NAME: SALLIT, NORALYN S.

YEAR & SECTION: BSN-2C

LUCID CHART NARRATIVE

NARRATIVE LUCID CHART FOR GLUMERULONEPHRITIS WITH UTI

DATA OF THE PATIENT:

An 11 year old male, Donald Jan, born in Laoag City seek medical consultation and was admitted on July
18, 2021 at 10: 00 PM due to abdominal pain, blood in the urine (Hematuria) and generalized edema under the
service of Dr. Cha Risma and his admitting diagnosis is ACUTE GLUMERULONEPHRITIS WITH UTI.

PATHOPHYSIOLOGY:

Modifiable Factors:
 Infections/History of a recent respiratory infections (prior within 1 week or more)
 Pyoderma or skin Infection
Non-modifiable:
 Age (5-12 years old)
 Gender (Male)

Glomerulonephritis is inflammation of the glomeruli, which are structures in the kidneys that are made up
of tiny blood vessels. These knots of vessels help filter the blood and remove excess fluids. If the glomeruli
are damaged, the kidneys will stop working properly. Glomerulonephritis can come on suddenly or acute or
gradually or known as the chronic. There are factors that play a role in the development of acute
glomerulonephritis (AGN) non-modifiable factors (age, gender) and modifiable factors (respiratory infections,
pyoderma or skin infection).

In order for us to clearly understand, let us look into the main pathophysiology of this disease while reflecting
to its signs and symptoms, and complications.
Glomerulonephritis in children prior to the age of aged five to twelve years is frequently caused by beta-
hemolytic streptococci.
Beta-hemolytic streptococci is a bacterium that lives in the nose and throat and can readily transfer to others.
Infected people can transfer the disease through coughing or sneezing, which produces minute respiratory
droplets containing the bacteria. If the bacteria enter the body, irritation will occur thus signaling the
inflammatory mediators. Proliferation of the bacteria occurs which now triggers the inflammatory response; as
part of the body’s response, there will be an increased production of cytokines that reaches the CNS, inducing
prostaglandins, that causes the hypothalamic thermoregulation center to increase body temperature causing
fever. When this fever becomes uncontrolled then this may progress to seizures. When the bacteria enter the
body it attacks the immune system of the child, and when the immune system detects bacterial pathogens in
the body, it launches an immune response to address the invasion. This includes immune cells sent to take out
bacterial cells via phagocytosis. 1st antigen-antibody complex disposition takes place, with complex
formation.
Antigen–antibody complexes or immune complex are formed when the body's immune system raises
antibodies against antigenic determinants of host or foreign substances that recognize and bind to the antigen
molecules. Immune complexes are deposited in a granular pattern in the glomerular basement membrane.
When this happens, In the process of phagocytosing these immune complexes that can disrupt the membranes
of Renal Glomerular. When the renal glomerular are damaged there will be leakage of blood in the urine
which leads to hematuria, thus causing the occurrence of nephritic syndrome or worse acute kidney failure.
Nephrotic syndrome is the excretion of 3.5g or more of protein in the urine per day. Due to this, there will be
a buildup of nitrogenous phase products in the blood called azotemia. Since the kidney cannot function
properly, wastes and extra fluid can build up in your blood and makes you feel sick eliciting nausea and
vomiting.
Moreover, other symptoms when the renal glomerular are damaged, there will be a trans-glomerular passage
of proteins due to increased permeability of glomerular capillary wall causes proteinuria and resultant of
nephrotic syndrome. Due to the leakage of proteins in the urine, the level of plasma proteins in the blood
decreases, that is known as hypoproteinemia.
However, there will be an increase in hepatic synthesis of proteins and lipids, which also cause
hyperlipidemia since plasma proteins are the inhibitors of LDL synthesis. On the other hand, hypoproteinemia
reduces oncotic pressure of the bloods, due to a low albumin level which allows fluid to leak out from the
interstitial spaces into the peritoneal cavity, caused by low glomerular filtration thus there will be an
accumulation of water and retention of sodium that expands plasma and interstitial fluid volumes, leading to
abdominal pain, abdominal girth, circulatory congestion and edema or worst an uncontrolled high blood
pressure.

