HISTORY TAKING

Profile of the patient

Identification data
Name of the patient - Master Ajay
Age/sex - 5YRS/Male
Waid/bed no. - p.m.w.I/16
Religion - Hindu
Education - -
Date of birth - 15 june, 2005
Date of admission - 15 feb. 2011
Diagnosis - Nephrotic syndrome
Dr. concerned - Dr. D.G. Shingwabar

FAMILY HISTORY
Type of family - Neulear family
Head of family - Mr. Ram Singh
No of family members - 6
S.No Name Age/sex Relation Occupation Health
1. Mr. Ram 55yrs/m Grand - Joint pain
Singh Grand father
2. Mr.Mohan 29yr/M Father Labour Healthy
3. Mrs.kamla 26yr/M Mother Labour Healthy
4. Master 6yr/M Client - Nephrotic syndrome
Ajay blurred vision
5. Ku.Khushi 8yr/M Sister - Healthy
FAMILY HEALTH HISTORY
Chief complaints as told by his mother are
 Increase frequency of urination (12-15 in 24 yrs.)
 Swelling on the whole body.
 Mild headache.
 Rashes on the buttock region
 Weakness.

PAST MEDICAL HISTORY-

My patient has nothing significant on past medical history.
PRESENT MEDICAL HISTORY
My patient Ajay was admitted in KRH on 15 feb. 2011. due to complaints of excessive sensation, swelling on the
whole body, hypertension, weakness Doctor diagnosed as nephrotic syndrome. New he is undergoing treatment of
mediations that are lasix, amikacin, prednisone. He is feeling better now.

PAST SURGICAL HISTORY-

Nothing significant on past surgical history.

PRESENT SURGICAL HISTORY

My patient Ajay is consumers and oriented. He has no any type of bad habits.
NUTRITIONAL HISTORY-
My patient is vegetarian doctor advised the prevents to give calcium diet, high protein untaken like milk, pulsar
and adequate water to drink.

SOCIO-ECONOMIC STATUS
Type of House - Kacheha
Area of living - Rural Area
Ventilation - Properly ventilated
Derange - not purer
Electrify - Available
VITAL SIGNS
S.No. Vital signs Patient valve Normal valve Remarks
1. Temperature 95.20F 96-60-980F Normal
2. Pulse 62 bits/min 60-110 bits/min Normal
3. Respiration 18 bits/min 16-20 bits/min Normal
4. Blood pressure 116 bits/mm of Hg 90-60 bits/mm of Hg Hypertension

LAB INVESTIGATION
S.No. Test Normal value Patient value Remarks
1. Uric acid 2.5-5 mg/dl 43 Increased
2. Urea 5-18 mg/dl 27 Increased
3. Serum Believing 5-40 U/L 0.40 Normal
4. SGOT 5-28U/l 27 Normal
5. SGPT 5-28 U/L 44 Normal
6. Alkaline phosphate 20-150 119 Normal
7. Serum Protein 6-2-8-0gm/dl 5-6gm/dl Decreased
8 Serum Albumin 40-50gm/litue 1.9 Deareased
ANTHROPOMETRIC MEASUREMNT
Head circumference - 49 cm
Chest circumference - 53 cm
Weight of the patient - 20kg
Height of the patient- 109 cm
Mid-aim circumference- 13cm.

PHYSICAL EXAMINATION

GENERAL APPEARANCE
Body build - fatly
Health - unheal
Activity - dull

MENTAL STATUS
Consciousness - conscious
Look - worried
POSTURE
Body carves - no body craves
Movement - normal range of motion is patient

SKIN
Lanugos - Absent
Colour - pallor
Texture - day skin
Lesions - skin lesion on the buttock region.
HEAD & FACE
Symmetry - well symmetry
Head circumference - 49 cm normal
Hairs - black hairs
Face - pale colored, puffiest
Scalp - dandruff is absent.
Eyes-
Eyebrows - present
Eyelashes - no inflation
Eyelids - no crust formation
Conjunction - no inflammation
Vision - normal vision
Pupil size - equally reating to light.
Down syndrome - absent
Hypeteleism - absent
Hypotetriom - absent
Blinking relive - present
Strabismus - absent

