OBJECTIVE

GENERAL

The general objective of this case presentations to foster and develop

knowledge and
skills in providing care and management fora patient with acute
glomerulonephritis.

SPECIFIC

To define acute glomerulonephritis

To know the clinical manifestations, nursing management and
interventions for patients who have this disease.
To know the different medication that needs to be taken including
its side effect which can be harmful the patient.
To be able to obtain, document and present a comprehensive medical
history.
To apply necessary skills in providing care for a client with acute
glomerulonephritis.
To learn how to establish rapport with the client and significant others.
To be able to recognize the importance of patient and familial
preference when selecting among treatment option.

1
 INTRODUCTION

Acute glomerulonephritis (AGN) is active inflammation in the glomeruli.

Each kidney is composed of about 1 million microscopic filtering "screens" known as
glomeruli that selectively remove uremic waste products. The inflammatory process
usually begins with an infection or injury (e.g., burn, trauma), then the protective
immune system fights off the infection, scar tissue forms, and the process is
complete.

There are many diseases that cause an active inflammation within the
glomeruli. Some of these diseases are systemic (i.e., other parts of the body are
involved at the same time) and some occur solely in the glomeruli. When there is active
inflammation within the kidney, scar tissue may replace normal, functional kidney
tissue and cause irreversible renal impairment.

The severity and extent of glomerular damagefocal (confined) or

diffuse(widespread)determines how the disease is manifested. Glomerular damage
can appear as subacute renal failure, progressive chronic renal failure (CRF); or simply a
urinary abnormality such as hematuria (blood in the urine) or proteinuria(excess protein
in the urine).

Epidemiology

Over the last 2-3 decades, the incident of acute glomerulonephritis has
declined in the United Sates as well as in other countries, such as Japan,
Central Europe, and Great Britain. The estimated worldwide burden of AGNs
is approximately 472,000 cases per year, with approximately 404,000 cases
being reported in children and 456,000 cases occurring in less developed
countries. AGN associated with skin infections is most common in tropical
areas where pyoderma is endemic, while pharyngitis-associated AGN
predominates in temperate climates. (WHO, 2011)

2
 PATIENTS PROFILE

Patients Name: L.P

Age: 5 years old
Gender: Female
Address: Pasig City
Civil Status: Single
Religion: Roman Catholic
Date of Birth: April 17, 2011
Date of Admission: January 28, 2017
Nationality: Filipino
Initial Diagnosis: AGE with moderate signs of dehydration, AVI: R/I UTI
Final Diagnosis: Acute Glomerulonephritis
Chief Complain: Fever

Present History:

5 days PTA, patients experienced headache associated with

undocumented fever which caused her to slip and fall hitting her
buttocks to the floor, without hitting her head and loss of
consciousness. Non associated symptoms of vomiting, chills, with good
appetite and activity. Patient was given Biogesic and temporary relief
noted. No onset done.
3 days PTA, still with persistence of symptoms now with abdominal
pain, loss of appetite and no bowel movements for 3 days, patient
bought to consult at AFPMC, CBC & UA was done which lead to the
diagnosis of UTI. Patient was sent home and given Amoxicillin but was
not given.
2 days PTA, patients still has persistence of symptoms with fever max
of 39C, patient was given paracetamol suppository given every 4
hours which the mother claimed to be effective for 1hour of temporary
relief.

3
 1 day PTA, still with persistence of symptoms, now with reddish
pigmentation on the neck and hands. Patient was given paracetamol
suppository and was brought to consult in our constitution thus
admission.

Past History:
(+) Bronchial Asthma
(+) hospitalization d/t asthma

PHYSICAL ASSESSMENT

General Symptomatology loss weight gain

Integumentary No itchiness
Head and Neck No stiffness
Eyes
Ears No ear discharge
Nose No nasal discharge
Mouth and Throat No sore throat
Respiratory No fast breathing
Cardiovascular No fast heart rate
Digestive (+) Constipation
Genitourinary No dysuria
Musculoskeletal No myalgia
Endocrine No palpitation
Nervous No tremors
General Irritability, not in cardio respiratory
distress
Vital Signs HR: 142bpm RR: 22cpm Temp:
39.8C SPO2: 98%
Anthropometrics Wt. 35.5kg Ht. 36ft Inaccessible
Water loss. 420 Total Fertility Rate.
933
Skin Reddish pigmentation in the neck
and mandible
HEENT: Swelling of eyelids, malting, dry lips.
Chest/Lungs Symmetrical chest expansion, no
retraction, clear breath sound.
Heart A dynamic pericardium normal rate,
regular rhythm, no murmur
Abdomen No lesion
Genitalia Grossly female genitalia
Extremities Grossly normal extremities, full equal

