Professional Documents
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INTRODUCTION
Acute pyelonephritis can occur at any age. In neonates it is 1.5 times more common in
boys and tends to be associated with abnormalities of the renal tract. Uncircumcised boys tend to
have a higher incidence than circumcised boys. Beyond that age girls have a 10-fold higher
incidence. In adult life it reflects the incidence of urinary tract infection (UTI) in that it is much
more common in young women. Over 65 the incidence in men rises to match that of women.
Glomerulonephritis (GN) comprises 25-30% of all cases of end-stage renal disease (ESRD).
About one fourth of patients present with acute nephritis syndrome. Most cases that progress do
so relatively quickly, and end-stage renal failure may occur within weeks or months of acute
nephritic syndrome onset.Geographic and seasonal variations in the prevalence of
poststreptococcal glomerulonephritis (PSGN) are more marked for pharyngeally associated GN
than for cutaneously associated disease. PGN has no predilection for any racial or ethnic group.
A higher incidence (related to poor hygiene) may be observed in some socioeconomic
group.Acute GN predominantly affects males (2:1 male-to-female ratio). PGN can occur at any
age but usually develops in children. Outbreaks of PSGN are common in children aged 6-10
years.
This case study will help the group in understanding the disease process of the patient.
This would also help the group in identifying the primary needs of the patient with acute GN and
acute PN. By identifying such needs and health problems of the patient associated with the
disease and understanding why such needs and health problems arise the group can now
formulate an individualized care plan for the patient that would address these needs and
problems effectively. Effective management of the problems identified will help the patient to
recover faster and maintain a holistic sense of wellness even while in the hospital.
This case study would also equip the group with knowledge, skills and attitude on how to
manage future patients with the same or similar disease.
b. NURSING PROCESS
A.ASSESSMENT
1. PERSONAL DATA
A. Demographic Data
Name: Boy X
Age: 5 y/o
Sex: Male
Religious Affiliation: Catholic
Role position of the family: Second son
Address: Brgy. Mangga, Capas Tarlac City
Date of Birth: February 21, 2003
Nationality: Filipino
Health care Financing: Father
Usual source of medical care: Doctor
B. Environmental Status:
Their house structures are made of concrete and wooden materials which
was build within a compound with their relatives. They have 2 bed rooms and
their appliances are arranged properly in their divider as verbalized by the father.
They have water pump which their particular source of water for bathing,
cleaning cooking etc. but not a source of water to drink because the family usually
bought mineral water for their source
C. Personal Habits:
He went to school every morning from 7:30 am to 11:30 am and play with his
uncle every afternoon. He usually eat variety of vegetables like “sayote, papaya,
carrots, kalabasa” as verbalized by her mother, which are good for his heath. He
loves to play holen and watched television. He usually play a long period of time
outside with his friends
D. Social:
He is the second son of Mr. and Mrs. Mejares and a pre-school student.
E. Psychological:
He loves to play outside with his friend so when his mother unable to permit
him to go and to play outside he usually cries and make himself busy inside the
house by playing in the room alone.
According to the mother the patient has asthma which started when he was 3
months old. Since then everytime the patient experiences the symptoms of asthma they
take salbutamol with the use of nebulizer to alleviate symptoms and improves airway
function. The patient’s asthma is usually triggered due to the weather changes, it usually
occurs during summer season or hot weather as the mother stated. When the patient has
fever, cough and colds the mother used OTC drugs like paracetamol for the patient
condition. The patient had not experience other childhood illnesses. Boy X has completed
his childhood immunizations. The patient has no allergies to drugs, animals, or insects,
and was never hospitalized due to serious illness.
4. HISTORY OF PRESENT ILLNESS
5. PHYSICAL ASSESSMENT
Date examined: Thursday, September 4, 2008
1. Vital Signs
1.1 Temperature 37.8 o C (L axilla) 35.4o C – 37.4o C (axillary) Abnormal There can be many causes of
1
(Hyperther hyperthermia (including
mia) infection), which results
from the body’s increased
basal metabolic rate.
