ACUTE Post-

streptoccocal
GLOMERULONEPHRITIS
INTRODUCTION

" Behind every good doctor

is a great nurse !"
-- Anonymous
What is Glomerulonephritis?

Glomerulonephritis is a type of kidney disease that involves

the glomeruli. The Glomeruli are very small, important
structure in the kidneys that supply blood flow to the small
units in the kidneys that filter urine, called the nephrons.
During glomerulonephritis, the glomeruli become inflamed and
impair the kidney’s ability to filter urine.

Causes :

Systemic Immune Disease such as systemic lupus erythematosus

(SLE, or lupus)

Other systemic diseases may include:

Polyarteritis nodosa group
Wegener vasculitis
Henoch-Schonlen purpura

In children, the most common cause is from streptococcal

infection.
v
v
Post - streptococcal GN

Is a disorder of the kidneys that occurs after infection with

certain strains of Streptococcus bacteria. It is a result of an
infection not of the kidneys but of a complete different area, such
as the skin or throat, with a specific type of group A hemolytic
Streptoccocus bacteria.

Symptoms :

Cough with sputum

Decrease urine output
Edema (swelling)
Smoky Urine
Rust-colored urine
Visible blood in the urine
Exams and Tests

Auscultation
Kidney Biopsy
Serum ASO
Urinalysis

Treatment

There is no specific treatment for Post Streptoccocal GN.

Treatment is focused on relieving symptoms.

Antibiotics such as penicillin, should be used to destroy any

streptoccocal bacteria that remain in the body. Blood pressure
medications and diuretic medications may be needed to control
swelling and high blood pressure. Corticosteroids and other
anti-inflammatory medications are generally not effective.

Dietary salt restriction may be necessary to control swelling

and high blood pressure.
Prognosis

Post-streptoccocal glomerulonephritis usually goes away by

itself after several weeks to months. In minority of adults,
it may progress to chronic kidney failure.
NURSING HEALTH
HISTORY
" No man , not even a doctor , ever gives any
other definition of what a nurse should be
than this - 'devoted and obedient . '
This definition would do just as well for a
porter .
It might even do for a horse ."
-- Florence Nightingale
Biographic Data:
Name: Abalos, Eric
Age: 3 years old Sex: Male
Address: Catbalogan,Samar

Birthdate: August 20, 2006

Birthplace: Catbalogan

Mother’s Name: Marissa Abalos

Father’s Name: Jojo Abalos

Religious Preference: Roman Catholic

 Chief Complaint : (+) pallor, dyspnea,
abdominal pain


 Physical Examination : Pale, abdomen (+)

tenderness in deep palpation


 Tentative Diagnosis : Hypertension ,

Anemia


 Principal Diagnosis: Acute

Poststreptococcal Glomerulonephritis

History of Past Illness:
 S.O. stated “Dida han Dec. 25, nakaka-oro pa
it akon anak, pero dida han Dec. 26 abot
Jan. 26, wara na paka-oro an akon anak. Amo
adto nagpatambalan kami kay nabuyagan man
adto hiya. Nag-alay na kami hin mga manok
pero waray la ngahaw mag-upay, salit gin-
admit namon ngadi ha ospital kay 1 month
na waray pakaka-oro an bata. Maluya na
ngan nagwawala na kay masakit duro it iya
tiyan.”
Past History :


 Childhood Ilnesses: Upper Respiratory Tract

Infection
 Childhood Immunizations: Complete


Family History of Illness : Leukemia, Cancer of



the Bone


Lifestyle :


 Diet: Mostly fish and vegetables


Admission :
Date: 01/26/2010 Time: 08:15 am


Admitting Physician : Dr. Catalan




Exam Requested: Abdomen Supine and Upright
X-ray No.: 36684

Requesting Physician: Dr. Mabulay

ROENTGENOGRAPHIC REPORT

Abdomen upright/flat:

 Non-dilated bowel loops. No differential air

fluid levels. No intraabdominal calcification or
radiopaque density noted. Intact psoas muscles
outline. No subdiaphragmatic air collection noted.
Normal osseous structures
IMPRESSION: Non-obstructive bowel pattern other as
described above.
 PHYSICAL
ASSESSMENT
" Bound by paperwork , short on
hands , sleep , and energy ...
nurses are rarely short on caring .

-- Sharon Hudacek , " A Daybook for

Nurses "
BODY PARTS NORMAL FINDINGS ACTUAL FINDINGS METHOD OF ASSESSMENT INTERPRETATION
HEAD
SKULL Rounded, smooth Rounded Inspection, Palpation Normal
skull contour
HAIR Smooth, silky, evenly Smooth, silky, evenly Inspection, Palpation Normal
distributed, thick distributed, thick

EYES
EYEBROWS Evenly distributed, Evenly distributed, Inspection Normal
skin is intact skin is intact
symmetrically symmetrically
aligned, equal aligned, equal
movement movement
EYELIDS Skin intact, no Presence of Edema, Inspection DEVIATION
discharge, no puffy eyelids.
CONJUCTIVA discoloration
Shiny, smooth, Shiny, smooth, Inspection Normal
pin/red pin/red
LACRIMAL GLAND No edema, no No edema, no Inspection Normal
tenderness tenderness
CORNEA Transparent, shiny Transparent, shiny Inspection Normal
and smooth and smooth
PUPIL Black, equal in size, Black, equal in size, Inspection Normal
3-7mm, round, iris 3-7mm, round, iris
and flat and flat
EARS
AURICLE Color same as facial Color same as facial Inspection Normal
skin, symmetrical skin, symmetrical
Mobile, firm and not Mobile, firm and not Inspection, Palpation Normal
tender, pinna recoils tender, pinna recoils
after it is folded after it is folded