4
 pulse, no cyanosis
Cerebrum Awake, conscious, GCS 15
Cerebellum Steady gait, no ataxia
Cranial Nerve
I: can smell
II: Pupils round equally reactive to light
and accommodation
III, IV, VI: Intact EOM
V: Intact facial sensation
VII: No facial asymmetry
VIII: Can hear
IX, X (+) Gag reflex
XI: Can shrug shoulders
XII: No tongue deviation

GORDONS HEALTH STUDY

CATEGORY BEFORE DURING

HOSPITALIZATION HOSPITALIZATION
HELATH PERCEPTION >Patient is healthy. >She is not aware of
her health condition.
>She start to take
prescribed medication
>Theres an IV line that
hooked in her.
NUTRITIONAL >she eats 3 times a >Low salt
METABOLIC day >Eats whatever the
>She eat whatever hospital provides.
food is served.
ELIMINATION >Patient voids at least >She defecates once a
3-4 times a day. day.
>She defecates once a >She voids 3 times a
day. day with minimal
amount.
ACTIVITIES-EXERCISE >Energetic Sobrang >Decrease energy
malikot as verbalized matamlay na siya as
by the mother verbalized by the
mother.
>She sleeps most of
the time.
COGNITIVE- >The patient is >The patient still

5
PERCEPTUAL oriented to time, place oriented to time, place
and person. and person.
SLEEP REST >She sleep late at >The patient
night sometimes lack of
>She sleeps almost 8 sleep because of
hours daily. changing IV bottle.
SELF-PERCEPTION/SELF- >She use too socialize >She is not socialize to
CONCEPT and mingle to other. others.
>She always think of a
playing a game.
SEXUALITY Not Applicable Not Applicable
REPRODUCTIVE
VALUES-BELIEFS >The patient is Roman >She still believe in
Catholic God.
>She truly believe that
God loves her.
ROLE RELATIONSHIP >She lives with her >The patient is
family confined at hospital
>She is good and and her grandmother
disciplined daughter. and mother is her
companion.

6
 ANATOMY AND PHYSIOLOGY

The kidneys are two bean-shaped organs, each about the size of a fist. They
are located just below the rib cage, one on each side of the spine.

7
Every day, the two kidneys filter about 120 to 150 quarts of blood to produce
about 1 to 2 quarts of urine, composed of wastes and extra fluid. The urine
flows from the kidneys to the bladder through two thin tubes of muscle called
ureters, one on each side of the bladder. The bladder stores urine. The
muscles of the bladder wall remain relaxed while the bladder fills with urine.
As the bladder fills to capacity, signals sent to the brain tell a person to find a
toilet soon. When the bladder empties, urine flows out of the body through a
tube called the urethra, located at the bottom of the bladder. In men, the
urethra is long, while in women it is short.

The kidneys are important because they keep the composition, or makeup, of
the blood stable, which lets the body function. They;

prevent the buildup of wastes and extra fluid in the body

keep levels of electrolytes stable, such as sodium, potassium, and
phosphate
make hormones that help
regulate blood pressure
make red blood cells
bones stay strong

How do the kidneys work?

The kidneys purify toxic metabolic waste products from the blood in several
hundred thousand functionally independent units called nephrons. Each
nephron filters a small amount of blood. The nephron includes a filter, called
the glomerulus, and a tubule. The nephrons work through a two-step
process.
The tubular epithelial cells reabsorb water, small proteins, amino acids,
carbohydrates and electrolytes, thereby regulating plasma osmolality,
extracellular volume, blood pressure and acidbase and electrolyte balance.
The glomerulus lets fluid and waste products pass through it; however, it
prevents blood cells and large molecules, mostly proteins, from passing. If
the glomerulus is unable to prevent or filter blood cells and large particles
incorrectly, then it leads to a problem called glomerulus nephritis and
even kidney failure. The filtered fluid then passes through the tubule,
which sends needed minerals back to the bloodstream and removes wastes.
The final product becomes urine.