1.2.a Rate
110 bpm Normal
3-6 years old: 100-110
bpm 1
1.2.b Rhythm
Pulse is regular with Normal
even intervals between
each beat Normal pulse rhythm
should be regular with
equal intervals between
pulses. 1
1.2.c Volume
Pulse is graded as Normal
+2/+3 which can be The pulse volume is
felt using moderate usually the same with each
amount of pressure. beat. A normal pulse
volume can be felt with a
moderate amount of
pressure and obliterated
with greater pressure. A
weak or thread pulse as
well as a bounding pulse
should not be observed. 1
Hypoxia and metabolic
acidosis are common causes
1.3 Respiration of tachypnea. The body
38 bpm 3-6 years old: 19-25 bpm 1 compensates to provide
1.3.a Rate itself with more oxygen and
Abnormal eliminate hydrogen ions
(tachypnea) when metabolism is
increased
6. DIAGNOSTIC AND LABORATORY PROCEDURES
Hematology Date ordered >specimens of venous >WBC 32.1 >4.1 – 10.9 G/L >mid cells may include
august 30, 2008 blood are taken for a G/L less frequent occurring
CBC(complete blood >0.6 – 4.1 10.0- and rare cells
Date result in: test), which includes >LYM 2.3 R2 50.5 % L collarating to
August 30, 2008 hemoglobin and 7.1 % L monocytes, eosinophils,
>1.0-1.8 0.1-24.0
hematocritt basophils, blasts and
Time:1:25 pm >MID 1.2 3.7
measurements, >2.0-7.8 37.0-92.0 other precursor white
%M
erythrocyte(RBI) count
leukocyte(WBC) >GRAN 28.6 >4.20-6.30 T/L cells.
count, red blood 89.2 % G
cell(RBC) indices and >1.20-1.80 g/L
differential white cell >RBC 3.69 T/L
>.370-.510 L/L
count. Increase in RBC
>HGB 98 g/L
count may be >80.0-97.0 F/L
indicative of >HCT.276 L/L
dehydration and >26.0-32.0
decrease with anemia. >MCV 74.8 F/L
White blood cell count >350-360 g/L
determines the no. of >HCH 26.6
>140-440 g/L
circulating WBC’s of
>MCHC 355.
whole blood. High
g/L
WBC counts are often
seen in the presence of >PLT 253g/L
a bacterial infection, by
contrast, WBC counts
may be low if a viral
infection is present.
Glucose: (-)
Microscopic:
RBC: TNTC
Bacteria: ++
Ephithelial
cells: few
A. Urates/
phosphate: few
Physical
examination:
Color: dark
yellow
Appearance:
turbid
Reaction: 6.0
Specific
gravity: 1.015
Chemical
examination
Albumin: +++
Glucose: (-)
Microscopic:
RBC: TNTC
Bacteria: few
Ephithelial
cells: rare
A. urates/
phosphate: few
Blood August 03, 2008 >specimen of venous Creatinine: >53-106 mol/L >
chemistry blood are taken for a 123.76
CBC which includes
hemoglobin and Electrolytes:
hematocrit Sodium:138.5 >136-142
measurements,
erythrocyte (RBC) Potassium: 4.84 >3.8-5.0
count,
Chloride: 111.7 >95-103 Meg 1L
leukocyte(WBC)
county, red blood cell
(RBC) indices, and
differential white cell
count.
They are paired that are reddish in color and resemble beans in shape.