SIGNS AND SYMPTOMS

1. Fever - Is a temporary increase in the body temperature, often due to an illness. Having fever is a sign
that something out of the ordinary is going on in the body.Inflammatory response occurs due to the
invasion of pathogens in the kidney. As the body responds to the infection it increases the release of
cytokines that reaches in the central nervous system (CNS), inducing synthesis of prostaglandins, which
are the central mediators of the coordinated responses leading to fever.
2. Hematuria- Presence of blood or blood cells in the urine. One of the common symptoms of
glomerulonephritis this is characterized by a thin glomerular basement membrane and small pores in the
podocytes of the glomerulus which is large enough to permit proteins and red blood cells that can cause
the glomeruli to leak blood into the urine.
3. Proteinuria- Increased levels of protein in the urine. This condition can be a sign of kidney damage. This
symptom is the cause of the condition called nephrotic syndrome (a kidney disorder that causes your
body to pass too much protein in the urine) because of the damage of the glomeruli there is inability of
the glomerular to filter waste and fluids which cause the kidney to be inflamed that can result the blood
and protein to be lost in the urine.
4. Edema- "Edema" is the medical term for swelling. Body parts swell from injury or inflammation. This
symptom is evident to a person who have Glomerulonephritis due to the invasion of pathogens that
caused the kidney to be inflamed, there is a response triggered by damage to the living tissues that can
result to the decrease of glomerular filtration that leads to fluid retention, a build-up of fluids in the body
that can result to swelling in the extremities and other parts of the body.
5. Abdominal Pain -Abdominal pain refers to cramps, a dull ache, or a sharp, burning or twisting pain in the
belly (abdomen).
6. Abdominal Girth- Abdominal girth is the measurement of the distance around the abdomen at a specific
point. It is also called as abdominal distention it is characterized by an increase in abdominal pressure
together with a visible increase in overall abdominal diameter. This is very evident to a person who have
Glomerulonephritis interfere the ability to filter waste products from the blood resulting to the increase of
the renal volume that cause the accumulation of fluid in the abdominal cavity, known as ascites, which
result tissues to be swollen the appearance of distension in the abdomen.
7. Oliguria-  Oliguria is when you pee less than usual. Oliguria is characterized by less than 500 milliliters
of urine in children. This is one of the earliest signs of impaired renal function because of inflammation
of the glomeruli there is a decrease of glomerular filtration in which the kidneys will be stop working
properly that can result to the less production of urine while excreting the waste metabolites.
 Modifiable Risk Factors: Non-Modifiable Factors:
Infections/History of a recent respiratory Age(5-12 yr old)
infections (prior within 1 week or more) Gender(male)
Pyoderma or skin Infection

Group A beta-hemolytic
Streptococcus

Cytokine
Inflammatory response fever
release

Antigen antibody product

Deposition of antigen-antibody complex in

glomerulus

Hematuria Damage to the glomeruli

proteinuria

Decreased glumerular filtration rate

Nephrotic Syndrome
Acute kidney Failure
Chronic kidney disease

Edema
Abdominal pain
↑ Abdominal girth
Oliguria
hypertension

High Blood
Pressure
DIAGNOSTIC TEST:

1. Name of Laboratory Examination: Antistreptolysin O (ASO). Date Ordered: July 19, 2021 and
Performed: July 19, 2021. ASO is a blood test to measure antibodies against streptolysin O, a substance
produced by group A streptococcus bacteria. ASO help determine a recent strep infection with the
bacteria group A Streptococcus; to help diagnose complications resulting from a strep infection such as
kidney inflammation or glomerulonephritis, a form of kidney disease. And the Result for this laboratory
being performed is 220 IU/mL.

Nursing Responsibilities Rationale

Verify doctor’s order verifying the patient at the To prevent error
same
Time.
Perform hand hygiene before having contact To effectively remove microorganisms from
with the patient. hands, preventing infection and to reduces the
risk of transmitting pathogens from one area of
the body

Tell the guardian that the test requires a So that the guardian and the child will be aware of
blood sample. the demands of the procedure and to evaluate
the child’s behavior about blood.

Explain to parents or significant others about To gain cooperation with the patient.
the procedure. Explain that slight discomfort may
be felt when skin is punctured.

Address the concerns of the family. To show support to the client by being an
information source and to reduce anxiety while
waiting for the result.

Document interventions rendered. For baseline data

So the analysis for this laboratory of the patient is, Generally, an ASO test value below 200 is considered
normal. In children under the age of 5, the test value should be less than 100. The results show that the
patient have an increasing ASO value. It means the patient have a recent streptococcal complication or strep
infection .

2. Name of Laboratory Examination:Complete Blood Count (CBC) and Ordered: July 19, 2021 and was
Performed: July 19, 2021. A complete blood count is a group of tests that evaluate the cells that
circulate in blood, including red blood cells, white blood cells and platelets. CBC test can be used to
evaluate the overall health and detect variety of diseases and conditions.

