University of Perpetual Help Dr. Jose G. Tamayo Medical University Sto.

Tomas Bian, Laguna College of Nursing

BS Nursing Level 2 Section A

Andanar, Regan Bautista, Rochevelle Coo, Mae Espinosa, Jennifer Fesalbon, Mary Gem Lalu, Faith Ombrete, Ramon Timothy Paradina, Mithziel Voss, Jennifer

Introduction
This is the case of a 5 year old that was diagnosed with Acute Glomerulonephritis. Glomerulonephritis is an inflammation of the tubules of the kidneys (glomeruli) which filter waste products from the blood. When this inflammation follows an infection, with streptococcal bacterial (most commonly via strep throat), its called acute post streptococcal glomerulonephritis.

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

Introduction
Its commonly seen in girls between ages 3 and 7 but can occur at any age. Up to 95% of children recover fully; the rest may progress to chronic renal failure. According to the department of health glomerulonephritis is included in top 10 leading causes of mortality ages 5 to 9 years of Age. This disease usually begins about 1 to 6 weeks after a streptococcal infection, although 2 weeks is the most common time of onset. In this immunologic disorder, antigens from streptococci clump together with the antibodies that killed them, and become trapped in the tubule of the kidneys. The tubules become inflamed and edema of the capillary walls decreases the amount of glomerular perfusion. The kidneys then become incapable of filtering and eliminating body wastes.

Patients Profile
Patients name: Gender: Address: Birth date: Age: Fathers name: Mothers name : Nationality : Civil status: Religion: M.C.R Female Brgy .Mabuhay Carmona,Cavite April 13,2006 5 years old J.B.R M.R.C Filipino Single (child) Roman Catholic

Patients Profile
Patient type: Pediatric Admission date: February 22, 2012 Admission Time: 9:00 pm Attending Physician: Dr .E Admission Diagnosis: Acute Glomerulonephritis Final Diagnosis : Acute Glomerulonephritis

Patient Medical History

Chief Complain History of past illness

Vomiting Patient was diagnosed with Gastroenteritis in 2010

History of present illness 1 week prior to admission- patient noted to have vomiting with associated on and off fever with facial edema , consult done and diagnosed with UTI prescribed with cephalexin morning prior to admission, still vomiting, urinalysis done but no improvement on the result. 8 days prior to admission- (+) Submandibular swelling, consult with the attending physician given unrecalled meds. 7 days prior to admission- urinalysis with noted hematuria and proteinuria which brought consult to local health center and given cephalexin then noted facial edema.

Review of Symptoms
(+) weight loss (+) Face edema, especially around eyes. (+) Tachypnea (+) Vomiting (+) High blood pressure

(+) Hematuria and Proteinuria (+) Mild anemia, Pallor (+) anorexia (+) intermittent fever (+) Oliguria

MATERNAL HISTORY
Patient was born to 22 y/o G2P1A1 (2006) starting @ 12 weeks AOG with regular intake of multivitamins, No exposure to radiation, and no intake of teratogenic drugs noted, no maternal Illness during pregnancy and complete tetanus toxiod vaccine. Patient was born term, live baby girl, via cesarian delivery by obstetrician no cord coiling, with good cry, with a birth weight of 2000 grams.

NEONATAL HISTORY
Patient has no history of jaundice; no history of cyanosis, meconium and urine was passed out within the first 24 hours of life.

Personal Medical History

A. Nutritional History
Patient was mixed feeding (breast fed and bottle fed) because her mother was working full time.

Personal Medical History

B. Growth and development:
Social smile @ 3 months 2 word phrases by 2 years of age can sit alone @ 10 months can walk by 14 months

Personal Medical History

C. Immunization History:
Mother claimed that her daughter had completed all vaccinations.

Personal Medical History

Family medical history UTI MOTHER Environmental History Pt. lives with 8 household members in congested neighborhood, source of clean water is by distilled /boiling, garbage is collected twice a week, and toilet is NOT flush type.

