INTRODUCTION

Chronic Glomerulonephritis, one of a group of kidney diseases characterized by

long term inflammation and scarring of the glomeruli (microscopic structures in the
kidney that filter blood and produce urine). This form of kidney disease usually develops
slowly (over years) and may not produce symptoms at the outlet. When symptoms and
signs do appear, they typically include blood in the urine (hematuria), swelling (edema),
high blood pressure, foamy urine (due to protein content), and frequent nighttime
urination

A number of different medical conditions can cause chronic Glomerulonephritis.

Hereditary conditions may be responsible, or immune diseases may be the cause. In
many cases, the exact cause is not apparent. Chronic Glomerulonephritis may progress
to kidney failure in some cases. Hypertension and diabetes are two conditions that
typically results in scarring of the glomeruli and in decline in kidney function There is no
specific treatment available. People with Chronic Glomerulonephritis May be advised to
reduce consumption of protein, potassium, and salt; and to take calcium supplements,
diuretic medications may be needed to treat swelling.

According to Siemens healthineers data published March 8, 2018 Affecting 10

percent of the global population and responsible for more than a million deaths each
year, chronic kidney disease (CKD) has become a major public health issue. In the U.S.
alone 30 million people, or 15 percent of adults, are estimated to have chronic kidney
disease. Around the world, the number of people with chronic kidney disease continues
to rise. The impact is immense; patients with CKD face diminished quality of life, higher
risk of other health problems, and significant financial costs or death.

According to MIMS TODAY data published in June 14, 2017 that 20 percent of
Filipinos were diagnosed with chronic kidney disease, based on the glomerular filtration
rate (GFR) which measures kidney function. Presently, there are 70,000 patients on
dialysis and even with thousands on the waiting list for a kidney transplant, only 400 are
able to undergo transplantation annually.

According to SUNSTAR PHIL. Data published in June 19,2017 Davao Region

ranked number four (4) with highest number of patients, who undergo kidney dialysis as
of 2016 up to present based on the report from the Renal Disease Control
Program(Redcop) and Departmet of heath (DOH), Davao Region has 2,743 kidney
dialysis patients as of 2016.

Given these scenarios, the researchers are interested to conduct a case study
about Chronic Glomerulonephritis case and patient X is the chosen subject, a client at
Medical Ward 1 of Southern Philippines Medical Center. The knowledge that they will
gain in the case study will serve as a foundation in making health care decisions and
appropriate roles of nursing care providers.

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 CHAPTER 1
GENERAL OBJECTIVE

Present the thorough physical assessment of the client. At the end of 3 days
hospital duty at Medical ward of Southern Philippines Medical Center last February 11-
12 and 13, 2019, the group aims to conduct and present a comprehensive case
analysis of a client with a health condition specifically Anemia Secondary to Chronic
kidney failure Secondary to Glomerulonephritis

SPECIFIC OBJECTIVES

Specifically, this study aims to attain the following objective:

1. Choose a client as a subject for the case study
2. Gather necessary information pertaining to the personal data of the as well as
the family background.
3. Present the thorough physical assessment of the client.
4. Discuss the anatomy and physiology of the affected organs and the system
involved.
5. Trace and illustration the pathology of he disease including the etiology and the
symptoms manifested by the client.
6. Discuss the diagnostic examinations, its result and its implications.
7. Discuss the pharmacology management and its nursing responsibilities.
8. Identify nursing problems and implement nursing care plan for the problems
identified.
9. Evaluate the clients prognosis.

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 PATIENT’S DATA

Table1: Patient’s Profile

Name of Patient: Patient X
Age/Sex: 32/Female
Civil Status: Married
Date of Birth: July 06, 1986
Birthplace: Compostela Valley
Address: Km 12 Purok 15 Budbud Bunawan Davo City
Religion: Catholic
Nationality: Filipino
Origin (Hometown): Compostela Valley
Educational 2nd year high school at Bunawan National High
Attainment: School ( BNHS )
Occupation: Housewife
Weight: kgs/pounds: 66 kg
Height: cm/ft-inches: 152 cm
Procedures/Surgeries: Hemodialysis, Colonoscopy, Hemorrhoidectomy
Date of Admission: January 12, 2019
Chief Complaint: Dizziness, Easy Fatigability
Impression: Anemia
Final Diagnosis: Chronic Glomerulonephritis

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Family Background

Patient X is at the age of 32 and a mother of 4 children. She has attained 2nd year
high school and started pregnancy at the age of 16. Patient X was an overseas Filipino
worker from 2013 to 2018 in Bahrain as a domestic helper. 5 years before she went
overseas, she married the father of her 4 children after living in for 10 years. Thereafter,
when she was in Bahrain, personal differences was claimed by the patient as to be the
problem and complicates their relationship. After 5 years of working abroad, she went
back to the Philippines to take a rest from work and be reunited with her very missed
family and children. Her husband and she then together agreed on living separately.
She is now living with her 58 year old mother and 60 year old father, together with her 4
children and some of her siblings. They have sari-sari store as source of their income.
In her paternal lineage, her grandfather died due to old age and of hypertension
while her grandmother died due to old age. Hypertension and diabetes mellitus was
present in their paternal family history.
In her maternal lineage, her grandfather died because of kidney disease and
hypertension while her grandmother died due to old age and was hypertensive as well.
Her uncle died because of liver disease and hypertension. Her 3 brothers were smokers
while her 6th sister had history of kidney stone 2 years ago. Hypertension, liver disease,
diabetes mellitus and bronchial asthma was present in their maternal family history.

