OLIVAREZ COLLEGE PARANAQUE

Dr. A. Santos Ave., Sucat, Parañaque

College of Health Related Sciences – Nursing Department

Case Study of a Client with a diagnosis of

Acute glomerulonephritis

CASE PRESENTATION
BS NURSING IV SECTION A, Group 2
1ST SEM - CLASS 2010-2011

Submitted to:
Ms. Acosta, RN
Introduction

Background of the study

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 (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 damage—focal (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).

Case Abstract

This was a case of E.D., 6 year old male born on November 8, 2003 residing at Muntinlupa City was admitted at Ospital ng Muntinlupa on
August 24, 2010 at 8:15am with a chief complaint of Tea Colored Urine. He arrived at the hospital awake, conscious and coherent with admitting
diagnosis of Acute Glomerulonephritis.

Patient had high fever, sore throat, tonsillitis and facial edema12 days prior to confinement.
Vital Signs taken and recorded upon admission; BP 135/85 mmHg, T: 37oC, RR: 30, PR 100 bpm and Laboratory test; Urinalysis, Hematology, Blood
Chemistry and ASO titer was done. Catheter was inserted upon admission. Furosemide, Nipedipine and Penicillin was given.

OBJECTIVES:

A. General Objectives

This study aims to convey familiarity and provide effective nursing care to a patient with admitting diagnosis of Acute Glomerulonephritis ,
through understanding the patient history, disease process and management.

B. Specific Objectives

At the end of the session, the students will be able to:

1. Present a thorough assessment regarding Acute Glomerulonephritis, through Nursing Health History, Maternal History, Physical
Assessment, and the interpretation of the laboratory examinations done on the patient.

2. Discuss the anatomy and physiology of Urinary system, pathophysiology of the patient’s condition, usual clinical manifestations and
possible complications of the condition.

3. Enumerate the necessary medications needed and be familiar to its mode of action.

4. Formulate a workable nursing care plan on the subjective and objective cues gathered through nurse-patient interaction to be able to help
the patient towards wellness.
PATIENT'S PROFILE
 
A. Biographical Data

Date: September 1, 2010 Clinical Area: 2nd Floor Pedia Ward; OSMUN

Name E.D.
Address Muntinlupa City
Date of Birth November 8, 2003
Age 6 years old
Sex Male
Civil Status N/A
Nationality Filipino
Religious Preferences Roman Catholic
Place of Birth Muntinlupa City
Educational Grade 1
Attainment
Occupation N/A
Language Spoken Filipino
Health Care Financing None
Date of Admission August 24, 2010
Admitting Diagnosis Acute Glomerulonephritis
Admitting Physician Dr. Patdu, Dr. Zabian, Dr. Juntin

B. Chief Complaint
 Patient had fever, facial edema and tea colored urine.
Vital Signs upon admission are as follows: (August 24, 2010)
 T = 37˚C
 PR = 100 bpm
 BP = 135/85mmHg
 RR = 30 cpm
 Wt= 17.5 kg
 Ht=113cm
 Head Circumference: 51cm
 Chest: 56cm
 Abdomen: 55cm

NURSING HEALTH HISTORY

A. History of Present Illness

Patient was diagnosed of Acute Glomerulonephritis and was treated with Furosemide, Nipedipine and Penicillin. Twelve (12) days prior to
consultation client experienced fever, facial edema and tea colored urine and Five (5) days PTC OPD consultation done.

B.   Past History

  Patient has no previous hospitalization and surgeries. Patient was not taking any medication. He has no known food and drug allergies.
                 

C. Family History
Patient has no family history of kidney-related diseases.
 Father has Hypertension

Physical Assessment
Date: September 1, 2010 Clinical Area: 2nd Floor Pedia Ward; OSMUN
Vital Signs
T = 36.4˚C PR = 89 bpm BP = 110/70mmHg RR = 28 cpm

Anthropometric Measurements:

Height: 113 cm Weight: 17.5 kg Chest Circumference: 56 cm Abdominal Circumference: 55 cm

Head Circumference: 51cm

GENERAL SURVEY TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

Inspection () no sign of distress
General Appearance Palpation ( ) With sign of distress
Normal
Auscultation ( ) Cardio Respiratory
( ) pain
() Conscious ( ) Drowsy
Level of consciousness
Inspection ( ) Comatose ( ) Others Normal