PHYSICAL ASSESSMENT
A) GENERAL APPEARANCE/ SURVEY: The client looks weak. She sleeps a lot and talks only when asked. B) MEASUREMENTS
FINDINGS NORMAL VALUES ANALYSIS/INTERPRETA TION

HEIGHT WEIGHT

106 cm 2/22- 16.3kg. 2/23-15 kg. 2/24-14.5 kg.

BMI= wt. kg Ht in m2 = 16.3 kg (1.06m)2 = 14.51kg./m2

Although within the normal range, it shows a significant decrease because of the elimination of excess fluid from the patients body.

VITAL SIGNS

BP-90/60 TEMP.-36.5 PR.-96bpm RR.-40cpm

BP- 94/55 TEMP.-36.5-37.5 PR.-75-115bpm RR.-20-25cpm

Tachypnea

PHYSICAL ASSESSMENT
C)
BODY PARTS

HEAD TO TOE ASSESSMENT

NORMAL FINDINGS Rounded (normo Cephalic and symmetrical, with frontal ,parietal, and occipital prominence) , smooth skull contour Smooth ,uniform consistency; absence of nodules or masses Evenly distributed Thick hair ACTUAL FINDINGS Rounded (normo cephalic and symmetrical, with frontal ,parietal, and occipital prominence) , smooth skull contour Smooth ,uniform consistency; absence of nodules or masses Evenly distributed Thick hair Silky , resilient hair ANALYSIS/INTERPRETATIO N

SKULL

NORMAL

HAIR

Silky , resilient hair No infection or infestations Variable amount

NORMAL No infection or infestations Variable amount

PHYSICAL ASSESSMENT
Eyes Symmetric or slightly asymmetric facial features; palpebral fissures equal in size , symmetric nasolabial folds Symmetric or slightly asymmetric facial features; periorbital area slightly puffy but nontender; asymmetric nasolabial folds Periorbital edema, excess fluid volume

Symmetric facial movements

skin intact: no discharge, no discoloration transparent pupils: constrict when looking at near object pupils dilate when looking at far object

Symmetric facial movements

skin intact: no discharge, pale conjunctiva Pale color signifies anemia

transparent pupils: constrict when looking at near object pupils dilate when looking at far object

PHYSICAL ASSESSMENT
Nose symmetric and straight no discharge or flaring symmetric and straight NORMAL no discharge or flaring

Mouth

pink gums smooth, moist and pink lips

pale pink gums

Pale color lips signifies anemia Dry lips signifies sodium/fluid retention Signifies edema of the face and upper neck on both sides

pale, dry lips

Neck

central placement in midline of neck: spaces are equal on both sides

central placement in midline of neck: spaces are equal on both sides Submandibular swelling bilateral.

PHYSICAL ASSESSMENT
Symmetric chest expansion Skin intact: uniform temperature asymmetric chest expansion Skin intact: warm to touch and pale With tachypnea

Chest and Lungs

Signifies anemia

Abdomen

Unblemished skin Uniform color No visible vascular pattern

Unblemished skin Uniform color NORMAL No visible vascular pattern

PHYSICAL ASSESSMENT
Musculo skeletal system *muscle Equal size on both sides of body Equal strength on each body side Equal size on both sides of body Equal strength on each body side NORMAL

*Bone

No deformities

No deformities NORMAL

*Joint

No tenderness or swelling

No tenderness or swelling

The Urinary System

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY

Collaborative Management

Diet: Feb. 22, 2012 NPO x 4 hours then Diet for Age with Aspiration Precaution if with no vomiting. Feb. 23, 2012 Low Salt Diet Maintain Fluid Intake to 1L/day (AM) Strict Intake and Output Monitoring Limit Fluid Intake to 500ml/day (4PM) Feb. 24, 2012 Maintain Low Salt Diet Fluid limitation of 500ml/day

Collaborative Management

IV Fluids: Feb. 22, 2012 D5 0.3 NaCl 1L 25-26 gtts/min Plain Lactated Ringers for volume/volume fluid replacement Feb. 23, 2012 Discontinue IV Fluids but maintain Heplock

Collaborative Management

Medications: Feb. 22, 2012 Zinc Sulfate Syrup 5ml PO OD Paracetamol 250mg/5ml every 4 hours PO, PRN for fever > 37.8C Feb. 23, 2012 Penicillin G 400,000 units every 6 hours ANST + 30 cc diluent to run as 30 minutes drip. Discontinue Zinc Sulfate Continue Paracetamol Furosemide 40mg IV every 8 hours