EARS
External ear - no abnormal discharges
Hearing - no difficulty in hearing
Set of ears - low set of ear is absent.
Nose
External nose - no devated nasal septum
Nasal flaming - absent
Nostrils - no abnormal desecrates

MOUTH & PHARYNX –

Lips - cracked lips, no let late
Odour of mouth - fowl smelling
Thrush - not present
Teeth - desecration of teeth
Tongue lie - absent
Tongue - dry wasted
Throat and pharynic - no enlargement
Gagging reflex - present

NECK
Symmetry - congenital tort Collis is absent
Lymph nodes - no enlargement
Thyroid gland - no enlargement
Range of motion - difficulty due to pressure sources
Trauma - absent

CHEST
Thoraic - symmetry of expansion
Rate of rhythm - decrease heart rate
Inspection - no abnormality seen
Percussion - no fluid collection
Auscultation - heat sounds corer normal
Breath sounds - no wheezing sound.

ABDOMEN
Observation - swellings and distention is present 49cm
Auscultation - bowel sounds one not clear.
Palpation - spleenomegaly
Regression - mild ascities
Lowes limib - normal range of motion is not possible due
to pressure sores, swelling do leg.
Fingers & nails - webbing of finger are absent.

BACK
Absence of Lordsis, hypnoses, sculleries, spina bifida.

GENITALIA & RECIUM

No abnormal discharges.
ANATOMY OF NEPHRONS

Kidneys: The kidneys are a pair of bean shaped brownish-red structures located retrope ritoneally (behind and
outside the peritonal cavatiy) on the posterior wall of the abdomens from the 12 th thoracic vertebra to the third
lumbar vetebra in the adult.
The advantage adult kidney weights aprons. 113 to 170 g. and is 10-12 cm long, 6cm wide & 2.5 cm thick.
The right kidney is slightly lower than the left due to the location of the lobes
Nephrons: Each kidney has 1 million neurons, which usually allows for adequate nonfunctional. Even if the
opposite kidney is damaged or becomes nonfunctional. The nephrons are the structures located within the seal
parenchyma.
There are two kinds of nephrons.
The cordial nephorns: which make up 80% to 85% of the total no, are located in the outermost part of the
curtain?
The junctameduallry nephrons: which make up the remaining 15% to 20% are located deeper in the cortex. The
junctameduallry nepherons are distinguished by long lows of henlg.
 Nephrons are made up of two basic components a filtering element composed of an enclosed capillary
networked and the cartouche tubule. The glomerulur is a unique network of capillaries suspended between b/w the
afferent & efficient blood vessels, which are enclosed in a epithelial structure called Bowman’s capsule.
The tubular component of the neoprene begins in the Bowman’s capsule. The tubular component consent of
Bowman’s capsule, the proximal tubule. The descending & ascending limbs of the coop of hence and the cordial &
medullar collecting ducts.

Physiology of nephrons
Each kidney has million nephrons which essually allows for adequate renal function if the opposite kidney
is damaged or becomes nonfunctional.
In glomerular capsule. The glomerular membrane is composed of 3 filtering layers: the capillary
endothelium, the basement membrane and the epithelium. This membrane normally allows filtration of fluid &
small molecules yet limits passage of large molecules, such as blood celles and albumin.

NEPHROTIC SYNDROME
Introduction: Nephrotic syndrome is one of the common cause of hospitalization among children. Incidence of the
condition is 2 to 7 per. 1000 children. It is more common in male child. Mean age of occurrence is 2 to 5 yrs move
than 90% of childhood.

DEFINITION:
According to dowthy R. Marlow: The nephroitic syndrome is clinically defined state characterized by potential,
hyoalbuminea, hyperlipidemia and edema.
According to parul dutta Nephrotic syndrome is a symptom compliance manifested by massive edema, hypo
albuminoidal marked albumin and hyperlipidemia.

TYPES
BOOK PICTURE PATIENT PICTURE
1. congenital nephrotic syndrome
A hereditary form of nephroitic
syndrome, is present in infancy. edema
are significant early findings often
immediately after birth.
 1Primary nephroitic syndrome It is the Primary nephroitic
most common type (about 90% and syndrome.
regarded as countermine phenomenon as
it responds to immenosupprrsive therapy.
2. Secondary nephroitic syndrome
When the necrotize syndrome occur as
paid of a recognized systemize disease or
result from some evident cause.

