TARLAC STATE UNIVERSITY

COLLEGE OF SCIENCE
DEPARTMENT OF NURSING
Awarded Level III Status by the Accrediting Agency of Chartered Colleges and Universities
in the Philippines

ACUTE
GLOMERULONEPHRITIS
NCM 112
Clinical Grand Case Study

Submitted by:
Basangan. Ella
Bongato, Bernadette
Buhay, Catherine
Diolazo, Kristin Erika
Dumayas, Bea Yzabel
Fernandez, Dexter Ivan
Garcia, Maya Angelou
Magcalas, Jeremiah
Nicolas, Jennifer
Tabangcora, Pearl Raven

Submitted to:
Ms. Rowena G. Escoto, RN. MSN.
Clinical Instructor
I. INTRODUCTION
Glomerulonephritis is inflammation of the glomeruli in the kidneys. Glomeruli remove excess
fluid, electrolytes and waste from the bloodstream and pass them into the urine. Glomerulonephritis
can come on suddenly or acute, or gradually or chronic. Glomerulonephritis can be either primary or
secondary to a systemic disease. In primary glomerulonephritis, disease is almost entirely restricted
to the kidneys while in secondary glomerulonephritis it occurs in association with more diffuse
inflammation. Acute glomerulonephritis is more common in children older than two years of age;
however, it can develop on individuals at any age. Chronic glomerulonephritis, in contrast, develop
due to repeated episodes of acute glomerulonephritis and other hematologic disorders such
hypertension and kidney injuries. Acute glomerulonephritis most often occurs as a complication of a
throat or skin infection with streptococcus, a type of bacteria. Infections with other types of bacteria,
such as viral infections, chickenpox, and parasitic infections, such as malaria, can also result in acute
glomerulonephritis. Acute glomerulonephritis that results from any of these infections is called
postinfectious glomerulonephritis. Glomerulonephritis could develop in a patient who had a recent
history of streptococcal infection caused by Group A beta-hemolytic streptococcus due to immune-
complex mediated factors. Thus, poststreptococcal glomerulonephritis is the most common type of
post-infectious diseases. (Hinkle & Cheever, 2018).
Glomerulonephritis is rare, with an estimated worldwide incidence of 0.5–2.5 per 100,000
patients per year depending on the specific type (Nanchen, G. et al., 2020). The Pediatric Nephrology
Society of the Philippines Census Report for 2018 states that from 1995-2018 Acute Post infectious
Glomerulonephritis has 8283 incident report and for Secondary Glomerulonephritis (e.g., SLE, HSP,
etc.) is 2256 from 1995-2018.
We, the students from Tarlac State University - College of Science, under the Department of
Nursing, with the supervision of our clinical instructor Ms. Rowena Gabriel Escoto, decided to take
up this particular topic. The general objective of this case study is to impart knowledge to the
individuals so they may know the different phase of the disease Glomerulonephritis. For health care
providers, its objective is to expand their capabilities for giving the best treatment and interventions
holistically whereas for students it is for better understanding regarding the extent of
glomerulonephritis. In addition, this study may benefit not only for the patients but also their families
in a way it provides information about their symptoms, medical history and their diagnoses.
Having the knowledge upon the different causative factors that precipitates the progression into
glomerulonephritis will help in easily identifying possible risk of having this disease and connecting
it to the presenting symptoms the patient is having.
 General Objective:
1. To improve and broaden our knowledge regarding Acute Glomerulonephritis. Also, to
satisfy and meet the optimum health needs of the patients, and to be able to gather
information to our patient’s case so we can achieve maximum care.

Specific Objectives:
• To build a rapport to the patient and establish a nurse patient relationship holistically.
• To assess the patient holistically
• To formulate accurate and relevant nursing diagnosis depending on the patient’s needs
• To plan and carry out nursing intervention that will address patient’s concerns and health
problems
• To give strong, protected, defensive, and agreeable measures/interventions to the
patients and work together with other medical services staff who engages with the
patient’s care and therapy.
• To assess all the given nursing interventions that have been given and the outcomes of
the patient's condition.
• To educate the patients regarding health and apply those health teachings to improve
the patient’s condition.

II. NURSING PROCESS

A. ASSESSMENT STAGE

1. PERSONAL DATA

a. Demographic Profile
i. Name: Patient X
ii. Age: 25 years old
iii. Sex: Female
iv. Civil Status: Single
v. Occupation: Waitress
vi. Position in the Family: Eldest daughter
vii. Address: San Isidro, Tarlac City
viii. Date of Birth: August 21, 1995
ix. Place of Birth: San Isidro, Tarlac City
x. Nationality: Filipino
xi. Chief Complaint: Swollen Hands
xii. Date of Admission: February 11, 2021
xiii. Admitting Diagnosis: Acute Glomerulonephritis
xiv. Final Diagnosis: Post Streptococcal Glomerulonephritis
b. Environmental Status
Patient X is currently living in San Isidro, Tarlac City with her family, she works as a waitress in
a fast-food restaurant. Their house is located beside the road where vehicles mostly passing by. She
stated that their house is made of cement and woods which is sturdy enough for them to live in and
well-ventilated. According to her, cockroaches, mosquitoes, flies, and other insects are present, and
they also own some basic appliances such as television, radio, and electric fans. Their electricity and
water connection are supplied by the City and their mode of transmission are walking, tricycle,
jeepneys and buses. Garbage collection trucks by the City collects their waste every Monday and
Friday making sure that it is properly disposed.

c. Lifestyle
Patient X commonly consume rice, meat, noodles, canned foods, processed foods such as
hotdogs and sausages for her meals and drink about five glasses of water daily. During snack time,
she loves to eat bread or junk foods and does not take any food supplements or vitamins. She usually
has 5 hours of sleep and does not perform any exercise due to her schedule in work. Also, she does
not smoke or consume alcohol beverages. According to her, she loves to cook, listening to music,
and spending time with her parents.
2. FAMILY HEALTH HISTORY
Patient’s grandfather on both paternal and maternal side are deceased due to vehicular accident and Asthma. According to her, both of her mother and maternal grandmother has
hypertension while her father has Urinary tract Infection and her eldest uncle died due to vehicular accident. And all the patient’s siblings are living healthy.

PATERNAL SIDE MATERNAL SIDE

Grandfather Grandmother Grandfather Grandmother

Aunt Uncle Father Uncle Aunt Uncle Mother

Aunt Aunt

Patient Brother Brother Sister

Deceased Male Living Male Vehicular Accident

Deceased Female Patient Asthma

Living Female Urinary Tract Infection

Hypertension
3. PAST MEDICAL AND HEALTH HISTORY
Patient X stated that she had fever and infected skin lesions on her thighs and feeling itchy three
weeks ago. She seeks medical consultation to a Physician and prescribed to take an antibiotic which
is Penicillin G, 500 mg tablet that should be taken twice a day for a period of 10 days. Two months
ago, she was tested negative on her HIV Test with no history of unprotected sex.
Patient X has recurrent Urinary tract Infection, she was initially diagnosed when she was 18
years old, and her physician prescribed to take Trimethoprim 100 mg Per Orem twice a day for 10
days. Patient X recover after completion of her antibiotic treatment. Subsequently, her Urinary Tract
Infection reoccur in the next year. Thus, her physician prescribed to take Nitrofurantoin 50 mg per
Orem, once a day for 3 months that used as prophylaxis for her recurrent Urinary Tract Infection.
Patient X had completed his childhood immunization from the Rural Health Unit. She had coughs
and colds during her childhood and used herbal medications such as boiling of oregano and Lagundi
leaves to alleviate her condition and had a chicken pox at the age of 5. She never had operations
and serious accidents or injuries and according to her she does not have any known allergies to any
kind of food and drug.

4. HISTORY OF PRESENT ILLNESS

The 25-year-old female patient presented to her primary healthcare physician complaining of
swollen hands for the last week. She had also noticed that over the last two days there was swelling
around her eyes and experiencing shortness of breath.
During the admission, the client experiencing tachypnea with bibasilar crackles heard upon
auscultation of the lungs, generalized body weakness, periorbital edema, and grade 2 bilateral
edema on hands and feet. Laboratory test were performed such as Urinalysis, Chest X-Ray, Arterial
blood Gas, Light Microscopy, Immunofluorescence, Electron microscopy, Complete Blood Count,
Serum Electrolytes, Blood Chemistry, Anti-Streptolysin O Titer Test, with the clinical result and
diagnosis of Post Streptococcal Glomerulonephritis.

5. 13 AREAS OF ASSESSMENT

1. SOCIAL STATUS

Patient’s Data Norms Analysis

Patient X is a 25 years old
female living in San Isidro,
Tarlac City with her family.
She is the eldest of the four
siblings and she has a close
relationship with her family.
She stated that they routinely
go to church every Sunday
together with her family and
she usually like to socialize
with her friends. The patient
The ability to interact The patient was sociable and
successfully with the people has a good relationship with
and within the environment of her family and friends.
which each person is a part,
to develop and maintain
intimacy with significant
others, and to develop respect
and tolerance for those with
different opinions and beliefs.
This is a period of
transformation, with a
also stated that she is
currently work as a waitress
and she usually get along with
hee colleagues.
realization of mortality and a
concern for health. There is
an increase in warmth and a
decrease in negativism. The
spouse is seen as a valuable
companion (Berman et.al.,
2018).

