St. Paul College of Ilocos Sur Member: St.

Paul University System Bantay, Ilocos Sur

Case Study of Postinfectious Glomerulonephritis

Prepared by: Click to edit Master subtitle style Arriana Krizzelle Briones Aubrey Ann Follosco Krizzia Mae Laroza Jayson Redoble Yusra Reyes Stephen Ujano BSN II (Peregrine Louise de la Infirmus Class of 2014) 4/27/12

INTRODUCTION St. Paul College of Ilocos Sur (SPUS Member), Nursing Department, 2nd Year College, Group 2 must present one case study in partial fulfilment of the requirements in Nursing Care 4/27/12 Management - Related Learning

The group then thought that it is a good topic of discussion for their case study because it is different among other common diseases they had already encountered, so they chose it. The disease of the child according to the admitting diagnosis is skin allergy secondary to skin infection, Post-streptococcal Acute Glomerulonephritis (PSAGN), and Pneumonia. So, the group decided to focus on the Poststreptococcal Acute Glomerulonephritis which is similar to Post-infectious Glomerulonephritis as initially diagnosed by the same doctor, Dr. Mabanag on the 24th day of November. 4/27/12

I. PATIENTS PROFILE:

Name: J.M.Q. Age: 2 yrs/old Gender: Male Civil Status: Child Nationality: Filipino
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II. NURSING HISTORY:

1.

Health Perception

1.1 Clients description of his health

Before Admission
Health

is when they give what the child wants for him to be healthy.

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At present

1.2 Health Management

Family & Children

They are consulting faith healers prior to medical practitioners.

1.3 History of Present Illness

He started having skin allergy last Nov. 15, 2011. Generalized edema occured since Nov. 16, 2011. Cloxacilin was given as prescribed by the doctor as a treatment for allergy.

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1.4 Past Illness

Measles

1.5 History of Hospitalization

He had his first admission last Nov. 17, 2011.

1.6 History of illness in the Family

Her cousin has kidney problem. Her nephew/niece has an asthma.

1.7 Expectation of Hospitalization

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She believe that her son will be cured and that hell not be sick again.

1.8 Anticipation of problem with caring of self upon discharge

This will be achieve by maintaining the cleanliness of his sons body and his things.

1.9 Knowledge of treatment or practices prescribed

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The mother is knowledgeable about the medications and treatments prescribed by the doctors as manifested by verbalization of instructions and lab results.

2. Nutrition and Metabolic Pattern

2.1 Usual Food Intake

He eats junk foods, biscuits and bbq. He drinks softdrinks, juice, milk and seldomly coffee.

2.2 Used fluid intake

He drinks half glass of water about 5 times a day.

2.3 Any food restriction

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He is not allowed to eat salty foods

2.4 Any problem with ability to eat

None

2.5 Any supplements

The mother is not aware of the vitamin given to their child.

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3. Elimination
3.1 Bladder

Before, he urinate for about more than 5 times a day and has a clear urine but now he has less frequent urination after admission and has a rusty in color.

3.2 Bowel

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Before, he defacate 3-4 times a day usually after meals and has an orange/ violet like color and had a soft texture but now, he defacates only

4. Activity Exercise Pattern

4.1 Usual daily/ weekly activities

He is always playing and seldom watching TV

4.2 Any limitations of physical activity

He love to hold a knife thats why he was prohibited of holding one.

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5. Sleep- Rest Pattern

5.1 Usual sleep pattern

He sleeps at night at 8pm and sleeps in the afternoon for about 4-5 hours.

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6. Cognitive- Perceptual Pattern

6.1 Any deficits in sensory perception

None

6.2 Ability to read and write

He is not yet able to read and write.

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7. Role- relationship Pattern

7.1 Language Spoken

He can speak in Ilocano such as manang and manong. He can make 1 sentence for about 3-4 words. His voice is loud and high pitch. He considers his brother and

7.2 Manners of speaking

7.3 Significant Person to Client

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8. Sexuality And Sexual Pattern

8.1 Anticipated change in sexual realtions because of illness

N/A

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9. Coping- Stress Management Pattern

9.1 Decision- Making

He can decide on anything that he wants such as foods.

9.2 Management of Stress

He frowns and cry afterwards to release his emotions.

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10. Value- Belief System

10.1 Source of Strength or meaning

According to his parents, their source of strength mainly is God.

10.2 Importance of God to Client

He is the Highest, Guide and Hope.

10.3 Religious Practices

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According to the parent, they seldom go to mass but always pray everynight. They also follow some

III. PHYSICAL ASSESSMENT

(Nov. 25, 2011: 12:00 nn-1:30PM)

A.

