Goodpasture Syndrome: Symptoms and Assessment (Nursing)

00:01 So what's the patient most likely to tell you? Well, that's just going to feel all over horrible, okay? Sometimes the patients will tell you that nosebleeds.

00:11 They start having more nosebleeds and those that will usually occur before the kidney disease in about two-thirds of the cases.

00:18 But all over there just not going to feel good going to have pain and discomfort.

00:23 They're going to be really tired.

00:25 Now that might be due to the anemia depending on how much blood loss or the extent of kidney failure because that can make you feel pretty tired too.

00:33 Now bleeding and nosebleeds we talked about that or they might notice some blood in their sputum.

00:38 They also might have blood in their urine.

00:40 Remember that's always a sign that needs to be investigated.

00:44 They also can have difficulty coughing or breathing.

00:48 Okay, here we are again.

00:50 Here's another big list, but when you are looking at this disease, you know that it's a problem because the basement membrane is being attacked in the lungs and in the kidneys.

01:00 In the lungs if it's attacking that basement membrane, I have bleeding.

01:05 My lungs are not going to function effectively.

01:07 So what would that feel like to me? Well difficulty breathing and cough is in a hard thing, right? Because even when you take something in you, that's your body's response to try to get rid of it to relieve itself of it.

01:21 So don't look at us this as a list.

01:23 Let's look at a big chunk of information.

01:26 If the lungs aren't functioning well, that's another reason they may be tired.

01:30 If the kidneys aren't functioning well and they've lost a lot of blood that's why they could be anemic.

01:35 So what makes sense to you? do we really need to remember all over pain and discomfort? That's probably not my top priority.

01:45 I would be looking at although I would care if the patient told me that, I'd be looking at lung problems and kidney problems.

01:52 I know what the lungs are supposed to do and they're not under attack.

01:56 So when they're under attack, they're not going to function as well.

01:59 Not oxygenated as well.

02:00 They're going to have dyspnea, difficulty breathing or they're going to have this cough because the lungs are so irritated by that bleeding.

02:07 Now since I know the lungs are bleeding, I might see it coming out other parts of their airway.

02:12 That's another way to remember it.

02:14 Kidneys smell when your kidneys aren't functioning well, you've got issues things building up all the signs that I already know about glomerulonephritis.

02:23 So whenever you see lists like this, don't just try and memorize them, take what you knew about the organs normal healthy functioning, Know that it's at risk.

02:32 That's how you remember signs and symptoms.

02:35 It's much easier than just try to keep memorizing list after list after list.

02:40 The last one I want to bring up was chest pain.

02:42 That goes right along with the not being able to get enough oxygen right? That's your body's way of telling you the heart is not getting enough oxygen.

02:51 Just another example of a respiratory problem with goodpasture's syndrome, or see if you can remember the really long name, we've just recently been talking about.

03:03 Now what assessments will you do as a nurse? Well, there's the two big ones respiratory and renal because we know those are the ones that take the biggest hit in this so what might you see.

03:14 Well if my lungs are functioning my skin color should be pink, my capillary refills really good.

03:19 Those are all signs.

03:20 I don't complain if feeling short of breath those are all signs that my respiratory system is functioning well.

03:27 Well in this syndrome a respiratory sunction is not functioning effectively, so I might look Pale to you.

03:33 I might not look I won't have a Rosy color because I don't have enough oxygen.

03:38 You might notice a nosebleed.

03:40 I maybe this nick or short of breath or that cough that we talked about and because of the fluid being blood in my lungs, I might have some crackles which is a sign of extra fluid, right or rhonchi.

03:53 So as a nurse, I would notice that the respiratory assessment is not normal.

03:59 Now, we giving you specific reasons there and signs of how it isn't normal, but those should all tie back to what you know about the impact of that basement membrane being attacked in the lungs, right? It's bleeding which is going to make it difficult for me to breathe well and I'm going to be coughing and very uncomfortable.

04:19 Now the other system that's involved, renal.

04:22 We're going to look at a urine analysis, you know, there's probably going to be some blood in this so you see hematuria, you're going to see Protein that's a sign of glomeruli.

04:32 We're going to see really abnormal kidney function because the kidneys can't function normally, you're going to see their labs go up BUN creatinine watch for those and watch for extra fluid because the kidneys can't get rid of the extra water.

04:47 That's their job.

04:48 The patient's going to have extra fluid on board.

04:51 So I focused on these two assessments, but what's going to happen to this patient's Vital Signs? Based on what you see here.

04:59 What difference am I going to see in a patient's basic vital signs? Well that's temperature pulse respirations and blood pressure temperature may or may not be affected right depends on what's going on.

05:11 Pulse. What would you expect? Well, let's look at what we have here.

05:17 They can't breathe very well.

05:20 They've got extra fluid on board.

05:22 So with pulse I would assume the heart is not getting effective oxygen.

05:26 So does it slow down then? No, initially at It's going to pick up the pace right? Because it knows it doesn't have enough oxygen in its blood.

05:35 So it's going to try and move it around faster.

05:38 So your heart rate will likely be elevated if it's impacted.

05:42 So temperature may or may not have an impact, pulse is going to be elevated.

05:47 So temperature pulse respirations.

05:49 What would you think? Right if they're dyspneic when I can't catch my breath.

05:56 I don't slow down right? I'd you're breathing faster.

06:02 So temperature, pulse faster, respirations are going to be faster.

06:07 Now, what about blood pressure up down or normal? Well, there's extra volume on board because my kidneys can't remove the extra water.

06:16 So my blood pressure is going to be elevated.

06:19 We know that kind of goes along with renal problems anyway, but we've got a edema, so we are going to have extra volume in your intravascular space which typically leads to a higher blood pressure.