2. MENTAL STATUS

Patient’s Data Norms Analysis

General Appearance and The patient should appear The patient is well-groomed
Behavior: Prior to admission, relaxed with the appropriate and well-oriented. She was
Patient X has a tidy amount of concern for the well-oriented and aware of her
appearance and with clean assessment. The patient condition. However, the she is
clothing; however, the patient should exhibit erect posture, in distress due to difficulty of
looks weak and irritable due tosmooth gait and symmetrical breathing. GCS score is
difficulty of breathing and is body movement. The patient 15/15. The patient’s speech
working hard to breath by should be clean and well- was altered due to her
using of accessory muscles groomed and should wear condition. She was able to
while breathing. There is also appropriate clothing for age, remote his memories and
frequent change in position weather, and socioeconomic good intellectual functioning.
due to irritability. status. Facial expressions
should be appropriate to the
Level of Consciousness: content of the conversation
During the interview, the and should be symmetrical.
patient looks sluggish with a The patient should be able to
GCS score of 15/15. produce spontaneous,
However, the patient coherent speech. Content of
response in a slow manner the message should match
and is weak in appearance. the patient educational level.
The patient should be
Orientation: Patient X was correctly responding to
able to answer questions questions and to identify all
about her properly and the objects as requested.
correctly and was able to Denial and poor eye contact
identify where she is and the are normal response on the
date today. She was also able first interaction that may be
to state the time of the day. due to uneasiness on the
He was aware of her condition presence of a stranger or an
and the procedures she will attempt to screen or ignore
undergo. unacceptable realities by
refusing to acknowledge
Speech: During the interview, them. The patient should
Patient X speaks in a slow demonstrate a realistic
manner due to awareness and understanding
lightheadedness. of self. The patient should be
able to evaluate and act
Intellectual Function: Patient appropriately in situations
X was able to respond to our requiring judgment. Thought
question properly and process should be logical,
correctly. She was also able coherent and goal-oriented.
to remember her past history Thought content should be
and recent significant based on reality (Jensen,
happenings to her. Patient 2019).
was able to elaborate habits
that contribute to her
condition.
Patient’s Data
According to the patient, she
is feeling anxious and worried
on what might happen to her.
She stated that if she was
able to surpass her current
condition, she will take care of
herself more. Despite of her
condition, she is hopeful
knowing that her family is
always there to support her.
Patient’s Data
Upon assessment, Patient X
has no corrective lenses. Test
for visual acuity was
performed using Snellen chart
with a result of 20/20. Six
cardinal field of gaze was also
performed, and she was able
to move her eyes on all fields
without difficulty or
tenderness.
Patient X’s nose is
symmetrical and nostrils are
patent. No epistaxis was
noted, and there is no
presence of lesion. she was
able to determine and classify
the scents of coffee and mint
correctly in both nostrils.
Patient X’s ears were clean
and well-groomed. Using
whisper test, standing in the
distance of 2 feet away from
the client, the patient was able
to determine the word
correctly in both ears.
Patient X is not using any
dentures, and stated that she
has no difficulty in masticating
3. EMOTIONAL STATUS
Norms
Normally, the patient should
have the ability to manage
stress and to express emotion
appropriately. It also involves
the ability to recognize, accept
and express feelings and to
accept one’s limitations
(Berman et.al., 2018)
4. SENSORY PERCEPTION
Norms
The client who has a visual
acuity of 20/20 is considered
to have normal visual acuity.
The eyes must be
symmetrical during the six
cardinal gazes’ test. The
sclera should be white with
some small blood vessels.
Papillary constriction should
occur when struck by light.
For the auditory acuity, the
patient should be able to hear
the tick of the watch 2 inch
away from the ear. Nose must
be symmetrical and along of
the face. Each nostril must be
patent and recognize the
smell of an object (Jensen,
2019).
Analysis
The patient was anxious and
worried about her condition,
especially on what might
happen to her during her
hospitalization, but she has a
good coping mechanism.
Analysis
Patient X has a good visual
acuity. She has intact sense
of smell, as manifested by
the ability to distinguish two
different odors. Her nose is
symmetrical and nostrils are
patent. No epistaxis was
noted and there is no
presence of lesion. The ears
of patient are clean and well-
groomed, and has a normal
hearing acuity. She has a
normal sense of taste and can
distinguish two different
flavors and she has a normal
tactile sensitivity and can
easily distinguish different
sensations such as heat, cold,
and pain sensations.
and swallowing. In assessing
the sense of taste, different
flavored-candies, coffee, and
mint were used. The patient
was asked to determine the
flavors, and was able to
recognized it correctly.

Patient X was asked to close

her eyes. Test tubes with
warm and cold water was
used to assess for heat and
cold sensations, and a paper
clip to assess for pain
sensation. She was easily
able to determine the sites
and sensations of being
touched.

5. MOTOR STABILITY

Patient’s Data Norms Analysis

During her confinement,
Patient X has decreased
movement due to
lightheadedness and
dizziness. She had some
difficulties in performing
activity of daily living
independently because of her
condition. She was not able to
perform full range of motion,
but her family helps her to
perform passive range of
motion every day.
Patient should have a smooth The patient is having difficulty
and well-coordinated in moving due to dizziness
movement. Her hands should and lightheadedness. Her
swing freely on the side. A edema alco contributes to her
patient should have a normal lack of movement.
gait, able to walk in smooth
and steady manner. Abnormal
findings might have hand
tremors, uncoordinated
movement, stiffness, shuffling,
shoulders should not be
slumped (Hinkle & Cheever,
2018).

6. BODY TEMPERATURE

DATE TEMPERATURE ANALYSIS

February 23, 2021 36.4 oC Normal
February 24, 2021 37.1 oC Normal
February 25, 2021 37.3 oC Normal
February 26, 2021 36.9 oC Normal
February 27, 2021 37.0 oC Normal
Patient’s Data Norms Analysis
Axillary temperature was Normal axillary temperature is The patient has a normal body
obtained from the patient within 36.4 to 37.4 centigrade temperature and skin warm to
daily. She had normal body (Berman et.al., 2018) touch.
temperature all throughout her
admission.

DATE
February 23, 2021
February 24, 2021
February 25, 2021
February 26, 2021
February 27, 2021
February 23, 2021
February 24, 2021
February 25, 2021
February 26, 2021
February 27, 2021
Patient’s Data
To prevent any alteration, the
patient’s respiratory rate was
taken while blood pressure is
being obtained. Upon
admission, the patient is
tachypneic with respiratory
rate of 29cpm. Use of
accessory muscle particularly
the trapezius and
sternocleidomastoid were
observed. Oxygen saturation
was taken using a pulse
oximeter with a result of 93%
which denotes mild hypoxia.
Auscultation was also done to
the patient, and crackles was
heard and noted at the base
of the right and left lung.
DATE
7. RESPIRATORY STATUS
RESPIRATORY RATE ANALYSIS
29 cpm Increased
20 cpm Normal
19 cpm Normal
18 cpm Normal
19 cpm Normal
OXYGEN SATURATION
93% Decreased
95% Normal
95% Normal
96% Normal
98% Normal
Norms Analysis
A normal respiratory rate Patient is tachypneic with
ranges from 12-20 cycle per increased respiratory rate and
minute. Average is 18 cycles decreased oxygen saturation
per minute. Breathing patterns due to accumulation of
must be regular and even in secretion and is working hard
rhythm. The normal breath to breathe by using of
sound is bronchial which is accessory muscle while
high pitch, loud in intensity breathing. Also, bibasilar
and blowing or hollow in crackles are heard upon
quantity. Bronchovesicular is auscultation. The oxygen
moderate in pitch, intensity, saturation is decreased due to
and combination of bronchial insufficient oxygen supply to
and vesicular. Vesicular is low the body.
in pitch, soft intensity, and
gentle rustling or breezy in
quality (Berman et.al., 2018).
A normal respiratory rate
ranges from 12-20 cycle per
minute. Average is 18 cycles
per minute. Normal Oxygen
saturation on the other hand
ranges from 95%-100%.
Breathing patterns must be
regular and even in rhythm.
The normal breath sound is
bronchial which is high pitch,
loud in intensity and blowing
or hollow in quantity. Bibasilar
crackle is bubbling or
crackling sounds at the base
of the lungs that are caused
by fluid in the airways or
alveoli (Hinkle & Cheever,
2018).
8. CIRCULATORY STATUS
PULSE RATE ANALYSIS
 February 23, 2021
February 24, 2021
February 25, 2021
February 26, 2021
February 27, 2021
February 23, 2021
February 24, 2021
February 25, 2021
February 26, 2021
February 27, 2021
Patient’s Data
Upon admission, the patient’s
heart rate was taken by
auscultation of the apical
pulse for a whole minute. The
patient is tachycardic with
heart rate of 112bpm. Blood
pressure was taken on the left
arm of the patient with an
elevated reading of
160/100mmHg. The patient
was then positioned in a low
fowler’s position and the
jugular vein was measure
with a height of 10cm from
the sternal angle.
Nutritional Parameters
Parameter Computation
Height: 5’4 Weight(kg)/[height(m)] ^2 <16=Malnourished
Weight: 62 kg.
BMI: 23.5
DATE
February 23, 2021
February 24, 2021
112 bpm Increased
108 bpm Increased
102 bpm Increased
97 bpm Normal
94 bpm Normal
BLOOD PRESSURE
160/100 mmHg Increased
135/95 mmHg Increased
125/90 mmHg Normal
120/85 mmHg Normal
120/80 mmHg Normal
Norms Analysis
Normal cardiac rate for an Upon assessment, the patient
adult is 60-100 beats per has above normal heart rate
minute while the normal blood and blood pressure, there is
pressure is 120/80 mmHg. also presence of jugular vein
Blanch Test was performed distention with a height of
and the capillary refill is less 10cm. These results were
than 2 seconds and is normal due to the fluid retention that
after it returned within normal the patient had which
state in 1-2 seconds. The elevates the heart rate and
pulse must have a regular blood pressure, as well as
beat and not bounding nor causes the jugular vein to be
weak. Blood pressure is not distended.
measured on the client’s limb
if its injured or ill, has an
intravenous infusion or blood
transfusion. Jugular Venous
Distention (JVD) is associated
with heart failure,
regurgitation, and fluid
volume overload. The neck
veins appear full, and the
level of pulsation may have
elevated JVP greater that
3cm above sterna angle.
(Berman et.al., 2018).
9. NUTRITIONAL STATUS
Norms Analysis
Normal
16-19=Underweight
20-25=Normal
31-40=Moderate to
severe obesity
>40=Morbidly obese
(Berman et.al., 2018)
WEIGHT (Original Weight is
ANALYSIS
55 kilogram)
62 kg Increased
60 kg Increased
 February 25, 2021
February 26, 2021
February 27, 2021
Patient’s Data
Patient X commonly consume
rice, meat, fish, and
vegetables for her meals and
drink about 8 glasses of water
daily. During snack time, she
loves to eat bread or junk
foods and does not take any
food supplements or vitamins.
Upon assessment, the
patient’s weight increased
from 55kg to 62 kg due to fluid
retention.
URINE OUTPUT
DATE
(cc/hr)
February 23, 2021
February 24, 2021
February 25, 2021
February 26, 2021
February 27, 2021
Patient’s Data
Patient X defecates once a
day every morning. According
to her, the stool is yellow in
color, average amount,
without presence of blood.
Patient X stated that she is
having difficulty in urination.
Her urine is dark-yellow in
color. The patient has
decreased urine output of
20cc/hour. According to the
result of the urinalysis, urine
serum osmolality is below the
normal range, with a value of
225 mOsm/kg. There is also
59 kg Increased
57 kg Increased
55 kg Normal
Norms Analysis
Nutritional status represents The patient has gained weight
the balance between from 55 to 62kg. due to fluid
nutritional and energy needs retention. The patient
of the body for carbohydrates, approximately drinks 5-6
protein, fats, vitamins, and glasses of water a day or
minerals, and the approximately 887 ml per day.
consumption of these
nutrients. Malnutrition or
altered nutritional status,
results from undernutrition
and over nutrition. Water
consumption a day requires 8
to 10 glasses of water a day.
Body mass index (BMI) is a
guide for maintaining ideal
weight for height. BMI can be
elevated from larger muscles
or edema rather than from
excess fat. BMI of 18.5-24.9 is
considered healthy. (Hinkle
& Cheever, 2018).
10. ELIMINATION STATUS
URINE OUTPUT
ANALYSIS
(cc/day)
20 cc 480 cc Decreased
35 cc 840 cc Normal
34 cc 816 cc Normal
34 cc 816 cc Normal
35 cc 840 cc Normal
Norms Analysis
The normal characteristic of The patient has oliguria due to
stool should be yellow or the inflammation of the
golden brown due to bile glomerulus which caused
pigment derivative known as decrease glomerular filtration
stercobilin. It should be rate.
aromatic upon defecation due
to indole and skatole which
are products of fermentation
and putrefaction in the large
intestine. Normal urine daily
output is 800 to 2000 ml daily
and 30 cc per hour (Hinkle &
Cheever, 2018).
presence of blood and
proteins in patient’s urine.

