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I. INTRODUCTION
a. Current trends about the disease condition
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.
Acute glomerulonephritis refers to 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.Most original research focuses on the poststreptococcal patient. Acute glomerulonephritis is defined as the sudden onset of hematuria, proteinuria, and red blood cell casts. This clinical picture is often accompanied by hypertension, edema, and impaired renal function. Acute glomerulonephritis can be due to a primary renal or systemic disease. Glomerulonephritis represents 10-15% of glomerular diseases. Variable incidence has been reported due in part to the subclinical nature of the disease in more than one half the affected population. Despite sporadic outbreaks, incidence of poststreptococcal glomerulonephritis has fallen over the last few decades. Factors responsible for this decline may include better health care delivery and improved socioeconomic conditions. With some exceptions, a reduction in the incidence of poststreptococcal glomerulonephritis has occurred in most western countries. It remains much more common in regions such as Africa, the Caribbean, India, Pakistan, Malaysia, Papua New Guinea, and South America. Immunoglobulin A (IgA) nephropathy glomerulonephritis (ie, Berger disease) is the most common cause of glomerulonephritis worldwide. Most epidemic cases follow a course ending in complete patient recovery (as many as 100%). Sporadic cases of acute nephritis often progress to a chronic form. This progression occurs in as many as 30% of adult patients and 10% of pediatric patients. Glomerulonephritis is the most common cause of chronic renal failure (25%). The mortality rate of acute glomerulonephritis in the most commonly affected age group, pediatric patients, has been reported at 0-7% .A male-to-female ratio of 2:1 has been reported.Most cases occur in
patients aged 5-15 years and only 10% occur in patients older than 40 years. Acute nephritis may occur at any age, including infancy.
b. Reasons of choosing such case for presentationThe group chose this study out of curiosity as it was our first time to encounter such case
and because of that, the group was interested in it. We were willing to undergo new experiences which would bring new learnings for the group as most of us have not been exposed yet to the Pediatric ward. Another reason was that it was one of the suggestions of our clinical instructor to be used in making case study.
c.Importance of the case study
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.
d. Objectives (Nurse Centered)- To gain new information about the patient’s disease and its etiology, pathophysiology,
clinical manifestations as well as the standard medical and nursing management so that we may apply this newly-acquired knowledge to our patient as well as similar situations in the future.
- To learn new clinical skills as well as sharpen our current clinical skills required in the management of the patient with acute GN and acute PN.
- To develop our sense of unselfish love and empathy in rendering nursing care to our patient so that we may be able to serve future clients with a higher level of holistic understanding as well as individualized care.
b. NURSING PROCESSA.ASSESSMENT
1. PERSONAL DATAA. Demographic Data
Name: Boy XAge: 5 y/oSex: MaleReligious Affiliation: CatholicRole position of the family: Second sonAddress: Brgy. Mangga, Capas Tarlac CityDate of Birth: February 21, 2003 Nationality: FilipinoHealth 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.
2. FAMILY HISTORY OF PAST ILLNESS
3. HISTORY OF PAST ILLNESSS
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
Time examined: 6:30 pm – 7:00 pm
Area / Region Findings Normal Findings Interpretation/Analysis
Pathophysiology
1. Vital Signs
1.1 Temperature
1.2 Pulse (Right radial pulse)
1.2.a Rate
1.2.b Rhythm
1.2.c Volume
1.3 Respiration
1.3.a Rate
37.8 o C (L axilla)
110 bpm
Pulse is regular with even intervals between each beat
Pulse is graded as +2/+3 which can be felt using moderate amount of pressure.
38 bpm
35.4o C – 37.4o C (axillary) 1
3-6 years old: 100-110 bpm 1
Normal pulse rhythm should be regular with equal intervals between pulses. 1
The pulse volume is usually the same with each 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
3-6 years old: 19-25 bpm 1
Abnormal (Hyperthermia)
Normal
Normal
Normal
Abnormal (tachypnea)
There can be many causes of hyperthermia (including infection), which results from the body’s increased basal metabolic rate.
Hypoxia and metabolic acidosis are common causes of tachypnea. The body compensates to provide itself with more oxygen and eliminate hydrogen ions when metabolism is increased
10.3.b Pattern
10.3.c Depth
10.3.d Audibility
Respirations are regular and even in rhythm.
Respirations are deep and labored.
Pt.’s deep breaths produce audible sounds which are audible 1 foot away.
Normal respirations are regular and even in rhythm. 1
The normal depth of breathing is nonexaggerated and effortless. 1
A patient’s respirations are normally heard by the unaided ear a few centimeters from the pt’s nose or mouth. 1
Normal
Abnormal
Abnormal
Hyperventilation results from the body’s efforts to compensate for the increase in oxygen demand of the body.
Any condition where air hunger exists has the potential to create audible and noisy breathing. The body is attempting to meet its oxygen demands.
2. Anthropometric Measurements
2.1 Height
2.2 Weight
2.3 BMI
106 cm
16.7 kg
14.86
104.0 cm – 121.8 cm (66 mos.old)2
15.3 kg – 25.1 kg (66 mos. old)2
13.1 – 18.1(66 mos. old)2
Normal
Normal
Normal
3. General Survey
3.1 Physical Presence
3.1.a Stated Age vs. Apparent Age
3.1.b General Appearance
3.1.c Stature
3.1.d Motor Activity
3.1.e Body and Breath Odor
Pt. looks according to his stated age
Body parts are symmetrical. No gross anomalies are noted.
Limbs and trunks appear proportional to height. Posture is erect.
Gait and body movements are smooth and well-coordinated. Pt. can ambulate without assistance. Pt. can perform all ROM exercises without discomfort or pain.
Exhibits foul body odor as well as bad breath.
