CASE STUDY

Acute Poststreptococcal Glomerulonephritis

Patient Profile NAME: Age: Sex: Birthdate: Religion: Nationality: Day admitted: Baby T.V 5 y/o Female 08-19-2007 Catholic Filipino February 14, 2010

Primary language: Tagalog

A. Chief concern (narrative of present illness) 2 weeks PTA – “hindi ko alam nagkaroon pala siya ng tonsillitis, nakakakain pa naman kasi siya ng hindi dumadaing” as verbalized by the mother. Client urinates once a day, edematous and was experiencing difficulty of breathing secondary to FLU. The child was brought to a health institution for check up. Series of diagnostic exams were taken and ruled out presumptive Urinary tract infection. The physician prescribed antibiotics and vitamins. 1 week PTA – the mother decided to have second opinion by another health institution but still ruled out UTI. Initial symptoms still exists and prescribed meds are being taken. On the day of admission – came to the emergency room with a chief complaint of facial swelling. Laboratory exams were done, client was diagnosed with Acute glomerulonephritis and was advised to be admitted. B. Vital Signs (taken 02-18-2010) T: 36.2c C. Past history 1. Perinatal and birth history P: 90bpm R: 18bpm BP: 100/70

non-hypertensive. non-diabetic. the child’s appetite has been slightly affected because of dietary restrictions. Functional Health Pattern Assessment Client is admitted due to the ruled out diagnosis of AGN. nursery Gordon’s Functional Health Pattern A. . Client doesn’t like orange juice and prefers to drink milk or water.  3. Home medications were given upon first check up. eats whatever the mother offers such as chicken. Diet history   Breastfed for 6 months. Right now. Immunizations The client completed her immunizations before 1 year old and therefore considered as Fully immunized child (FIC) 4. all are taken orally and client has no allergic reactions to any drugs. Developmental milestones 6 months – “sobrang daldal niya nun” verbalized by the mother 7 months – first eruption of deciduous teeth 1 y/o – walks without support 4 y/o – starts studying. She doesn’t experience any gum and dental problems. B. This is her first time and it was explained to her properly why based on her age. veggies and fried fishes or any kind of dishes. Nutritional and Metabolic Pattern Family eats thrice a day and usually the client eats first. Among her favorite foods are chicken and veggies of any type.CASE STUDY Acute Poststreptococcal Glomerulonephritis G3P3. likes eating junk foods. non-asthmatic mother delivery via normal spontaneous delivery with no fetomaternal complications 2.

There are also some restrictions in the type of TV shows being watched. Needs assistance in performing personal hygiene and grooming. Self Perception-Self Concept Pattern The child takes time to adjust to people whom she met for the first time.CASE STUDY Acute Poststreptococcal Glomerulonephritis C. D. She knows how to identify basic colors and shows interest in drawing. e. No experienced sleep disturbances during the client’s stay in the ward but she started to snore upon the first day of confinement. combing hair etc. cries when being teased by older brothers and recently having trauma with the series of laboratory procedures being undergone. G. taking a bath. Currently enrolled as a nursery student and participates actively in school. E. vision problems and no learning disabilities. Feeding: 2 Bathing/ hygiene: 2 Dressing / grooming: 2 Toileting: 2 F. Cognitive-Perceptual Pattern No hearing difficulty. usually daytime. She sleeps together with her parents in one room with lights off. No reported changes. . Client is a bit of shy. Sleep-Rest Pattern Client sleeps 8hours during the night and 2 to 3 hours after lunch. Elimination Pattern Client is toilet trained and defecated once or twice a day. Activity-Exercise Patterns Client goes to school in the morning and usually watches cartoons during noon time. Has no problems with urination and wears diapers during night time. No problems reported.g brushing teeth.

