A.

Demographic Data Patient PL is an 11- year old female that was born last November 15, 2001 and raised as a Roman Catholic. The said patient is currently in the grade school and as of now, the patient lives in 1012 Sto. Nio Street, Poblacion Muntinlupa City. On the 26th of November 2012 at about 1: 45 PM, the patient was admitted in the Ospital ng Muntinlupa with the impression of Acute Glomerulonephritis with Dr. Maximo Abuel acting as the attending physician due to severe edema and difficulty of breathing felt. B. Nursing History 1. DEVELOPMENTAL TASK A. Freuds Psychosexual Theory: A child in this Latency Stage directs their energy to physical and intellectual activities. Their sexual impulses tend to be repressed at this time so they develop relationships between peers of the same sex. In relation to our patients case what we do is that we encourage her to enjoy school and doing other activities same- sex peers, then she stated that, that is what she does all the time. B. Eriksons Eight Stages of Development: In this stage, Industry versus Inferiority is where focus should be. This is where child choses to be a hard working gal or the opposite, to feel uncompetitive towards other people. It may bring about positive resolutions such as: development and manipulation of perseverance and sense of competence. Our patient when asked to give her hand to the nurse refuses to do so, due to trauma but when she was told that it is for her to be able to get back to her playmates; she would fight the fear and follow the said orders. C. Piagets Phases of Cognitive Development (7- 11 y/o): Based on Piagets Concrete Operation Phase, this is where one person progresses in development and this phase is believed to be the angle where learning to reason about events in the here and now happens. D. Havighursts Developmental Stages and Tasks

Middle Childhood stage implies that this is where a certain individual learns physical skills and healthy self- identity. It is also where socialization with peers are noticed since this stage is where an individual happen to learns appropriate gender- based roles. E. Kohlbergs Moral Development In level 2: Conventional stage, *Source: Kozier and Erbs Fundamentals of Nursing Concepts, Process, and Practice 8th ed, Vol. 1. Pp. 351- 353. Fundamentals of Nursing(nursing foundations) Philippine Ed, Volme 1: Table 17-9.

2. Health History Family Medical History As inferred, the patients family has not really experienced a lot of troubles in relation to medical aspects such as diabetes mellitus, hypertension, allergies or any genetic disorders. The only significant one was noted to be a cardiovascular disorder from the maternal side. The patients father had nothing much to say when asked about the medical history. Past Childhood Diseases Ever since the patient was still a kid, the feeling of being admitted was not really familiar to her. The only illnesses she had were the common ones such as colds, coughs, tooth and head aches and as what is really observed, they are the ones that can be given remedies at home. The only severe thing the patient remembered was when she had an asthma attack but eventually that did not lead to any admission or anything as such. Hx of Present Illness: Five days prior to admission (+) facial edema and sore throat were noted. All throughout the time, same signs and symptoms were manifested. Two days prior, there were still persistence

of signs and symptoms and it was tot up with difficulty of breathing so the patients parent decided to seek for medical attention. A day prior to the admission, both the parents decided to have a formal medical consultation for the child and were advised to undergo admission.

Post- streptococcal infection (Group- A, beta hemolytic) Release of material from the organism, into the circulation (Antigen) Formation of Antibody Immune Complex reaction (in the glomerular capillary) Inflammatory Response Proliferation of epithelial cells Lining glomerulos & cells between endothelium & epithelium of capillary membrane filtration rate
permeability for large molecular weight substances RBC escapes with urine

CHON escapes with urine

urine

excretion of

brain compensates

CREA, Urea excessive accumulation of H2o in system Azotemia

by activating RAAS

v
Angiotensin I converted

hematuria

Albumin

globulin loss

to Angiotensin II
Vasoconstrition Release of

Oncotic pressure
*

hypertension
overwhelm
oncotic pressure

Aldosterone
Na and H20 Retention Risk for infections

*edema

blood volume Hypertension

Manifestations: Body Malaise Hyperthermia Flank Pain

Glomerular cells proliferate on macrophages

Chronic glomerulonephritis (Fibrosis) size of kidneys kidney malfunction destruction of uriniferous tubules in the kidneys Chronic renal failure Death?

Legends *edema

Health Assessment based on Gordons Functional Health Pattern I. Health Maintenance- Perception Pattern **ASK: PARAGRAPH FORM OR NARRATIVE

I. Introduction What is AGN? Acute GN comprises a specific set of renal diseases in which an immunologic mechanism triggers inflammation and proliferation of glomerular tissue that can result in damage to the basement membrane, mesangium, or capillary endothelium. Hippocrates originally described the manifestation of back pain and

hematuria, which lead to oliguria or anuria. With the development of the microscope, Langhans was later able to describe these pathophysiologic glomerular changes. Acute GN is defined as the sudden onset of hematuria, proteinuria, and red blood cell (RBC) casts. This clinical picture is often accompanied by hypertension, edema, azotemia (ie, decreased glomerular filtration rate [GFR]), and renal salt and water retention. Acute GN can be due to a primary renal disease or to a systemic disease. The acute disease may be caused by infections such as strep throat. It may also be caused by other illnesses, including lupus, Goodpasture's syndrome, Wegener's disease, and polyarteritis nodosa. Early diagnosis and prompt treatment are important to prevent kidney failure. Types: There are two types of glomerulonephritisacute and chronic. The acute form develops suddenly. You may get it after an infection in your throat or on your skin. Sometimes, you may get better on your own. Other times, your kidneys may stop working unless the right treatment is started quickly. The early symptoms of the acute disease are:

puffiness of your face in the morning blood in your urine (or brown urine) urinating less than usual. You may be short of breath and cough because of extra fluid in your lungs. You may also have high blood pressure. If you have one or all of these symptoms, be sure to see your doctor right away. The chronic form may develop silently (without symptoms) over several years. It often leads to complete kidney failure. Early signs and symptoms of the chronic form may include:

Blood or protein in the urine (hematuria, proteinuria) High blood pressure Swelling of your ankles or face (edema) Frequent nighttime urination Very bubbly or foamy urine

Prevalence:

NCP Nursing Diagnosis: Deficient knowledge regarding condition related to unfamiliarity with information resources evidenced by questions and request for information Cues: (Subjective) Di ko nga alam, pero noong isang araw sabi nila baka i- dialysis daw sya kapag hindi pa bumuti- buti yung pakiramdam niya. Aba hindi ako papayag. Bakit naman kasi aabot pa sa ganun? (Objective) kkk