TYMPANIC Gray, semi Gray, semi Inspection Normal

MEMBRANE transparent transparent
NOSE
EXTERNAL NARIS Straight, no Straight, no Inspection Normal
discharge, flaring, discharge, flaring,
uniform color uniform color
Not tender, no Not tender, no Inspection, Palpation Normal
lesions lesions
NASAL CAVITIES Air moves freely as Air moves freely as Inspection Normal
client breath client breath
Clear watery Clear watery Inspection, Palpation Normal
discharge, no lesions discharge, no lesions

SINUSES Not tender Not tender Inspection, Palpation Normal

MOUTH
OUTER LIPS Uniform pink color, Cracked, dry lips, Inspection, Palpation DEVIATION
soft, moist, smooth pale
texture
Ability to pursue lips Ability to pursue lips Inspection

INNER LIPS Uniform pink color, Dry and pale Inspection DEVIATION
soft, moist, smooth,
elastic texture
TEETH Smooth, shiny tooth Smooth, shiny tooth Inspection Normal
enamel enamel
GUMS Pink, moist, firm, Pink, moist, firm, Inspection, Palpation Normal
texture, no texture, no
retraction retraction
TONGUE Central position Central position Inspection Normal
Pink, moist, slightly Inspection, Palpation Normal
rough, thin, whitish
coating, lateral, no
lesions
Move freely, no Move freely, no Inspection, Palpation Normal
tenderness tenderness
Smooth w/ no Smooth w/ no Inspection, Palpation Normal
palpable nodules palpable nodules
SALIVARY GLAND Same as color of Decreased mucus Inspection, Palpation DEVIATION
Buccal mucus, secretion
adequately secreting
NECK Muscles equal in size, Muscles equal in size, Inspection Normal
head centered, head centered,
coordinated coordinated
movement movement

SKIN Smooth & intact, Cold and clammy, Inspection, Palpation DEVIATION
uniform in color poor skin turgor

ABDOMEN Symmetric contour, Hard and increased Inspection, Palpation DEVIATION

smooth and intact abdominal girth. 22.5
inches

No visible vascular No visible vascular Inspection Normal

pattern pattern

Audible sound and Audible sound and Auscultation Normal

absence of friction absence of friction
rub rub

MUSCLE TONE Flexible, fast Weak, lack of energy Inspection DEVIATION

NAIL BED Pinkish Pale Inspection DEVIATION

GENITALIA No inflammation, no Presence of edema of Inspection, Palpation DEVIATION

discharges, no lesions the testes.

LOWER EXTREMITIES No deformities Presence of edema of Inspection, DEVIATION

the feet. Palpation
ANATOMY AND
PHYSIOLOGY
" It is not how much you do , but
how much love you put in the
doing ."
-- Mother Theresa
 Urinary system
 The urinary system produces urine, but
physiologically it may be better understood
as a system that maintains appropriate levels
of many substances in blood plasma.
Functions of the urinary system include:
 maintenance of water and electrolyte
homeostasis by removing excesses via urine.
 maintenance of acid-base balance by secretion
of H+ into the urine.
 excretion of many toxic metabolic waste
products from the body, such as urea and
creatinine.

 participation in other homeostatic
mechanisms of the body through endocrine
pathways:
 blood pressure regulation through the
production of renin and the renin-
angiotensin-aldosterone mechanism.
 maintenance of the oxygen-carrying capacity
of the blood through the production of
erythropoietin which stimulates
erythrocyte production in the bone marrow.
 regulation of calcium balance through
conversion of vitamin D to its active
form.

 The urinary system consists of two kidneys that
produce urine and the accessory organs (two
ureters, the bladder and the urethra) through
which it is transported to the outside of the
body.

 The Kidney
 is a bean-shaped organ invested by a tough fibrous
capsule. The hilum, found in the centre of the
medially-directed concave face, is the site of
entry and exit of its major vessels and the renal
pelvis, the distended initial portion of the
ureter.
 is organised into 10-18 lobes with an outer cortex
and an inner medulla. Each lobe consists of a
medullary pyramid (conical in shape) that is
capped by the cortical components of each lobe.
The pointed, centrally-oriented part of the
medullary pyramid (the renal papilla) is
surrounded by a branch of the renal pelvis called
a calyx (pl. calyces; Gr. kalyx- cup of a flower),
which form the initial portions of the lower
urinary tract.
 Nephrons, the functional units of the
kidney, originate in the cortex and loop
down into the medulla for variable
distances before returning to the cortex
and draining provisional urine into the
collecting duct system. The collecting
ducts then extend back into the medulla
merging successively to form the largest
ducts (papillary ducts or ducts of
Bellini) that open into the calyces.


 The renal cortex
contains the renal
corpuscles where
ultrafiltration of
plasma occurs and the
tortuous or convoluted
portions of the renal
tubule system. Some
collecting ducts are
visible in the cortex
and are called
'medullary rays'.
 The renal medulla
contains the straight
looping portions of
the tubule system as
well as the collecting
ducts.

 Vasculature of the kidney - The blood
supply of the kidney is central to its
function.
 The main renal artery
sequentially divides into
 posterior and anterior
branches
 interlobar arteries that run
between the medullary
pyramids
 arcuate arteries that run
laterally where the renal
cortex abuts the medulla
(the corticomedullary
junction)
 interlobular arteries
running upwards into the
cortical tissue

 afferent arterioles
 the glomeruli, tufts of capillary loops within
the renal corpuscle where plasma filtration
occurs
 efferent arterioles
 two secondary capillary plexuses which provide
the blood supply to the parenchyma of the
kidney:

  The vasa recta. Arising from efferent arterioles
of juxtamedullary glomeruli (in the cortex near
the medulla), this capillary system runs
straight down into the medulla and loops back
on itself ultimately draining into the veins at
the corticomedullary junction. As well as
providing the blood supply to the medulla, the
vasa recta, help to generate the high osmotic
pressure in the medulla necessary for
concentration of urine.
 The cortical capillary network. Arising from the
efferent arterioles in the rest of the cortex,
these capillaries allow the exchange of
materials between the blood and cortical
tubules (eg. oxygen to tubular cells; molecules
reabsorbed from the provisional urine to blood).
 Blood returns via a venous system which
follows the path taken by the arterial
system except there is no venous equivalent
of the glomerulus.