Pt.’s stated chronological age should be congruent with apparent age. 1
The pt. should exhibit body symmetry, no obvious deformities and a well appearance. 1
Limbs and trunk should appear proportional to body height and posture should be erect. 1
Gait and body movements should be effortless and smooth. All body parts should have controlled purposeful movement. ROM performance should not elicit pain or discomfort. 1
There should be no apparent odor from pt. It is normal for some people to have bad breath related to the type of foods ingested or due to individual digestive processes. 1
Normal
Normal
Normal
Normal
Abnormal Poor hygiene can cause body odors due to perspiration and bacteria left on the skin. Bad breath can result from poor oral hygiene, allergic rhinitis, or from infections such as tonsillitis, sinusitis or
3.2 Psychological Presence
3.2.a Dress, Grooming and Personal Hygiene
3.2.b Mood and Manner
3.2.c Speech
3.2.d Facial Expressions
Hair exhibits foul odor. Pt.’s clothes appear dirty. Mother states that pt’s clothes have not been changed for a few days now and pt. has not yet taken a bath since admission. Clothing exhibits foul urine odor. Fingernails and toenails are long and dirty.
Pt. cooperates during the examination and participates willingly.
Pt. responds to questions and commands easily. Pt’s speech is clear and understandable.
Pt. is awake and alert. Facial expressions change appropriately in accordance to the environment. (e.g. mother tells a joke, pt.
Pt. should appear clean and neatly dressed. Clothing choice should be appropriate to weather. Norms and standards for dress and cleanliness may vary among cultures. 1
Pt. should be cooperative and pleasant. 1
Pt. should respond to questions and commands easily. Speech should be clear and understandable. Pitch, rate and volume should be appropriate to circumstances. 1
Pt. should appear alert and awake. Facial expressions should be appropriate in relation to what is happening and should change naturally. 1
Abnormal
Normal
Normal
pneumonia.
Psychiatric disorders like dementia, depression and psychotic disorders may be reflected in inappropriate appearance. This may also reflect abuse or neglect of the pt. by the pt’s caretaker.
3.2.e Distress
smiles, pt. nods when given a command, pt. grins when pain is elicited)
Pt. does not exhibit any signs of pain, difficulties, anxiety or emotional distress. Pt. has a productive cough and shows signs of respiratory distress like deep, labored breathing, productive cough, wheezes being audible during breathing and frequent blowing of nose (every 5-10 minutes) w/ thick, clear mucus. Pt. is also irritable.
Breathing should be effortless, without cough or wheezing. Face should be relaxed and there should be no serious or life-threatening conditions. The patient should nor perspire excessively or show signs of emotional distress such as nail biting and avoiding of eye contact. 1
Normal
Abnormal
An underlying pulmonary disease may be present which causes excessive mucus secretion and coughing.
4. Skin and Hair
4.1 Skin in general
4.1.a General Color
4.1.b Lesions
Pt.’s skin color is light brown. Slight flushing is noted on the face. No signs of jaundice, cyanosis or pallor noted.
Presence of scars and scabs on legs and thighs noted, circular in shape about 1-2 cm in diameter. Mother said they were ant bites and the pt. would
Skin is uniform whitish pink or brown color, depending on race. No signs of jaundice, hyperemia, pallor, or cyanosis should be noted. 1
No skin lesions should be present except for presence of nevi, birthmarks or freckles. 1
Abnormal
Abnormal
Hyperemia occurs because of dilated superficial blood vessels, increased blood flow, febrile states, local inflammatory condition or excessive alcohol intake.
Insect bites can easily irritate the skin which can cause itching, and when excessively done, can cause abrasions on the integument.
4.1.c Moisture
4.1.d Temperature
4.1.e Tenderness
4.1.f Texture
4.1.g Turgor
scratch his legs until it eventually formed abrasion wounds. No other lesions noted.
Skin is dry.
Skin feels warmer to touch esp. in the forehead and axilla.
No tenderness noted.
Skin is smooth, even and firm.
Skin returns to original contour rapidly.
Hair color is black.
Vellus hair is lightly and evenly distributed in the body such as the
The skin is dry with a minimum amount of perspiration. 1
Skin surface should be warm and equal bilaterally. Hands and feet may be slightly cooler than the rest of the body. 1
Skin surfaces should be nontender. 1
Skin should feel smooth, even and firm. 1
When skin is released after pinching, it should return to original contour rapidly. 1
Hair varies in color based on the amount of melanin present. 1
Normal
Abnormal
Normal
Normal
Normal
Generalized hyperthermia may be indicative of a febrile state, hyperthyroidism, or increased metabolic function caused by exercise.
4.2 Hair
4.2.a Color
4.2.b Distribution
4.2.c Texture
face, arms and legs. Terminal hair is found in the eyebrows, eyelashes and scalp without baldness.
Scalp hair is fine and oily. It is resilient to breakage when lightly pulled.
The body is covered in vellus hair. Terminal hair is found in the eyebrows, eyelashes and scalp. 1
Hair may feel thin, coarse, thick, curly or straight. It should be resilient when traction is applied. 1
Normal
Normal
Normal
5. Head and Neck
5.1 Head
5.2 Scalp
Head is normocephalic and symmetrical. No masses are noted. Fontanels closed.
No lesions, lice or dandruff noted.
Facial features and
Head should be symmetrical and normocephalic. The skull should be smooth and without masses or depressions. Fontanels should be closed at approximately 2 years of age.1
The scalp should be intact and without lesions, lice or seborrhea. 1
Facial features should be symmetrical. Both
Normal
Normal
5.3 Face
5.3.a Symmetry
5.3.b Shape and Features
5.4 Neck
5.5 Thyroid Gland
5.6 Lymph Nodes
movements are symmetrical.
Face is oval in shape. Edema, disfigurement, and involuntary movements are absent.