8
 PATHOPHYSIOLOGY

PATHOPHYSIOLOGY DIAGRAM OF ACUTE GLOMERULO-NEPHRITIS

NON-MODIFIABLE RISK FACTORS MODIFIABLE RISK FACTORS

Gender streptococcal infection
Aged 5-11 years old skin infections
Family history of kidney disease poor personal hygiene

Antigen-antibody reaction

Insoluble immune complexes developed and become entrapped to glomerular tissue

Destruction and inflammation of kidneys fever

9
Damaged on glomerular basement membrane

Increased permeability

Leakage of protein proteinuria

Protein and RBCs going to interstitial space

Periorbital edema

10
 LABORATORY EXAMINATIONS

HEMATOLOGY
Hematology Normal Results: Interpretatio
Value 01/27/17 n & Analysis
Hgb 130-160 gm/L 114 This indicates
that there is
less oxygen in
the blood and
a possibility of
deficiency of
iron in the body.
Hct 0.37-0.49 0.355
RBC 4.5-6.2 x 4.59
10^12/L
WBC 4.0-11.0 x 8.1 .
10^9/L
Neutrophils 0.55-0.65 0.71 An increase of
Segmenters is
an indication
of the
presence of an
infection
Lymphocyte 0.25-0.35 0.25
Eosinophil 0.02-0.04 0.01 The body is
sending more
and more
white blood
cells to fight
off infections.
Monocyte 0.03-0.06 0.04
Basophil 0.00-0.01 0.01
MCV 78-102fl 77.31
MCH 39-35 pg 24.83 Low MCH may
indicate
microcytic
anemia
MCHC 32-36 g/dL 32.11
RDW 11.0-15.0 12.18
Platelet count 150-400 x 188.2
10^9L

11
Hematology Normal Results: Interpretati
Value 1/28/17 on &
Analysis
Hgb 130-150 99.50 This
gm/L indicates that
there is less
oxygen in
theblood and
a possibility
of deficiency
of ironin the
body.
Hct 0.37-0.49 0.309
RBC 4.5-6.2 x 3.98
10^12/L
WBC 4.0-11.0 x 15.4 An increase
10^9/L in WBC count
may indicate
the presence
of a viral
infection or
an acute
infection
Neutrophils 0.55-0.65 0.76 An increase
of
Segmenters
is an
indication of
the presence
of an
infection
Lymphocyte 0.25-0.35 0.18 Decreased
lymphocytes
indicate the
possibility
of presence
of sepsis
Eosinophil 0.02-0.04 0.02
Monocyte 0.03-0.06 0.03
Basophil 0.00-0.01 0.01

12
MCV 78-102fl 77.58
MCH 39-35 pg 24.99 Low MCH ma
y indicate
microcytic
anemia
MCHC 32-36 g/dL 32.11
RDW 11.0-15.0 12.47
Platelet 150-400 x 170.83
count 10^9L

Hematology Normal Results: Interpretati

Value 01/29/17 on &
Analysis
Hgb 130-150 98.00 This
gm/L indicates that
there is less
oxygen in
theblood and
a possibility
of deficiency
of ironin the
body.
Hct 0.37-0.49 0.307
RBC 4.5-6.2 x 3.88
10^12/L
WBC 4.0-11.0 x 22.4 An increase
10^9/L in WBC count
may indicate
the presence
of a viral
infection or
an acute
infection.
Neutrophils 0.55-0.65 0.68 An increase
of
Segmenters
is an
indication of
the presence
of an
infection
Lymphocyte 0.25-0.35 0.26 Decreased
lymphocytes

13
 indicate the
possibility
of presence
of sepsis
Eosinophil 0.02-0.04 0.02
Monocyte 0.03-0.06 0.04
Basophil 0.00-0.01 0.01
MCV 78-102fl 79.22
MCH 39-35 pg 25.25 Low MCH ma
y indicate
microcytic
anemia
MCHC 32-36 g/dL 31.87
RDW 11.0-15.0 13.01
Platelet 130-400 x 162.92
count 10^9L

Hematology Normal Results: Interpretati

Value 01/30/17 on &
Analysis
Hgb 130-150 104.00 This
gm/L indicates that
there is less
oxygen in the
blood and a
possibility of
deficiency of
iron in the
body.
Hct 0.37-0.49 0.325
RBC 4.5-6.2 x 4.17
10^12/L
WBC 4.0-11.0 x 24.4 An increase
10^9/L in WBC count
may indicate
the presence
of a viral
infection or
an acute
infection.
Neutrophils 0.55-0.65 0.73 An increase
of
Segmenters
is an

14
 indication of
the presence
of an
infection
Lymphocyte 0.25-0.35 0.21 Decreased
lymphocytes
indicate the
possibility
of presence
of sepsis
Eosinophil 0.02-0.04 0.01
Monocyte 0.03-0.06 0.04
Basophil 0.00-0.01 0.01
MCV 78-102fl 78.01
MCH 39-35 pg 24.94 Low MCH ma
y indicate
microcytic
anemia
MCHC 32-36 g/dL 31.97 Low MCH ma
y indicate
microcytic
anemia
RDW 11.0-15.0 13.06
Platelet 130-400 x 167.83
count 10^9L