11. REPRODUCTIVE STATUS

Patient’s Data Norms Analysis

According to patient X, she
had her menarche when she
was 13 years old with regular
cycles. She stated that her
flows last for only 2-3 days
and often experiences
dysmenorrhea. According to
the patient, she had no
tenderness, swelling, or any
abnormal discharge.
Menarche usually begins Patient has normal
around 12 years of age. The reproductive status.
usual cycle is 28-35 days, but
cycles can be as short as 20
days of as long as 40 days.
Normal duration of flow is
between 2 and 8 days. Pubic
hair is evenly distributed and
growing downward. Vagina
has no discharges or redness,
and smooth with no lesions,
tears, or tenderness. (Sharon
Jensen, 2019)

12. SLEEP AND REST PATTERN

Patient’s Data Norms Analysis

Upon assessment, Patient X
only sleep for about 5-6 hours
daily. She stated that she
wasn’t able to rest well
because of irritability. She
often changes in position
when she cannot sleep. She
cannot sleep with only one or
no pillow at all because she is
having difficulty of breathing.
Sometimes she has trouble in
sleeping because of the noise
and unfamiliarity of the
environment. She also stated
that she seldomly take a rest
during afternoon so that she
can sleep well at night.
An individual sleeps for about The patient sleeping pattern
7-9 hours a day and takes a was altered as evidenced by
rest using some of activities decreased sleep time due to
that will help you to relax difficulty of breathing caused
including reading, watching by the pulmonary edema, and
television and others. Sleep to some external factors.
refers to altered
consciousness with general
showing of physiologic
process while rest refers to
relaxation and calmness, both
mental and physical. (Berman
et.al., 2018).

13. SKIN AND APPENDAGES

Patient’s Data Norms Analysis

The patient has had an
infected skin lesions on her
thighs that had been treated
with an antibiotic prescribed
by her doctor three weeks
Skin surfaces should not be
tender and the skin is dry with
a minimum of perspiration.
Skin temperature should be
warm and equal bilaterally,
The patient has impaired skin
integrity due to the infected
lesions on her thighs and
itchiness of skin. 2+ bilateral
edema of on the hands and
prior to her admission. Patient
X’s skin is warm to touch in
edematous area. There is
presence of 2+ bilateral
edema on the hands and feet.
Also, periorbital edema is
observed. There is no
presence of clubbing of
fingers and patient’s nails is
groomed and well-trimmed.
hands and feet maybe slightly feet as well as periorbital
cooler than the rest of the edema are observed due to
body. Skin should normally fluid retention.
feel smooth. The skin turgor
should return within 2-3
seconds and edema should
not normally present. The skin
should be free from lesions
and inflammations. (Jensen,
2019).

6. LABORATORY AND DIAGNOSTIC TEST

HEMATOLOGY RESULT
Normal Values Results Analysis
Hemoglobin 12.1-15.2 g/L 11.5 g/L Low
Hematocrit 35.5-44.9% 33.2% Low
WBC 4-12x10^9/L 5.31 Normal
Platelets 140-450x10^9/L 219 Normal

• Low hemoglobin and hematocrit due to hemodilution

• White Blood Cells is normal because the patient is no longer in the infectious state
BLOOD CHEMISTRY
Normal Values Results Analysis
BUN 2.5-6.4 mmol/L 38 mmol/L Elevated
Creatinine 50-80 umol/L 780 µmol/L Elevated
Serum osmolality 275-300 mOsm/kg 245 mOsm/kg Low
ELECTROLYTES
Sodium 135-145 mmol/L 162 mmol/L Elevated
Potassium 3.3-5.0 mmol/L 6.1 mmol/L Elevated
Calcium 2.1-2.6 mmol/L 1.9 mmol/L Low
Phosphorus 0.8-1.4 mmol/L 4 mmol/L Elevated

• Elevated Blood Urea Nitrogen (BUN), Creatinine, Sodium, Potassium and Phosphorus due
to decreased glomerular filtration rate causes the kidney not to excrete waste products that
results in retention of uremic toxins and excess sodium, potassium and phosphorus in the
blood
• Low serum osmolality due to hemodilution caused by decreased concentration of cells and
solids in the blood
• Low calcium level due to increased serum phosphorus

ANTI-STREPTOLYSIN O
Normal Values Results Analysis
Anti-streptolysin O >200 significant 1280 POSITIVE

• Patient had a recent streptococcus infection about 2 weeks ago

Anti-DNAse B
Normal Values Results Analysis
Anti-DNAse B <85 units/mL significant Positive to a titer of 360 POSITIVE

• Patient had an elevated amount of anti-deoxyribonuclease-B antibody in the blood due to

recent streptococcus infection about 2 weeks ago

ARTERIAL BLOOD GAS

 Normal Values Results Analysis
pH 7.38-7.42 7.2 Low
PaO2 80-100 mmHg 75 mmHg Low
PCO2 35-45 mmHg 50 mmHg Elevated

• Low blood pH due to increased hydrogen ions in the blood

• Low Partial pressure of Oxygen (PaO2), Low Oxygen Saturation (SaO2) and Elevated
Partial pressure of Carbon Dioxide (PaCO2) due to impaired gas exchange between
oxygen and carbon dioxide in the alveoli. Low blood pH due to increased hydrogen ions in
the blood

URINE DIPSTIX ANALYSIS

Normal Values Results Analysis
Color Yellow Cola-Dark Abnormal
Clarity Clear Foamy Abnormal
pH 6.5-7.5 6.0 Low
Specific Gravity 1.005-1.030 1.003 Low
Blood Negative 4+ Positive
Ketones Negative Negative Negative
Protein Negative 2+ Positive
Urobilinogen Negative Negative Negative
Bilirubin Negative Negative Negative
Leukocyte esterase Negative Negative Negative
Nitrite Negative Negative Negative
Dysmorphic red cells N/A Present Present
Urine serum osmolality 250-900 mOsm/kg 225 mOsm/kg Low

• Cola-Dark urine color due to presence of blood in the urine

• Foamy urine due to presence of protein in the urine that causes the urine’s surface tension
to reduce
• Low urine pH is caused by kidney’s compensatory mechanism to excrete excess carbon
dioxide in the blood that causes the urine to be acidic
• Presence of blood and protein in the urine is caused by inflammation to the glomeruli that
causes blood and protein to leak into the urine.
• Low urine serum osmolality and Low urine specific gravity due to decrease concentration
of dissolved particles in the urine

FINDINGS:
Oliguric, showing blood and protein on examination

CHEST X-RAY FINDINGS:

There is hazed opacity in the right mid to lower lung fields
Heart is not enlarged
Hemidiaphragms and sulci are intact
Osseous structures are unremarkable
Impression
Pulmonary edema, right mid to lower lung fields

ECG TEST RESULT: NORMAL

RENAL BIOPSY FINDINGS: Percutaneous biopsy (renal needle biopsy) was used to extract
kidney tissue by inserting a thin biopsy needle through the skin. Ultrasound was obtained prior to
procedure to direct the needle to the kidney.