An idealised nephron showing its vasculature. Note that efferent arterioles normally form either a
 cortical capillary network or the vasa recta but rarely both.
The NEPHRON

 is the basic structural and functional

unit of the kidney. There are
approximately one million nephrons in
each kidney. The nephron consists of:
 The renal corpuscle (Bowman's capsule and
the glomerulus within it) which is the
site of filtration of the blood.
 The renal tubule, which is a long folded
duct that processes the filtrate. The last
portion of the tubule empties into the
collecting duct. Collecting ducts
ultimately merge to form the large
papillary ducts (of Bellini) that open at
the tips of the renal papillae.


.

1. The renal corpuscle


 

•consists of Bowman's capsule and the renal
glomerulus
•is the site of filtration of the blood:
 A. Bowman's capsule
 consists of two contiguous layers of
epithelial cells with a space between
them (the urinary space)
 The outer, capsular epithelium (the parietal
wall) is simple squamous epithelium and
may be thought of as the funnel portion of
the renal tubule.
 The inner, podocyte layer (the visceral wall)
forms part of the filtration barrier -or
filter paper within the funnel- between
blood plasma and provisional urine formed
in the urinary space. The podocytes
(meaning cells with feet!) are so-named
because they have interdigitating
cytoplasmic extensions or 'foot processes'
apposed to the basement membrane
surrounding the glomerular capillaries.

B. The glomerulus
 is a tuft of capillary loops enclosed by the
visceral layer of Bowman's capsule. The
capillaries have a fenestrated endothelium
which lacks diaphragms.
 is supported by mesangial cells. These cells
 synthesise a connective tissue matrix
(mesangium).
 phagocytise any particles trapped on the
endothelial side of the glomerular filtration
barrier and maintain its basement membrane
(see below).
 control glomerular blood flow by contracting or
relaxing to make the glomerular capillaries
narrower or wider.

 2. The Renal tubule
 The four parts of the renal tubule are the
proximal convoluted tubule, the loop of
Henlé, the distal convoluted tubule and the
collecting tubule. The proximal and distal
convoluted segments are found exclusively
in the cortex and can be distinguished. In
the medulla, we will find thick and thin
segments of the loop of Henlé intermingled
with collecting ducts and the vasa recta.
Form and function are closely linked in the
kidney as in all organ systems; hence a
short introduction on each part of the
tubule will hopefully facilitate your
understanding of the kidney
A. The proximal convoluted tubule

 begins at the urinary pole of the renal

corpuscle
 is continuous with the parietal layer of
Bowman's capsule
 is the longest, most convoluted portion of
the tubule
 is lined by simple cuboidal epithelial
cells with abundant mitochondria, a
prominent brush border of microvilli and
basolateral interdigitations of the
plasma membrane which increase surface
area.

Functions of Proximal Convoluted Tubule

 The proximal convoluted tubule functions

in the extensive reabsorption of many
components of the glomerular filtrate:
 Na+ undergoes active transport via a Na+-
K+ ATPase into the basolateral spaces
between cells and then into peritubular
capillaries. The reabsorption of water
and negatively charged ions is driven by
the osmotic and electrical forces
created. 70-80% of the water, sodium and
chloride ions are reabsorbed from the
filtrate in the proximal convoluted
tubule.

 Bicarbonate ions are reabsorbed with H+
ion secretion.
 Almost 100% of amino acids and glucose is
also recovered by facilitated diffusion
(using carrier proteins) driven by co-
transport of Na+.
 Larger proteins and carbohydrates undergo
endocytosis and are degraded by
lysosomal enzymes into amino acids and
simple sugars which can then diffuse
from the cells.

B. The Loop of Henlé

 extends for varying lengths into the medulla.

Juxtamedullary nephrons may have long Loops
of Henle reaching far into the inner
medulla whereas other nephrons generally
only extend a short distance in the medulla.
 has four segments:

 the pars recta (straight portion) of the
proximal tubule extends into the outer medulla
and is similar in morphology and function to
the rest of the proximal tubule.
 the thin descending limb, lined by simple
squamous epithelium, travels a variable
distance into the medulla.


 the thin ascending limb, also lined by
simple squamous epithelium, begins
immediately after the tubule loops back on
itself. This segment may be quite short.
 the thick ascending limb is similar in
structure to the distal convoluted tubule
being simple cuboidal with basolateral
interdigitations and abundant mitochondria
reflecting its ability to actively
transport ions. It extends back to the
cortex and is continuous with the distal
convoluted tubule.
 Functions of the Loop of Henle
 to produce an increasing osmotic gradient from the
cortex to the tip of the renal papilla by the
counter-current multiplier mechanism.
 The counter - current multiplier mechanism
 descending limb is permeable to water and urea, but
less permeable to NaCl. Water which moves into the
surrounding tissue is removed by the vasa recta. As
the urine moves in this tubule it gains urea and
loses water.
 The thin ascending limb is permeable to NaCl but not to
water.
 The thick ascending limb actively transports NaCl out
of the tubule but limits diffusion of most other
molecules including water, ions and urea. A high
solute concentration (high osmotic pressure) is
generated and maintained in the medullary
interstitium and the tubule fluid becomes hypotonic.

C. The distal convoluted tubule
 is lined by simple cuboidal epithelium
with basolateral interdigitations and
abundant mitochondria.
 lacks the extensive brush border of the
proximal tubule.
 forms part of the juxtaglomerular
apparatus found at the vascular pole of
the renal corpuscle.