Neck muscles in good tone and strength. Neck ROMs can be done without discomfort.
Thyroid gland is palpable without tenderness, masses or notable enlargement.
Lymph nodes are nonpalpable.
palpebral fissures should be equal and the nasolabial fold should be present bilaterally. 1
The shape of the face can be oval, round or slightly square. There should be no edema, disproportionate structures or involuntary movements. 1
The pt. should be able to move in full range of motions the neck without complaint, discomfort or weakness. 1
No enlargement, masses or tenderness should be noted on palpation. 1
Lymph nodes should not be palpable and tender in healthy individuals. 1
Normal
Normal
Normal
Normal
Normal
6. Eyes
6.1 Gross Visual Acuity
Pt. can read small letters written on a paper at a feet’s distance.
Pt. should be able to read letters the size of letters in a newspaper at 1 feet distance. 1
Normal
6.3 Cardinal Fields of Gaze
6.3 Eyelids
6.4 Conjunctiva
6.5 Sclera
6.6 Pupil
Both eyes move in all six fields of gaze uniformly and smoothly.
Eyelids are symmetrical and without any swelling or redness.
Conjunctiva is pinkish and moist.
Sclera is anicteric.
PERRLA with brisk direct and consensual pupil constriction from 4 mm to 2 mm. Pupils are black.
Both eyes should move symmetrically and without lag and difficulty in all six fields of gazes. 1
The eyelids should appear symmetrical with no drooping, infections or tumor. 1
Conjunctiva should appear pinkish and moist. It is without swelling, lesions, injection, exudates or foreign bodies. 1
The sclera should be white with some small, superficial vessels and without exudates, lesions or foreign bodies. 1
The pupils should be deep black, round and of equal diameter, ranging from 2 to 6 mm. Pupil should constrict briskly to direct and consensual light and to accommodation. 1
Normal
Normal
Normal
Normal
Normal
7. Ears
7.1 Voice whisper test
Patient can hear his name being whispered from 2 feet.
Patient should be able to repeat words whispered from a distance of 2 feet. 1
Normal
7.2 External Ear
The external ear shows normal ear alignment. Ear color is light brown which is consistent with his skin color. No impacted cerumen, discharge, or lesions noted. External ear is nontender.
The ear should match the flesh color of the rest of the pt.’s skin and should be positioned centrally and in proportion to the head. The top of the ear should cross an imaginary line drawn from the outer canthus of the eyes to the occiput. Cerumen should be moist and not obscure the tympanic membrane. There should be no foreign bodies, redness, drainage, deformities, nodules or lesions. Pt. should not complain of pain during palpation. 1
Normal
8. Nose
8.1 External Inspection
8.2 Patency
The nose is at the midline of the face with symmetry. No signs of bleeding, swelling, lesions or masses are noted.
There is slight obstruction in the left nostril.
The shape of the external nose can vary greatly among individuals. Normally, it is located symmetrically in the middle of the face and is without swelling, bleeding, lesions or masses. 1
Each nostril should be patent. 1
Normal
Abnormal Occlusion of the nostrils can occur with a deviated septum, foreign body, upper
8.3 Internal Inspection
8.4 Sinuses
Nasal mucosa appears pink. No lesions or polyps noted. Nasal septum is at the midline without any deviation. A moderate amount of think, clear mucus discharge is noted.
Maxillary and frontal sinuses are nontender.
Nasal mucosa should be pink or dull red without swelling or polyps. The septum is at the midline and without perforation, lesion, or bleeding. A small amount of clear, watery discharge is normal. 1
Pt. should experience no discomfort during palpation of the frontal and maxillary sinuses. 1
Abnormal
Normal
respiratory infections, allergies, mucus, or nasal polyps.
Unilateral discharge without other findings of an upper respiratory infection indicates the development of a local infection. A localized infection is commonly caused by the presence of a foreign body which causes increased mucus secretion.
9. Mouth and Throat
9.1 Lips
9.2 Tongue
Lips appear pinkish and moist. Lesions and inflammation absent.
Tongue is at the midline of mouth with pinkish color. No lesions noted. Tongue
The lips and membranes should be pink and moist with no evidence of lesions or inflammation. 1
The tongue is at the midline of the mouth. The dorsum of the tongue should be pink, moist, rough and without lesions.
Normal
Normal
9.3 Buccal Mucosa
9.4 Gums
9.5 Teeth
strength is symmetrical and tongue control is smooth.
Buccal mucosa appears pinkish and moist without any lesions and inflammation.
Gums appear pinkish without any bleeding or swelling.
Pt. has 20 teeth with smooth edges. The two upper incisors have mild dental caries.
The tongue is symmetrical and moves freely. The strength of the tongue is symmetrical and strong. The ventral surface of the tongue has prominent blood vessels and should be moist without lesions. 1
The color of the mucosa depends on race. Asians have a pinkish mucosa. Mucosa should be smooth, moist, and free of inflammation and lesions. 1
Gum color depends on race. Asians have pinkish gums. Gums should be absent of bleeding or swelling. 1
Completion of primary eruption of teeth produces 20 deciduous teeth by 30 months of age. Secondary eruption starts at 6 years of age. Teeth should be white with smooth edges and without dental caries. 1
The uvula is at the midline. Throat mucosa is normally pink and vascular without swelling, exudates, or lesions. Normal tonsilar size is evaluated as +1 or +2. Patient’s gag reflex should be present. 1
Normal
Normal
Abnormal Dental caries, or cavities, can result from poor oral hygiene in which bacteria thrive and colonize while secreting acidic exotoxins which erode the tooth’s enamel.
9.6 Throat
The uvula is at the midline and surrounding mucosa appears pinkish. Swelling and lesions are absent. Tonsilar size is rated +2. Gag reflex intact. Normal
10. Thorax and Lungs
10.1 Shape of thorax
10.2 Muscles of respiration
The AP-transeverse diameter ratio is about 1:2.