Light microscopy: Hypercellularity of the glomeruli with enlarged glomerular tufts

Neutrophils and monocytes: Crescent formation noted in 30% of the glomeruli
Immunofluorescence: Deposits of immunoglobulin G and C3 present along the glomerular
capillary wall and mesangium.
Electron microscopy: Occasional patchy thickening in the glomerular basement membrane.
Humps of electron-dense immune-type deposits noted in the glomerular basement membrane
overlying the mesangium.

7. ANATOMY AND PHYSIOLOGY by Hinkle and Cheever, 2018

The kidneys are a pair of brownish-red structures located retro- peritoneally (behind and outside
the peritoneal cavity) on the posterior wall of the abdomen from the 12th thoracic vertebra to the 3rd
lumbar vertebra in the adult (Fig. 43 - 1). An adult kidney weighs 120 to 170 g (about 4.5 oz) and is
12 cm (about 4.5 inches) long, 6 cm wide, and 2.5 cm thick. The kidneys are well protected by the
ribs, muscles, Gerota's fascia, perirenal fat, and the renal capsule, which surround each kidney. The
kidney consists of two distinct regions, the renal parenchyma and the renal pelvis. The renal
parenchyma is divided into the cortex and the medulla. The cortex contains the glomeruli, proximal
and distal tubules, and cortical collecting ducts and their adjacent peritubular capillaries. The medulla
resembles conical pyramids. The pyramids are situated with the base facing the concave surface of
the kidney and the apex facing the hilum, or pelvis. Each kidney contains approximately 8 to 18
pyramids. The pyramids drain into 4 to 13 minor calices that, in turn, drain into 2 to 3 major calices
that open directly into the renal pelvis. The hilum, or pelvis, is the concave portion of the kidney
through which the renal artery enters and the renal vein exits. The renal artery (arising from the
abdominal aorta) divides into smaller and smaller vessels, eventually forming the afferent arteriole
(Hinkle & Cheever, 2018).
 The afferent arteriole branches to form the glomerulus, which is the capillary bed responsible for
glomerular filtration. Blood leaves the glomerulus through the efferent arteriole and flows back to the
inferior vena cava through a network of capillaries and veins. Each kidney contains about 1 million
nephrons, the functional units of the kidney. Each kidney is capable of providing adequate renal
function if the opposite kidney is damaged or becomes nonfunctional. The nephron consists of a
glomerulus containing afferent and efferent arterioles, Bowman's capsule, proximal tubule, loop of
Henle, distal tubule, and collecting ducts (Fig. 43 - 2). Collecting ducts converge into papillae, which
empty into the minor calices, which drain into three major calices that open directly into the renal
pelvis. Nephrons are structurally divided into two types: cortical and juxtamedullary. Cortical
nephrons are found in the cortex of the kidney, and juxtamedullary nephrons sit adjacent to the
medulla. The juxtamedullary nephrons are distinguished by their long loops of Henle and the vasa
recta, long capillary loops that dip into the medulla of the kidney. The glomerulus is composed of
three filtering layers: the capillary
endothelium, the basement membrane,
and the epithelium. The glomerular
membrane normally allows filtration of
fluid and small molecules yet limits
passage of larger molecules, such as
blood cells and albumin. Kidney function
begins to decrease at a rate of
approximately 1% each year beginning
at approximately age 30 (Hinkle &
Cheever, 2018).

8. PATHOPHYSIOLOGY (book-based)
B. PLANNING STAGE

a. Prioritizing Problems
i. The following problems were chosen as the top priorities among other identified
problems due to their vital effects to a person’s survival. Some theories were used to
support their rankings according to their critical effects which can cause other
complications or death if not treated.

NURSING DIAGNOSIS RANK JUSTIFICATION

Excess Fluid Volume 1st Abdellah’s 21 typology of Nursing Problems stated that it is
necessary to maintain the proper volume of circulation to all
body cells to survive. This is the 1st prioritized nursing
diagnosis because:
• According to the CAB rule, Circulation must be
prioritized which can be impaired due to the
excessive fluid volume.
• Moving and maintaining desirable posture is
included to Henderson’s 14 basic needs which can
be altered due to the excessive fluid volume
resulted edema.
• Excessive fluid volume causes edema which can
result an impairment to person’s mobility (Hinkle &
Cheever, 2018).
• Excessive fluid volume can alter circulation by
elevating the blood pressure which can stimulate
the risk of decreasing cardiac output (Hinkle &
Cheever, 2018).
Impaired Gas 2nd This is the 2nd prioritized nursing diagnosis because:
Exchange • According to CAB’s rule, normal breathing is vital to
sustain life.According to Maslow’s Hierarchy of
Needs, Physiological needs should be initially
prioritized for survival. Impaired Gas Exchange may
lead to oxygen deficiency; oxygen is the most
necessary element to survive (Hinkle & Cheever,
2018).
• Henderson’s 14 basic needs says that breathing
normally should be ranked first.
Activity Intolerance 3rd This is the 3rd prioritized nursing diagnosis because:
• Henderson’s 14 basic needs says that move and
maintain desirable postures should be met by an
individual to be able to function well holistically
• Abdellah’s 21 typology of Nursing Problems stated
that it is necessary to attain an optimal activity such
as exercise, rest, and sleep. Also, to be able to
perform activity of daily living will help to facilitate
the maintenance of regulatory mechanisms and
functions; promote optimal health through healthy
activities, such as exercise
Nursing Care Plan # 1

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective data: Excess Fluid Volume Short term goal: Independent Actions Short term goal:
• “pakiramdam ko related to decreased After six to eight hours of 1. Monitor patient vital 1. to obtain baseline data After seven hours of
sobrang bigat ko glomerular filtration rate rendering proper nursing signs particularly the particularly the blood rendering proper nursing
kasi sobrang care and intervention, the blood pressure and pressure and pulse care and intervention, the
nagmamanas yung patient fluid volume will pulse rate rate since it is directly patient fluid volume
mga kamay at paa stabilize affected by the fluid partially stabilized, as
ko, pati mukha ko retention evidenced by:
sa umaga manas Long term goal: 2. Monitor intake and 2. to monitor hydration • Absence of
din” as verbalized After two to three days of output of patient by status of the patient by bilateral edema
by the patient rendering proper nursing measuring cc/hr or means of urine output • Jugular vein
care and intervention, the cc/day distention of 6cm
Objective data: patient will verbalize 3. Monitor the weight of 3. to evaluate the on the sternal
• Bilateral edema of understanding of health the patient daily severity of fluid angle
2+ on the hands condition and demonstrate retention of the patient • Weight of 61kg
and feet behavior of adherence to 4. Auscultate for the 4. to determine the • Blood pressure of
• Periorbital edema treatment regimen breath sounds of the presence of pulmonary 135/90
• Distention of the patient in the right and congestion by means • Urine output of
jugular vein: 10cm left base of the lungs of determining the 34cc/hr
• Increased weight breath sounds such as • Respiratory rate of
from 55kg to 62kg: crackles 19cpm
7kg in total 5. to evaluate for severity
• Elevated blood 5. Evaluate the of edema and any skin Long term goal:
pressure of edematous deterioration caused After three days of
160/100mmHg extremities for degree by fluid retention rendering proper nursing
and integrity by care and intervention, the
patient verbalized
• Decrease serum means of inspection 6. To promote breathing understanding of health
osmolality of and palpation and lung expansion, condition and
245mOsm 6. Position the patient in thus oxygenating the demonstrated behavior of
• Decreased kidney a semi-Fowler’s patient adequately adherence to treatment
filtration rate as position 7. To oxygenate the regimen, as evidenced by:
evidenced by: patient and promote • “kaya pala parang
• Urea: 7. Promote deep airway clearance for tumaba ako at
38mmol/L breathing exercise easy breathing bumigat, hindi
• Creatinine: and coughing 8. To avoid fluid retention natatanggal ng
780 mmol/L because water always maayos yung tubig
• Decreased urine 8. Educate the patient to fallow salt sa katawan ko,
output of 20cc/hr avoid salty foods 9. To provide dapat alagaan ko
• Chest x-ray findings understanding ang bato ko” as
shows fluid 9. Discuss the regarding too much verbalized by the
overload in the importance of fluid intake of fluids and its patient
base of lungs restrictions to less implications to • “iinumin ko yung
• Dyspnea with than 1,200ml/D patient’s condition mga gamot ko
respiratory rate of 10. Providing rest will para naman
29 cycles per conserve energy and gumaling na ako at
minute 10. Encourage bed rest will decrease oxygen makalabas na ng
and provide calm and demand of the body hospital” as
• Tachycardia with
quiet environment, as verbalized by the
heart rate of 112
well as provide safety patient
bpm
by raising the side • “sige, susundin ko
rails po mga utos ni
doctor, para
Dependent/Collaborative gagaling na ako”
Actions as verbalized by
11. Administer 3L/min 11. To provide adequate the patient
supplemental oxygen oxygenation to the
patient
 via nasal cannula, as
ordered
12. Administer medication 12. to provide treatment
as ordered such as for the condition of the
furosemide, 20mg patient
every 6 hours
Intravenous
Nursing Care Plan #2

