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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-asthmatic mother delivery via normal spontaneous delivery with no fetomaternal complications 2. 3. . all are taken orally and client has no allergic reactions to any drugs. the child’s appetite has been slightly affected because of dietary restrictions. nursery Gordon’s Functional Health Pattern A. She doesn’t experience any gum and dental problems. eats whatever the mother offers such as chicken. Client doesn’t like orange juice and prefers to drink milk or water. veggies and fried fishes or any kind of dishes. B. Diet history Breastfed for 6 months. Right now. 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. likes eating junk foods. Immunizations The client completed her immunizations before 1 year old and therefore considered as Fully immunized child (FIC) 4. non-hypertensive. This is her first time and it was explained to her properly why based on her age.CASE STUDY Acute Poststreptococcal Glomerulonephritis G3P3. Functional Health Pattern Assessment Client is admitted due to the ruled out diagnosis of AGN. non-diabetic. Nutritional and Metabolic Pattern Family eats thrice a day and usually the client eats first. Home medications were given upon first check up. Among her favorite foods are chicken and veggies of any type.
CASE STUDY Acute Poststreptococcal Glomerulonephritis C. Needs assistance in performing personal hygiene and grooming. . Activity-Exercise Patterns Client goes to school in the morning and usually watches cartoons during noon time. taking a bath. She knows how to identify basic colors and shows interest in drawing. Feeding: 2 Bathing/ hygiene: 2 Dressing / grooming: 2 Toileting: 2 F.g brushing teeth. Client is a bit of shy. Has no problems with urination and wears diapers during night time. D. 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. No reported changes. combing hair etc. Currently enrolled as a nursery student and participates actively in school. Self Perception-Self Concept Pattern The child takes time to adjust to people whom she met for the first time. She sleeps together with her parents in one room with lights off. vision problems and no learning disabilities. No experienced sleep disturbances during the client’s stay in the ward but she started to snore upon the first day of confinement. Cognitive-Perceptual Pattern No hearing difficulty. There are also some restrictions in the type of TV shows being watched. e. G. cries when being teased by older brothers and recently having trauma with the series of laboratory procedures being undergone. usually daytime. E. No problems reported.
. And is an accident prone just like children of her age. Client doesn’t have any speech or hearing problem. Role Relationship Pattern The mother is the primary care giver and is a housewife. The client’s hospitalization affects the family budget. I. Value-Religion Pattern Client’s family is a Roman Catholic and do religious practices like praying before meal or bed time. Coping Stress Tolerance Pattern Client has no temper tantrums. J.CASE STUDY Acute Poststreptococcal Glomerulonephritis H. Father works as a family driver.
00-100.2 reference value 11. 2010 Yellow Turbid 1.00 g/dl 31.00 % 3.2 27. 2010 Creatinine: Sodium: Potassium: ASO TITER: Hematology Hgb: Hgt: RBC count: MCV: MCH: 41 MMOL / L 139 MMOL /L 5.8 3.30 x 106 / L 80.00-16.00 fl 27.00-43.0 Trace Negative 3+ Negative Normal Negative Negative Trace 2-4 / HPF TNTC Rare Rare Rare February 17.2 25.CASE STUDY Acute Poststreptococcal Glomerulonephritis DIAGNOSTIC EXAMINATIONS February 14.00-31.65 76.00 pg Light yellow Slightly turbid 1. 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 14.90-5.010 7.020 6.0 +1 (--) +3 (-) (-) (-) (-) +2 15-20 / HPF TNTC Rare Rare Few .1 MMOL /L Positive Results 9.
4 x 2.00-400.00-50.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 31.7 cm .Urinary bladder is well distented .00-37.8 x 3.Right kidney: 7.00-3.CASE STUDY Acute Poststreptococcal Glomerulonephritis MCHC: Platelets: WBC count: Eosinophil: Neutrophil: Lymphocyte: Monocyte: RDW February 15.00 % 42.29 4 58 31 7 14.00 % 4.00-43.Pre void volume: 130cc .1 316 10.2 x 3.50-15.00 x 103 / L 5.00 % 25.00m x 103 / L 2.0 x 3. 2010 ULTRASOUND 33.00 % 8.00 KUB UTZ PRE and POST VOID: .00 pg 150.Left kidney: 7.Both shows increased parenchymal echogenecity .00-17.00-5.2 cm .