Abdominal rectus muscle significantly elevates on inspiration.
The AP diameter to transverse diameter ratio is approximately 1:2 to 5:7. 1
No accessory muscles are used in normal breathing. 1
Normal
Abnormal Any condition that creates a state of hypoxemia or hypermetabolism may lead to the use of accessory muscle. Accessory muscles are attempting to create an extra respiratory effort to inhale needed oxygen. Patients with hypermetabolic states such as exercise, fever, and infection or with hypoxic events like COPD, pneumonia, pneumothorax, pulmonary edema and pulmonary embolus usually present with respiratory accessory muscle use.
10.3 Palpation of Thorax
10.4 Thoracic Expansion
10.5 Auscultation of Thorax
No masses, tenderness and crepitus noted.
Thumbs moved horizontally equally towards each side with a distance of 3 cm.
Wheezes and coarse crackles noted on the left and right lower lobes.
Tenderness, masses and crepitus should be absent upon palpation. 1
The thumbs separate an equal amount from the spinal column or xyphoid process and remain in the same plane of the 10th vertebra or costal margin. The normal distance for thumbs to separate during inhalation is 3-5 cm. 1
Decreased or increased breath sounds as well as adventitious breath sounds should be absent upon auscultation. 1
Normal
Normal
Abnormal
Wheezes are caused by narrowing or obstruction of the bronchus which is due to asthma, chronic bronchitis, emphysema, tumor and foreign body obstruction. Coarse crackles are caused by air which passes through moisture in large airways suddenly reinflate. Pneumonia, pulmonary edema, bronchitis and atelectasis can cause coarse crackles.
11. Heart and Precordium
11.1 Aortic area
11.2 Pulmonic Area
No pulsations, thrills, heaves or murmurs noted. S1<S2
No pulsations, thrills, heaves or murmurs noted. S1<S2
No pulsations should be observed. No thrills or heaves should be palpated. No murmurs should be auscultated. S1<S2 1
No pulsations should be observed. No thrills or
Normal
11.3 Tricuspid Area
11.4 Mitral Area
No pulsations, thrills,
heaves or murmurs noted.
S1>S2
PMI noted at 4th ICS at the parasternal line. No other pulsations, heaves or thrills noted. No murmurs noted.
S1>S2
heaves should be palpated. No murmurs should be auscultated. S1 < S2 1
No pulsations should be observed. No thrills or heaves should be palpated. No murmurs should be auscultated. S1>S2 1
The apical impulse at the mitral area is generally visible in half of the patients. This pulsation is called the point of maximal impulse (PMI) which is normally located at the 4th ICS on the parasternal line in children below 7 years old. No other pulsations, heaves or thrills should be palpated. No murmurs should be auscultated. S1>S2 1
Normal
Normal
Normal
12. Abdomen
12.1 Contour
12.2 Symmetry
Contour is flat.
Abdomen is symmetrical.
The abdominal contour is normally flat or rounded. 1
The abdomen should be symmetrical bilaterally. 1
The abdominal skin color should be consistent with rest of body. There should
Normal
Normal
12.3 Skin
12.4 Umbilicus
12.5 Bowel Sounds
12.6 Vascular Sounds
12.7 Percussion
Skin is light brown in color. No striae, dilated veins or lesions noted.
Umbilicus is sunken.
Bowel sounds audible in all four quadrants on auscultation. Rate of bowel sound is 13 per minute.
No bruits noted.
The abdominal area is tympanic except for areas above the liver and spleen.
be no striae, dilated veins or lesions visible. 1
The umbilicus should be depressed and beneath the abdominal surface. 1
Bowel sounds are heard as intermittent gurgling sounds throughout the abdominal quadrants. These high-pithced sounds usually occur between 5-30 times per minute. 1
No audible bruits should be auscultated on the abdominal aorta, renal arteries, iliac arteries and femoral arteries. 1
Tympany is the predominant sound heard on areas above the stomach and intestines. Dull sounds should be elicited over organs such as the liver and the spleen. 1
The abdomen should feel smooth with consistent softness. Tenderness should be absent. 1
No organomegaly should be palpable. Masses, bulges or swelling should
Normal
Normal
Normal
Normal
12.8 Palpation
12.8.a Light Palpation
12.8.b Deep Palpation
The abdomen is smooth, soft and nontender.
be absent. 1
13. Extremities and Back
13.1 ROMs of the extremities, hips and back
13.2 Nails
13.2.a Color
13.2.b Shape and configuration
Pt. is capable of full ROMs without difficulty or discomfort
Fingernails and toenails are pinkish. Capillary refill is 2 seconds.
Nails are slightly rounded with curve edges. No broken or splintered nails are present. Nail angle is approximately 160o.
Pt. should be able to perform all ROMs the extremities, hips and back without pain or difficulty. 1
Nails have a pink cast in light-skinned individuals and are brown in dark-skinned individuals. Normal capillary refill is within 2-3 seconds. 1
The nail surface should be smooth and slightly rounded or flat. Nail thickness should be uniform with no splintering or brittle edges. Nail bed angle should be approximately 160O. 1
The cervical spine’s alignment should be
Normal
Normal
Normal
13.3 Spine
13.4 Fist Percussion of Kidney
Spine is at midline without any deviation.
Costovertebral angle tenderness is noted.
straight at the midline of the back. 1
No tenderness should be elicited in both the direct and indirect fist percussion of the kidneys. 1
Normal
Abnormal CVA tenderness can occur in pyelonephritis.