() Coherent
Coherence Inspection ( ) Incoherent Normal
( ) Others
( )Oriented
Inspection ( ) Disoriented
Orientation Normal
Time ____ Place
____Person_______
 () Endomorph / Well
developed
( ) Mesomorph / Fairly
Inspection developed
Development
( )Ectomorph / Poorly Normal
developed
() Looks According to Age
( ) Appears older/ younger
than stated age
() Well Nourished
Nutrition
Inspection ( ) Obese Normal
( ) Cachexic
() Calm ( ) Tense
Inspection ( )Worried ( ) Restless
Emotional State Normal
( ) Others
_____________________

II
SKIN TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE
( ) Pinkish ( ) Pallor
General Color ( ) Jaundice () Flushed
Normal
Inspection ( ) Cyanotic ( ) Others
_________
Inspection ( ) Smooth ( ) Rough
Texture Palpation ( ) Others Normal
_________________
() Good
Turgor Inspection ( ) Fair Normal
Palpation ( ) Poor
( ) Warm
Temperature Inspection ( ) Cool Normal
Palpation ( ) Others______________
Moisture ( ) Dry Normal
 Inspection ( ) Wet
Palpation ( ) Clammy
() Oily

III
HEAD TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE
() Normocephalic
Configuration Inspection ( ) Masses Normal
Palpation ( ) Other
( ) Closed
Fontanelles Inspection ( ) Open
Normal
Palpation ( )Sunken
( )Bulging
( ) Fine
Inspection ( ) Coarse
Hair
Palpation ( ) Dry
Normal
( ) Normal / Even
Distribution
( ) Alopecia
( ) Clean
( ) Dandruff
Scalp Inspection ( ) Lice Normal
( ) Wounds / Scars /
Lesions
( ) Symmetrical
Lids Inspection ( ) R/L Edema / Swelling Normal
( ) R/L Ptosis
( ) Edema
Periorbital region Inspection ( ) Sunken Normal
( ) Discoloration
( ) Pink Normal
Conjunctiva Inspection ( ) Pale
 ( ) Lesion
( )Discharge
() Anecteric
Inspection ( ) Subicteric
Sclera Normal
( ) Eteric
( ) Hemorrhage
( ) Smooth ( )
Clear
Cornea and Lens Inspection ( ) Lesion ( ) Normal
Opacity
( ) Arcus Senilia
( ) Equal
Pupil Size Inspection ( ) Unequal
Normal
R: _____mm L:
_____mm
R: ( ) Brisk L: ( )
Inspection Brisk
Reaction to Light
( ) Sluggish ( )
Normal
Sluggish
( ) Fixed ( ) Fixed

Inspection () Uniform constriction

Reaction to ( ) Unequal constriction Normal
Accommodation
Inspection () Intact
Convergence ( )Others __________ Normal

Visual acuity Inspection () Gross Normally

( ) Farsighted Normal
( ) Nearsighted

IV
 EARS TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE
Inspection () Normoset
External Pinnae
() Symmetrical
Normal
( ) Gross Abnormality
( ) Tenderness

External Canal Inspection ( ) Impact Cerumen Normal

( ) Foul smelling
Inspection ( ) Serous
Discharge Normal
( ) Purulent
( ) Mucoid
() Symmetrical
Gross Hearing Inspection ( ) R / L Deafness Normal

V
NOSE TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE
( ) Symmetrical
Inspection ( ) R / L Shallow nasal
Nasolabial Fold Normal
Palpation fold

( ) Midline
Septum Inspection ( ) Deviated Normal
( ) Perforation
Inspection ( ) Pinkish
Mucosa ( ) Pale Normal
( ) Reddish
Inspection ( ) Serous
Discharge ( ) Mucoid
Normal
( ) Purulent
( ) Bloody
 Inspection ( ) Both Parent
Patency ( ) R / L Obstructed Normal
exhalation
Inspection () Symmetric
Gross Smell
( ) R/L Olfactory Normal
Deficiency
Sinuses () Non tender
Normal
( ) Tender