Hematology Normal Results: Interpretati

Value 01/31/17 on &
Analysis
Hgb 130-150 100.70 This
gm/L indicates that
there is less
oxygen in
theblood and
a possibility
of deficiency
of ironin the
body
Hct 0.37-0.49 0.313
RBC 4.5-6.2 x 3.97
10^12/L
WBC 4.0-11.0 x 21.9 An increase
10^9/L in WBC count

15
 may indicate
the presence
of a viral
infection or
an acute
infection.
Neutrophils 0.55-0.65 0.74 An increase
of
Segmenters
is an
indication of
the presence
of an
infection
Lymphocyte 0.25-0.35 0.20 Decreased
lymphocytes
indicate the
possibility
of presence
of sepsis
Eosinophil 0.02-0.04 0.02
Monocyte 0.03-0.06 0.04
Basophil 0.00-0.01 0.00
MCV 78-102fl 78.76
MCH 39-35 pg 25.36 Low MCH ma
y indicate
microcytic
anemia
MCHC 32-36 g/dL 32.20
RDW 11.0-15.0 13.11
Platelet 150-400 x 164.52
count 10^9L

Hematology Normal Results: Interpretati

Value 02/01/17 on &
Analysis
Hgb 130-150 107.20
gm/L
Hct 0.37-0.49 0.336
RBC 4.5-6.2 x 4.31
10^12/L
WBC 4.0-11.0 x 16.8 An increase
10^9/L in WBC count
may indicate

16
 the presence
of a viral
infection or
an acute
infection.
Neutrophils 0.55-0.65 0.76 An increase
of
Segmenters
is an
indication of
the presence
of an
infection
Lymphocyte 0.25-0.35 0.18 Decreased
lymphocytes
indicate the
possibility
of presence
of sepsis
Eosinophil 0.02-0.04 0.02
Monocyte 0.03-0.06 0.03
Basophil 0.00-0.01 0.01
MCV 78-102fl 78.08
MCH 39-35 pg 24.88 Low MCH ma
y indicate
microcytic
anemia
MCHC 32-36 g/dL 31.87
RDW 11.0-15.0 13.09
Platelet 150-400 x 158.51
count 10^9L

Hematology Normal Results: Interpretati

Value 02/02/17 on &
Analysis
Hgb 130-150 92.70 This
gm/L indicates that
there is less
oxygen in
theblood and
a possibility
of deficiency
of ironin the
body

17
Hct 0.37-0.49 0.294
RBC 4.5-6.2 x 3.77
10^12/L
WBC 4.0-11.0 x 11.2 An increase
10^9/L in WBC count
may indicate
the presence
of a viral
infection or
an acute
infection.
Neutrophils 0.55-0.65 0.73 An increase
of
Segmenters
is an
indication of
the presence
of an
infection
Lymphocyte 0.25-0.35 0.19 Decreased
lymphocytes
indicate the
possibility
of presence
of sepsis
Eosinophil 0.02-0.04 0.01
Monocyte 0.03-0.06 0.06
Basophil 0.00-0.01 0.01
MCV 78-102fl 77.95
MCH 39-35 pg 24.58 Low MCH ma
y indicate
microcytic
anemia
MCHC 32-36 g/dL 31.53
RDW 11.0-15.0 13.16
Platelet 150-400 x 162.68
count 10^9L

CHEMISTRY TEST

NORMAL 1/28/17 Interpreta 1/30/17 Interpret

VALUE tion and ation and

18
 Analysis Analysis
BUN 2.5-7.2 3.79
mmol/L
Creatinin 53-106 49.70 Indicates
e umol/L renal
dysfunctio
n
SGOT/AS </ 35 U/L
T
SGPT/ALT </ 45 U/L
Chloride 9-107 110
mmol/L
Sodium 135-148 134.8
mmol/L
Potassiu 3.5-5.3 4.22
m mmol/L
Calcium 2.15-2.87 1.78
mol/L
Total 64-83 g/L 52.60
Protein
Albumin 38-54 g/L 28.00 Indicates
proteinuria
and edema
Globulin 11-35 g/L 24.5
A/G Ratio 1.5:1- 1.14
2.5:1

02/04/17
Test Normal Range Results Interpretation
and Analysis
SGOT/AGT 5 34 U/L 74.00 U/L H
SGPT/ALT 0 55 U/L 709.00U/L H

URINALYSIS

Normal Value Specimen No. Interpretation

E6 and Analysis
COLOR Yellow Amber Yellow
TRANSPARENCY Slightly Turbid Slightly Turbid
REACTION 4.5-8 5.0
SP GRAVITY 1.005-1.030 1.020
SUGAR Negative Negative