Incidence: The annual incidence of nephroitic syndrome in the united states in children younger than 16 yrs is 2 er
100, 000 children.
nephroitic syndrome can present at any age, but the onset is usually between 2 & 7 yrs. With a mole- to
female ratio of 2 to 1%
 ETIOLOGY
S.No Book picture Patient picture
1 Primary renal causes
- Minimal change nephropathy
- Mechanical proliferation
- FOCAL GLOMERULOSLEROES
- immune complex glummer
- Congenital nephrons.
2) Systemic causes
- Inflation Inflation
- Toxins
- Allergies
- Cardiovascular
- Malignancies

CLINICAL MANIFESTATION
BOOK PICTURE PATIENT PICTURE
Weight gain Weight gain
Puffiness of face present
Abdominal swelling Mild ascities
Pleural effusion
Ankle /leg swelling leg swelling present
Easily fatigued
Lethargic
infection urine alteration. Increased frequency of urination.
DIAGNOSTIC EVALUATION
S.NO BOOK PICTURE PATIENT PICTURE
01 History taking History taking
02 Physical examination Physical examination
03 Complete blood count
04 Ultrasound Ultrasound
05 Urinalysis Urinalysis
06. Scream studies Scream studies
Serum bilisubin Serum bilisubin
SGOT SGOT
SGPT SGPT
07 Serum protein Serum protein
08 Serum albumin Serum albumin
09 Serum calcium Serum calcium

COMPLICATION
S.No. Book picture Patient picture
01 Infection
02 Hypovolemia Hypovolemia
03 Circulatory insufficiency
04 Thromboembolisim
 PHARMACOLOGICAL MANAGEMENT
S.No. Book picture Patient picture
1. Corticosteroid Predinsone tab.
2. Dubieties Furosemide
3. Antibiotic Amikacin, ciplone
4. Antipretic Paracetanwaf tab.
5. Antacid Aciloc tab.

Drugs Dose Frequency Function indication

INJ LASIX 2.5m BD Loop duiretce reapportion Increased toni city : literal digitalis
l of Na & cl at proxemial and Infuriated ob lovirty. Decreased anti
distal tube and in the loop hypertensive effort.
of hence.
INJ 300m B1) Interferes with protein Serve system infection of CNS,
AMIKACIN g synthesis in bacterial by
binding to ribosomal subnet
which causes misreading of
genetic code.
 NURSING MANAGEMENT

GOALS:
a) Providing Care During hosptialization.
b) Administering Mediations
c) maintaining proper fluild balance and
d) assessing edema.
e) ordering a nutritious diet
f) preventing inflation
g) preventing skin breakdown
h) promoting psychological growth
i) providing emotional support and education
j) For all family members.
1) Providing care during hospitalization.
 parents should be enivlved in setting goals and in planning care for their children.
 Try to maintain a good IPR with client and family members.
  Detailed charting of vital signs, weight, activity level untaken and output.
2) Administering mediation.
 The nurse must be aware of the casual side effects and copulation of steroid therapy.
 The child should be observed for GI bleeding & unless treated c antacid.
 If vomiting occurs during steroid therapy the modulation should be administered with milk or food.
3) Main ting proper fluid balance and assessing edema
 Monitoring sodium and fluid taken orally & IV.
 Daily weight and urine is tested for albumen and specific gravely..

4) Providing a nutritious diet.

 Small frequent feedings that are nutritionally balanced
 A sodium restricted diet is recommended only when there is marked edema.
 Daily flaccid gate should be at minimum equal to urinary output.