Collaborative Management

Medications:

Feb. 24, 2012 Shift to oral Furosemide 40mg/tablet BID Continue Penicillin G

Collaborative Management

Laboratory Examinations: Feb. 22, 2012 Complete Blood Count with Platelet Count Urinalysis Feb. 23, 2012 BUN and Creatinine C3 Complement Antistreptolysin O Titer

Collaborative Management

Diagnostic Examinations:

Feb. 22, 2012 Whole Abdominal Ultrasound

Diagnostic Examination
Name: M.R Date: 2/23/12 Examination done: Sonogram; Whole Abdominal Findings: The liver is normal in size. No parenchymal masses noted. Intrahepatic ducts are not dilated. The gallbladder is normal in size.No intraluminal echoes are seen. The wall is not thickened. The pancreas and spleen are not enlarged with any focal mass. Pancreatic duct is not dilated. Both kidneys are normal size. The parenchymal echo pattern in the right kidney is diffusely increased with fairly delineable cotico-medullary junctions. The parenchymal echo pattern in the left kidney is isechoic in relation to the spleen with fairly delineable corticomedullary junctions.

Diagnostic Examination
No lithiasis mass or hydronephrosis noted. The urnary bladder is physiologically distended with intact wall. Lumen is echo free. Wall is no thickened. No fluid collection nor intra-abdominal masses seen in the intraperitoneal cavity anechoic fluid collection seen in both hemithraces. Impression: Diffuse parenchymal renal disease, bilateral Normal ultrasound of the liver, gallbladder, biliary tree, pancreas, spleen and urinary bladder Pleural effusion, bilateral

Diagnostic Examination

Nursing Responsibilities Secure consent for the procedure Educate patient about the purpose and benefits of the test to reduce the anxiety of the patient Initiate NPO status at bedtime; prepare bowel as directed to prevent interference of any gas in bowel that can interfere the result

Laboratory Exam Result

Patients Name: M.R Gender: Female Medical Diagnosis: Acute Glomerulonephritis Hematology
Test
Hemoglobin 110-140 gm/l 93 gm/l

Age: 5 y/o

Normal Values

Actual Result

Interpretation
There is a decrease in Hemoglobin. This indicates that there is less oxygen in the blood and a possibility of deficiency of iron in the body. Low hematocrit indicates anemia, which can result to Hemolysis (red blood cell destruction). Decrease in RBCs may indicate anemia.

Hematocrit 0.37 0.47/L 0.28/l

Red Blood Cells 4.5-5X1012/l Total White Blood Cells 3.3/3

5.0X10/110X104 /l 150-450 x 10 /3 16.25/3

An increase in WBC count may indicate the presence of a viral infection or an acute infection. The result shows no increase or decrease in the platelet count which indicates that it is within the normal range.

Platelet Count

365/3

Laboratory Exam Result

Differential Count
Eosinophils 0-0.04 0.02/ 3 The result shows no increase or decrease in the Eosinophils which indicates that it is within the normal range. The result shows no increase or decrease in the Monocytes which indicates that it is within the normal range. An increase of Segmenters is an indication of the presence of an infection. Decreased lymphocytes indicate the possibility of presence of sepsis.

Monocytes

0-0.06

0.02/ 3

Segmenters 0.50-0.70

0.79/3

Lymphocyte 0.20-0.40 s

0.12/3

Laboratory Exam Result

BUN and Creatinine Test Name: M.R Age: 5 y/o Sex: Female Date Requested: February 23, 2012
Test Urea/ BUN Fullname Blood Urea Nitrogen Creatinine Concentration 10.9 Unit Mg/dl Results Normal Reference 7-18 mg/dl

Crea

0.80

Mg/dl

Normal

0.40-1.40 mg/dl

Test
Urea/ BUN Crea

Interpretation
Normal Normal

Laboratory Exam Result

Urinalysis
Name: M.R Age: 5 y/o Date Requested: February 22, 2012 Specimen: Urine Result Normal Value Sex: Female