19
PROTEIN Negative +1 due to
increased glome
rular
permeability
MICROSCOPIC
RBC 0-2
PUS CELLS 3-5 Pus cells
increased value
indicates
infection
BACTERIA few
EPITHELIAL few
CELLS
CRYSTALS
AMORPHOUS URATES Few
MUCUS THREADS few
AMORPHOUS Few
PHOSPHATE
KETONES Negative

Normal Value SPECIMEN Interpretation

NO: and Analysis
3
COLOR Yellow Amber Light Yellow
TRANSPARENCY Slightly Turbid Slightly Turbid
REACTION 4.5-8 6.0
SP GRAVITY 1.005-1.030 1.020
SUGAR Negative Negative
PROTEIN Negative +3 Due to disease
of the kidney
such as
glomerulonephr
itis.
MICROSCOPIC
RBC 6-8/hpf Indicates
possible injury
to kidney tissue
PUS CELLS few 1-2/hpf Indicative
of bacterial
infection
BACTERIA few
EPITHELIAL few few Indicative

20
 of nephrotic
syndrome
CELLS
CRYSTALS
AMORPHOUS URATES Few few
MUCUS THREADS few few
AMORPHOUS Few
PHOSPHATE
KETONES Negative

Normal Value SPECIMEN Interpretation

NO: and Analysis
2
COLOR Yellow Amber Yellow
TRANSPARENCY Slightly Turbid Slightly Turbid
REACTION 4.5-8 6.0
SP GRAVITY 1.005-1.030 1.020
SUGAR Negative Negative
PROTEIN Negative +2 Due to disease of
the kidney such
as
glomerulonephrit
is.
MICROSCOPIC
RBC 4-6hpf Indicates
possible injury to
kidney tissue
PUS CELLS few 0-2/hpf Indicative
of bacterial
infection
BACTERIA few
EPITHELIAL few Indicative
of nephrotic
syndrome
CRYSTALS
AMORPHOUS URATES Few few
MUCUS THREADS few few
AMORPHOUS Few
PHOSPHATE
KETONES Negative

21
02/02/17
RESULTS REFERENCE Interpretation
INTERVAL and Analysis
Color Light Yellow
Transparency CLEAR
URINE CHEMICAL
Specific Gravity 1.010 1.003-1.053
pH 7.00 5.00-7.00
Protein + NEGATIVE Due to disease of
the kidney such
as
glomerulonephrit
is.
Glucose NEGATIVE NEGATIVE
Bilirubin NEGATIVE NEGATIVE
Blood (ERY/Hb) ++++ NEGATIVE
Leukocyte NEGATIVE NEGATVE
Nitrite NEGATIVE NEGATIVE
Urobilinogen 0.20 mg/dL <1.00
Ketone + NEGATIVE
MICROSCOPIC
RBC 1-3/hpf 0-3 Indicates
possible injury to
kidney tissue
WBC 1-2/hpf 0-5 WBCs in
the urine may m
ean a UTI is
present.
Epithelial Cells FEW
Bacteria FEW
Mucua Threads FEW

FECALYSIS

COLOR Yellow
CONSISTENCY Soft

RBC
PUS CELLS 2-3/hpf

MUCUS
OVA & PARASITES No ova nor parasites seen

22
 DRUG STUDY

Generi Brand Classifi Actua Action Ration Side Nursing

c name cation l dose ale effect conside
name ration
Ampic Ampici Novo- Antibio 700m Bacterici Used CNS: -
illin llin ampic tic g tiv dal in the letharg Allergie
sodiu illin Penicilli q6 action treat y s to
m (CAN) n after against ment GU: penicilli
, ANST sensitive of nephrit n, renal
Princi organis respir is disorder
pen, ms; atory Hemat s, CBC,
Ampic inhibit tract, ology: LFTs,
in synthesi urinar leukop renal
s of y enia function
bacterial tract tests,
cell wall and serum
causing gastro electrol
cell Intesti ytes,
death. nal Hct,
infecti urinalys
ons, is
septic -Inspect
emia skin
and daily for
endoc rash.
arditis
ceftria Ceftria Rocep Antibio 1.4g Bacterici Used CNS: -
xone xone hin tic tiv q8 dal: in the letharg Hepatic
sodiu Cephal hours inhibits treat y and
m osporin ANST synthesi ment GU: renal
(third s of of nephro impairm
genera bacterial urinar toxicity ent
tion) cell wall, y Hemat Renal
causing tract ologic: function
death. infecti decrea test,
on. sed skin