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective data: Impaired Gas Exchange Short term goal: Independent Actions Short term goal:
• “Nahihirapan akong related to accumulation of After 30 minutes to one 1. Monitor the patient’s 1. To obtain baseline After one hour of rendering
huminga kahit wala secretion in the lungs hour of rendering proper vital signs particularly data particularly proper nursing care and
naman akong secondary to fluid retention nursing care and the respiratory rate evaluate the intervention, the patient
ginagawa” as due to decreased kidney intervention, the patient will and oxygen saturation oxygenation status of demonstrated an improved
verbalized by the filtration rate demonstrate an improved the patient ventilation and
patient ventilation and oxygenation 2. Auscultate for the 2. Auscultating for the oxygenation, as evidenced
breath sounds breath sounds will by:
Objective data: Long term goal: evaluate the • Respiratory rate of
• Bibasilar crackles After two to three days of respiration of the 20cpm
upon auscultation rendering proper nursing patient, and determine • Oxygen saturation
of the lungs care and intervention, the the severity of of 95%
• Retraction of patient will verbalize pulmonary • Absence of
sternocleidomastoid understanding of causative congestion/edema retractions and
and trapezius factors and participate in 3. Obtain the GCS score 3. To assess the level of difficulty of
muscles the treatment regimen consciousness of the breathing
• Difficulty of patient • PaO2 of 85mmHg
breathing 4. Position the patient in 4. To promote breathing • GCS score of
• Increased a semi-Fowler’s and lung expansion, 15/15
respiratory rate of position thus oxygenating the
29 cycles per patient adequately Long term goal:
minutes 5. Encourage deep 5. To oxygenate the After three days of
• Lightheadedness breathing exercise and patient and promote rendering proper nursing
• Dizziness coughing airway clearance for care and intervention, the
6. Inform the patient easy breathing patient verbalized
• Oxygen saturation
about the disease understanding of causative
of 93%
• Decreased PaO2 of process and the
75mmHg causative factors to be
• Increased PaCO2 of avoided
50mmHg 7. Reiterate the
• Chest x-ray findings importance of
shows fluid compliance to
overload in the treatment regimen
base of lungs 8. Provide a calm and
• Generalized body quiet environment by
weakness as lowering volume of
evidenced by television, dim the
decrease light, avoid noise
movements 9. Encourage adequate
• Increased heart rest and limit activities
rate of 112 beats such as walking and
per minute running
• GCS score of 15/15 10. Provide patient’s
safety by raising the
side rails
Dependent/Collaborative
Actions
11. Provide 3L/min
supplemental oxygen
via nasal cannula as
ordered
12. Administer medication
as ordered, such as
furosemide, 20mg
every 6 hours
Intravenous
6. To provide information factors and participated in
about the client’s the treatment regimen, as
situation, and identify evidenced by:
causative factors that • “iinumin ko yung
should be avoided mga gamot ko
7. To increase the para naman
adherence to gumaling na ako at
treatment regimen makalabas na ng
hospital” as
8. To provide verbalized by the
environment suitable patient
for relaxation and rest • “sige, susundin ko
po mga utos ni
doctor, para
9. Decreased oxygen gagaling na ako”
demand of the body as verbalized by
and provide rest the patient
10. To avoid any
accidental fall of the
patient
11. Increase oxygen
supply to the body
12. To provide
pharmacologic
treatment
Nursing Care Plan #3

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective data: Activity Intolerance related Short term goal: Independent Actions Short term goal:
• “hinang hina ang to body weakness After three to five hours of 1. Monitor the patient’s 1. To obtain baseline After five hours of
katawan ko, hindi secondary to the rendering proper nursing vital signs particularly data especially in rendering proper nursing
ko muna kayang decreased oxygen supply care and intervention, the the oxygen saturation monitoring the blood care and intervention, the
maggagagalaw at of the body patient will understand the and blood pressure pressure and patient understood her
sobrang health condition and use oxygenation health condition and used
napapagod ako” as techniques to enhance 2. Obtain for the GCS 2. To assess level of techniques to enhance
verbalized by the activity tolerance score consciousness from activity tolerance, as
patient time to time evidenced by:
Long term goal: 3. Evaluate the patient’s 3. To assess patient • “nahihirapan akong
Objective data: After three to five days of ability to perform ability to perform task huminga, baka
• Generalized body rendering proper nursing activities kaya nanghihina
weakness as care and intervention, the 4. Note patient’s 4. To provide first-hand din ako kasi ganito”
evidenced by patient will participate to verbalization of information regarding as verbalized by
decrease treatment regimen and weakness and fatigue intolerance the patient
movements report increase in activity 5. Limit or avoid 5. To prevent the patient • “hindi muna ako
• Lightheadedness tolerance extraneous activities from being tired and magpapakapagod
• Dizziness like walking long conserve energy as para magka lakas
• Dyspnea at rest distances; provide much as possible naman ako,
• Increased assistance like ipapahinga ko
respiratory rate of wheelchair and muna ang katawan
29 cycles per ambulation ko” as verbalized
minutes 6. Provide a calm and 6. To provide by the patient
• Low hemoglobin quiet environment by environment • GCS score of
level of 11.5 g/L lowering volume of conducive for resting 15/15
 (normal value is television, dim the
12.1-15.2 g/L) light, avoid noise
• Oxygen saturation 7. Encourage bed rest
of 93%
• Decreased PaO2 of 8. Provide safety by
75mmHg raising the siderails of
• Increased PaCO2 the bed
of 50mmHg 9. Increase activity level
• Heart rate of 112 of the patient
beats per minute gradually as tolerated:
• Blood pressure of light activities such as
160/100mmHg stretching, walking
• GCS score of short distances
15/15 10. Educate about proper
techniques of
conserving energy
such as sitting down
instead of standing;
stop walking for rest
Dependent/Collaborative
Actions
11. Educate about proper
diet that provides high
energy such as high
carb diet or well-
balanced diet
12. Provide supplemental
oxygen of 3L/min via
nasal cannula or as
prescribed
Long term goal:
7. To provide rest and After five days of rendering
conserve energy proper nursing care and
8. To prevent accidental intervention, the patient
fall and injury participated to treatment
regimen and reported slight
9. To allow the patient to increase in activity
perform usual activity tolerance, as evidenced by:
of daily living without • “susundin ko lang
exerting much ang mga utos niyo
pressure po para gumaling
na ako, iinumin ko
10. To educate patient din ang mga gamot
how to conserve ko” as verbalized
energy necessary to by the patient
avoid fatigue • “hindi na ako
nahihilo, kaya ko
ng maglakad pero
alalayan niyo lang
ako ng bahagya”
as verbalized by
11. Proper and adequate the patient
diet provides energy to
perform activities
12. To provide the body an
adequate amount of
oxygen
SOAPIE Charting #1

Subjective “pakiramdam ko sobrang bigat ko kasi sobrang nagmamanas yung mga

kamay at paa ko, pati mukha ko sa umaga manas din” as verbalized by
the patient
Objective • Bilateral edema of 2+ on the hands and feet
• Periorbital edema
• Distention of the jugular vein: 10cm
• Increased weight from 55kg to 62kg: 7kg in total
• Elevated blood pressure of 160/100mmHg
• Decrease serum osmolality of 245mOsm
• Decreased kidney filtration rate as evidenced by:
• Urea: 38mmol/L
• Creatinine: 780 mmol/L
• Decreased urine output of 20cc/hr
• Chest x-ray findings shows fluid overload in the base of lungs
• Dyspnea with respiratory rate of 29 cycles per minute
• Tachycardia with heart rate of 112 bpm
Assessment Excess Fluid Volume related to decreased glomerular filtration rate
Planning Short term goal:
After six to eight hours of rendering proper nursing care and intervention,
the patient fluid volume will stabilize
Intervention 1. Positioned the patient in a semi-Fowler’s position
2. Administered 3L/min supplemental oxygen via nasal cannula, as
ordered
3. Administered medication as ordered such as furosemide, 20mg
every 6 hours Intravenous
4. Promoted deep breathing exercise and coughing
5. Monitored patient vital signs particularly the blood pressure and
pulse rate
6. Monitored intake and output of patient by measuring cc/hr
7. Monitored the weight of the patient
8. Auscultated for the breath sounds of the patient in the right and left
base of the lungs
9. Evaluated the edematous extremities for degree and integrity by
means of inspection and palpation
10. Educated the patient to avoid salty foods
11. Discussed the importance of fluid restrictions to less than
1,200ml/D
12. Encouraged bed rest and provide calm and quiet environment, as
well as provide safety by raising the side rails
Evaluation After seven hours of rendering proper nursing care and intervention, the
patient fluid volume partially stabilized, as evidenced by:
• Absence of bilateral edema
• Jugular vein distention of 6cm on the sternal angle
• Weight of 61kg
• Blood pressure of 135/90
• Urine output of 34cc/hr
• Respiratory rate of 19cpm