Interpretation

Significance

Color

Amber

Transparency

Hazy

Pale to Normal Dark Yellow or Amber Clear Abnormal

Indicates the presence of crystals, blood cells, or bacteria

Specific Gravity Ph Sugar

1.010 6.0 Acidic negative

1.010 1.020 5.0 6.0 negative

Normal Normal Normal

Laboratory Exam Result

Urinalysis
Leukocytes 75-80 0-5/HPF Abnormal Indicates possible UTI
Indicates possible injury to kidney tissue

RBC

15-20

0-5/HPF

Abnormal

Epithelial Cells Mucus Threads

Rare A.Deposit

0.5 Rare

Normal Abnormal Indicates possible UTI or Bacterial Infection

Bacteria

Drug Study
Drug Name Generic (Brand) Benzylpenicillin Na (Harbipen) Stock Dose 1000000u (vial) 1mg=1500-1750u Prescription 400,000 units IV q 6 hours ANST(-) + 30cc diluent @ 30min drip 40mg IV q 8hrs

Furosemide (Furoxide)

20mg/ 2ml (amp)

Paracetamol (Aeknil)

150 mg/1 mL (amp)

Oral 250 mg/5ml PRN for temp. 37.8

Drug Name Generic name: Benzylpenicillin Na Brand name: Harbipen Classification: Penicillins Dosage And Frequency: 400,000 units IV q 6 hours ANST(-) + 30cc Isotonic Sodium Chloride Solution @ 30min drip Route: IV

Mechanism of Action Indication Penicillin G is bactericidal against Treatment of infections including penicillin-susceptible microorganisms abscess, actinomycosis, anthrax, bites & during the stage of active stings; diphtheria, endocarditis, gas multiplication. It acts by inhibiting gangrene, leptospirosis, Lyme disease, biosynthesis of cell-wall mucopeptide. meningitis, meningococcal infections, It is not active against the necrotising enterocolitis & fasciitis; penicillinase-producing bacteria, neonatal conjunctivitis, perinatal strep which include many strains of infections, pharyngitis, pneumonia, skin staphylococci. Penicillin G is highly infections, syphilis, tetanus, toxic shock active in vitro against staphylococci syndrome & Whipple's disease. (except penicillinase-producing strains), streptococci (groups A, B, C, G, H, L and M), pneumococci and Patient Specific: Neisseria meningitidis. Other organisms susceptible in vitro to Prophylactic therapy for acute penicillin G are Neisseria glomerulonephritis. gonorrhoeae, Corynebacterium diphtheriae, Bacillus anthracis, clostridia, Actinomyces species, Spirillum minus, Streptobacillus monillformis, Listeria monocytogenes, and leptospira; Treponema pallidum is extremely susceptible.

Contraindication Hypersensitivity to penicillins. Do not inject into or near an artery or nerve.

Side Effect GI: Pseudomembranous colit, nausea, vomiting, stomatitis, black or hairy tongue, and other symptoms of gastrointestinal irritation may occur. Hematologic system: Neutropenia, Coombs-positive hemolytic anemia, a bleeding diathesis, can occur secondary to platelet dysfunction. Metabolic: May cause serious and even fatal electrolyte disturbances. CVS: congestive heart failure.

Nursing Consideration Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy. Obtain a history to determine previous use of and reactions to penicillins, cephalosporins, or other beta-lactam antibiotics. Persons with a negative history of penicillin sensitivity may still have an allergic response. IV: Reconstitute according to manufacturers directions with sterile water for injection, D5W, or 0.9% NaCl. IV: Change IV sites every 48 hr to prevent phlebitis. Administer slowly and observe patient closely for signs of hypersensitivity

Nervous system: . Neurotoxic reactions including hyperreflexia, myoclonic twitches, seizures and coma. Urogenital system Renal tubular damage and interstitial nephritis. Manifestations of this reaction may include fever, rash, eosinophilia, proteinuria, eosinophiluria, hematuria and a rise in serum urea nitrogen. Other: Phlebitis and thrombophlebitis may occur with intravenous administration.