General Survey/ General Appearance

The boy was crying that time. He was wearing simple sando and shorts. He was breast fed by her mother.

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B. Head-to-Toe Assessment
1. The Integuments

Skin

Presence of skin lesions (scars) Hairs are not evenly distributed Scars all over the scalp Nails are dirty and not well cut

Hair

Nails

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2. Head

Skull and Face

Scars on the forehead No abnormalitites were found No abnormalities were found Presence of discharges

3. Eyes & Vision

4. Ears & Hearing

5. Nose & Sinuse

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6. Mouth

Teeth are not aligned Presence of dental caries No abnormalities were found Presence of scars 159 bpm (tachycardia)

7. Neck

8. Thorax

9. Cardiovascular

10. Breast & Axillae

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11. Abdomen

Presence of scars No abnormalities were found N/A Not assessed due to child aggressiveness (Crying) No abnormalities were found.

12. Musculoskeletal System

13. Neurologic System

14. Male Genital

15. Rectum & Anus

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IV. REVIEW OF RECORDS

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V. Data from Textbook/URL

Post-streptococcal Glomerulonephritis/PSGN (Postinfectious Glomerulonephritis)

Poststreptococcal glomerulonephritis (PSGN) is an acute, immune complex-mediated inflammatory disorder of the glomerulus. It is an uncommon sequela 4/27/12 of acute infection with streptococcal

Causes
PSGN develops most frequently after an acute throat or skin infection with a nephritogenic strain of GAS. GAS M types 47, 49, and 57 are the common pathogens in skin infections; GAS M types 1, 2, 4, and 12 are the common pathogens in upper respiratory infections. Post-streptococcal GN is a form ofglomerulonephritis. It is the result of an infection, not of the kidneys, but of a completely different area, such as the skin or throat, with a specific types of Group A beta hemolytic streptococcus bacteria.
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The strep bacterial infection causes the tiny blood vessels called glomeruli in the kidneys to become inflamed, making the kidneys less able to filter and control the content of the urine. Poststreptococcal GN is uncommon these days because infections that can lead to the disorder are commonly treated with antibiotics. The disorder may develop 1 - 2 weeks after an untreated throat infection, or 3 - 4 weeks after a skin infection. It may occur in people of any age, but most often occurs in children ages 6 4/27/12 10. Although skin and throat infections are

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VI. PATHOPHYSIO LOGY

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VII. THERAPEUTIC MANAGEMEN T

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VIII. DRUG STUDY

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IX. NURSING CARE PLAN

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X. DISCHARGE PLANNING
ENVIRONMENT:
Encouraged to maintain a safe home free from any healthy hazards such as sharp objects, chemicals and matches Encouraged to provide adequate lighting on stairs and bathrooms to avoid injury Encouraged to maintain cleanliness 4/27/12 of the house and surroundings

TEACHINGS:
Encouraged SO to give child a good sleeping time and adequate nutrition Reminded SO to always assess patient needs Reminded to have a follow up checkup at attending physicians clinic one week after discharge Instructed SO to observe proper hygiene such as bathing the baby 4/27/12 daily to keep the baby from infection

OBSERVABLE SIGNS AND SYMPTOMS:

Advised to go to the physician if the following signs and symptoms of pneumonia are observed: fever chills cough unusually rapid breathing breathing with grunting or wheezing sounds labored breathing that makes a childs rib 4/27/12

 vomiting chest pain abdominal pain decreased activity loss of appetite (in older children) or poor feeding (in infants) in extreme cases, bluish or gray color of the lips and fingernails

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DIETS:
Reminded SO to serve the food mentioned to the patient. Advised to follow the right vitamin C and multivitamin supplements to be taken Encouraged oral fluids at least 8 glasses per day Encouraged to eat green leafy vegetables such as kamungay, kangkong, and petchay Encouraged to eat high calorie or carbohydrates foods such as rice, bread, and root crops to provide adequate energy and to improve nutrition 4/27/12

SAFETY, SECURITY AND SPIRITUALITY:

Encouraged SO to continue praying to God and to attend mass every Sundays and other days Encouraged to put pillows bedside the patient on the bed to avoid injury or falls Advised not to leave patient alone and to keep watch at all times Instructed to keep sharp objects away from the patient
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Bibliography

http://www.nlm.nih.gov/medlineplus/ency/

http://emedicine.medscape.com/article/96 http://www.medicineonline.com/topics/p/2

http://emedicine.medscape.com/article/22

http://www.scribd.com/doc/20404319/nurs
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http://health.wikinut.com/Types-of-Primary