VI
MOUTH TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE
( ) Pinkish
Lips ( ) Cyanosis
Inspection Normal
( ) Dryness / Crackles
( ) Lesion
Inspection ( ) Midline
Tongue ( ) R/ L Deviation
Normal
( ) Atrophy
( ) Fasciculation
Inspection ( ) Complete
( ) Missing teeth
Teeth
( ) Carries
Normal
( ) Denture
( ) Braces / Retainers
Specify ______________
Inspection ( ) Pinkish
Gums ( ) Pallor Normal
( ) Bleeding
Inspection () Pinkish
Mucosa ( ) Pallor Normal
( ) Cyanotic
Inspection () Intact Normal
 ( ) Slurred
Speech
( )Aphasic
( ) Others _____________

VII
PHARYNX TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE
Inspection () Midline
Uvula ( ) R / L Deviation Normal

Inspection () Pinkish

Mucosa ( ) Pallor Normal
( ) Reddish
Inspection () Not Inflamed
Tonsils ( ) R / L Inflamed Normal
( ) R / L With exudates

VIII
NECK TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE
() Midline
Trachea Inspection ( ) R / L Divation Normal
Palpation
Inspection () Non palpable
Cervical lymph nodes Palpation ( ) Palpable Normal
( ) Tender
Inspection ( ) Non palpable
Thyroid Palpation ( ) Enlarge Normal

( ) Normal ROM Normal

Inspection ( ) Neck rigidity
Others Palpation ( ) Neck vein
engorgement visible
 Upright
( ) Masses

IX
CHEST AND LUNGS TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

Inspection
Inspiration / Exhalation Auscultation Normal
Ratio
( ) Regular (Eupnea)
( ) Effortless
( ) Hyperpnea
Breathing Pattern Inspection ( ) Tachypnea
Normal
( ) Dsypnea
( ) Uses of accessory
muscle
( ) Other ___________
AP __2-1_________ L
Shape of Chest: Inspection ____________
Inspection ( ) Barrel chest
Anterior – Posterior – ( ) Funnel
Normal
Lateral Ratio ( ) Pigeon
( ) Others
_______________

Inspection () Symmetrical

Lung Expansion ( ) R/ L Decreased / Lag
Normal

() Symmetrical
Vocal/ Tactile Fremitus Auscultation ( ) Decreased / Increased
Normal
at _____
 ( ) Resonant at
______________
( ) Dullness at
_______________
Percussion ( ) Hyper-resonant at
Normal
_________
( ) Liver Dullness at
__________
( ) Spleen Dullness at
________
Breath Sounds ( ) Bronchial at
______________
() Bronchovesicular at
________
( ) Vesicular at
______________
Normal
( ) Crackles at
______________
( ) Wheezing at
_____________
( ) Pleural friction rub
_________

X
HEART TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

() Flat
( ) Bulging Normal
Precordial Auscultation ( ) Tenderness
( ) Heavy
( ) Thrill
( ) Normo-dynamic pre
cordium
 At
Point of Maximum Impulse Auscultation _______________________
__ Normal
Apical beat at
________________
() Distinct
( ) Regular
( ) Faint
Heart Sounds Auscultation ( ) Irregular
S1 __________ S2 at the
base Normal
S1 __________ S2 at the
apex
Others: ( ) S3 ( ) S4 ( )
Murmurs best heard at
____________

XII
BREAST AND TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE
AXILLAE

Size Inspection () Equal Normal

( ) Unequal

Inspection () Symmetric

Shape ( ) Asymmetric Normal

Inspection () Pinkish Normal

( ) Straic
Color ( ) Blue Hue
( ) Increased vein
engorgement
 Inspection () Smooth
Palpation ( ) Retraction
( ) Dimpling
( ) Edema
( ) Lesions
Normal
Surface ( ) Tenderness
( ) Masses at
____________
( ) Others at
_____________

XII
ABDOMEN TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

( ) Specific vein Normal

General Inspection ( ) Straic
( ) Scars / Lesions

() Symmetrical
( ) Asymmetrical
Configuration Inspection ( ) Flat
Normal
Palpation () Globular
( ) Protuberal
( ) Scaphoid
()Normoactive Normal
Bowel Sounds Auscultation ( ) Hyperactive
( ) Hypoactive
( ) Absent
() Tymphanic Normal
Percussion ( ) Hyperthmphanic
( ) Fluid wave
( ) Shifting dullness
() Muscle guarding Normal
Palpation ( ) Direct tenderness
( ) Indirect tenderness