Drug Name Generic name: Furosemide Brand name: Furoxide Classification: Diuretics Dosage And Frequency: 40mg IV q 8hrs Route: IV

Mechanism of Action Indication Furosemide inhibits reabsorption of For the treatment of edema associated Na and chloride mainly in the with congestive heart failure, cirrhosis of medullary portion of the ascending the liver, and renal disease, including the Loop of Henle. Excretion of nephrotic syndrome. Also for the potassium and ammonia is also treatment of hypertension alone or in increased while uric acid excretion is combination with other antihypertensive reduced. It increases plasma-renin agents. levels and secondary hyperaldosteronism may result. Furosemide reduces BP in Patient Specific: hypertensives as well as in normotensives. It also reduces Causes the kidneys to get rid of unneeded pulmonary edema before diuresis has water and salt from the body into the set in. urine. Absorption: Fairly rapidly absorbed from the GI tract (oral). Distribution: Crosses the placenta and enters breast milk. Proteinbinding: 99%. Excretion: Via urine (as unchanged); 2 hr (elimination half-life), may be prolonged in neonates and renal and hepatic impairment

Contraindication Severe sodium and water depletion, hypersensitivity to sulphonamides and furosemide, hypokalaemia, hyponatraemia, precomatose states associated with liver cirrhosis, anuria or renal failure. Addison's disease.

Side Effect GI: Nausea, anorexia, vomiting, oral and gastric irritation, constipation, diarrhea, acute pancreatitis, jaundice Hematologic system: Leukopenia, anemia, thrombocytopenia, fluid and electrolyte imbalances, hyperglycemia, hyperuricemia. CVS: Orthostatic hypotension, volume depletion, cardiac arrhythmias, thrombophlebitis

Nursing Consideration Administer with food or milk to prevent GI upset. Reduce dosage if given with other antihypertensives; readjust dosage gradually as BP responds. Give early in the day so that increased urination will not disturb sleep. WARNING: Do not mix parenteral solution with highly acidic solutions with pH below 3.5. Do not expose to light, may discolor tablets or solution; do not use discolored drug or solutions. Discard diluted solution after 24 hr. Measure and record weight to monitor fluid changes. Arrange to monitor serum electrolytes, hydration, liver function. Arrange for potassium-rich diet or supplemental potassium as needed.

Nervous system: Dizziness, vertigo, paresthesias, xanthopsia, weakness, headache, drowsiness, fatigue, blurred vision, tinnitus, irreversible hearing loss Dermatologic: Photosensitivity, rash, pruritus, urticaria, purpura, exfoliative dermatitis, erythema multiforme Other: Muscle cramps and muscle spasms

Drug Name Generic name: Paracetamol Brand name: Aeknil Classification: Non-narcotic analgesics, antipyretics Dosage And Frequency: Oral 250 mg/5ml PRN for temp. 37.8

Mechanism of Action The exact mechanism of action of is not known. Paracetamol produces analgesia by raising the threshold of the pain center in the brain and by obstructing impulses at the painmediating chemoreceptors. The drug produces antipyresis by an action on the hypothalamus; heat dissipation is increased as a result of vasodilation and increased peripheral blood flow.

Indication It is suitable for the treatment of pains of all kinds, as well as hyperthermia. Migraine headaches, dysmenorrhea and joint pain can also be influenced advantageously. In cancer patients, paracetamol is used for mild pain or it can be administered in combination with opioids Patient Specific: Temp: No signs of fever presently currently.

Route: Oral

Contraindication Paracetamol is contraindicated in hypersensitivity, analgesic nephropathy, renal and hepatic impairment.

Side Effect CNS: Headache

Nursing Consideration Assess possibile allergy to Paracetamol, impaired hepatic function, chronic alcoholism, pregnancy, lactation Give drug with food if GI upset is noted.