23
 WBC status,
count, LFTs,
decrea sensitivi
sed ty tests.
platele -
ts, Monitor
decrea ceftriax
sed Hct one
blood
levels in
patients
with
severe
renal
impairm
ent and
in
patients
with
renal
and
hepatic
impairm
ent.
cetiriz Cetiriz Zyrte Antihis 5mg/ Potent Used CNS: -Allergy
ine ine Hcl c tamine ml at histamin for somnol to
Reacti bedti e (H1) renal ence, histami
ne me receptor dysfu sedatio ne,
(CAN) BID antagoni nction n bladder
st, CV: neck
inhibits edema obstruct
histamin ion.
e release -
and Monitor
eosinoph skin
il color,
chemota renal
xis function
during tests.
inflamm -Report
ation, difficult
leading y of
to breathin
reduced g.
swelling
and

24
 decrease
d
inflamm
atory
response
.

glycer glyceri Colac Hypero 1- Elevates Used GU: Hyperse

in n e smolar 1.7g the to increas nsitivity
suppo laxativ rectal osmolari clear ed to
sitory, e ly ty of the edem urinati glycerin
Osmo Ophtha once. glomerul atous on ,
glyn, lmic ar corne Others: edema,
Sani- hyper filtrate, a Ocular pupillar
supp, osmola thereby pain y
Fleet r hinderin and reflexes
babyl prepar g the irritatio .
ax ation reabsorp n. Monitor
Osmoti tion of urinary
c water output
diureti and pattern,
c. leading serum
to a loss electrol
of water, ytes,
sodium, urinalys
and is.
chloride; Headac
creates he and
an blurred
osmotic vision.
gradient
in the
eye
between
plasma
and
ocular
fluids,
thereby
reducing
IOP;
causes
the
reabsorp

25
 tion of
sodium
and
water in
the
stool,
leading
to a
more
liquid
stool and
local
intestina
l
moveme
nt.
parac Parace Bioge Non- 250m The Used Throm -
etamo tamol, sic, narcoti g/5ml mechani for bo- Monitor
l Aceta Panad c q6 sm of treati cytope CBC,
mino ol, analge PRN action is ng nia, liver
phen Tyleno sic, associat mode Leukop and
l Antipyr ed with rate enia, renal
etic inhibitio to Drowsi function
n of sever ness s.
prostagl e -Assess
andin pain, for fecal
synthesi fever, occult
s, the arthrit blood
predomi is and
nant pain nephriti
influence and s.
on the muscl -Report
thermore e pain
gulation ache. that
center in persists
the for
hypothal more
amus, than 3-
enhance 5 days.
s heat -
transfer. Phenma
cetin
may
cause
urine to
become

26
 dark
brown
or wine-
colored.

27
 COURSE IN THE WARD

January 27, 2017 (NO DUTY)

Received patient conscious and coherent with fever and no cough

and colds. Patient has a weak faces and loses good appetite. Vital sign taken
and recorded. Patient body temperature after checking was 38.7C. Not
distress and pink palpebral was observed.

January 28, 2017 (NO DUTY)

For continuity of care same patient, the patient has macculo pupil
rash on mouth, extremities no signs of fever, chilling, bleeding and DOB.
Physical assessment done Anterior posterior, normal rate regular rhythm. (-)
murmurs, Saturated Calomel Electrodes, (-) reactions. Capillary Blood Sugar ,
soft Normal Active Sounds and non-tender. Patient also lack of sleep and non-
cooperative and not in distress.

January 29, 2017 (NO DUTY)

Patient was (+) fever, (+) macculo pupil rash. Difficulty of

breathing, (+) periorbital edema. Decrease appetite and activity. She was
asleep, non-cooperative and not in distress. And, Nasal Respiratory
Resistance, (-) murmur. Saturated Calomel Electrodes (-) reaction.

January 30, 2017 (NO DUTY)

Patient was (+) for fever and chills. Her appetite and physical
activities were decreased. Signs of bleeding and abdominal pain was
negative. She was examined while sleeping, there was no cardio pulmonary
distress, skin was warm to touch and good anger.

January 31,2017 (NO DUTY)

28
 Patient was (+) for fever, periorbital swelling. She was conscious
coherent and not in distress. Symmetrical chest expansion, clear breath
sound, full and equal pulse.

February 1, 2017 (NO DUTY)

Nursing care done, for continuity of care same patient, Vital signs
are monitored and recorded due to medicine given. The patient has normal
Blood pressure 110/60, pulse rate 94 and temperature 37.7C but (+) on
edema on eyelids R/L. Full equal pulses, symmetric chest expansion no
reaction and breath sounds.