5) Preventing infection
 Control with infected person should be avoided.
 Child should be kept dry and warm.
6) Preventing skin breakdown
 Change the potion frequently.
 Meticulous skin care is gain to the edematous areas opposing skin surfaces should be kept clean , separated
with soft cotton and powdered to avoid breakdown through fruitions.
 Avoiding enclosure to heat or old, provide loose lothing to avoid leriation and keeping child’s nails trimmed.
 NURSING DIAGNOSIS

1) Altered tissue perfusion:- Altered tissue perfusions dies to nepenthe syndrome related to hypertension
evidenced by increase blood pressure and mild headache; wetting.
2) Fluid volume excess:- fluid volume excess related to desires condition eve dined by edema and underside
frequency of urination.
3) Risk for infection: Risk for unfitting related to poor nutritious status.
4) Impaired skin integrity:- Impaired skin intergraty related to edema evidenced by redness, irratation of skin
on back and buttock septum region.
5) Knowledge defect:- Knowledge difficult about the decease condition, treatment, diet evedenied by parent’s
report.
 Assessment Nsq Goal Intervention Rationale Implementation Evaluation
diagnose
Data Altered tissue Maintai Asoses and nonitor Assossment of protein loss helps Assessed protein On
subjective perfusion n normal losses of peotein in to determine replacement loes in lecine. evaluation it
My patient related to tissue urine needed. Mentioned the is found that
parents heypestensium perusing Moneter the child Homitoing BP ensures early child blood child blood
complaints due to disease blood pressure energy recognition and prompt pressue eney 4hr pressure get
about the mild condition on 4hrs. treatment of hypelansion. Kept on oral normal
headwall, evidemed by Keep on oral always Oral airway and situation curiway and
sweating, hypeactenstion, and suetion equepinent equepoint should be available, section
giddiness. mild headache. near the child’s bedsedi because severse hypertensior equaceprent near
Objective Restriet swdium in the encreases the sisk for seizures. the Childs bed
data diet as oxdated by the Restiulted sodium in diat as Restituted sodium
On doctor, sodium uniqaser blood pressure. in the deet.
observation it Administer Adminemestration of Administered
is found that antihypeitensive centihypelonsive dugs helps to antihypertensive
my patient medcation as ordered clavese blood pressure and risk cloves.
having hyper by the physucion of olha compliation.
tension.
Subjective Fluid volume Deseces Weigh the held daily at Daily weighing helps to Weight the chili at On
data parents evcess relate to e edema the same time sing the determine flutuators in the child the same time salutation it
compla-ents desease & urine some, stude flucd status. each day as found
about the evederied by out put Monitor the child fluid Dily homitoing of untabe and Monitored the that the
swelling of edema and of 1-2 inta ka and output output helps to determine the child fluicd sltus. child fluid
the whole increased m/kg./hr Monitoning the child child fluid status. Placed the child volume is
body and utination. . for deveased urine Plaing the child on sodium on sodeinrestuted main tained.
cresed specific granety. restriled diet helps to prevent diet.
frequencyof Assess skin cntegity. fluid retention. Monitored the
clunation. Monitoring is necessary beurse child for deceased
dersed with spcifi gravely urine sp civic
undiates dunicie. gravelty.
Ssossment lindial, skin Assessed skin
breakdown. Dome may unelase integrity.
the risk of skin ulegity.
 HEALTH EDUCATION

Personal Hygiene
Advised the parents.
 To provide daily mouth care to the child .
 Clean the body of the child daily with warm water.
 To change the cloths daily
 To keep the child finials trimmed to avoid serializing and excoriation.

Diet
 Advised the parents
 To give small frequent feedings that we neither tiorsly balanced.
 To give low sodium diet.
 To give low caloric diet as a child may be overweight.
 To give diet containing sufficient amount of protein.
Exercise
 Advices the position of child frequently every 2 hrs.
 To change the position of the child frequently every 2 hrs.
 To provide active and passive exersise.
 BIBLIOGRAPHY

1. “TEXTBOOK OF PEDIATRIC NURSING”

“BY: DOROTHY R-MARLOW”
EDITION: 6TH
PAGE N0. 834-836

2. “WONG’S ESSENTIAL OF PEDIATRIC NURSING”

“BY: DON“EDITION: 2ND
“PAGE No: 1043-1046

3. “TEXTBOOK OF PEDIATRIC CARE PLANNING”

“BY: KATHLEEN MORGAN SPEER”
“EDITION: 3RD
‘’PAGE NO.: 153-155”
4. “NURSING DRUG REFERENCE”
“BY: MOSBY’S”
“PAGE NO: 880-881, 836-837, 486-487”

5. PRINCPLES OF ANATONMY AND PHYSIOLOGY”

“BY: GERARD J. TORTORA”
“EDITION: 11TH
‘’PAGE NO- 999