CV: Chest pain, dyspnea, myocardial damage when doses of 58 g/day are ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr GI: Hepatic toxicity and failure, jaundice GU: Acute kidney failure, renal tubular necrosis Hematologic: Methemoglobinemia cyanosis; hemolytic anemia hematuria, anuria; neutropenia, leukopenia, pancytopenia, thrombocytopenia, hypoglycemia

Check VS before and after administering the drug. Do not administer with anticoagulants because it may cause bronchospasm

Hypersensitivity: Rash, fever

Nursing Care Plan

Patients Name: Age: Medical Diagnosis: Nursing Diagnosis: M.R. 5 years old Acute Glomerulonephritis Excess fluid volume related to retention of sodium and water. The patient will have a urine output of 167-267 ml within 8 hours. The patient will maintain urine output of 500-800 ml/day.

Short Term Goal:

Long Term Goal:

Cues Problem / Nursing Diagnosis Subjective: Dalawang beses Excess fluid volume related to lang po umihi ang anak ko retention of sodium and water. tpos kokonti pa, hindi po yung normal n pagihi nya. Stated by the mother.

Objective: Dry pale lips Facial Edema (eyelids, cheeks, submandibular swelling), BP: 120/80 mmHg Weight: 2/22- 16.3kg. 2/23-15 kg. 2/24-14.5 kg. 180ml urine output/day Tea colored urine

Scientific Reason Renal disorder impairs glomerular filtration that resulted to fluid overload. With fluid volume excess, hydrostatic pressure is higher than the usual pushing excess fluids into the interstitial spaces. Since fluids are not reabsorbed at the venous end, fluid volume overloads the lymph system and stays in the interstitial spaces leading the patient to have edema, weight gain, pulmonary congestion and HPN at the same time due to decrease GFR, nephron hyperthrophized leading to decrease ability of the kidney to concentrate urine and impaired excretion of fluid thus leading to oliguria/anuria.
Reference: Medical surgical nursing by Lewis, Dirksen, Heitkemper, Bucher, Camera

Nursing Intervention Rationale

Independent: 1. Assess fluid status:

a. Weight monitoring once a day. b. Intake and output balance. c. Skin turgor and presence of edema. d. Distention of the neck and veins. e. Monitor vital signs. Rationale Assessment provides baseline and ongoing database for monitoring changes and evaluating interventions. 2. Identify potential sources of fluid a. Medications and fluids used to take or administer medications (oral and intravenous). b. Foods Rationale- Identification of unrecognized sources of fluid can be discourage or restricted to prevent worsening of the condition. 3. Explain to the patient and mother the consequence of fluid retention. Rationale- Understanding promotes patient and familys cooperation with fluid restriction. 4. Assist patient to cope with the discomforts resulting from fluid restriction. Rationale- Increasing patient comfort promotes compliance with dietary restrictions. 5. Provide frequent oral hygiene. Rationale- Oral hygiene minimizes dryness of oral mucous membranes.

Nursing Intervention Rationale

Dependent:

1. Diet restriction (low salt diet) as prescribed. Rationale- to prevent fluid retention caused by sodium intake.

2. Limit fluid intake to prescribed volume. Rationale- Fluid restriction will determine on the basis of weight, urine output and response to therapy.

3. Administer diuretics as prescribed. Rationale- to facilitate removal of excess fluid in the body.

Evaluation

Standard

Criteria

The patient has urine output of 167-267 ml in 8-hour shift.

The patient voided 180 ml of urine after 8 hours.

Nursing Care Plan

Patients Name Age Medical Diagnosis Nursing Diagnosis : : : : M.R. 5 years old Acute Glomerulonephritis Imbalanced nutrition: less than body requirements related to anorexia, vomiting, and dietary restrictions and altered oral mucous membranes. Patient will be able to consume high calorie foods within dietary restrictions. Patient will maintain adequate nutritional intake.

Short Term Goal

Long Term Goal

Cues

Problem / Nursing Diagnosis

Scientific Reason

Subjective: Wala siyang gana kumain, nakadalawang subo lng ng crackers. Stated by the mother.

Imbalanced nutrition: less than body requirements related to anorexia, vomiting, and dietary restrictions and altered oral mucous membranes.