ketones. a diet low in carbohydrates and high in protein and fat can raise ketone levels in the blood which can then enter the urine. in which the test results can be read as color changes. Usually. protein. For example. A part of a urinalysis can be performed by using urine dipsticks. physiology. A low RBC indicates anemia. normal pregnancy. hemolysis. HEMATOLOGY Definition: Hematology. Normal urine may vary in color from almost colorless to dark yellow. glucose. the blood-forming organs. and pediatrics that is concerned with the study of blood. is the branch of internal medicine. A low HCT indicates anemia. severe hemorrhage. Nitrites.CASE STUDY Acute Poststreptococcal Glomerulonephritis Cardiomegaly Bilateral moderate pleural effusion February 16. and blood diseases. Interpretation: the urinalysis results are normal. and bilirubin are not detectable in urine. clinical laboratory work. cancer. kidney disease. 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. which often leads to fatigue. pathology. and splenomegaly. White blood cells. The following are not normally found in urine Hemoglobin. hemorrhage and leukemia. . Interpretation: a low HGB indicates anemia. 2010 C3 – 430 mg / L LAB RESULTS: Definition. Nursing Consideration: Special diets can change test results. Red blood cells.
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. diet list. Nursing Consideration: should be aware of tests that do require special food restrictions. if required for testing or for the procedure. Some tests require fasting prior to the test. or other special diet. Many hospitals have a specific procedure to follow for NPO. and put signs in their room. Mild pulmonary congestion. Also remember that some tests/procedures might require that the patient consume a light meal. young adults and thus. Be sure to follow this procedure and follow-up on keeping them NPO. Xrays have a wavelength in the range of 10 to 0. It is no secret that many tests and procedures had to be canceled at the last minute because the patient ate some food. Cardiomegaly Bilateral moderate pleural effusion Nursing Consideration: The effect of X-rays on the film depends upon three factors: PPV.01 nanometers. Decreased MCH occurs in microcytic anemia or hypochromic anemia. And the rest is normal. Be sure you inform your patient verbally and in writing. it is approximately 20 kilohertz (20. the intensity of X-rays and the contrast equivalent X-ray tube voltage. 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. They are shorter in wavelength than UV rays. . Be sure to mark the patient's chart.CASE STUDY Acute Poststreptococcal Glomerulonephritis MCV decreases value may indicate iron deficiency anemia and thalassemia. Be sure that the staff is informed of any food restrictions. Interpretation: Mild perihilar pneumonia. Although this limit varies from person to person. a liquid meal.000 hertz) in healthy. ULTRASOUND Definition: Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing.
Obtaining a blood sample from some people may be more difficult than from others. groups of tests that are performed to evaluate the function of the body’s major organs. such as a burning feeling or abnormal discharge during urination.. below the ribs. Blood is drawn from a vein. and nephrotoxic drugs. Discussion and consensus of the exact treatment goals with patients and their families must be done prior to treatment. decrease in the amount of urine. or a change in the frequency of urination. such as cephalosporins (e. An elastic band is placed around the upper arm to apply pressure and cause the vein to swell with blood. Nursing Consideration: Avoid Drugs that can interfere with creatinine clearance measurements include: cimetidine. especially at night .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. cefoxitin). .High blood pressure . CREATININE BLOOD TEST Definition: Creatinine blood test is used along with a BUN (blood urea nitrogen) test to assess kidney function. or coffee-colored . usually from the inside of the elbow or the back of the hand.g. Both are frequently ordered as part of a basic or comprehensive metabolic panel (BMP or CMP). The puncture site is cleaned with antiseptic. near where the kidneys are located. ASO TITER Definition: ASO titer is a blood test to measure anti-streptolysin O (ASO) antibodies. Interpretation: Urine that is foamy. Mid-back pain (flank). Problems urinating. trimethoprim. Veins and arteries vary in size from one patient to another and from one side of the body to the other. bloody.
000U. rheumatic fever. q12h Pen G 400. orally.CASE STUDY Acute Poststreptococcal Glomerulonephritis Interpretation: active streptococcal infection. fainting or feeling lightheaded after the blood is drawn. but may include slight bleeding from the blood-drawing site. q6h . bacterial endocarditis. or blood accumulating under the puncture site. intravenously. scarlet fever Nursing Consideration: The risks associated with these tests are minimal. MEDICATIONS Furosemide 10mg. post-streptococcal glomerulonephritis.