Effects of Present Disease

Patient X’s condition brought difficult adjustments to the family especially to herself
mainly due to financial constraints and stress brought about by her illness. Her family is
very optimistic that she will be able to recover the soonest time possible. Her younger
sister takes care of her in the hospital

History of Past Illness

Patient X claimed that last July 2018, she had edema on both feet and took a
check-up at MDMRC which results she had high creatinine of 520 umol/L as claimed
and was suggested for hemodialysis. She refused the suggestion and asked for home
medication for 6 months but stopped after 2 months when she observed that the edema
subsided.
November 2018, she was admitted at Southern Philippines Medical Center and
was directed to Intensive Care Unit complaining dizziness, weakness, no appetite and
easy fatigability. She claimed her creatinine was at 1,800 umol/L and has been
transfused with 4 packs of red blood cells. She then decided to accept hemodialysis
having intrajugular shunt on right side of her neck. She was admitted for 3 weeks and
was discharged December 21, 2018.

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History of Present Illness

Last January 12, 2019, Patient X felt dizzy and observed easy fatigability for just a
few steps and decided to go to hospital. She travelled from Bunawan to Southern
Philippines Medical Center in pallor condition. She was directed to Intensive Care Unit
having Hemoglobin count of 39mg/dl and was transfused right after with 4 packs of red
blood cells. She was then admitted. During her confinement she was ordered for
colonoscopy last January 26, 2019. Patient was on status post colonoscopy Grade III
haemorrhoids with bleeding and was referred for general surgery January 29,2018.
She was then ordered for hemorrhoidectomy February 12, 2019. Patient was still for
colonoscopy.

ASSESSMENT

Table 2: Physical Assessment

A. Vital Signs Day 1 Day 2

Feb. 11, 2019 Feb. 13, 2019
8 AM 12 NN 8 AM 12 NN
Blood Pressure 150/120 mmHg 150/120 mmHg 150/120 mmHg 150/120 mmHg
Temperature 36.3 ̐C 36.5 ̐C 36.6 ̐C 36.8 ̐C
Pulse Rate 68 bpm 70 bpm 82 bpm 86 bpm
Respiratory Rate 28 cpm 22 cpm 24 cpm 23 cpm
B. Review of Systems
A. Neurologic Eyes opened spontaneously; Eyes opened spontaneously;
Status conscious, aware of the date, conscious, aware of the date, time
time and places; Able to obey and places; Able to obey
commands when instructed. commands when instructed.
B. Cardiovascular The pulse rate was normal. The The pulse rate was normal. The
System patient was hypertensive having patient was hypertensive having
150/120 mmHg and tachypneic 150/120 mmHg with normal
having 28 cpm respiratory rate.
C. Respiratory Tachypnea was noted. No The breathing was regular. No
System crackles noted upon crackles noted upon auscultation.
auscultation. She has no She has no allergies in food and
allergies in food and drugs. drugs. Patient has no asthma.
Patient has no asthma.
D. Gastrointestinal Able to masticate the food well; Patient was on NPO order. Didn’t
System patient was on renal diet. Didn’t defecate during the shift; weight of
defecate during the shift; weight 66 kg. Haemorrhoids present as
of 66 kg. verbalized by patient.
E. Genitourinary No tenderness noted; genitals No tenderness noted; genitals had
System had no lesion or mass no lesion or mass
F. Musculo Skeletal Patient can flex and extend Patient can flex and extend both
System arms and legs; slightly extremities; slightly slouching; able
slouching; able to do ADL to do ADL without assistance but
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 without assistance but claimed
to experience easy fatigability,
body weakness was observed.
G. Integumentary Skin color was pale and dry,
System intrajugular shunt on left side of
neck was noted. CRT of more
than 2 seconds. Non pitting
edema noted on both upper and
lower extremities.
claimed to experience easy
fatigability, body weakness was
observed.
Skin color was pale and dry,
intrajugular shunt on left side of
neck was noted. CRT of more than
2 seconds. Non pitting edema still
noted on both upper and lower
extremities.

Table 3. Psychosocial Assessment

Primary caregiver and significant other The family caregiver(s) were her sister.
Family History/Social History Fourth child in the brood of 8
Education Second year high school
Suicidal/Homicidal ideation (-) Suicidal/ Homicidal tendencies
Financial Assessment The breadwinner of the family was her
Abuse Assessment (-) Physical hurt
Spiritual Assessment Catholic
Mental Status Assessment Patient was well oriented of the place, time
and date. The patient can relate well to others.
And can answer coherently.