Since there is a fluid retention in a patient with renal disorder, sodium intake should be limited. This can cause decrease appetite especially for children who loves to eat tasty foods thus their nutrition could be compromised. Reference: Medical surgical nursing by Lewis, Dirksen, Heitkemper, Bucher, Camera

Objective: Weakness Anorexia Untouched serve food

Nursing Intervention Rationale

Independent: 1. Assess nutritional status such as weight changes. Rationale- Baseline data allow for monitoring of changes and evaluating effectiveness of interventions. 2. Assess patient nutritional dietary patterns: a. Diet history b. Food preferences c. Calorie counts Rationale- Past and present dietary patterns are considered in planning meals. 3. Assess factors contributing to altered nutritional intake: a. Anorexia, nausea and vomiting. b. b. Diet unpalatable to patient. c. c. Lack of understanding of dietary restrictions. Rationale- Information about other factor that maybe altered or eliminated to promote adequate dietary intake. 4. Provide patients food preferences such as eggs, rice and chicken within dietary restrictions. Rationale- To provide proper nutrition. 5. Promote intake of high-biologic-value protein food: eggs, dairy products, meats. Rationale- Complete proteins are provided for positive nitrogen balance needed for growth and recovering.

Nursing Intervention Rationale

Dependent:

1. Monitor laboratory values (serum electrolyte, BUN, creatinine, protein tranferin, and iron levels) Rationale- To assess for any changes in the baseline data and evaluate the effects of interventions.

2. Maintain on prescribed diet. Rationale- to prevent the occurrence of complications.

Evaluation

Standard

Criteria

Consume at least 85% of served meals.

The patient consumed 50% of her meal.

Nursing Care Plan

Patients Name Age Medical Diagnosis Nursing Diagnosis : : : : M.R. 5 years old Acute Glomerulonephritis Activity intolerance related to fatigue, pallor and retention of waste products Patient will be able to perform personal hygiene with assistance. Patient will be able to tolerate activities of choice within hospitalization.

Short Term Goal

Long Term Goal

Cues Subjective: Konting lakad lang ng anak ko pagod na sya, stated by the mother.

Problem / Nursing Diagnosis

Scientific Reason

Objective: BP: 120/80 mmHg RR: 40 cpm Hemoglobin: Hematocrit: 93 gm/l 0.28/l

Activity intolerance related to fatigue, The kidneys contribute to the blood pallor and retention of waste pressure regulation by controlling products sodium excretion and extracellular fluid volume. The increase in extracellular fluid volume can increase venous return to the heart, increase stroke volume which elevates the blood pressure through increase in cardiac output. This increase in cardiac output can cause weakness and fatigue. Reference: Medical surgical nursing by Lewis, Dirksen, Heitkemper, Bucher, Camera

Flat affect

Nursing Intervention Rationale

Independent:
1. Assess factors contributing to activity intolerance: a. Fatigue b. Anemia c. Fluid and electrolyte imbalances. d. Retention of waste products. e. Depression Rationale- Indicates factors contributing to severity of fatigue to note for the cause of the problem. 2. Promote independence in self-care activities as tolerated. Assist patient and supervise. Promote returning of strength and improve self-esteem. Rationale-

3. Encourage alternating rest and activity. Rationale- Promotes activity and exercise within limits and adequate rest.

Evaluation

Standard

Criteria

The patient will perform activities of daily living such as eating, dressing and brushing teeth with supervision and minimal assistance.

The patient needed assistance in eating and performing hygiene and grooming. She preferred to stay in bed and sleep most of the shift

Nursing Care Plan

Patients Name Age Medical Diagnosis Nursing Diagnosis : : : : M.R. 5 years old Acute Glomerulonephritis Parents deficient knowledge regarding condition and treatment. The parents of the patient will verbalize the meaning of acute glomerulonephritis and its causes. States in their own words understanding of the disease process.

Short Term Goal

Long Term Goal

Cues

Problem / Nursing Diagnosis

Scientific Reason

Subjective:
Hindi naman sakitin ang anak ko e, nilalagnat sya kaso hindi ko alam kung ano temperature. Stated by the mother.

Parents deficient knowledge regarding condition and treatment.

