I.INTRODUCTIONa.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 tohave 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 muchmore 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 doso relatively quickly, and end-stage renal failure may occur within weeks or months of acutenephritic syndrome onset.Geographic and seasonal variations in the prevalence of poststreptococcal glomerulonephritis (PSGN) are more marked for pharyngeally associated GNthan 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 socioeconomicgroup.Acute GN predominantly affects males (2:1 male-to-female ratio). PGN can occur at anyage but usually develops in children. Outbreaks of PSGN are common in children aged 6-10years.Acute glomerulonephritis refers to a specific set of renal diseases in which animmunologic mechanism triggers inflammation and proliferation of glomerular tissue that canresult in damage to the basement membrane, mesangium, or capillary endothelium. Hippocratesoriginally 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, andred blood cell casts. This clinical picture is often accompanied by hypertension, edema, andimpaired renal function. Acute glomerulonephritis can be due to a primary renal or systemicdisease. 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 theaffected population. Despite sporadic outbreaks, incidence of poststreptococcalglomerulonephritis has fallen over the last few decades. Factors responsible for this decline mayinclude better health care delivery and improved socioeconomic conditions. With someexceptions, a reduction in the incidence of poststreptococcal glomerulonephritis has occurred inmost 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) nephropathyglomerulonephritis (ie, Berger disease) is the most common cause of glomerulonephritis worldwide. Most epidemic cases follow a course ending in complete patientrecovery (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 rateof 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 mayoccur at any age, including infancy.
b. Reasons of choosing such case for presentation
The group chose this study out of curiosity as it was our first time to encounter such caseand because of that, the group was interested in it. We were willing to undergo new experienceswhich would bring new learnings for the group as most of us have not been exposed yet to thePediatric 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 andacute PN. By identifying such needs and health problems of the patient associated with thedisease and understanding why such needs and health problems arise the group can nowformulate 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 torecover 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 tomanage 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 mayapply 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 themanagement 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 understandingas well as individualized care.
b.NURSING PROCESSA.ASSESSMENT1.PERSONAL DATA
A.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: Filipino
Health care Financing: Father Usual source of medical care: Doctor
B.Environmental Status:
Their house structures are made of concrete and wooden materials whichwas build within a compound with their relatives. They have 2 bed rooms andtheir 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 hisuncle every afternoon. He usually eat variety of vegetables like “sayote, papaya,carrots, kalabasa” as verbalized by her mother, which are good for his heath. Heloves to play holen and watched television. He usually play a long period of timeoutside 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 permithim to go and to play outside he usually cries and make himself busy inside thehouse 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 3months old. Since then everytime the patient experiences the symptoms of asthma theytake salbutamol with the use of nebulizer to alleviate symptoms and improves airwayfunction. The patient’s asthma is usually triggered due to the weather changes, it usuallyoccurs during summer season or hot weather as the mother stated. When the patient hasfever, cough and colds the mother used OTC drugs like paracetamol for the patientcondition. The patient had not experience other childhood illnesses. Boy X has completedhis childhood immunizations. The patient has no allergies to drugs, animals, or insects,and was never hospitalized due to serious illness.
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