Functions of the Distal Convoluted Tubule

 reabsorbs Na+ ions through coupled secretion

of H+ or K+ ions into the tubular fluid, a
process which requires the presence of the
adrenal hormone aldosterone. By acidifying
the urine the distal convoluted tubule
plays an important role in acid-base
balance.
 normally is relatively impermeable to water.
However in the presence of antidiuretic
hormone (ADH) its permeability to water
increases permitting concentration of the
urine.
 secretes ammonium ions and some drugs


 D. The collecting tubule

 is the final segment of the nephron. It is
lined by simple cuboidal epithelium of
varied functions and morphologies that
overlap with those of distal tubules and
collecting ducts.
 begin in the renal cortex as medullary rays
(portions of cortex resembling the medulla).
 merge to form larger ducts in the medulla and
ultimately the papillary ducts that empty
urine into the renal calyces.
 are lined by simple columnar cells with
distinct lateral plasma membranes due to
reduced interdigitation of these membranes
with neighbouring cells.


Functions of the Collecting Ducts

 have similar functions to the distal tubule:

1) concentration of urine in the presence of
ADH (which also increases their permeability
to water).
2) regulation of acid base balance through
secretion of H+ and reabsorption of
bicarbonate ions.
3) secretion of ammonia ions and some drugs.
 are permeable to urea which may leave down
its concentration gradient from
concentrated urine, thereby aiding the
maintenance of the high solute
concentration of the medulla.

The Lower Urinary Tract
The urinary tract consists of:


 renal calyces into which the large collecting

ducts in the medullary papillae discharge
their urine
 the renal pelvis in the hilum of the kidney
 the ureter, a muscular tube which conveys the
urine toward the bladder
 the bladder which acts as a reservoir for
urine and a pump that expels the urine
during micturition
 the urethra, through which urine is voided
from the body

PATHOPHYSIOLOGY

" God appoints our graces to be

nurses to other men's
weaknesses ."
-- Henry Ward Beecher
Acute post-STREPTOCCOCAL
glomerulonephrtis
DRUG ANALYSIS

" Nurses dispense comfort , compassion ,

and caring without even a
prescription ."
-- Val Saintsbury
Drug Mechanism Indication Dosage Adverse Drug Available Contraindicatio Nursing
of Action Reaction Interaction Form n Considerati
Furosemide Inhibit Oral , IV : ADULT CNS : Dizziness, Drug - drug Tablet Contraindicated Administer
on
reabsorptio Edema Edema : vertigo, Increased 20, 40, with allergy to with food or
Loop n of sodium associated Initially, paresthisas, risk of 80 mg furosemide, milk to
Diuretic and with the 20-80 mg/day xanthopsia, cardiac Oral sulfonamides; prevent GI
chloride heart PO as a weakness, arrhythmias Solution allergy to upset.
from the failure, single dose. headache, with cardiac 10 mg/5 mL, tartazine (in oral
Order: proximal cirrhosis If needed, a drowsiness, glycosides 40 mg/5 mL solution); anuria, Reduce
and distal and rectal second dose fatigue, blurred (due to Injection severe renal dosage if
tubules and disease. may be vision, tinnitus, electrolyte 10 mg/ mL failure; hepatic given with
Furosemide ascending given in 6-8and irreversible imbalance). coma; pregnancy; other anti-
12 mg IVTT limb of the IV : Acute hr. If hearing loss. lactation. hypertensive;
q 8 hours loop of pulmonary response is Increased readjust
STAT ANST Henle, edema unsatisfact CV : Orthostatic risk of Use cautiously dosage
(-) leading to ory dos may hypotension, ototoxity with SLE, gout, gradually as
a sodium- Oral : be volume with diabetes mellitus. BP responds.
rich Hypertension increased depletion, aminoglyoside
dieresis. in 20- to cardiac antibiotics, Give early
40-mg arrhythmias, cisplatin. in day so
increment thrombo- that the
at 6- to 8- phlebitis. Decreased increased
hr natriuretic urination
intervals. Dermatologic : and anti- will not
Photosensitivity hypertensive disturb
rash, pruritus, effects with sleep.
urticaria, indomethacin,
purpura, ibuprofen, Avoid IV use
exfoliative other NSAAIDs. is at all
dermatitis, possible.