() Organomely
Tenderness ( ) Liver Normal
( ) Spleen

XIII
GENITO-URINARY TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE
(EXTERNAL
GENITALIA)
( ) Discharge Normal
Inspection ( ) Nodules / Growth or
Male: Penis lesion
( ) Tenderness
() Equal shape with
Inspection lower than __left___
Scrotum ( ) Non Tender
( ) R / L Enlargement
( ) Tenderness
Normal
( ) Nodules / Growth /
Lesion
( ) Others
( ) Hernia
( ) Hdyrocelle
 XIV
BACK AND TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE
EXTREMITIES

() Symmetrical
() Regular
Inspection ( ) Absent Normal
Extremities: Peripheral Palpation ( ) Warm
Pulses ( ) Faint
( ) Weak
( ) Strong
( ) Pounding
() Pinkish
( ) Pallor
Inspection ( ) Cyanosis
Nails and Nail Beds ( ) Inflammation
Normal
( ) Clubbing
( ) Delayed capillary refill
( ) Blanching
() Full
() Symmetrical Normal
Range of Motion Inspection ( ) Decreased ROM upon
__________
Palpation ( ) Tenderness / Pain
( ) Joint swelling
() Equally strong
() Symmetrical in
Muscle Tone and strength Inspection muscle size
Normal
( ) R / L; Upper / Lower
weakness
( ) Atrophy
 () Midline Normal
Spine ( ) Kyposis
Inspection ( ) Lordosis
( ) Scoliosis
Others ( ) CVA Tenderness
Normal
() Coordinated
() Smooth Normal
Gait Inspection ( ) Uncoordinated
( ) Staggering
( ) Shuffling
( ) Stumbling

XV
NEUROLOGICAL
TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE
ASSESSMENT
() 6 Obeys command
( ) 5 Localized pain Normal
( ) 4 Flexion-Withdrawal
Motor Response (Adult) Inspection ( ) 3 Flexion Abnormal
( ) 2 Extension
( ) 1 No response
() 4 Spontaneous
( ) 3 To verbal command
Eyes Open Inspection ( ) 2 To pain Normal
( ) 1 No response
() 5 Oriented and Normal
Converses
( ) 4 Disoriented and
Verbal Response Converses
( ) 3 Inappropriate word
 ( ) 2 Incomprehensible
sound
( ) 1 No response
() 6 Normal
spontaneous movement
( ) 5 Withdrawal to touch
Motor Response (Pedia) ( ) 4 Withdrawal to pain Normal
( ) 3 Flexion-abnormal
( ) 2 Extension-abnormal
( ) 1 No response
() 4 Spontaneous Normal
Eyes Open ( ) 3 To verbal command
( ) 2 To pain
( ) 1 No response
() 5 Coos Babbles
( ) 4 Irritable Cry
Verbal Response ( ) 3 Cries to pain Normal
( ) 2 Moves to pain
( ) 1 No response

REVIEW OF SYSTEMS

BRIEF ANATOMY AND PHYSIOLOGY of SYSTEMS and BODY MECHANISM INVOLVED IN THE CASE.

Human Kidney Anatomy

The kidneys are bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage, one on each side of the spine. The
kidneys are sophisticated reprocessing machines. Every day, a person’s kidneys process about 200 quarts of blood to sift out about 2 quarts of waste products and extra water.
The wastes and extra water become urine, which flows to the bladder through tubes called ureters. The bladder stores urine until releasing it through urination.

The kidneys remove wastes and water from the blood to form urine. Urine flows from the kidneys to the bladder through the ureters.

Wastes in the blood come from the normal breakdown of active tissues, such as muscles, and from food. The body uses food for energy and self-repairs. After the
body has taken what it needs from food, wastes are sent to the blood. If the kidneys did not remove them, these wastes would build up in the blood and damage the
body.