1 Health Assessment & Physical Examination (3rd Edition) by Mary Ellen Zator Estes
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/)
6. DIAGNOSTIC AND LABORATORY PROCEDURES
Diagnostic/ Laboratory Procedure
Date ordered & Date Results in
Indication/s or Purpose/s
Results/s Normal Values( units used in the Hospital)
Analysis Interpretation of Results
Hematology Date ordered august 30, 2008
Date result in: August 30, 2008
Time:1:25 pm
>specimens of venous blood are taken for a CBC(complete blood test), which includes hemoglobin and hematocritt measurements, erythrocyte(RBI) count leukocyte(WBC) count, red blood cell(RBC) indices and differential white cell count. Increase in RBC count may be indicative of dehydration and decrease with anemia. White blood cell count determines the no. of circulating WBC’s of whole blood. High WBC counts are often seen in the presence of a bacterial infection, by contrast, WBC counts may be low if a viral infection is present.
>WBC 32.1 G/L
>LYM 2.3 R2 7.1 % L
>MID 1.2 3.7 % M
>GRAN 28.6 89.2 % G
>RBC 3.69 T/L
>HGB 98 g/L
>HCT.276 L/L
>MCV 74.8 F/L
>HCH 26.6
>MCHC 355. g/L
>PLT 253g/L
>4.1 – 10.9 G/L
>0.6 – 4.1 10.0-50.5 % L
>1.0-1.8 0.1-24.0
>2.0-7.8 37.0-92.0
>4.20-6.30 T/L
>1.20-1.80 g/L
>.370-.510 L/L
>80.0-97.0 F/L
>26.0-32.0
>350-360 g/L
>140-440 g/L
>mid cells may include less frequent occurring and rare cells collarating to monocytes, eosinophils, basophils, blasts and other precursor white cells.
Urinalysis August 30, 2008
Results: august 30, 2008
> to determine the presence of microorganisms, the type of organism, and the antibiotics to which the organisms are sensitive.
> assess the color, odor and consistency of the urine and the presence of clinical signs of UTI (eq. frequency, urgency, dysuria, hematuria, flank, pain, cloudy urine with foul
Physical examination:
Color: red
Appearance: turbid
Reaction: 6.5
Specific gravity: 1.025
Chemical
Physical examination:
Color: straw, amber transparent
Appearance: amber transparent
Reaction:
Specific gravity: 1.010-1.025
Chemical examination
August 03, 2008
odor. examination
Albumin: +++
Glucose: (-)
Microscopic:
Pus cells: 10-15
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:
Pus cells: 20-30
RBC: TNTC
Albumin: ---
Glucose: (-)
Bacteria: few
Ephithelial cells: rare
A. urates/ phosphate: few
Blood chemistry
August 03, 2008 >specimen of venous blood are taken for a CBC which includes hemoglobin and hematocrit measurements, erythrocyte (RBC) count, leukocyte(WBC) county, red blood cell (RBC) indices, and differential white cell count.
>CBC is one of the most frequently ordered blood tests, it shows the increase, and decrease of blood cell count that may be associated with different disorders, and also determines the presence of bacterial infection or viral infection.
Creatinine: 123.76
Electrolytes:
Sodium:138.5
Potassium: 4.84
Chloride: 111.7
>53-106 mol/L
>136-142
>3.8-5.0
>95-103 Meg 1L
>
Nursing Responsibility for urinalysis :
Explain to the client that the urine specimen is required, give the reason, and explain to be used to collect. Discuss how the results will be used in planning further care or treatments.
Wash hands observe other appropriate infection control procedure.
Provide client privacy.
If uncircumcised, retract the foreskin slightly to expose the urinary meatus
Routine urine examination is usually done on the first voided specimen in the morning because it tends to have a higher, more uniform concentration and a more acidic pH than specimens later in the day.
At least 10 ml of urine is generally sufficient for a routine urinalysis.
The specimen must be free of fecal contamination, so urine must be kept separate from feces.
Female client should discard the toilet tissue in the toilet or in a waste bag rather than in the bedpan because tissue in the specimen makes laboratory specimen makes laboratory analysis more difficult.
Put the lid tightly on the container to prevent spillage of the urine and contamination of other objects,
Make sure that the specimen label and laboratory requisition carry the correct information and attach them securely to the specimen.
Nursing responsibility for blood specimen collection:
Place a tourniquet above the venepuncture site.
Palpate and locate the vein. It is critical to disinfect the venepuncture site meticulously with 10% povidone iodine or 70% isopropyl alcohol by swabbing the skin concentrically from the centre of the venepuncture site outwards. Let the disinfectant evaporate. Do not repalpate the vein again. Perform venepuncture.
If withdrawing with conventional disposable syringes, withdraw 510
ml of whole blood from adults, 25ml from children and 0.52ml for infants.
If withdrawing using vacuum systems, withdraw the desired amount of blood directly into each
transport tube and culture bottle.
Remove the tourniquet. Apply pressure to site until bleeding stops, and apply sticking plaster (if
desired).
Using aseptic technique, transfer the specimen to the relevant cap transport tubes and culture
bottles. Secure caps tightly. Be sure to follow manufacturer’s instructions on the correct
amount and method for inoculation of blood culture bottles.
Label the tube, including the unique patient identification number using indelible marker pen.
Do not recap used sharps. Discard directly into the sharps disposal container
Complete the case investigation and the laboratory request forms using the same identification
Number
7. ANATOMY AND PHYSIOLOGY
EXTERNAL ANATOMY KIDNEYThey 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
The average adult kidney weighs approximately 133-170g. (4.5 oz) and is 10-12 cm long 6 cm wide and 2.5 cm thick the right kidney is slight lower than the left due to the location of the liver
Kidney are well protected by the ribs and by the muscles of the abdomen and back
3 LAYERS OF TISSUE SURROUNDING EACH KIDNEY
1. RENAL CAPSULE- innermost layer, it is a smooth transparent fibrous connective tissue membrane that connects with the outermost covering of the ureter at the hilum. It serves as a barrier against infection and trauma to the kidney
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.