Refrigerate
oral
solution.
Acute erythema Decreased GI Do not mix
pulmonary multiforme. absorption parenteral
edema : 40 mg with charcoal. solution
IV over 1-2 GI : Nausea, with high
min. May be anorexia, May reduce acidic
increased to vomiting, oral effect of solution
80 mg IV give & gastric insulin or with pH
over 1-2 min irritation, oral below 3.5.
if response constipation, antidiabetics
is diarrhea, acute because blood Do not
unsatisfactor pancreatitis, glucose levels expose to
y after 1 hr. jaundice can become light, which
  elevated. may discolor
Hypertensio GU : Polyuria, tablet or
n : 40 mg bid nocturia, solution; do
PO. If needed, glyosuria, not use
additional urinary discolored
anti- bladder spasm drug or
hypertensive   solutions.
may be added. Hematologic :  
Leukopenia, Discard
anemia, diluted
thrombocytopen solution
ia, fluid and after 24 hr.
electrolyte  
imbalance,  
hyperglycemia, Arrange to
hyperuricemia. monitor
  serum
OTHER : Muscle electrolytes,
cramps and hydration,
muscle spasm. liver and
renal
function.
Drug Mechanism Indication Dosage Adverse Drug Available Contraindicatio Nursing
of Action Reaction Interaction Form n Considerati
on
Cefuroxime Bactericida Oral Oral CNS : Lethargy, Drug - drug Tablets Contraindicated Culture
l: Inhibits (cefuroxime Adults & headache, Increased 125, 250, with allergy to infection,
Antibiotic synthesis axetil) patient12yr dizziness, nephrotoxicit 500 mg cephalosporins or and arrange
Cephalospor of Pharyngitis, & older : paresthesias y with penicillin. for
in (second bacterial tonsillitis, 250 mg bid. aminoglycosid Suspen - sensitivity
generation) cell wall, otitis media, For severe GI : Nausea, e. sion Use cautiously tests before
causing acute infection, vomiting, Increased 125 mg/5 with renal and during
Order: cell death. bacterial may be diarrhea, bleeding mL, 250 failure, therapy if
maxillary increased to anorexia, effects with mg/5 mL lactation, expected
4 mg IVTT q sinusitis, 500 mg bid. abdominal pain, oral pregnancy. response is
8 hours lower Treat for up flatulence, anticoagulant Powder not seen.
ANST (-) respiratory to 10 days. pseudo- s. for
infection, membranous injection Give oral
UTI, Pediatric colitis, Drug - lab 750 mg, drug with
uncomplicate patients hepatoxicity test 1.5 g food to
d gonorrhea, younger Possibility decrease GI
skin & skin than 12 yr : GU : Nephro- of false Injection upset and
structure 125 mg toxicity results on 750 mg, 1.5 enhance
infection, tx test of urine g absorption.
for Lyme dse. Parenteral Local : Pain, glucose using
Adult : 750 abscess at Benedict’s Have vitamin
mg-1.5 g IM or injection site, solution, K available
IV every 8 phlebitis, Fehling’s in case
hr, depending inflammation solution, hypopro-
on severity at IV site Clinitest thrombinemia
of infection, tablets; occurs.
for 5-10 days.
Parentera .Pediatric Hematologic : urinary 17- Discontinue
l patients Bone marrow ketosteriods; if hyper-
(cefuroxime older than depression direct Coombs’ sensitivity
sodium) 3 mo : 50-100 (decreased test. reaction
Lower mg/kg/day IM WBC, decreased occurs.
respiratory or IV in platelets,
tract divided decreased Hct) Give oral
infection, doses every tablets to
dermatologi 6-8 hr. Hypersen - children
c infection, sitivity : who can
UTI, Pediatric Ranging from swallow
uncomplicat patients rash to fever tablets,
ed & with to rushing the
disseminate impaired anaphylaxis; drug
d gonorrhea, renal serum results in
septicemia, function : sickness a bitter,
meningitis, Adjust reaction. unpleasant
bone & dosage for taste.
joint renal Other :
infection, impairment Superinfectio Use
preoperativ by weight or ns, disulfram- solution
e age of like reaction for
prophylaxis, child. with alcohol children
tx of acute who cannot
bacterial swallow
maxillary tablets.
sinusitis I
patients 3
mo-12 yr.
Drug Mechanism Indication Dosage Adverse Drug Available Contraindicatio Nursing
of Action Reaction Interaction Form n Considerati
on
Ampicilli Bactericida Treatment of Maximum CNS : Lethergy, Drug - drug Capsule Contraindicated Culture
n l action infection recommended hallucination, Increased 250, 500 mg with allergies to infected
against caused by dosage, 8-14 seizures ampicillin penicillin, area if
Antibiotic sensitive susceptible g/day effect with Powder cephalosporins, or response is
Penicillin organism; strains of (reserve 14 CV : Heart probenecid. for oral other allergies not as
inhibits Shigella, g for failure Increased suspen - . expected.
Order: synthesis Salmonella, S serious risk of rash sion Use cautiously
of bacteria typhosa, infections, GI : Glossitis, with 125 mg/ 5 with renal Check IV
500 mg cell wall, Escherichia such as stomatitis, allopurinol. mL, 250 disorder. site for
IVTT q 8 causing coli, meningitis, gastritis, sore mg/5 mL signs of
hours ANST cell death. Haemophilus septicemia); mouth, black Increased thrombosis
(-) influenza, may be given “hairy” tongue, bleeding Powder or drug
Proteus IV, IM, or PO. nausea, effect with for reaction.
mirabilis, Use vomiting, heparin, oral injection
Neisseria parenteral diarrhea, anticoagulant 250, 500 Administer
gonorrheae, route as abdominal pain, s. mg, 1.2 g oral drug on
enterococci, soon as bloody an empty
gram (+) possible. diarrhea, Decreased stomach, 1 hr
organism enterocolitis, effectiveness before or 2
(penicillin G nonspecific with hr after
sensitive hepatitis tetracylines, meals with
staphylococci chloram- full glass
, GU : Nephritis pehenicol. of water; do
streptococci, not give
pneumococci). with fruit
juice or
soft drinks.
Meningitis . Hematologic : Decreased Do not give
caused by Anemia, efficacy of IM injection
Neisseria thrombo- hormonal in the same
meningitides. cytopenia, contraceptives, site, atrophy
Unlabeled leukopenia, atenolol with can occur.
use: prolonged ampicillin. Monitor
Prophylaxis bleeding time. injection
in cesarean Drug - lab test sites.
section in Hyper - False-positive
certain sensitivity : Coombs’ test if Take this
high-risk Rash, wheezing, given IV. drug around
paents. anaphylaxis. Decrease the clock.
plasma
Local : Pain, estrogen Take the
phlebitis, concentrations full course
thrombosis at in pregnant of therapy;
injection site women. do not stop
(parenteral). taking the
Drug - food drug if you
Other : Oral feel better.
Superinfection- ampicillin may
-oral and be less You may
rectal effective with experience
moniliasis, food; take on these side
vaginitis an empty effects:
stomach. Nausea,
vomiting, GI
upset (eat
frequent
small meals).
Drug Mechanism Indication Dosage Adverse Drug Available Contraindication Nursing
of Action Reaction Interaction Form Considerati
on