They are about size of a close fist located at retro peritoneally ( behind and outside
peritoneal cavity) on the posterior wall of the abdomen from 12 thoracic vertebrae to
the third lumbar vertebrae in adult
Kidney are well protected by the ribs and by the muscles of the
abdomen and back
2. ADIPOSE CAPSULE- second layer it is a mass of fatty tissue that protects the
kidney from blows. It firmly holds the kidney in the abdominal activity
3. RENAL CAPSULE- outer most layer which consist of a thin of a layer of fibrous
connective tissue that also anchors the kidney to their surrounding structures and
to the abdominal wall
INTERNAL ANATOMY OF KIDNEY
The renal parenchyma is divided into two parts the cortex and the medulla
MEDULLA
Medulla is approximately 5 cm wide which is the inner portion of the kidney. It contains
the loop of Henle, the Vasa Recta and the collecting ducts of the juxtamedullary nephrons the
collecting duct from both the juxtamedullary and the cortical nephrons connect to renal pyramids
which are triangular and are situated with base facins the concave surface of the kidney and the
point (papilla)facins the hilum/pelvis. Each kidney contains approximately 8-18 pyramids. The
pyramids drain into 4 to 13 minor calices which drain into 2 major calices that open directly into
the renal pelvis. The renal pelvis is the beginning of the collecting system and is composed of
structures that are designed to collect and transport urine. Once the urine leaves The renal pelvis,
the composition of urine does not change.
CORTEX
- It is approximately 2 cm wide, is located farthest from the center of the kidney and
around the outer most edges. It contains the nephrons.
NEPHRONS
-these are the functional units of kidney. It is microscopic renal tubule which functions as
a filter. Each kidney has 1 million nephrons, which usually allows for adequate renal function
even if the opposite kidney is damaged or becomes nonfunctional. The structures are located
within the renal parenchymas that are responsible for initial formation of urine.
2 KINDS OF NEPHRONS
a. Cortical nephrons – this makes up 80 to 85% of total number of nephrons in the kidney which
are located in the innermost part of the cortex.
b. Juxtamendullary – nephrons which make up the remaining 15 to 20% are located deeper in the
cortex. There are distinguished by long loops of Henle, which are surrounded by long capillary
loops called Vasa Recta that dip into Medulla of the Kidney.
The tubular component of the nephrons begins in the Bowman’s capsule. The filtrate
created in the Bowman’s capsule travel first into the proximal tubule, then into loops of Henle,
distal tubule, and either the cortical or medullary collecting ducts. The structural arrangement of
the tubule allows the distal tubule to lie in close proximity to where the afferent and efferent
arteriole respectively enter and leave the glumerulus. The distal tubular cells located in this area,
known as the Macula Densa which functions with the adjacent afferent arteriole and create what
is known as juxtaglumerulus apparatus. This is the site of the renin production. Renin is a
hormone directly involved in the control of arterial blood pressure; it is essential for proper
functioning of the glumerulus.
The tubular component consists of the Bowman’s capsule, the proximal tubule, the
descending and ascending limbs of the loop of Henle, and the cortical and medullary collecting
ducts. This portion of the nephrons is responsible in making adjustments in the filtrate based on
the body’s needs. Changes are continually made as the filtrate travels through the tubules until it
enters the collecting system and is expended from the body.
The hilum of pelvis is the concave portion of the kidney through which are renal artery
enters and ureters and renal vein exit. The kidney received 20% to 25% of the total cardiac
output, which means that all of the body’s blood circulates through the kidneys approximately 12
times per hour. The renal artery (arising from the abdominal aorta) divided into smaller and
smaller vessels, eventually forming the afferent arterioles. Each afferent arterioles branches to
form a glumerulus, which is the capillary bed responsible for glumerular filtration
.