The actual removal of wastes occurs in tiny units inside the kidneys called nephrons. Each kidney has about a million nephrons. In the nephron, a glomerulus—
which is a tiny blood vessel, or capillary—intertwines with a tiny urine-collecting tube called a tubule. The glomerulus acts as a filtering unit, or sieve, and keeps
normal proteins and cells in the bloodstream, allowing extra fluid and wastes to pass through. A complicated chemical exchange takes place, as waste materials and
water leave the blood and enter the urinary system.
In the nephron (left), tiny blood vessels intertwine with urine-collecting tubes. Each kidney contains about 1 million nephrons.

At first, the tubules receive a combination of waste materials and chemicals the body can still use. The kidneys measure out chemicals like sodium, phosphorus, and
potassium and release them back to the blood to return to the body. In this way, the kidneys regulate the body’s level of these substances. The right balance is
necessary for life.

In addition to removing wastes, the kidneys release three important hormones:

 erythropoietin, or EPO, which stimulates the bone marrow to make red blood cells
 renin, which regulates blood pressure
 calcitriol, the active form of vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body
Nephron

Is the basic structural and functional unit of the kidney. Its chief function is to regulate the concentration of water and soluble substances like sodium salts by filtering the
blood, reabsorbing what is needed and excreting the rest as urine. A nephron eliminates wastes from the body, regulates blood volume and blood pressure, controls levels of
electrolytes and metabolites, and regulates blood pH. Its functions are vital to life and are regulated by the endocrine system by hormones such as antidiuretic hormone,
aldosterone, and parathyroid hormone. In humans, a normal kidney contains 800,000 to one million nephrons. Types of nephrons Two general classes of nephrons are cortical
nephrons and juxtamedullary nephrons, both of which are classified according to the location of their associated renal corpuscle. Cortical nephrons have their renal corpuscle in the
superficial renal cortex, while the renal corpuscles of juxtamedullary nephrons are located near the renal medulla. The nomenclature for cortical nephrons varies, with some
sources distinguishing between superficial cortical nephrons and midcortical nephrons.
The Glomerulus

The glomerulus is the main filter of the nephron and is located within the Bowman's capsule. The glomerulus resembles a twisted mass of tiny tubes through which
the blood passes. The glomerulus is semipermeable, allowing water and soluble wastes to pass through and be excreted out of the Bowman's capsule as urine. The
filtered blood passes out of the glomerulus into the efferent arteriole to be returned through the medullary plexus to the intralobular vein.

Bowman's Capsule

The Bowman's capsule contains the primary filtering device of the nephron, the glomerulus. Blood is transported into the Bowman's capsule from the afferent
arteriole (branching off of the interlobular artery). Within the capsule, the blood is filtered through the glomerulus and then passes out via the efferent arteriole.
Meanwhile, the filtered water and aqueous wastes are passed out of the Bowman's capsule into the proximal convoluted tubule.
PATHOPHYSIOLOGY

Acute Glumerulonephritis (patient based)

Predisposing Factor (Non-modifiable) Patient History: Predisposing Factor (Modifiable)

Age, and Gender Patient had High fever, Immune deficiency, Awareness and Knowledge of
sore throat and tonsillitis Mother, Nutrition of Baby
12 days PTC.

Etiologic Agent : Bacteria

Group A beta-hemolytic
Streptococcus

Post-infection of Etiologic Agent

Etiologic Agent travel to the kidney via the Bloodstream

Immune system response, sending antibody to counter act antigen

Antigen-antibody complexes deposition on the glomerular capillary wall.

 Activation of biochemical mediators of inflammation;
leukocytes and fibrin; neutrophils and monocytes – releases
lysosomal enzymes.