GOAL MET
SOAPIE Charting #2

Subjective “Nahihirapan akong huminga kahit wala naman akong ginagawa” as

verbalized by the patient
Objective • Bibasilar crackles upon auscultation of the lungs
• Retraction of sternocleidomastoid and trapezius muscles
• Difficulty of breathing
• Increased respiratory rate of 29 cycles per minutes
• Lightheadedness
• Dizziness
• Oxygen saturation of 93%
• Decreased PaO2 of 75mmHg
• Increased PaCO2 of 50mmHg
• Chest x-ray findings shows fluid overload in the base of lungs
• Generalized body weakness as evidenced by decrease movements
• Increased heart rate of 112 beats per minute
• GCS score of 15/15
Assessment Impaired Gas Exchange related to accumulation of secretion in the lungs
secondary to fluid retention due to decreased kidney filtration rate
Planning Short term goal:
After 30 minutes to one hour of rendering proper nursing care and
intervention, the patient will demonstrate an improved ventilation and
oxygenation
Intervention 1. Positioned the patient in a semi-Fowler’s position
2. Provided 3L/min supplemental oxygen via nasal cannula as
ordered
3. Administered medication as ordered, such as furosemide, 20mg
every 6 hours Intravenous
4. Encouraged deep breathing exercise and coughing
5. Monitored the patient’s vital signs particularly the respiratory rate
and oxygen saturation
6. Auscultated for the breath sounds
7. Obtained the GCS score
8. Informed the patient about the disease process and the causative
factors to be avoided
9. Reiterated the importance of compliance to treatment regimen
10. Encouraged adequate rest and limit activities such as walking and
running
11. Provided a calm and quiet environment by lowering volume of
television, dim the light, avoid noise
12. Provided patient’s safety by raising the side rails
Evaluation After one hour of rendering proper nursing care and intervention, the
patient demonstrated an improved ventilation and oxygenation, as
evidenced by:
• Respiratory rate of 20cpm
• Oxygen saturation of 95%
• Absence of retractions and difficulty of breathing
• PaO2 of 85mmHg
• GCS score of 15/15

GOAL MET
SOAPIE Charting #3

Subjective “hinang hina ang katawan ko, hindi ko muna kayang maggagagalaw at
sobrang napapagod ako” as verbalized by the patient
Objective • Generalized body weakness as evidenced by decrease movements
• Lightheadedness
• Dizziness
• Dyspnea at rest
• Increased respiratory rate of 29 cycles per minutes
• Low hemoglobin level of 11.5 g/L (normal value is 12.1-15.2 g/L)
• Oxygen saturation of 93%
• Decreased PaO2 of 75mmHg
• Increased PaCO2 of 50mmHg
• Heart rate of 112 beats per minute
• Blood pressure of 160/100mmHg
• GCS score of 15/15
Assessment Activity Intolerance related to body weakness secondary to the
decreased oxygen supply of the body
Planning Short term goal:
After three to five hours of rendering proper nursing care and
intervention, the patient will understand the health condition and use
techniques to enhance activity tolerance
Intervention 1. Provided supplemental oxygen of 3L/min via nasal cannula or as
prescribed
2. Provided a calm and quiet environment by lowering volume of
television, dim the light, avoid noise
3. Encouraged bed rest
4. Provided safety by raising the siderails of the bed
5. Monitored the patient’s vital signs particularly the oxygen saturation
and blood pressure
6. Obtained for the GCS score
7. Evaluated the patient’s ability to perform activities
8. Noted patient’s verbalization of weakness and fatigue
9. Limited or avoided extraneous activities like walking long distances;
provided assistance like wheelchair and ambulation
10. Increased activity level of the patient gradually as tolerated: light
activities such as stretching, walking short distances
11. Educated about proper techniques of conserving energy such as
sitting down instead of standing; stop walking for rest
12. Educated about proper diet that provides high energy such as high
carb diet or well-balanced diet
Evaluation After five hours of rendering proper nursing care and intervention, the
patient understood her health condition and used techniques to enhance
activity tolerance, as evidenced by:
• “nahihirapan akong huminga, baka kaya nanghihina din ako
kasi ganito” as verbalized by the patient
• “hindi muna ako magpapakapagod para magka lakas naman
ako, ipapahinga ko muna ang katawan ko” as verbalized by the
patient
• GCS score of 15/15

GOAL MET
 C. IMPLEMENTATION

1. Drug Studies

ROUTE,
NAME OF THE DATE MECHANISM CLIENT’S
DOSAGE AND INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
DRUG ADMINISTERED OF ACTION RESPONSE
FREQUENCY
Generic name: Upon admission Stock Dose: Inhibits cell wall Amoxicillin CNS: seizures, The patient - Observe patient’s 10 rights in drug
amoxicillin February 23, 2021 500mg/cap synthesis during is used as a anxiety, confusion, remained free from administration.
until discharge bacterial prophylactic agitation, dizziness, infection. - Before giving, ask patient about allergic
Brand name: February 27, 2021 Desired Dose: multiplication. treatment for reversible reactions to penicillin.
Amoxil 500 mg Per the patient. hyperactivity, anxiety, There are no signs - Administer drug with or without food.
Orem every 12 insomnia, behavioral and symptoms of
Therapeutic hours for 10 days changes. possible side and HEALTH TECHINGS
class: adverse - Take drug 30 minutes to 1 hour before
Antibiotics GI: diarrhea, nausea, effects manifested or after meal.
pseudomembranous by the patient. - Advise patient to notify immediately if
Pharmacologic rash, fever, or chills develop.
class: GU: interstitial - Avoid immunizations while taking the
Aminopenicillins nephritis, drug.
nephropathy. colitis, - Take the full course of the drug as
vomiting. prescribed.

Hematologic:
agranulocytosis,
leukopenia,
thrombocytopenia,
thrombocytopenic
purpura, anemia,
eosinophilia,
hemolytic anemia.

Other: anaphylaxis,
hypersensitivity
reactions, overgrowth
of nonsusceptible
organisms.
 ROUTE,
NAME OF THE DATE MECHANISM CLIENT’S
DOSAGE AND INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
DRUG ADMINISTERED OF ACTION RESPONSE
FREQUENCY
Generic name: Upon admission Stock Dose: Inhibits sodium Furosemide is CNS: asthenia, The patient's fluid - Observe patient’s 10 rights in drug
furosemide February 23, 2021 10mg/ml and chloride indicated for headache, pain, volume stabilized administration.
until discharge reabsorption at the treatment dizziness, insomnia, moderately, as - Assess patient's vital signs before and
Brand name: February 27, 2021 Desired Dose: the proximal and and fever, paresthesia, evidenced by: after administration of drug particularly
Lasix 20 mg distal tubules management depression, anxiety, the BP, do not give drug if BP is less
Intravenously and the of the fatigue. - Decreased of 2+ than 90/60 mmHg because of its
Therapeutic every 6 hours ascending loop patient’s to 1+ bilateral antihypertensive effects.
class: of Henle. periorbital CV: hot flashes, chest edema of hands - Monitor weight, BP, and PR routinely.
Antihypertensiv edema, pain, peripheral and feet. - Monitor for signs and symptoms of
es bilateral edema, vasodilation. - Decreased of hypokalemia such as muscle weakness
edema of 10cm to 5cm and cramps; and arrange potassium -
Pharmacologic hands and EENT: pharyngitis. jugular vein rich diet as needed.
class: feet and distention on the - Raise the siderails to promote
Loop diuretics pulmonary GI: nausea, vomiting, sternal angle patient’s safety.
edema. constipation, - Decreased of
abdominal pain, 160/100mmHg HEALTH TEACHINGS
It is also used diarrhea, anorexia. to135/90mmHg of - Avoid sudden position changes and to
to lower the blood pressure rise slowly to avoid dizziness upon
increased GU: UTI. - Increased urine standing quickly.
blood output of 20cc/hr to - Avoid direct sunlight and use
pressure of Hematologic: 35cc/hr. protective clothing and sunblock to
the patient. anemia. prevent photosensitivity reactions.
- There are no - Inform patient of the most common
Hepatic: elevated signs and adverse effects, including pain at
AST and ALT levels. symptoms of injection site, headache, GI symptoms,
possible side and back pain, hot flushes, and sore throat.
adverse effects
Musculoskeletal: manifested by the - Advise patient to report all adverse
bone pain, back pain, patient. reactions promptly.
pelvic pain, arthritis.

Respiratory:
dyspnea, cough.

Skin: injection-site
pain, rash, sweating.