. Father works as a family driver. The client’s hospitalization affects the family budget.CASE STUDY Acute Poststreptococcal Glomerulonephritis H. And is an accident prone just like children of her age. I. Coping Stress Tolerance Pattern Client has no temper tantrums. Role Relationship Pattern The mother is the primary care giver and is a housewife. J. Value-Religion Pattern Client’s family is a Roman Catholic and do religious practices like praying before meal or bed time. Client doesn’t have any speech or hearing problem.

2 27.010 7.0 Trace Negative 3+ Negative Normal Negative Negative Trace 2-4 / HPF TNTC Rare Rare Rare February 17.90-5.1 MMOL /L Positive Results 9.00 pg Light yellow Slightly turbid 1.00-16.00 g/dl 31.00-100.8 3. 2010 MACROSCOPIC Color Transparency Specific gravity pH (reaction) Albumin Glucose CHEMISTRY Blood Bilirubin Urobilinogen Ketone Nitrate Leukocyte Pus cells Red cells Epithelial cells Mucus threads Bacteria February 14.CASE STUDY Acute Poststreptococcal Glomerulonephritis DIAGNOSTIC EXAMINATIONS February 14.00 fl 27.020 6. 2010 Creatinine: Sodium: Potassium: ASO TITER: Hematology Hgb: Hgt: RBC count: MCV: MCH: 41 MMOL / L 139 MMOL /L 5.2 reference value 11.00 % 3.00-43.65 76. 2010 Yellow Turbid 1.30 x 106 / L 80.00-31.2 25.0 +1 (--) +3 (-) (-) (-) (-) +2 15-20 / HPF TNTC Rare Rare Few .

8 x 3.00m x 103 / L 2.00-43.1 316 10.0 x 3.50-15.00-400.00 % 4.Post void shows Impression: Kidneys – mild diffuse parenchymal disease consistent with AGN Urinary bladder – unremarkable Xray Mild perihilar haziness with thickened minor fissure and both sulci Both bases shows minimal fuzziness Heart is slightly enlarged Diaphragm and bony thorax unremarkable Impression: Mild perihilar pneumonia Mild pulmonary congestion .1 31.Pre void volume: 130cc .00-17.CASE STUDY Acute Poststreptococcal Glomerulonephritis MCHC: Platelets: WBC count: Eosinophil: Neutrophil: Lymphocyte: Monocyte: RDW February 15.Urinary bladder is well distented .7 cm .2 x 3.Left kidney: 7.Both shows increased parenchymal echogenecity .00 x 103 / L 5.00-50.Right kidney: 7.29 4 58 31 7 14.00-37.00 KUB UTZ PRE and POST VOID: .00 % 25. 2010 ULTRASOUND 33.00 % 8.00-3.4 x 2.00 pg 150.00 % 42.00-5.2 cm .

the blood-forming organs. Nitrites. is the branch of internal medicine. pathology. White blood cells. 2010 C3 – 430 mg / L LAB RESULTS: Definition. severe hemorrhage. glucose. which often leads to fatigue. Interpretation: the urinalysis results are normal. cancer. Interpretation and Nursing Considerations URINALYSIS Definition: A urinalysis is an array of tests performed on urine and one of the most common methods of medical diagnosis. A part of a urinalysis can be performed by using urine dipsticks. protein. ketones. A low HCT indicates anemia. kidney disease. hemolysis. . For example. and pediatrics that is concerned with the study of blood. Usually. and blood diseases. A low RBC indicates anemia. and bilirubin are not detectable in urine. a diet low in carbohydrates and high in protein and fat can raise ketone levels in the blood which can then enter the urine. Nursing Consideration: Special diets can change test results. and splenomegaly. Red blood cells. HEMATOLOGY Definition: Hematology. in which the test results can be read as color changes. clinical laboratory work. normal pregnancy. Normal urine may vary in color from almost colorless to dark yellow.CASE STUDY Acute Poststreptococcal Glomerulonephritis Cardiomegaly Bilateral moderate pleural effusion February 16. physiology. The following are not normally found in urine Hemoglobin. hemorrhage and leukemia. Interpretation: a low HGB indicates anemia.