Paracetamol Antipyretic: Temporary Adults CNS : Headache Drug-drug Suppositor Contraindicated Do not
Reduces reduction and Increased ies with allergy to exceed the
Analgesic fever by of fever, children CV : Chest toxicity with 80, 120, 325, acetaminophen. recommended
(nonopioid) actin temporary older Pain, dyspnea, long-term, 650 mg Use cautiously dosage; do
Antipyretic g directly relief of than 12 myocardial excessive with impaired not take for
on the minor aches yr damage when ethanol Tablets hepatic function, longer than
Order: hypothalami and pains By doses of 5-8 ingestion. 325, 500 mg chronic alcoholism, 10 days
c heat- caused by suppositor g/day are pregnancy, unless
Oral drops 5 regulating common cold y, 325-650 ingested Increased ER Tablets lactation. directed by
ml q 4 hours center to and mg every 4- daily for hypopro- 650 mg prescriber.
PRN cause vaso- influenza, 6 hr. PO, several weeks thrombinemic
dilation headache, or 1300 mg or when doses effect of Disintegra Consult
and sore throat, ER tablets of 4 g/day are oral ting physician if
sweating, toothache every 8 hr. ingested for anticoagulant Tablets needed for
which helps (patients Do not 1 yr. s. 80, 160 mg children
dissipate ages 2 yr exceed 4 less than 3
heat. and older), g/day. . yr; if needed
backache, for longer
menstrual than 10 days;
cramps, if continued
minor fever, severe
arthritis or recurrent
pain, pain occurs
(possible
serious
illness).
Analgesic: and muscle . Pediatric GI : Hepatic Increased risk Rapid - Give drug
Site and aches patients toxicity and of release with food if
mechanism (patients Doses may failure, hepatoxicity tablets GI upset
of action older than repeated 4-5 jaundice. and possible 500 mg occurs.
unclear. 12 yr.). times/day; do GU : Acute decreased Capsules
not exceed 5 renal failure, therapeutic 500 mg Avoid using
Unlabeled doses in 24 renal tubular effects with multiple
use: hour or 10 necrosis barbiturates, Elixir preparations
Prophylaxis mg/kg. Hematologic : carbamazepine, 160 mg/5 containing
in children Methemo- hydantoins, mL acetaminophe
and patients globinemia— rifampin, n.
at risk for cyanosis; sulfinpyrazone. Liquid
seizures who hemolytic 160 mg/5 Discontinue
are anemia— Possible mL, 166.6 drug if
receiving hemturia, delayed or mg/5 mL, hypersensiti
DPT anuria; decreased 500 mg/5 vity
vaccination neutrupenia, effectiveness mL reactions
to reduce leucopenia, with occur.
incidence of pancytopenia, anticholinergi Solution Treatment of
fever and thrombo- cs. 100 mg/mL. overdose:
pain. cytopenia, Possible 160 mg/mL Monitor
hypoglycemia reduced serum levels
absorption of regularly, N-
acetaminophen acetylcystei
with activated ne should be
charcoal. available as
a specific
antidote;
basic life
support
measures may
be necessary.
Unlabeled Hyper - Possible Reduce
use: sensitivity : decreased dosage with
Prophylaxis Rash, fever. effectiveness hepatic
in children of zidovudine. impairment.
and
patients at Drug-lab test
risk for Interference Report rash,
seizures with unusual
who are Chemstrip G, bleeding or
receiving Dextrostix, bruising,
DPT and Visidex yellowing
vaccination II home blood of skin or
to reduce glucose eyes,
incidence measurement changes
of fever systems; involving
and pain. effects vary. patterns.
LABORATORY
RESULTS &
ANALYSIS
"... the character of the nurse is as
important as the knowledge she possesses ."

-- Jarvis , 1996
 X - ray Abdomen Flat Supine and Upright
 
ROENTGENOGRAPHIC REPORT

 
Abdomen Upright/ Flat:
 
Nondilated bowel loops. No differential air fluid
levels. No intraabdominal calcification or radiopaque density
noted. Intact psoas muscles outline. No subdiaphragmatic air
collection noted. Normal osseous structures.

 
IMPRESSION : Non-obstructive bowel pattern.
Others as described above.
 LAB RESULTS

Actual Normal Value Interpretat ANALYSIS

Value ion

Hemoglobin 49.8 M (140-180 g/L) DEVIATION Anemia

Hematocrit 0.15 M(0.40-0.54) DEVIATION Anemia

WBC 16.8 (5-10 x103/mm3) DEVIATION Infection

Segmenter 0.85 (0.40-0.60) DEVIATION Infection

Lymphocytes 0.45 (0.20-0.35) DEVIATION Infection

Blood type: “O”

 URINALYSIS

ACTUAL NORMAL INTERPRETATION ANALYSIS

Color lt. yellow Pale yellow Normal

to deep
Transparency Clear amber
Clear Normal
Specific 1.010 1.002-1.035 Normal
Gravity
Albumin (+1) (-) DEVIATION Glomerulo -
nephritis
Sugar (-) (-) Normal

Epithelial Moderate None to few DEVIATION Inflammation

Cells or infection
of urethra
Pus Cells Abundant None to 4 DEVIATION Bacteria in
urine
Glomerular
Red Blood 11-15 0- 3 DEVIATION bleeding
Cells
NURSING CARE
PLAN
" You might be a nurse if you firmly
believe that 'too stupid to live'
should be a diagnosis ."
-- Anonymous
ASSESSMENT NURSING DIAGNOSIS BACKGROUND STUDY GOALS AND NURSING RATIONALE EVALUATION
OBJECTIVES INTERVENTIONS
Cues: Urinary retention Patient Goal: At the end of Independent: Goal partially
S: related to experiences 8-hour shift, met. As evidenced
“Nahubag na it infection incomplete patient will be I>O may by the patient’s
buyong tak anak secondary to emptying of the able to empty his 1. Determine
kay dire nakaka- ureteral blockage bladder. bladder completely. balance
indicate ability to empty
his bladder
ihi” as verbalized
by the S.O.
    between I and retention completely but
Nursing Care Plan Specifically, the
  patient will be O . S.O. was able to
 