Other: accidental
injury, flulike
syndrome.
 ROUTE,
NAME OF THE DATE MECHANISM CLIENT’S
DOSAGE AND INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
DRUG ADMINISTERED OF ACTION RESPONSE
FREQUENCY
Generic name: Upon admission Stock Dose: As a calcium Calcium CNS: tingling The patient’s serum - Observe patient’s 10 rights in drug
calcium February 23, 2021 500mg/tab supplement, it is Carbonate sensations. phosphorus and administration.
carbonate until discharge essential for is indicated to calcium level had - Assess and monitor serum calcium
February 27, 2021 Desired Dose: bone formation treat and CV: bradycardia, been normalized. level before and after administration of
Therapeutic 500 mg Per and blood manage arrhythmias, mild drug, calcium should be 2.1-2.6 mmol/L.
class: Orem every 8 coagulation. It is hyperphospha drop in BP, There are no signs - Administer drug after meal and at
Calcium hours also used as a temia and vasodilation. and symptoms of bedtime to enhance drug absorption.
Supplements replacement of hypocalcemia possible side and - Watch out for any signs of
calcium in of the patient. GI: constipation, adverse hypercalcemia.
Pharmacologic deficiency state. irritation, chalky effects manifested - Assess for constipation, add bulk in
class: taste, hemorrhage, by the patient. the diet if needed.
Calcium salts nausea, vomiting, - Administer laxative as prescribed if
thirst, abdominal constipation occurs.
pain. - Assess patient for milk-alkali
syndrome; nausea, vomiting,
GU: polyuria, renal disorientation and headache.
calculi.
HEALTH TEACHINGS
Metabolic: - Instruct patient to take drug 1 hour to 1
hypercalcemia. ½ hour after meals if GI upset occurs.
- Take drug with full glass of water.
Skin: local - Warn patient not to eat rhubarb,
reactions, including spinach, bran and whole-grain cereals,
burning, necrosis, or dairy products in the meal before
tissue sloughing, taking calcium; these foods may
cellulitis. interfere with calcium absorption.
- Instruct patient to report anorexia,
nausea, vomiting, constipation,
abdominal pain, dry mouth, thirst, or
polyuria.
- Advise patient to notify prescriber if
taking OTC products such as iron.
 ROUTE,
NAME OF THE DATE MECHANISM CLIENT’S
DOSAGE AND INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
DRUG ADMINISTERED OF ACTION RESPONSE
FREQUENCY
Generic name: Upon admission Stock Dose: Decreases Prednisolone CNS: euphoria, The patient’s - Observe patient’s 10 rights in drug
prednisolone February 23, 2021 5mg/tab inflammation, is indicated for insomnia, psychotic swelling gradually administration.
until discharge mainly by the treatment behavior, diminished. - Determine whether the patient is
Brand name: February 27, 2021 Desired Dose: stabilizing and pseudotumor sensitive to corticosteroids.
Pred 30 mg Per Orem leukocyte management cerebri, vertigo, There are no signs - Always adjust to lowest effective dose.
every 12 hours lysosomal of the headache, and symptoms of - Monitor patient’s weight, BP, and
Therapeutic membranes; patient’s paresthesia, possible side and electrolyte level.
class: suppresses rapidly seizures. adverse - Monitor patient for cushingoid effects,
Corticosteroids immune progressive effects manifested including moon face, buffalo hump,
response; acute CV: HF, HTN, by the patient. central obesity, thinning hair, HTN, and
Pharmacologic stimulates bone glomerulonep edema, arrhythmias, increased susceptibility to infection.
class: marrow; and hritis. thrombophlebitis, - Watch out for depression or psychotic
Glucocorticoids- influences thromboembolism. episodes, especially during high-dose
mineralocorticoi protein, fats, therapy
ds and EENT: cataracts, - Give patient a low-sodium diet.
carbohydrate glaucoma.
metabolism. HEALTH TEACHINGS
GI: peptic ulceration, - Do not stop drug abruptly or without
pancreatitis, Gl prescriber's consent
irritation, increased - Take oral form of drug with food or
appetite, nausea, milk to reduce GI irritation.
vomiting, abdominal - Instruct patient immediately report
distention sudden weight gain or swelling and
slow healing.
GU: menstrual - Advise patient receiving long-term
irregularities, therapy to consider exercise or physical
therapy.
increased urine - Avoid exposure to infections and to
calcium level notify prescriber if exposure occurs.
- Avoid immunizations while taking the
Metabolic: drug.
hypokalemia,
hyperglycemia.
carbohydrate
intolerance,
hypercholesterolemi
a, hypocalcemia,
weight gain

Musculoskeletal:
growth suppression
in children, muscle
weakness,
osteoporosis

Skin: hirsutism,
delayed wound
healing, acne,
various skin
eruptions

Other: cushingoid
state, susceptibility
to infections, acute
adrenal insufficiency
after increased
stress or abrupt
withdrawal after
long-term therapy.

After abrupt
withdrawal:
rebound
inflammation,
fatigue, weakness,
arthralgia, fever.
dizziness, lethargy,
depression, fainting,
orthostatic
hypotension,
dyspnea, anorexia,
hypoglycemia.
After prolonged use,
sudden withdrawal
may be fatal.
 ROUTE,
NAME OF THE DATE MECHANISM CLIENT’S
DOSAGE AND INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES
DRUG ADMINISTERED OF ACTION RESPONSE
FREQUENCY
Generic name: Upon admission Stock Dose: Inhibits ACE, Captopril is CNS: dizziness, The patient’s blood - Observe patient’s 10 rights in drug
captopril February 23, 2021 25mg/tab preventing indicated to fainting, headache, pressure had been administration.
until discharge conversion of correct malaise, fatigue, decreased from - Assess vital signs particularly the BP
Brand name: February 27, 2021 Desired Dose: angiotensin I to increased fever, insomnia, 160/100 mmHg to - before and after administration of drug.
Capoten 25mg Per Orem angiotensin II. blood paresthesia. 135/95 mmHg. - Administer 1 hour before meals to
every 8 hours Less pressure. enhance drug absorption.
Therapeutic angiotensin II CV: tachycardia, There are no signs - Raise the siderails to promote
class: decreases hypotension, chest and symptoms of patient’s safety.
Antihypertensiv peripheral pain, angina possible side and
es arterial pectoris, adverse HEALTH TEACHINGS
resistance, palpitations. effects manifested - Avoid sudden position changes and to
Pharmacologic decreasing by the patient. rise slowly to avoid dizziness upon
class: aldosterone GI: abdominal pain, standing quickly.
ACE inhibitors secretion, which anorexia, - Advise patient to report all adverse
reduces sodium constipation, reactions promptly, including signs and
and water diarrhea, dry mouth, symptoms of infection such as fever
retention and dysgeusia, nausea, and sore throat.
lowers BP. vomiting. - Urge patient to promptly report
swelling of the face, lips or mouth or
Hematologic: difficulty of breathing.
leukopenia,
agranulocytosis,
thrombocytopenia,
pancytopenia,
anemia.
Metabolic:
hyperkalemia.

Respiratory: dry,
persistent,
nonproductive

Skin: urticarial rash,

maculopapular rash,
cough; dyspnea.
pruritus, alopecia.

Other: angioedema.
 2. Medical Management (IVFs, BT, O2 Therapy, Etc.)

MEDICAL
MANAGEMENT/TREATMENT
Oxygen therapy via nasal
cannula 3L/min
1 liter 0.9 PNSS regulated at 10-
11 gtts/min via infusion pump
DATE
PERFORMED/CHANGED/
DISCONTINUED
February 23, 2021 upon
admission; Discontinued on
February 25, 2021
February 23, 2021 upon
admission; Discontinued upon
discharge
GENERAL DESCRIPTION
Oxygen therapy is prescribed for
people who can’t get enough
oxygen on their own. This is often
because of lungs conditions that
prevents the lungs from
absorbing oxygen.
This solution is used to supply
water and salt (sodium chloride)
to the body. Sodium chloride
solution may also be mixed with
other medications given by
injection into a vein.
INDICATION/PURPOSE
Patient has difficulty of breathing.
The patient sodium level is low,
thus, administration of 0.9 PNSS
is necessary but with extreme
regulation precaution since the
patient has fluid retention.
CLIENT’S REACTION
The patient was able to tolerate
the oxygen therapy and difficulty
of breathing was addressed.
The client was able to tolerate the
Intravenous fluid.

3. Diet

TYPE OF DIET DATE INDICATION NURSING RESPONSIBILITY

Low sodium, Low protein, High
carbohydrate
Admission: February Low sodium, Low protein limits the thirst and
23, 2021 fluid weight gain and to minimize vascular
overload and hypertension. High
carbohydrate limits the catabolism of protein
reducing BUN
Instructed the patient that eating low sodium and low protein like fresh
meats, frozen vegetables and fruits are very important to prevent the
buildup of urea in the bloodstreams. Give liberal amount of
carbohydrates such as rice and potatoes to provide energy
 4. Activity and Exercise

TYPE OF EXERCISE GENERAL DESCRIPTION INDICATION CLIENT’S RESPONSE

Deep breathing exercise Deep breathing is breathing that is done The patient has difficulty of The patient performed deep breathing exercise 10 times and thrice a
by contracting the diaphragm, a muscle breathing because of day. the patient's ventilation (breathing) rate, lung endurance and
located horizontally between the thoracic pulmonary edema. strength were increased.
cavity and abdominal cavity.
D. EVALUATION STAGE

a. Discharge planning
a. General condition upon discharge; February 27, 2021
i. Patient with vital signs upon discharge as follows: Temperature: 37.0°C
(normal) Pulse rate: 94 bpm (normal); respiratory rate: 19cpm (normal);
Blood pressure: 120/80mmHg (normal); Weight: 55kg; Oxygen Saturation:
98% (normal), Urine output: 35cc/hr (normal output); without present of
edema and jugular vein distention. Laboratory results upon discharge with
Urinalysis, Hematology results, and Blood chemistry came out with normal
values. Physician informed the patient about follow-up check-up and
educated upon the signs and symptoms patient might feel that needs
immediate medical intervention and prescribed with take-home medication
of captopril in controlling the blood pressure once it persists again and
prednisolone for continued recovery from acute glomerulonephritis.

Laboratory Result:
HEMATOLOGY RESULT
Normal Values Results Analysis
Hemoglobin 12.1-15.2 g/L 13.7 Normal
Hematocrit 35.5-44.9% 38.5% Normal
WBC 4-12x10^9/L 5.01 Normal
Platelets 140-450x10^9/L 198 Normal
Analysis: Hematology values of hemoglobin, hematocrit, WBC, and platelets are within the normal
range.