Lysosomal enzymes damages the glomerular wall

Glomerular proliferation and damage

Proliferation of extra-cellular matrix

Tension builds within the rigid medullary cavity

Capillary damage Decrease glomerular filtration Increased vasopressor activity

Release of protein and RBC to the urine Increase in aldosterone Vasoconstriction

Signs and symptoms: Sodium retention Signs and symptoms:

Proteinuria and Hematuria. Hypertension (Client’s Bp

is 135/85 mmHg)
Water retention

Chief Complaint: Losses oncotic pressure

Tea colored Urine

 Diagnostic Procedure:
Signs and symptoms:
Urinalysis, Hematology, Blood Chemistry and
ASO titer. Edema

Hematology reveals decreased in level of hemoglobin (110 g/L),

increase in both WBC count (15.6 x 10 9 L), and neutrophils (0.84%)

Urinalysis reveals increase in Ph is acidic (Ph 5), protein (+2), RBC

(TNTC), and pus cells (TNTC).
Diagnosis: Acute Glumerulonephritis

Blood chemistry reveals elevated BUN (14.6 mmol/L)

ASO Titer is elevated (>400 IU/ML)

 Disease and Treatment

Definition

Glomerulonephritis, also known as glomerular nephritis, abbreviated GN, is a renal disease characterized by inflammation of the glomeruli, or
small blood vessels in the kidneys.It may present with isolated hematuria and/or proteinuria (blood resp. protein in the urine); or as a nephrotic
syndrome, a nephritic syndrome, acute renal failure, or chronic renal failure. They are categorised into several different pathological patterns, which
are broadly grouped into non-proliferative or proliferative types. Diagnosing the pattern of GN is important because the outcome and treatment differs
in different types. Primary causes are ones which are intrinsic to the kidney, whilst secondary causes are associated with certain infections (bacterial,
viral or parasitic pathogens), drugs, systemic disorders (SLE, vasculitis) or diabetes.
 
 

Treatment
 
Treatment varies depending on the cause of the disorder, and the type and severity of symptoms. High blood pressure may be difficult to control, and
it is generally the most important aspect of treatment.
Medicines that may be prescribed include:
 Blood pressure medications are often needed to control high blood pressure. Angiotensin-converting enzyme inhibitors and angiotensin
receptor blockers are most commonly prescribed.
 Corticosteroids may relieve symptoms in some cases.
 Medications that suppress the immune system may also be prescribed, depending on the cause of the condition.
A procedure called plasmapheresis may be used for some cases of glomerulonephritis due to immune-related causes. The fluid part of the blood
containing antibodies is removed and replaced with intravenous fluids or donated plasma (without antibodies). Removing antibodies may reduce
inflammation in the kidney tissues.
Dietary restrictions on salt, fluids, proteinprotein, and other substances may be recommended to Persons with this condition should be closely
watched for signs that they are developing kidney failure. Dialysis or a kidney transplant may eventually be necessary.
 LABORATORY AND DIAGNOSTIC PROCEDURES

LABORATORY AND SIGNIFICANCE OF THE RESULT

DIAGNOSTIC NORMAL VALUES RESULT OR FINDINGS IN RELATION TO THE DISEASE
PROCEDURES PROCESS
Urinalysis

Color Yellow Amber

Appearance Clear Turbid may be caused by excessive

cellular material or protein in the
urine or may develop from
crystallization or precipitation of
salts upon standing at room
temperature or in the refrigerator
which is usually of no significance.

PH 7.35 -7.45 5 Respiratory acidosis is a medical

condition in which decreased
respiration (hypoventilation) causes
increased blood carbon dioxide and
decreased pH

Specific gravity 1.002-1.030 1.025 Normal

Protein negative-trace +2 If there is protein in urine, there is

something wrong with the filtration
process in the kidneys. Normally,
proteins molecules that are too
large to enter the filtrate in the
nephron of the kidney. If protein
were to make it into the filtrate, then
the kidneys are taking too much out
 of the blood and that could be
disasterous.
Sugar

Puss Cells negative Negative Normal

RBC Too numerous to count Indicates infection

0-2/HPF Too numerous to count Increased RBC in urine is termed

hematuria, which can be due to
hemorrhage, inflammation,
necrosis, trauma or neoplasia
Epithelial Cells
somewhere along the urinary tract
Bacteria Few Few
Normal
Mucous thread Negative Moderate

Moderate
Mucus is a frequent finding of the
urinary sediment. The exact
Crystals
function of mucus is unknown.
A. Urates

Moderate
Its an insignificant finding. Many
times amorphous urates form as a
result of the refrigeration process of
urine when it is being processed. It
has no clinical significance
Miscelaneous

ASO titer
 <200 IU/ml >400IU/ml

HEMATOLOGY Normal

Hemoglobin

13.2-16.2 gm/dL (Male) 11.0

Decrease may be in indicator of

dietary deficiency, hemorrhage,
Hematocrit lymphoma, anemia or sickle cell
anemia
WBC 31-43% (Child) 0.33

4.1-10.9x103/µL 15.6 Normal

Neutrophils Elevated WBC can be an indication

of infection, inflammation, trauma,
2.5-7.5 x 10 9 /L 0.84 and stress or tissue necrosis

Eosinophils Neutropenic patients are more

susceptible to infections and less
0-7% 0.06 successful in fighting them off.