February 2, 2017 (ON DUTY)

Patient is conscious and coherent and in cardiorespiratory distress,

Anicteric, pink palpebral conjunctiva, has signs of periorbital edema.
Symmetrical chest expansion, normal breath sounds, precordium, negative
from murmurs, flabby abdomen, soft and non-full and equal pulses. (-)
edema and (-) vomiting was observed. Patient has normal vital sign. BP
90/60, Temperature 37.2, PR 98. Appetite id now on fair to good as well as
her activity.

February 4, 2017 (ON DUTY)

Patient was (-) for fever, (+) edema, no bleeding and no

abdominal pain. Vital signs: BP 90/60, CR 71, RR 36, TEMP. 36.3. She was
conscious coherent, not in distress.

February 6, 2017 (NO DUTY)

Patient had no complain, assessment was done. She was (-) for
fever and no eye contact but she was awake. There was decrease facial
edema. Vital signs: BP 90/60, CR 82. She has a good appetite and in good
condition.

February 7,2017 (NO DUTY)

Patient was conscious coherent with good appetite and good in

activity. Assessment and vital signs were recorded. She was (-) for fever,

29
edema and seizures and also the pink palpebral conjunctiva and dynamic
precordium was clear, breath sounds with normal rate.

February 11,2017 (0N DUTY)

Patient was (-) for fever, edema, bleeding, vomiting. She had
good activity and appetite. She was conscious coherent, not in stress. Vital
signs: BP 90/60, CR 119, RR 28. Pink palpebral sclera. Symmetrical chest
expansion, clear breath sound.

February 12, 2017 (No Duty)

Patient was (-) fever, vomiting, headache and pain. Good oral
intake, Conscious coherent and not in distress. Vital signs: BP: 110/60 CR: 90
RR: 23 Temperature: 36.3. Pink palpebral conjunctiva anicteric sclera. Angina
Pectoris, Nasal Respiratory Resistant (-) murmur. Her abdomen was soft and
non-distended.

February 13, 2017 (No Duty)

Patient was (-) for seizure, vomiting, and fever. She was conscious
coherent and not in distress. Vital signs: CR 92, RR 24, TEMP. 36.5. She had
Pink palpebral conjunctiva and anicteric sclera. Saturated Calomel Electrodes
(-) reaction, clear breath sounds. A dynamic precordium normal rate,
irregular rhythm murmur.

February 14, 2017 (No Duty)

Patient was (-) for vomiting, fever. She had a good activity and
good appetite. She was a conscious coherent and not in distress. Vital signs:
CR 90, RR 25, TEMP 36.7. She had Pink palpebral conjunctiva anicteric
symmetrical chest expansion and clear breath sounds. She had
(-) No Apparent Distress and (-) Canine Leukocyte adhesion Defficiency.

February 15, 2016 (No Duty)

Patient was (-) fever, seizure, pain and (+) scalp itchiness. She
was conscious coherent and not in distress. She had Saturated Calomel
Electrodes and (-) reaction. Angina Pectoris Nasal Respiratory Resistant (-)
murmur full and not equal pulses.

30
 NURSING CARE PLAN (1)

Assessme Diagnos Backgrou Planning Intervent Rational Evaluati

nt is nd ion e on
knowledg
e
Subjective: Hyperthe Infectious After 4hrs - Monitor - Assist in After 4hrs
Mainit ang rmia Agents of nursing clients determini of
anak ko related (Pyrogens) interventio temperatu ng the nursing
as as to n the re and diagnosis. interventi
verbalized secondar patient note for Room ons the
Monocytes
by the y will presence temperat patient
patients infection maintain of chills/ ure was able
mother Pyrogenic core profuse should be to
cytokines temperatu diaphoresi changed maintain
re within s; also to core
Objectve: normal note for maintain temperat
(+) fever Anterior range. degree near ure within
(+) Hypothala and normal normal
periorbital mus pattern of temperat range.
edema occurrenc ure.
(+) chills e.
- Elevated - To
decreased thermoreg - Monitor obtain
appetite ulatory set the baseline
- point temperatu data.
decreased re of the
activity Increased environme
Conservati nt. -Can help
VS : on reduce
- Temp -Monitor fever
: the vital
38.3 Increased signs -
- PR: heat Antipyreti
113 production - Provide cs acts on
- RR: warm the
24 FEVER water hypothala
compress mus,
reducing
- hyperther
Administer mia
antipyretic

31
 s as
prescribed
by the
physician. - Water
regulates
- body
Encourage temperat
client to ure.
increase -
fluid Providing
intake health
teachings
-Educate to client
client of could
signs and help
symptoms client
of cope with
hyperther disease
mia condition
and could
help
prevent
further
complicat
ions of
hyperther
mia