BLOOD CHEMISTRY
Normal Values Results Analysis
BUN 2.5-6.4 mmol/L 4.8 Normal
Creatinine 50-80 umol/L 78 Normal
Serum osmolality 275-300 mOsm/kg 295 Normal
ELECTROLYTES
Potassium 3.3-5.0 mmol/L 4.1 Normal
Calcium 2.1-2.6 mmol/L 2.4 Normal
Phosphorus 0.8-1.4 mmol/L 1.2 Normal
Analysis: Blood Chemistry results of BUN, Creatinine, Serum Osmolality, and electrolyte values
are in normal range.

URINE DIPSTIX ANALYSIS

Normal Values Results Analysis
Color Yellow Pale yellow Normal
Clarity Clear Clear Normal
pH 6.5-7.5 6.7 Normal
Specific Gravity 1.005-1.030 1.011 Normal
Blood Negative Negative Negative
Ketones Negative Negative Negative
Protein Negative Negative Negative
Urobilinogen Negative Negative Negative
Bilirubin Negative Negative Negative
Leukocyte esterase Negative Negative Negative
Nitrite Negative Negative Negative
 Dysmorphic red cells N/A N/A Negative
Urine serum osmolality 250-900 mOsm/kg 450 mOsm/kg Normal
Analysis: Urine Dipstix Analysis components are all within normal values.

b. Method approach (medication, exercise, treatment, health teachings, follow-

up, diet).
i. Provided information about the current situation of the patient.
ii. Patient informed about the disease process and the causative factors to be
avoided
iii. Instructed to not take any anti-inflammatory medicines such as ibuprofen
and naproxen.
iv. Taught patient how to do proper deep breathing exercise and coughing
v. Encouraged to rest and limit activities such as walking and running
vi. Advised patient to limit touching the face and to wash hands using soap
and water frequently
vii. Promoted frequent oral hygiene
viii. Explained to the patient the importance of avoid salty foods and encourage
to have a low salt diet
ix. Encouraged to lessen low protein and potassium intake
x. Discussed the importance of fluid restrictions
xi. Emphasized to the patient the importance of regular follow-up check-up.

Objectives Evaluation:
i. The nursing students were able build rapport by gaining the trust of the patient upon
the use of therapeutic communication and explaining procedures to be done.
ii. The nursing students were able to broaden their knowledge about Acute
Glomerulonephritis, starting with the assessment wherein different signs and
symptoms were seen on the patient, and this information would be used for future
encounter with patients with this condition.
iii. Learned about Acute Glomerulonephritis, the risk factors, disease processes,
possible nursing diagnosis, sign & symptoms, nursing and medical intervention, and
the effects of different drugs prescribed to the patient to take and what nursing
responsibilities to be considered.
iv. Planned and implemented nursing care upon the needs of the patient.
v. Optimum health needs were met focusing on the concerns of the patient.
vi. Educated the patient upon his health condition, did health teachings in order to for
the patient to do self-care activities during admission and upon discharge.
 III. CONCLUSION
Glomerulonephritis is seen to have been associated with high blood pressure, dark urine,
tachypnea, and edema present in the feet, hands, and around the eyes, hematuria and proteinuria.
With this it is encouraged to restrict fluid intake and have a low sodium, protein, and potassium intake
to decrease the volume the kidney had to filter and prevent overworking it and cause further damage
in the kidney function.
The objective of this study is to highlight the case of Glomerulonephritis after having a recent
streptococcal infection and its associated immune-complex body responses. History of patient
illness, risk factors and present sign and symptoms should be identified in order to know the nursing
management needed by the patient, it is also important for the physician to be able to give orders on
the treatment regimen the patient needs. This includes laboratory tests such as urinalysis, CBC,
chest x-ray, ASO titer test and other more that the physician would order the patient to have.
Learning upon the different causative agent and factors which leads to the progression of having
glomerulonephritis would be very helpful for a future encounter of a patient who has a
glomerulonephritis, when you are equipped with this knowledge you would be able to give a more
proper nursing care to your patient promoting optimum health outcomes. A comprehensive
assessment of the patient and its’ history of illnesses are very important in order to be able to give
the physician a detailed patient data and for him to know what to give and should do to be able to
assess and form a diagnosis of the patient.
What we, the student nurses learned from this case study is the differences of reading from
book-based information about acute glomerulonephritis to real cases. We learned different factors
other than what the book says, which we need to consider with a patient who has this condition. And
we also learned new nursing interventions we could implement independently, dependently and
collaboratively which helps alleviate the concerns of the patient.

IV. RECOMMENDATION
a. To the student Nurse: This case study is recommended to student nurses who will
going to have a future study about Poststreptococcal Glomerulonephritis. Used as
baseline and reference to strengthen their knowledge about this topic on their
clinical case study. This will also serve as a guide to accomplish a better nursing
intervention to their future clients who have Glomerulonephritis and to promote
proper client education to render faster recovery.
b. To the Patient: This study is suitable to the patient who has Glomerulonephritis, to
be aware on proper care and independent intervention that they can do to help treat
their condition and prevent further aggravation that could lead to complications. It
will also serve as a learning guide to enhance their knowledge about normal and
abnormal indications that can alert them to pursue medical care immediately.
 c. To the Health care provider: To focus on giving a high-quality health education and
intervention to the client to prevent any complication and danger to the patient
specially with geriatric patients. They must also promote common nutritional
teaching to impart knowledge to the patient and patient’s family.
d. To the Institution: This study will work for coming up into an intervention of promoting
health programs among patients with glomerulonephritis.

V. REVIEW OF RELATED LITERATURE

Factors Affecting the Progression of Infection-Related Glomerulonephritis to CKD

Takashi Oda and Nobuyuki Yoshizawa (2021)

Acute glomerulonephritis triggered by infection is still one of the major causes of acute kidney
injury. During the previous two decades, there has been a major paradigm shift in the epidemiology
of AGN. The incidence of poststreptococcal acute glomerulonephritis, which develops after the cure
of group A Streptococcus infection in children has decreased, whereas adult AGN cases have been
increasing, and those associated with non-streptococcal infections, particularly infections by
Streptococcus, are now as common as PSAGN.
In adult AGN patients, particularly older patients with comorbidities, infections are usually
ongoing at the time when glomerulonephritis is diagnosed; thus, the term “infection-related
glomerulonephritis” has recently been popularly used instead of “post-infectious AGN”. The
prognosis of children with PSAGN is generally considered excellent compared with that of adult IRGN
cases. However, long-term epidemiological analysis demonstrated that an episode of PSAGN in
childhood is a strong risk factor for chronic kidney disease, even after the complete remission of
PSAGN.
Although the precise mechanism of the transition from IRGN to CKD remains unknown, its
clarification is important as it will lead to the prevention of chronic kidney disease. In the study of Oda
and Yoshizawa (2021), they focused on the possible factors that may contribute to the progression
of infection-related glomerulonephritis into chronic kidney disease. Four factors, namely, persistent
infection, genetic background of the host’s complement system, tubulointerstitial changes, and pre-
existing histological damage, were discussed.
In conclusion, this study found out that persistent infection, with positive glomerular staining,
can be used as general histological markers. If these markers are persistently positive, eradication
of the infection is the most important therapeutic strategy to stop the transition of IRGN to CKD.
Understanding the possible involvement of the genetic background of the host’s immune system and
pre-existing comorbidities is also important, because both factors are potentially modifiable.
 International Statistics and Epidemiology of Acute Glomerulonephritis
Malvinder S. Parmar (2020)

In Japan, the incidence of postinfectious GN peaked in the 1990s. PSGN, which accounted for
nearly all postinfectious GN cases in the 1970s, has decreased to around 40-50 percent since the
1990s. The proportion of Staphylococcus aureus infection-related nephritis has increased to 30
percent, and hepatitis C virus infection–associated nephritis has increased to 30 percent. In Africa,
the Caribbean, India, Pakistan, Malaysia, Papua New Guinea, and South America, PSGN is still
much more common. The incidence of acute GN in children aged 3 to 16 years in Port Harcourt,
Nigeria, was 15.5 cases per year, with a male-to-female ratio of 1.1:1; the current incidence is not
much different. Research from an Ethiopian regional dialysis center showed that acute GN was the
second most common cause of acute kidney injury requiring dialysis, accounting for around 22% of
cases.
Postinfectious GN can develop at any age, but it is most common in children. The majority of
cases involve children between the ages of 5 and 15, with just 10% of cases affecting individuals
over the age of 40. PSGN outbreaks are common in children aged 6 to 10. Acute nephritis can affect
anyone at any age, including children.

Prognosis of Acute Glomerulonephritis

Frank O'Brien (2020)

In most cases, particularly in children, acute post-streptococcal glomerulonephritis resolves

fully. Chronic kidney disease affects approximately 1% of children and 10% of adults. The degree of
glomerular scarring and whether the underlying condition, such as infection, can be healed
immediately and will determine the prognosis for people with rapidly progressive glomerulonephritis.
Kidney function is retained in certain people who receive early care, and dialysis is not needed.
However, since the early signs of rapidly progressive glomerulonephritis can be subtle and
ambiguous, most people with the condition are unaware of it. They do not seek medical help until
kidney failure occurs.
The person is more likely to develop chronic kidney disease and kidney failure if treatment is
delayed. Since kidney failure often occurs before people realize it, 80 to 90 percent of people with
rapidly progressive glomerulonephritis require dialysis. The prognosis is often influenced by the
cause, the person's age, and any other illnesses they may be suffering from. The prognosis may be
worse when the cause is unclear, or the person is elderly. Some kidney conditions, such as
asymptomatic proteinuria and hematuria syndrome or nephrotic syndrome, occur in some children
and adults who do not fully recover from acute glomerulonephritis. Chronic glomerulonephritis is
common in people with acute glomerulonephritis, particularly older adults.
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