When family member becomes ill all of the family members are affected especially the primary care giver. Cognitive abilities, emotional strengths, relationship capabilities, willingness to use community resources and individual strengths and talents were also associated with coping. As nurses work with families they must not underestimate the impact of their therapeutic interactions, educational information, positive role modeling, provision of care and teaching health promotion.
Reference: Medical surgical nursing by Lewis, Dirksen, Heitkemper, Bucher, Camera

Nursing Intervention Rationale

Independent: 1. Assess the level of education and the mode of communication of both parents. Rationale-For proper dissemination of the information. 2. Assess the understanding the cause of acute glomerulonephritis, consequences and treatment: a. cause of acute glomerulonephritis b. meaning of acute glomerulonephritis c. Understanding of acute glomerulonephritis. d. Relationship of fluid and dietary restrictions e. Rationale for treatment Rationale- provides baseline for further explanation and treatment. 3. Provide explanation of renal function and consequences of the disease at patients level of understanding and guided by the patient readiness to learn. Rationale- The parents can learn about the disease and treatment. 4. Assist parents to identify ways to incorporate changes to the patients related to illness and its treatment into the familys lifestyle. Rationale- The parents can see that the patients and familys life does not have to revolve around the disease. 5. Provide oral and written information as appropriate about: a. Renal function and failure b. Fluid and dietary restrictions c. Medications d. signs and symptoms e. Follow-up schedule f. Community resources g. treatment options

Evaluation

Standard

Criteria

Parents state in own words the meaning, causes and prevention of acute glomerulonephritis.

Maga daw ang kidney nya Stated by the other.

DISCHARGE PLAN

MEDICATION

Penicillin- to prevent recurrence of streptococcal infection Zinc Sulfate syrup 5ml PO OD- for maintenance of normal growth and skin hydration, and senses of taste and smell. Furosemide (Lasix)- diuretic that is used to treat excessive accumulation of fluid and/or swelling (edema) of the body . It is sometimes used alone or in conjunction with other blood pressure pills to treat high blood pressure.

DISCHARGE PLAN
EXERCISE/ENVIRONMENT Advise caregiver to encourage the child to have non-strenuous and non jarring exercise such as walking. They can attend school and engage in normal activities after 1 or 2 weeks, but competitive activity is limited until kidney function has returned to normal to avoid overstressing the kidney.

Advice client and her family to try to have or maintain safe , clean, comfortable and calm environment .

Advise significant others to be supportive.

DISCHARGE PLAN

TREATMENT Ensure follow up and self-care. Advice client or significant others to take in time the prescribed medicines specially the medicine for high blood pressures. Ensures dietary restrictions on salt and protein. Tell significant others to closely watched and monitor for signs of developing kidney failure.

DISCHARGE PLAN

HEALTH TEACHING/ HYGIENE Describe to the client the signs and symptoms to be reported immediately: Blood in the urine, foamy urine, swelling on her face , legs and abdomen. Clearly and specifically explain the nature of the disease, its coarse and eventual prognosis of the condition to the child (if old enough to understand) and parents or caregivers. They need to understand the while complete resolution is expected a small possibility exists for persistent disease and that an even smaller possibility exists for progression . This information is necessary for some patient to ensure that compliance with the follow up program occurs. Clearly outline a follow-up plan and discuss the plan with the family. Blood Pressure measurements and urine examinations for proteins and blood constitutes the basis of follow up plan. Perform examination at 4 weeks- 6 weeks intervals for the first 6 months. And at 3 months to 6 months intervals thereafter until both hematuria and proteinuria have been absent and blood pressure has been normal for 1yr. Advise significant others to immediately consult physician if signs and symptoms of the diseases occurs or persist. Remind client or significant others about the check-up schedules and appointments. Tell them to attend as diligently as they can. This is to rule out the recurrence or progression of the problem.

DISCHARGE PLAN
DIET Assure a low sodium, low protein diet. Limitation of fluid and salt intake to minimize vascular overload and hypertension. The diet should contain sufficient amount of carbohydrates to prevent protein from being used for energy which will result from muscle wasting and nitrogen imbalance.

DISCHARGE PLAN

SPIRITUAL Counselling: Tell the client that neither she nor GOD is to blame for her condition, everything happens for a reason, GOD will not give you a problem you cant handle. Advise relatives or significant others to provide moral support and widen their understanding Also tell them to pray for the client to help with the recovery

The End
Thank You From Section A