8. PATHOPHYSIOLOGY
i BOOK BASED
ANTIGEN (GROUP A BETA-HEMOLYTIC
STREPTOCOCCUS)
ANTIGEN – ANTIBODY
PRODUCT
MANIFESTATION
DECREASE GLOMERULAR FILTRATION RATE
(BFR)
ACUTE ONSET OF EDEMA
OLIGURIA
PROTENURIA
ANEMIA
COCOA COLORED URINE
WITH RED BLOOD CELLS
CAST (HEMATURIA)
HYPERTENSION
HEADACHE
FEVER
NAUSEA AND VOMITING
PATHOPHYSIOLOGY
ii CLIENT CENTERED
ANTIGEN (GROUP A BETA-HEMOLYTIC STREPTOCOCCUS)
DECREASE
SCARRING
GLOMERULAR
AND LOSSFILTRATION
OF
MANIFESTATION
EDEMA(facial and
bipedal) 08/30/08
HEMATURIA
08/30/08
HEADACHE 08/30/08
FEVER08/30/08
09/04/08
09/05/08
NAUSEA AND
VOMITING
B. IMPLEMENTATION
I. DRUGS
GENERIC DATE ROUTE OF GEN. ACTION INDICATION/S
NAME: ORDERED ADMINISTRATION MECHANISM PURPOSES
CEFUROXIME 8/30/08 DOSAGE AND OF ACTION >Pharyngitis tonsillitis
12:50 pm FREQUENCY OF infection of urinary and
BRAND DATE TAKEN ADMINISTRATION Chemical lower respiratory tract
NAME: / GIVEN Effect: Inhibits and skin structure
Ceftin, Kefurox 8/30/08 Cefuroxime 650 mg cell wall infections. Susceptible
Zinacef 9:00pm I.V q 8 hours synthesis are Streptococcus
8/31/08 promoting pneumonia, S pyogens,
Pharmacologic 6:00 am osmotic Staphyloccus aureus,
class: second- 2:00pm instability: Escherichia coli
generation 10:00 pm usually > Secondary bacterial
cephalosporin 9/01/08 bactericidal infection of acute
6:00 am bronchitis
Therapeutic 2:00 pm Therapeutic
Class: antibiotic 10:00 pm Effect:
9/02/08 Hinders or kills
6:00 am susceptible
2:00 pm bacteria
10:00 pm including many
9/02/08 gram-positive
6:00 am organisms and
2:00 pm enteric gram-
10:00 pm negative bacilli
9/03/08
6:00 am
2:00 pm
10:00 pm
9/04/08
6:00 am
2:00 pm
10:00 pm
DATE
CHANGED
9/05/08
NURSING RESPONSIBILITIES:
BEFORE ADMINISTRATION
1. Explain to the patient and family on what is the effect of drug and its action
4. Before giving the first dose , ask patient about previous reaction to cephalosporins or
penicillin
AFTER ADMINISTRATION
3. Tell patient/ significant others to report adverse effect seen and experience
DATE
CHANGED
09/03/08
10:00 am Furosemide IVP OD
09/04/08
10:10 am D/C Furosemide
NURSING RESPONSIBILITIES
BEFORE ADMINISTRATION:
1. Explain to the patient and family on what is the effect of drug and its action
2. Assess patients underlying condition before administration
3. Monitor weight peripheral edema breath sounds blood pressure fluid intake and output
and electrolyte glucose BUN
AFTER ADMINISTRATION:
2. Tell patient/ significant others to report adverse effect seen and experience
3. Monitor weight peripheral edema breath sounds blood pressure fluid intake and output
and electrolyte glucose BUN
BEFORE ADMINISTRATION:
1. Explain to the patient and family on what is the effect of drug and its action
2. Assess patient temperature before the therapy
AFTER ADMINISTRATION:
NURSING RESPOSIBILITIES
BEFORE ADMINISTRATION
1. Assess if the patient has penicillin hypersensivity and cross sensitivity with other β
lactam antibiotic e.g cephalosporin
2. Preparation of the medication
>Direction of Reconstitution
To make up to &0 ml first shake the bottle to loosen powder. Then ad 58 ml water
and shake well.