young adults and thus. if required for testing or for the procedure. And the rest is normal. and put signs in their room. Interpretation: Mild perihilar pneumonia. Mild pulmonary congestion. a liquid meal. X-RADIATION(X-RAYS) Definition: X-radiation (composed of X-rays) is a form of electromagnetic radiation. 20 kHz serves as a useful lower limit in describing ultrasound. They are shorter in wavelength than UV rays. ULTRASOUND Definition: Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. corresponding to frequencies in the range 30 petahertz to 30 exahertz (3 × 1016 Hz to 3 × 1019 Hz) and energies in the range 120 eV to 120 keV. Be sure to mark the patient's chart. Xrays have a wavelength in the range of 10 to 0.01 nanometers. it is approximately 20 kilohertz (20. diet list. Some tests require fasting prior to the test. Cardiomegaly Bilateral moderate pleural effusion Nursing Consideration: The effect of X-rays on the film depends upon three factors: PPV. or other special diet. the intensity of X-rays and the contrast equivalent X-ray tube voltage. Nursing Consideration: should be aware of tests that do require special food restrictions. Although this limit varies from person to person. . Many hospitals have a specific procedure to follow for NPO. Be sure to follow this procedure and follow-up on keeping them NPO.000 hertz) in healthy. Be sure that the staff is informed of any food restrictions.CASE STUDY Acute Poststreptococcal Glomerulonephritis MCV decreases value may indicate iron deficiency anemia and thalassemia. Decreased MCH occurs in microcytic anemia or hypochromic anemia. It is no secret that many tests and procedures had to be canceled at the last minute because the patient ate some food. Also remember that some tests/procedures might require that the patient consume a light meal. Be sure you inform your patient verbally and in writing.

Obtaining a blood sample from some people may be more difficult than from others. Interpretation: Urine that is foamy.CASE STUDY Acute Poststreptococcal Glomerulonephritis Interpretation: Kidneys – mild diffuse parenchymal disease consistent with AGN Urinary bladder – unremarkable Nursing Consideration: Patient education is an important part of preparation. trimethoprim. CREATININE BLOOD TEST Definition: Creatinine blood test is used along with a BUN (blood urea nitrogen) test to assess kidney function. The puncture site is cleaned with antiseptic. usually from the inside of the elbow or the back of the hand. . An elastic band is placed around the upper arm to apply pressure and cause the vein to swell with blood.g. such as cephalosporins (e. decrease in the amount of urine. or a change in the frequency of urination. such as a burning feeling or abnormal discharge during urination. Problems urinating. cefoxitin). below the ribs. and nephrotoxic drugs. or coffee-colored . Blood is drawn from a vein. groups of tests that are performed to evaluate the function of the body’s major organs. Discussion and consensus of the exact treatment goals with patients and their families must be done prior to treatment.. Nursing Consideration: Avoid Drugs that can interfere with creatinine clearance measurements include: cimetidine.High blood pressure . bloody. near where the kidneys are located. especially at night . Veins and arteries vary in size from one patient to another and from one side of the body to the other. ASO TITER Definition: ASO titer is a blood test to measure anti-streptolysin O (ASO) antibodies. Both are frequently ordered as part of a basic or comprehensive metabolic panel (BMP or CMP). Mid-back pain (flank).

or blood accumulating under the puncture site.CASE STUDY Acute Poststreptococcal Glomerulonephritis Interpretation: active streptococcal infection.000U. rheumatic fever. orally. scarlet fever Nursing Consideration: The risks associated with these tests are minimal. post-streptococcal glomerulonephritis. q6h . but may include slight bleeding from the blood-drawing site. fainting or feeling lightheaded after the blood is drawn. MEDICATIONS  Furosemide 10mg. bacterial endocarditis. q12h  Pen G 400. intravenously.