Nephrons are made up of two basic components; a filtering element component of an enclosed capillary network and the attach tubule. The glumerulus is a unique network of capillaries suspended between the afferent and efferent blood vessels, which are enclosed in an epithelial structure called Bowman’s capsule. The glumerular membrane is composed of three filtering layers: (a) Capillary endothelium, (b) basement membrane, and (c) epithelium. This membrane normally allows filtration of fluid and small molecules yet limits passage of larger molecules, such as blood cells and albumin.
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.
BLOOD SUPPLY TO THE KIDNEY
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. PATHOPHYSIOLOGYi BOOK BASED
ANTIGEN (GROUP A BETA-HEMOLYTIC STREPTOCOCCUS)
ANTIGEN – ANTIBODY PRODUCT
DEPOSITION OF ANTIGEN-ANTIBODY COMPLEX IN GLOMERULUS
THICKENING OF THE GLOMERULAR FILTRATION MEMBRANE
INCREASE PRODUCTION OF EPITTHELIAL CELLS LINING THE GLOMERULUS
SCARRING AND LOSS OF GLOMERULAR FILTRATION MEMBRANE
DECREASE GLOMERULAR FILTRATION RATE (BFR)
MANIFESTATION
ACUTE ONSET OF EDEMA
OLIGURIA
PROTENURIA
ANEMIA
COCOA COLORED URINE WITH RED BLOOD CELLS CAST (HEMATURIA)
HYPERTENSION
HEADACHE
FEVER
NAUSEA AND VOMITING
LEUKOCYTE INFILTRATION OF THE GLOMERULUS
PATHOPHYSIOLOGY
ii CLIENT CENTERED
A
ANTIGEN (GROUP A BETA-HEMOLYTIC STREPTOCOCCUS)
ANTIGEN – ANTIBODY PRODUCT
DEPOSITION OF ANTIGEN-ANTIBODY COMPLEX IN GLOMERULUS
THICKENING OF THE GLOMERULAR FILTRATION MEMBRANE
INCREASE PRODUCTION OF EPITTHELIAL CELLS LINING THE GLOMERULUS
SCARRING AND LOSS OF GLOMERULAR FILTRATION MEMBRANE
DECREASE GLOMERULAR FILTRATION RATE (BFR)
MANIFESTATION
EDEMA(facial and bipedal) 08/30/08
HEMATURIA 08/30/08
HEADACHE 08/30/08
FEVER 08/30/08
09/04/08
09/05/08
NAUSEA AND VOMITING 08/30/08
LEUKOCYTE INFILTRATION OF THE GLOMERULUS
B. IMPLEMENTATIONI. DRUGS
GENERIC NAME:CEFUROXIME
BRAND NAME:Ceftin, Kefurox Zinacef
Pharmacologic class: second-generation cephalosporin
Therapeutic Class: antibiotic
DATE ORDERED8/30/08 12:50 pmDATE TAKEN / GIVEN8/30/089:00pm8/31/086:00 am2:00pm10:00 pm9/01/086:00 am2:00 pm10:00 pm9/02/086:00 am2:00 pm10:00 pm9/02/086:00 am2:00 pm10:00 pm9/03/086:00 am2:00 pm10:00 pm9/04/086:00 am2:00 pm10:00 pmDATE CHANGED9/05/08
ROUTE OF ADMINISTRATION DOSAGE AND FREQUENCY OF ADMINISTRATION
Cefuroxime 650 mg I.V q 8 hours
GEN. ACTION MECHANISM OF ACTION
Chemical Effect: Inhibits cell wall synthesis promoting osmotic instability: usually bactericidal
Therapeutic Effect:Hinders or kills susceptible bacteria including many gram-positive organisms and enteric gram-negative bacilli
INDICATION/S PURPOSES>Pharyngitis tonsillitis infection of urinary and lower respiratory tract and skin structure infections. Susceptible are Streptococcus pneumonia, S pyogens, Staphyloccus aureus, Escherichia coli> Secondary bacterial infection of acute bronchitis
NURSING RESPONSIBILITIES:BEFORE ADMINISTRATION
1. Explain to the patient and family on what is the effect of drug and its action2. Assess patients infection before therapy3. Before giving first dose do sensitivity test4. Before giving the first dose , ask patient about previous reaction to cephalosporins or
penicillin AFTER ADMINISTRATION
1. Be alert for adverse reaction and drug interaction2. If adverse GI reaction occur, monitor patients hydration3. Tell patient/ significant others to report adverse effect seen and experience4. Assess patients infection after the therapy
GENERIC NAME: FUROSEMIDE
BRAND NAME:Apo-furosemide, Furoside, Lasix, Lasix Special, Novosemide, Uritol
Pharmacologic class: Loop diuretic
Therapeutic class: diuretic
DATE ORDERED8/30/08 12:50 pmDATE TAKEN / GIVEN8/30/082:00 pm7:00 pm8/31/0812:00 am12:00pm9/01/082:00 pm10:00 pm9/02/086:00 am2:00 pm9/03/08 6:00am6:00 pm
DATE CHANGED09/03/0810:00 am
09/04/0810:10 am
ROUTE OF ADMINISTRATION DOSAGE AND FREQUENCY OF ADMINISTRATION
Furosemide 19 mg I.V q 6 hours
Furosemide IVP OD
D/C Furosemide
GEN. ACTION MECHANISM OF ACTION
Chemical Effect: Inhibits sodium and chloride reabsorption at proximal and distal tubules and ascending loop Henle
Therapeutic Effect: Promotes water and sodium excretion
INDICATION/S PURPOSES>Edema
NURSING RESPONSIBILITIES
BEFORE ADMINISTRATION:
1. Explain to the patient and family on what is the effect of drug and its action2. Assess patients underlying condition before administration3. Monitor weight peripheral edema breath sounds blood pressure fluid intake and output
and electrolyte glucose BUNAFTER ADMINISTRATION:
1. Be alert for adverse reaction and drug interaction2. Tell patient/ significant others to report adverse effect seen and experience3. Monitor weight peripheral edema breath sounds blood pressure fluid intake and output
and electrolyte glucose BUN
GENERICNAMEACETAMINOPHEN (APAP, PARACETAMOL) BRAND NAMEAbenol Acephen, Aceta Anacin Apacef Dymadon Genapapp Childrens Elexir
Pharmacologic class: para- aminophenol derivatie
Therapeutic class: nonopioda nalgesic, antipyretic
DATE ORDERED8/30/0812:50 pmDATE TAKEN / GIVEN8/30 /087:00 pm
DATE CHANGED08/05/08
ROUTE OF ADMINISTRATION DOSAGE AND FREQUENCY OF ADMINISTRATION
Paracetamol 190 mg IVP q 4 hours
GEN. ACTION MECHANISM OF ACTION
Chemical Effect: May produce analgesic effects by blocking pain impulses by inhibiting prostaglandin or pain receptors sentisizers. May relieve fever by acting in hypothalamic heat- regulating center.
