01:02 Now we don't automatically jump to someone has blood in their urine to good pressure.

01:06 Right? That wouldn't be a logical conclusion.

01:09 Remember diagnosing you're part of the team you're bringing important information to the table to help the healthcare provider make an accurate diagnosis.

01:17 You do know that protein in the urine and kidneys that are putting blood in the urine.

01:23 There is a problem that needs to be followed up on.

01:26 Now we can actually confirm the diagnosis with a specific test that looks for those Antibodies in the blood or even more specific you can do a kidney biopsy and I'm giving you that face because that's not comfortable for your patients.

01:40 They literally go in and snip off a part of the kidney and take it back out for examination.

01:45 So you can imagine why that would not be fun.

01:48 But based on what you know about antibodies, you know that they can live in your blood you solve it in her bloodstream or be deposited in tissues, and that's why a tissue biopsy may be helpful.

02:00 Well not pleasant for your patience.

02:03 So let's talk about some good news.

02:04 Let's talk about how you can treat this disease.

02:07 Now, there's two options here.

02:08 We're going to try to either get rid of the antibodies that you have and we're gonna try to prevent new ones from forming.

02:15 All right, that's the overall plan for treatment get rid of the antibodies you have and stop new ones from forming.

02:22 So how do we get rid of the ones we have? Plasmapheresis.

02:26 So you take that out you remove those antibodies and that will help with the inflammation.

02:31 - how do we stop new ones from forming? We've got to suppress that immune system two options corticosteroids or cyclophosphamide Okay.

02:41 So we've got these two options that can be used.

02:44 That's what will stop further antibodies from forming because if I suppress that immune system stop the binding and those antibody to the basilar membrane, you get the picture.

02:56 So when you're thinking about treatment, get rid of the antibodies you have Stop the new ones from forming.

03:02 Plasmapheresis, and then corticosteroids or cytotoxic drugs like cyclophosphamide.

03:08 Now, what do you do with this patient after discharge? We talked earlier new patients die from this the answer is usually not some do from pulmonary Hemorrhage, but usually they don't, but they need to get acute treatment quickly.

03:22 We need to figure out what their factors are and help them get rid of those the environmental factors and then they need proper follow-up care.

03:30 So after discharge, the patient needs regular visits for follow-up for a long period of time have to keep an eye on their kidney function and want to make sure they keep taking their immunosuppressive therapy.

03:41 We also want to see if they're having any of those side effects from immunosuppressive therapy and help them address those.

03:47 Now the patient might need dialysis if the damage was really severe, it might need to start on some dialysis and continued indefinitely.

03:56 If that can't resolve the problem then they may even consider a kidney transplant.

04:01 So after discharge, they need great follow-up care.

04:04 We need to keep a really close eye on that immunosuppressive therapy and kidney function and then watch of the patient may progress to need dialysis or even a kidney transplant.

04:15 Now we talked about helping them in the middle.

04:17 We want to help them identify those environmental factors and get rid of them.

04:21 So smoking is one of the more obvious ones you want to give that patient support encouragement and education about how they can stop smoking without.

04:30 any form of judgment.

04:32 So if you're not a smoker, you don't have any right to be self-righteous with them be understanding all of us have coping mechanisms and smoking is definitely a coping mechanism and really difficult to stop.

04:47 So be kind, don't judge just help the patient take a step toward a healthier life.

04:54 So this patient is exposed to any other type of impossible environmental factors that have to work together to help them recognize that and eliminate or minimize them from your life.