3rd Edition, p. 75
2 . Use ice 2. To stimulatedemonstrate
able:
  Demonstrate techniques, reflex arc. techniques to
O: techniques / stroking inner   alleviate
>I: 65 ml behaviors to   retention.
>O: 0 ml alleviate / prevent thighs, running 
>(+) Ascites retention. water in sink
>Abdominal girth or warm water
22 ¼ in
>T = 38.8 C over perineum.
> (+) Scrotal 3. Encourage  
edema client to 3. So treatment
report can be
problems instituted
immediately. promptly.
4. Stress need 4. To
for ingestion discourage
of vitamin C. bacterial
growth and
stone
formation.
ASSESSMENT NURSING DIAGNOSIS BACKGROUND STUDY GOALS AND NURSING RATIONALE EVALUATION
OBJECTIVES INTERVENTIONS

Collaborative:
1. Administer 1. To stimulate
Bethanecol as parasympathetic
ordered. nervous system to
  release
  acetylcholine at
  nerve endings and
  to increase tone
  and amplitude of
  contractions of
  smooth muscles of
  urinary bladder.
  2. To control
  hypertension and
2. Pharmacologic edema
Interventions:  
3. Regular
3. periodic use of a
Antihypertensives catheter to empty
and Diuretics the bladder.
Catheterize with  
intermittent and References:
indwelling Nursing Care Plan
catheter 3rd Edition, p. 75
Nurses pocket
guide 11th edition,
doenges, moorhouse,
murr.
ASSESSMENT NURSING BACKGROUND STUDY GOALS / NURSING
INTERVENTIONS
RATIONALE EVALUATION
DIAGNOSIS OBJECTIVES

S : “ Dire hea Fluid Volume -Fluid Volume Excess Goal : Independent : To asses Goal met as

nakakaihi .” As Excess related to is a result of the

kidney’s inability to At the end of Beware of risk causative / precip evinced by :
reduced urine factors ( e . g . itating factors .
verbalized by the function well. The my 8hr shift ,   The client
mother , when asked output. primary function of my client renal To evaluate was able to
why the abdomen is glomerulus is to
will be able insuffiency ) degree of verbalize
filter blood, most Measure vital excess .
distended . cases result when to stabilize signs understanding
  antigen – antibody fluid volume .   of
complexes produced by   For presence of
O : (+) Periorbital an infection Specifically , Auscultate crackles / congest individual ’ s
elsewhere in the body the client breath sounds ion . It may dietary / fluid
edema in the body become will able to :   indicate restriictions
trapped in the CHF / Pulmonary
(+) Intake exceeds glomerulus. This Verbalize   and he was
Output : understanding   edema . able to
entrapment causes For changes that
Measure
I : 65ml inflammatory damage Of individual
may indicate demonstrate
and impedes abdominal girth increasing fluid behaviors to
O : (U) – 0 glomerular function, dietary / fluid
(S) – 0 reducing the restrictions .   retention / edema . monitor fluid
(+) Rales glomerular membrane’s Demonstrate     status and
capacity for Monitor intake Facilities
(+) Ascites selective behaviors to and output . identification reduce
BP : 90 / 40 mmHg permeability. These monitor fluid Estimate of fluid recurrence of
Abdominal Girth : manifestations are status & insensible requirements fluid excess .
result from the
22 ½ in . kidney’s inability to reduce losses through based on renal  
concentrate urine and reccurrence lungs , skin & function
Insensible
.  
as the disease of fluid bowel . losses can add  
progresses, these
manifestations excess .   up to 800 -   
  1000cc / day &
metabolism of  
carbohydrated  
can liberate up
to 350cc / day of  
fluid from
ingested foods .
 
 
ASSESSMENT NURSING BACKGROUND GOALS / NURSING INTERVENTIONS RATIONALE EVALUATION
DIAGNOSIS STUDY OBJECTIVES

Intensifies & Offer ice cheap than To relieve  

the client may dependent glasses of thirst , since  
experience water . fluid intake  
respiratory Administer diuretics is usually  
difficulty due as ordered . restricted .  
to fluid      
accumulation in   May be given  
the abdominal   to convert  
cavity which Dependent : oliguric  
may progress up   phase to  
to the lungs . Restrict fluid nonoliguric  
Edema increases intake as ordered . phase , to  
as heart   flush debris
failure becomes Administer from
more severe . antibiotics as tubulates ,
The cardinal ordered . decreased
manifestation   hyperkalemia
is   or faster
hypertension . Collaborative : improved
  urine output .
Consult dietitian as  
indicated . Because of
Assist with the presence
procedure as of edema .
indicated .  
( nurses pocket guide For
11 th edition , doenges , infection
moorhouse , murr .)  
 
ASSESSMENT NURSING BACKGROUND GOALS / NURSING RATIONALE EVALUATION
DIAGNOSIS STUDY OBJECTIVES INTERVENTIONS

S : “ Deri na Fatigue Rest is Goal : At the Independent:

hiya related to essential – end of my Identify To asses Goal was not met

nakakalingkod increased both physical nursing presence of causative/contrib as evidenced by:

kay waray na metabolic and emotional . interventions physical and uting factors. Theclient was not
hiya kusog .” As demand and Exercise also of my 8h shift , psychological To determine able to report
verbalized by anemia . increases the client disease states. degree of improved sense
the mother . catabolic will have an Discuss fatigue/impact on of energy.
  activity . Red adequate lifestyle life.
O : (+) Drowsy blood cells balance of changes/limitatio This individual
Disinterest in are the oxygen rest & n imposed by may not be able
surrounding . carrying cells activity . fatigue state. to verbalize
  that circulate Specifically Interview feelings or
Decreased throughout the the client parents regarding relate meaningful
performance . body . Deficient will be able specific changes information.
  number of to : observe in child. To allow for
Weakness noted . these results Report Schedule nursing rest.

to exhaustion improved sense interventions.