Therapeutic Effect: Relieves pain and reduces fever
INDICATION/S PURPOSES >Mild fever or pain
NURSING RESPONSIBILITIES
BEFORE ADMINISTRATION:
1. Explain to the patient and family on what is the effect of drug and its action2. Assess patient temperature before the therapy
AFTER ADMINISTRATION:
1. Assess patient temperature after the therapy
2. Be alert for adverse reaction and drug interaction3. Tell patient/ significant others to report adverse effect seen and experience
GENERICNAMEAmoxicillin with clavulanic acid or Amoxicillin+ clavulanate
BRAND NAMECo- amoxiclav
DATE ORDERED8/05/0810:00 am
DATE TAKEN / GIVEN8/05 /0811:00 am
ROUTE OF ADMINISTRATION DOSAGE AND FREQUENCY OF ADMINISTRATION
Oral route 1 tsp 3x a day for 7 days
GEN. ACTION MECHANISM OF ACTION
Amoxicillin + potassium clavunate is usually bactericidal in action. Concurrent administration of clavulanic acid does not alter the mechanism of action of amoxicillin. However because Clavulanic acid has a high affinity for and binds to certain β lactamases that generally in activate Amoxicillin by hydrolizing its β lactam ring, concurrent administration of the drug with amoxicillin results in a synergistic bactericidal effect. This synergisms expands Amoxicillin’s spectrum of activity against many strains of β- lactamase-producing bacteria resistant to amoxicillin alone
INDICATION/S PURPOSES
Infections of the organs associated with breathing, including nasal passages, sinuses, windpipe and lungs (respiratory tract)
NURSING RESPOSIBILITIESBEFORE 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 dose5. Administer medication at the start of a meal to minimize potential gastrointestinal
intolerance and to optimize drug’s absorptionAFTER ADMINISTRATION
1. Be alert for adverse reaction and drug interaction2. Advice the patient to drink plenty of water to ensure proper ate of hydration and adequate
urinary output3. Advice the parents to maintain the take of medication at regular intervals4. Advice the parents to refrigerate the medication to maintain effectiveness
GENERICNAMECarbocisteine
BRAND NAMEEmyxer
DATE ORDERED8/05/0810:00 am
DATE TAKEN / GIVEN8/05 /0811:00 am
ROUTE OF ADMINISTRATION DOSAGE AND FREQUENCY OF ADMINISTRATION
Oral route 1 tsp 3x a day
GEN. ACTION MECHANISM OF ACTION
Carbocisteine is a mucolytic medicine which breaks down some of the chemical bonds in mucus. This makes the mucus less thick and sticky (viscous) and thus easier to cough up
INDICATION/S PURPOSES
Artificial airway opening in the neck (tracheostomy) Chronic obstructive pulmonary disease
NURSING RESPONSIBILITIES:BEFORE ADMINISTRATION1. Explain to the patient and family on what is the effect of drug and its action2. Assess if the patient has known sensitivity to drug3. Shake well before the patient take the first doseAFTER ADMINISTRATION1. Be alert for adverse reaction and drug interaction
GENERICNAMEPHENYL PROPANOLAMINE
BRAND NAMECoway,
DATE ORDERED8/05/0810:00 am
DATE TAKEN / GIVEN8/05 /0811:00 am
ROUTE OF ADMINISTRATION DOSAGE AND FREQUENCY OF ADMINISTRATION
Oral route 1 tsp 3x a day
GEN. ACTION MECHANISM OF ACTION
It works by constricting (shrinking) blood vessels (veins and arteries) in your body. Constriction of blood vessels in your sinuses, nose, and chest allows drainage of those areas, which decreases
INDICATION/S PURPOSES
used to treat the congestion associated with allergies, hay fever, sinus irritation, and the common cold.
congestionNURSING RESPONSIBILITIES:BEFORE ADMINISTRATION1. Assess if the patient has the following condition;
high blood pressure;
any type of heart disease, hardening of the arteries, or
irregular heartbeat;
thyroid problems;
diabetes;
glaucoma or increased pressure in your eye;
an enlarged prostate or difficulty urinating; or
liver or kidney disease.
You may not be able to take phenylpropanolamine, or you may require a lower dose or special monitoring during treatment if you have any of the conditions listed above.