Lymphocytes Normal

20-40 0.10

A decreased lymphocyte count of

less than 500 places a patient at
very high risk of infection,
particularly viral infections. It is
important when the lymphocyte
 ESR count is low to implement measures
to protect the patient from infection.
0-15 mm/hr 117

A very high ESR usually has an

obvious cause, such as a marked
RBC increase in globulins that can be
due to a severe infection.
4.3-6.2x106/µL (Male) 3.86

Anemia is a decrease in normal

number RBCs or less than the
Platelet count normal quantity of hemoglobin in
the blood.
150,000-400,000 cumm 395,000 cumm

Clinical Chemistry

BUN Normal
2.86-8.93 14.6

When the kidneys aren't functioning

as well as they should urea can
build up in the blood causing an
elevated BUN level
 DRUG STUDY

NAME OF CLASSIFICATION DOSAGE INDICATION MECHANISM OF ADVERSE REACTION NURSING

DRUG FREQUENCY ACTION RESPONSIBILITY

ROUTE

FUROSEMIDE Loop diuretic Decrease plasma Increases excretion of Fluid and electrolyte Perform frequent serum
(LASIX) volume and edema water by interfering imbalance. Rashes, electrolyte monitoring.
by causing diuresis. with chloride-binding photosensitivity, nausea,
cotransport system, diarrhoea, blurred vision,
inhibiting sodium and dizziness, headache, Monitor patients fluid intake
chloride reabsorption in hypotension. Bone marrow
and output
ascending loop of depression (rare), hepatic
Henle and distal renal dysfunction.
tubule. Hyperglycaemia,
glycosuria, ototoxicity
 NAME OF CLASSIFICATION DOSAGE INDICATION MECHANISM OF ADVERSE REACTION NURSING
DRUG FREQUENCY ACTION RESPONSIBILITY

ROUTE

NIFEDIPINE Anti- 90 mg OD It decreases BP WOF hypotension and

caused by fluid It blocks the slow Peripheral edema, hypotension, bradycardia.
hypertensive palpitations, tachycardia, flushing,
retention due to
infection of calcium channels
Calcium- dizziness, headache, nausea,
glomerulus. thus preventing the
Channel increased micturition frequency,
flow of calcium ions mental depression, visual
blocker disturbances, tremor, impotence,
into the cell. It
fever, paradoxical increase in
produces peripheral ischaemic chest pain during
and coronary initiation of treatment

vasodilatation,

peripheral

resistance and BP,

increases coronary

blood flow and

causes reflex

tachycardia.
 NAME OF CLASSIFICATION DOSAGE INDICATION MECHANISM OF ADVERSE REACTION NURSING
DRUG FREQUENCY ACTION RESPONSIBILITY

ROUTE

PENICILLIN V Antibiotic 50 mg TID IV Used to control Penicillin V works by Nausea, vomiting, epigastric
local symptoms binding to specific distress, diarrhea, and black hairy
and to prevent penicillin-binding tongue.
spread of infection proteins in bacterial cell
to close contacts. walls and blocking the
final cross-linking step The hypersensitivity reactions
in the synthesis of reported are skin eruptions
bacterial cell walls. (maculopapular to exfoliative
This dermatitis), urticaria and other
induces autolysis of the serum sicknesslike reactions,
bactertial cells laryngeal edema, and
by autolysins. anaphylaxis.

Fever and eosinophilia may

frequently be the only reaction
observed.

NURSING CARE PLAN

Problem and Cues Nursing Diagnosis Planning Intervention Rationale Evaluation

Final Evaluation of the Client

Evaluation of learning Experience