32
 NURSING CARE PLAN (2)

Assessme Diagnosis Backgro Planning Intervent Rationale Evaluatio

nt und ion n
Knowled
ge
Subjective: Fluid After 7 >Establis >To gain After 7
Nagmama volume Renal days of h rapport trust to the days of
nas yung excess Failure nursing patient. nursing
paligid ng related to interventio >Monitor interventio
mata ng decrease ns, patient the vital >To obtain ns, the
anak ko as golumerul will able to signs. baseline goal was
verbalized ar filtration Loss of maintain data. met the
by the secondary albumin fluid >Asses patient
patients to volume, patients maintaine
mother. glomerular normal VS, appetite d fluid
inflammati and free >To prevent volume,
Objective: on. Reduction from signs >Record fluid the puffy
-(+) in of the overload eyelids
Periorbital colloidal periorbital amount of easily
edema osmotic edema. fluid gone and
-puffy pressure intake. >To monitor went to
eyelids fluid back to
-Reddish in retention normal
palpebral and and, free
conjuctiva Edema >Record evaluate from
I&O degree of periorbital
Temp: accurately excess . edema.
38.2C and
BP: 90/60 calculate >Weight
CR: 113 fluid gain
RR: 24 volume. indicates
fluid
>Restrict retention or

33
 sodium edema.
and fluid
intake.
>To monitor
kidney
>Explain function.
to the
mother
the >Understan
conseque ding
nce of promotes
fluid patient and
retention familys
cooperation
with fluid
restriction.

NURSING CARE PLAN (3)

Assessme Diagnosi Backgrou Planning Interventi Rationale Evaluation

nt s nd on
knowledg
e

34
Subjective: Imbalance General After 7-14 Establishe To facilitate After 7-14
Matamlay Nutrition: body days of d cooperation days of
at mahina Less than weakness nursing rapport as well as nursing
siyang body related to interventi to gain intervention,
kumain as requireme Acute on the patients the patient
verbalized nts related Glomerulon patient trust. manifested
by the to dietary ephritis will Daily increase in
mother. restriction manifest physical To assess appetite and
as Poor increase and weight gain mood
Objective: evidence appetite in weight or weight improvement
-Weakness by and desire appetite, monitori loss. and weight
-Patient decrease to eat and mood ng improvement
untouched desire to drink improvem from 33kg to
to her food. eat. ent and Assess To provide 35.5kg Goal
-150ml Decrease weight nutrition foods that was met.
water intake of improvem al status will increase
intake food and ent her
-wt 33kg fluids between appetite.
Temp: 33kg to Increase
38.2C Nutrition 35.5kg fluids To maintain
BP: 90/60 imbalance per fluid
CR: 113 doctors balance.
RR: 24 order.

Assess
and To prevent
encoura dehydration
ge the and
patient ti nutritional
increase deficit.
fluid and
increase
food
intake.

Provide To prevent
low salt further
diet. water
retention
due to
acute
glomerulon
ephritis

35
 RECOMMENDATION

MEDICATION -explain to the mother of the

patient and family members the
importance of taking medicines

> Ampicillin - tiv q6 after ANST

> ceftriaxone - IVq 12 hours.
> cetirizine - at bedtime
>Paracetamol - q6 PRN
> glycerin Given once
EXERCISES -Advise the mother of the client
to have an exercise to her child
such as walking.

-As time and experiences

increases the client can move to
higher intensity exercise.

>Advice the mother of the

patient to have or maintain safe
and clean environment
TREATMENT -Ensure follow up and self-care.

-Advice the mother or significant

others to take in time prescribe
medicines specially in kidney
function.

-Advise the mother of the patient

to limit water intake; that she
drink and monitor output.

Health Teachings >Describe to the family of the

patient the signs and symptoms
to be reported
immediately (Blood in the urine,
foamy urine, swelling and
swelling on her face.
> Advise significant others to
immediately consult her
physician if signs and symptoms
of the diseases occurs persist.

36
OUTPATIENT Encourage the mother of the
(CHECK UP) patient that when her child
discharged, she need to have a
regular checkup, to her physician
until is needed. To check
regularly her condition.
DIET -limit the amount of protein,
potassium, and salt that be
eaten of her child.

-eat healthy foods and get plenty

of exercise.

- eat low fat and low sodium foods

that will help not worsen
her condition.

Spiritual >Advise relatives or significant

others to provide moral support
and widen their understanding.
>Tell to the significant other to
pray for the client to help with
the recovery.
>and also Instruct the patient to
pray for her fast recovery and
guidance.

37