2. Explain to the patient and family on what is the effect of drug and its action3. Shake well before the patient take the first dose
AFTER ADMINISTRATION1. Be alert for adverse reaction and drug interaction2. Advice to store the medication on a less light and heat exposure place
II. DIET
TYPE OF DIET:
DATE ORDERED:
GENERAL DESCRIPTION
INDICATION/S OR PURPOSES
SPECIFIC FOODS TAKEN
Diet as Tolerated (DAT)
August 30, 2008
DATE STARTED:
the customary amount and kind of food and drink taken by a person from day to day; more narrowly, a diet planned to meet specific
Diet as tolerated is ordered when client’s appetite, ability to eat and tolerance for certain foods may change.
September 4
Breakfast:
1 hotdog
Lunch:
2 hotdogs
half rice
August 30,2008 requirements of the individual, including or excluding certain foods dietary
Dinner:
Half rice and vegetable
September 5
Breakfast:
1 egg
arozcaldo
I glass of Milo
III ACTIVITY/EXERCISE1. 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 EVALUATIONA. EVALUATION
DAILY PROGRAM ADMISSION DATE:8/30/08
1ST
DATE:9/04/08DISCHARGE DATE
NURSING PROBLEM1.Ineffective airway clearance2 fever3. poor hygieneVITAL SIGNS Temp=38.9
RR=40PR=108Bp=110/80
Temp=37.8RR=38PR=110Bp=110/80
Temp=39.1 10:00 am 38.3 10:30 amRR=40 6:00 am 26 10:30 amPR= 140 6:00 am 106 10:30Bp=110/70 6:00 am100/70 10:30 am
DIAGNOSTIC/LAB PROCEDURES
HematologyU/ASerum electrolyteCreatineC3HSO
Serum CreatinineU/A
MEDICAL MANAGEMENTDRUGS Cefuroxime 650 IVP
q 8Paracetamol 190 g IVP q 4 +≥ 37.8 CFuroxemide 19 mg IVP q 6
Cefuroxime 650 IVP q 8Paracetamol 190 g IVP q 4 +≥ 37.8 C
D/C Furosemide
PHENYL PROPANOLAMINE1 tsp 3x a dayCarbocisteine 1 tsp 3x a dayCo-amoxiclav1 tsp 3x a day
DIET DAT CONTROLLED LIQUID INTAKE TO 300 ml
DAT DAT
ACTIVITY/EXERCISE A. Gently move or reposition the child every 2 hours if he is to remain in a bed or chair position.
Bedrest Assess the child for signs of fatigue such as excessive sleepiness, yawning, or inability to help with activities of daily living. A child
Moving the child gently promotes circulation of the blood, lessens chance of pain, and helps comfort the child.
B. Position an edematous extremity on a support pillow. Supporting a swollen leg or arm will help decrease the pain.
may show signs of fatigue in subtle ways such as sleeping more than usual, yawning, or reluctance to help with bath or feeding activities.
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.
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.
Rest periods during activities are important
2.DISCHARGE SUMMARY
M: Take home medication instructed to the patient mother as follows:
Coamixilae (Amocram) 150 g/mL 1 tsp 3x a day for 7 days
Carbocisteine syrup ( emyxer) 1 tsp 3x a day
Phenypropanolamine (coway) 1 tsp 3x a day
E: Advised the mother to let his child continue his usual daily activities as tolerated
T: Ø
H: The following are advised to the patient’s mother:
Increase the patients fluid intake to prevent dehydration
Watch her child carefully for symptoms of asthma to prevent further complications
Don’t let her child to stay outside on hot environment for long period of time.
O: Scheduled for OPD check up on September 08, 2008 at Tarlac provincial hospital
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
Patient education is directed toward maintaining kidney function and preventing complications. Fluid and diet restrictions must be reviewed with the patient, such as avoiding dietary protein when renal insufficiency and nitrogen retention (elevated BUN) develop, and sodium when the patient has hypertension, edema and heart failure. The importance of follow-up evaluations of blood pressure, urinalysis for protein and serum BUN and creatinine levels to determine if the disease has progressed is stressed to the patient. A referral for home care may be indicated, a visit from a home care nurse provides an opportunity for careful assessment of the patient’s progress and detection of early signs and symptoms of renal insufficiency. Void every 2-3 hours during the day and completely empty the bladder. This prevents over distention of the bladder and compromised blood supply to the bladder wall. With regards to hygiene, shower rather than bathe in tub because bacteria in the bath water may enter the urethra. After each bowel movement, clean urethral meatus. Indicate that strenuous exercise should be avoided because exercise can induce proteinuria, hematuria, and cylindruria (renal cylinders or casts in the urine). Some recommend other nutritional approaches such as consuming cranberry juice, blueberry juice, and fermented milk products containing probiotic bacteria, have been shown to inhibit adherence of bacteria to the epithelial cells of the urinary tract
V. BIBLIOGRAPHY
Website2 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/Carbocisteinehttp://en.wikipedia.org/wiki/Co-amoxiclav(http://www.emedicine.com/med/topic879.htm)http://www.nlm.nih.gov/medlineplus/ency/article/003090.htmhttp://www.patient.co.uk/showdoc/40024643/)Book:
1 Health Assessment & Physical Examination (3rd Edition) by Mary Ellen Zator EstesPediatric Nursing (Caring for children and their families)by Nicki L Potts and Barbara L Mandleco
Tarlac State UniversityCollege of Nursing
Lucinda Campus, Tarlac CityA.Y. 2008 – 2009
A Case Study on“Acute Glomerulonephritis and Acute Pyelonephritis”
Submitted by:Canlas, MyleneCasilang, FredaCayabyab, Jodi
Cayabyab, ShielaDaguro Wella
Espinosa, RachelDijamco, ArcenDizon, Robert
Escalona, HesusitoGaleon, Paolo
Group A2
Submitted to:Mr. Apollo G Facun RN,MSN