& decreased of energy .
capacity for Identify basis

physical and of fatigue &

mental work at individual
usual level . areas of
.( medical & control .
surgical  
nursing by
Joyce Black )
Collaborativ
e: To allow
Refer the continuity of
family to a care.
community
health nurse
for ff - up
care after
discharge .
for further
evaluation,
Refer for laboratory &
medical . diagnostic
Technologist exam
,
( nurses
pocket guide
11 th edition ,
doenges ,
moorhouse ,
murr .)
Fundamentals
of Nursing
7 th Ed ,
Kozier et .
Al . p . 1266
Lippincot
Manual of
Nursing
Practice ed .
P . 394 , 395
 
ASSESSMENT NURSING DIAGNOSIS BACKGROUND STUDY GOALS AND NURSING RATIONALE EVALUATION
OBJECTIVES INTERVENTIONS
Cues: Activity Insufficient General: Goal Partially met as
Subjective: intolerance physiological or   evidenced by the
“ha usa ka adlaw, related to psychological energy At the end of my 7-3 patient has able to
pirme nala ito hiya imbalance to endure or complete shift, the patient sit while eating but
naghihinigda kay dire between oxygen required or desired will be able to report still cant stand and
naman niya kaya supply (delivery) daily activities. measurable increase in walk.
bumuhat” as verbalized and demand as Since anemia is a activity tolerance.  
by the mother of the evidenced by weakness decrease in normal  
patient. and fatigue, decreased number of red blood Specific:
“bisan pagpakaon, exercise or activity cells (RBCs) or less  
nakahigda nala hiya” level and dyspnea. than the normal At the end of my 7-3 Independent:
as verbalized by the quantity of shift, the patient  
mother of the patient. hemoglobinin the will be able to  
  blood, so there is perform measurable Assess patient’s Influences choice of
Objective: also a decreased activities of daily ability to perform interventions or
Bulging eyes oxygen-binding ability living such as normal task or needed assistance.
Pallor of each hemoglobin walking, sitting, activities of daily  
(+) weakness /fatigue molecule due to playing. living.  
Increased abdominal deformity or lack in      
girth : 22 ½ inches numerical development Note changes in May indicate
Irritability as in some other types balance/ gait neurological
Vital signs: of hemoglobin disturbance, muscle changes associated
Temp: 38.8 C deficiency. Since weakness. with vitamin B12
BP: 90/6o mmHg hemoglobin (found   deficiency, affecting
RR: 52cpm inside RBCs) normally   patient safety or risk
HR: 146bpm carries oxygen from of injury.
Dyspnea the lungs to the  
Restless tissues, anemia leads Recommend quiet Enhances rest to
to hypoxia (lack of atmosphere, bed rest lower body’s oxygen
oxygen) in organs. So if indicated. requirements, and
fatigue and weakness reduces strain on
occur. the heart and lungs.
   
Reference: Elevate the head of Enhances lung
www.wikipedia.com the bed as tolerated expansion to
NANDA(Nurses Pocket   maximize
Guide) Serena Nanda,   oxygenation for
Richard L. Warms. Page:   cellular uptake.
201  
· ^ MedicineNet .com  
ASSESSMENT NURSING DIAGNOSIS BACKGROUND STUDY GOALS AND NURSING RATIONALE EVALUATION
OBJECTIVES INTERVENTIONS

Provide or Although help may

recommend be necessary, self
assistance with esteem is enhanced
activities or when patient does
ambulation as some things for self.
necessary, allowing  
patient to do as much  
as possible.  
   
Provide or Although help may
recommend be necessary, self
assistance with esteem is enhanced
activities or when patient does
ambulation as some things for self.
necessary, allowing  
patient to do as much  
as possible.  
   
Plan activity Promotes gradual
progression with return to normal
patient, including activity level and
activities that the improved muscle
patient views tone or stamina
essential. Increase without undue
levels of activities fatigue.
as  
tolerated.  
  Encourages patient
Identify or implement to do as much as
energy saving possible, while
technique like sitting conserving limited
while doing a task. energy and
  preventing fatigue.
   
   
www.wikipedia.com
NANDA(Nurses Pocket
Guide) Serena Nanda,
Richard L. Warms. Page:
201
· ^ MedicineNet .com
ASSESMENT NURSING DIAGNOSIS DESCRIPTION EXPECTED OUTCOMES NURSING RATIONALE EVALUATION
INTERVENTIONS
S: Knowledge deficit A state in which At the end of 8- Independent: Goal met, as
“Ginpatambalan ko related to cognitive hour shift the Provide physical This allows patient evidenced by
ini hiya kay unfamiliarity with information or patient will be comfort for to concentrate on patient’s
bangin nabuyagan” information psychomotor skills able to identify learner. what is being ability to
as verbalized by resources. are lacking causative factors. Allow learner to discussed. identify
the mother of the identify what is This clarifies causative
patient. most important to learner expectations factors.
O: him. and helps the nurse
>Request for Explore attitude match the
information and feelings about information to be
>Statement of changes. presented to
misconceptions Assist the learner individual’s needs.
>Inaccurate follow in integrating This assists the

through of information into nurse in

instructions, daily life. understanding how
development of Give thorough learner’s may respond
preventable explanation. to the information
complications Encourage and possibly how
questions. compliant patient
may be with the
expected changes.

. Collaborative: 4.This helps learner Goal met, as
Provide access make adjustments in evidenced by
information for daily life that will patient’s
contact person result in the ability to
Identify available desired change in identify
community behavior or learning. causative
resources, support 5.To help patient factors.
group. understands well.
6.Learners often feel
shy or embarrassed
about asking
questions and often
want permission to
ask them.
To answer questions,

validate information
post-discharge
Bibliography:
Nursing Care Plan 3rd
Edition, p. 41
 END

Confucius say : " Man who want pretty

nurse , must be patient ." `
-- Anonymous