3. Explain to the patient and family on what is the effect of drug and its action
4. Shake well before the patient take the first dose
5. Administer medication at the start of a meal to minimize potential gastrointestinal
intolerance and to optimize drug’s absorption
AFTER ADMINISTRATION
1. Be alert for adverse reaction and drug interaction
2. Advice the patient to drink plenty of water to ensure proper ate of hydration and adequate
urinary output
3. Advice the parents to maintain the take of medication at regular intervals
4. Advice the parents to refrigerate the medication to maintain effectiveness
AFTER ADMINISTRATION
1. Be alert for adverse reaction and drug interaction
2. Advice to store the medication on a less light and heat exposure place
II. DIET
1 egg
arozcaldo
I glass of Milo
III ACTIVITY/EXERCISE
1. For patient risk for impaired skin integrity r/t the presence of edema.
A. Change the child’s position at least every 2 hours. Changing the position keeps pressure sores
from appearing.
B. Give bath daily and cleanse skin as needed. Attention to hygiene deters skin breakdown.
C. Use lotion over areas of dry skin. Lotion help and moisture to the skin to decrease the chance
of skin breakdown.
D. Use a support pillow under any edematous extremity. Support pillow will increase circulation
and decrease pressure points that might lead to skin breakdown.
2. For patient experiencing fatigue r/t infectious process.
A. Assess the child for signs of fatigue such as excessive sleepiness, yawning, or inability to
help with activities of daily living. A child may show signs of fatigue in subtle ways such as
sleeping more than usual, yawning, or reluctance to help with bath or feeding activities.
B. Ask the child what he wants to play with or what activities he wishes to engage in today. A
child of 5 years usually wants to play no matter how sick he is. If he has some choice he may
play more than if he was told what to do.
C. Observe the child’s activity to do activities even if these are bed games. Observation will
indicate the child’s tolerance of an activity and level of fatigue.
D. Rest periods during activities are important because the child will fatigue easily.
3. For patient who has pain r/t presence of infection and edema.
A. Assess the child for signs of pain such as grimacing, crying, staying quiet, verbal complaints
of pain, or reluctance to move. Assessment of child’s pain level allows for easily intervention
to make the child, more comfortable.
B. Gently move or reposition the child every 2 hours if he is to remain in a bed or chair position.
Moving the child gently promotes circulation of the blood, lessens chance of pain, and helps
comfort the child.
C. Position an edematous extremity on a support pillow. Supporting a swollen leg or arm will
help decrease the pain.
D EVALUATION
A. EVALUATION
2.DISCHARGE SUMMARY
E: Advised the mother to let his child continue his usual daily activities as tolerated
T: Ø
D:
Advised the mother to give her child nutritious food like fruits and vegetables to sustain
the needed nutrients of the body.
Advised the mother not to let her child to eat junk foods.
III CONCLUSION
IV RECOMMENDATION
V. BIBLIOGRAPHY
Website
2
New international Child Growth Standards for infants and young children (2006) by the World
Health Organization (retrieved from: http://www.who.int/growthref/en/)
http://www.drugs.com/mtm/phenylpropanolamine.html
http://www.chem-online.org/generic-pharmaceutical.htm
http://en.wikipedia.org/wiki/Carbocisteine
http://en.wikipedia.org/wiki/Co-amoxiclav
(http://www.emedicine.com/med/topic879.htm)
http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm
http://www.patient.co.uk/showdoc/40024643/)
Book:
1
Health Assessment & Physical Examination (3rd Edition) by Mary Ellen Zator Estes
Pediatric Nursing (Caring for children and their families)by Nicki L Potts and Barbara L
Mandleco
A Case Study on
“Acute Glomerulonephritis and Acute Pyelonephritis”
Submitted by:
Canlas, Mylene
Casilang, Freda
Cayabyab, Jodi
Cayabyab, Shiela
Daguro Wella
Espinosa, Rachel
Dijamco, Arcen
Dizon, Robert
Escalona, Hesusito
Galeon, Paolo
Group A2
Submitted to:
Mr. Apollo G Facun RN,MSN