And this is the result for the performed laboratory of Donald Jan.
 COMPLETE RESULT REMARKS
BLOOD COUNT

Hemoglobin 97 LOW
Hematocrit 0.28 LOW
Red Blood Cell 3.70 LOW
White Blood Cell 14, 000 HIGH
Platelet Count 365 NORMAL

Nursing Responsibilities Rationale

Verify doctor’s order. To prevent error.

Perform hand hygiene before having contact with To effectively remove microorganisms from
the patient hands, preventing infection and to reduces the
risk of
transmitting pathogens from one area of the body
Inform patient and significant other/s that the test is To reduce anxiety and support compliance. And to
used to evaluate numerous conditions involving red gain cooperation with the patient.
blood cells, white blood cells,
platelets. And Explain that slight discomfort
may be felt when skin is punctured.
Apply manual pressure and dressings over to prevent further bleeding
puncture sight
To avoid stress that may change result values.
Provide comfort to the patient during the procedure

Make and request laboratory procedure and forward. The medical technologist performs the procedure.

Address the patient must be at bed rest. To conserving energy and reduce metabolic
demands/oxygen consumption.

Document interventions rendered. To ensure interventions are rendered.

Analysis of the Result:

The hematocrit, hemoglobin and the RBC are low which contributed now to the damage glomerulus which
blood been excreted through the urine at the same time the damage glomerolus in which that kidney is
responsible in producing appropriate in factor and this is needed in the production of RBC in the bone
marrow that's why the values are below. Thus, nurses must increase the iron intake like taking medications
and eating iron rich food (meat, fish etc. ) of the patient to boost the production of hemoglobin and helps to
form more red blood cells.

3. Name of Laboratory Examination:Blood Chemistry and Ordered: July 19, 2021 and was
Performed: July 19, 2021. A blood urea nitrogen (BUN) test measures the amount of nitrogen in the
blood that comes from the waste product urea. Urea is made when protein is broken down in the body.
 Urea is made in the liver and passed out of the body in the urine. This test is done with a blood
creatinine test.
It measure of how well the kidneys are performing their job of filtering waste from the blood.
Creatinine is a chemical compound left over from energy-producing processes in the muscles. Healthy
kidneys filter creatinine out of the blood. Creatinine exits the body as a waste product in urine.
Complement C3 is a blood test that measures the activity of a certain protein. This protein is part of the
complement system. The complement system is a group of nearly 60 proteins that are in blood plasma or on
the surface of some cells. Lipid Profile is also known as Lipid panel that measures the amount of specific fat
molecules called lipids in the blood. It measures multiple substances, including several types of cholesterol.
A serum albumin test is a simple blood test that measures the amount of albumin in the blood. The purpose
of these are: BUN is done to see how well kidneys are working. If your kidneys are not able to remove urea
from the blood normally, your BUN level rises. Heart failure, dehydration, or a diet high in protein can also
make BUN level higher. Liver disease or damage can lower BUN level. A measurement of creatinine in
blood or urine provides clues to help doctor determine how well the kidneys are working. C3 done to
protect the body from infections, and to remove dead cells and foreign material. Lipid profile test helps
evaluate cardiovascular health by analyzing cholesterol in the blood. Too much cholesterol can build up in
the blood vessels and arteries, damaging them and heightening the risk of problems like heart disease,
stroke, and heart attack. Serum albumin test help diagnose,evaluate, and watch kidney and liver
conditions.
And these are the result of the tests being performed:

TEST RESULT REMARKS

BUN 22 mg/dl HIGH
Creatine 1.45 mg/dl HIGH
C3 75 mg/dl LOW
Lipid 148 mg/dl NORMAL
Albumin 2.2 g/dl LOW

Nursing Responsibilities Rationale

Verify doctor’s order at the same times verify patients To prevent error.

Inform patient and significant other/s that the test is To reduce anxiety and support compliance.
used to evaluate numerous conditions involving red
blood cells,
white blood cells, platelets, BUN, creatinine
Explain to parents or significant others about the To gain cooperation with the patient.
procedure.
Explain that slight discomfort may be felt when skin is
punctured.
Provide patient privacy, a quite and safe environment In order for the procedure will goes correctly
and to promote health and well being of the
patient.

Comfort patient during the procedure. To reduce unusual behavior of the patient
during the procedure that results unusual
result.

Make and request laboratory procedure and forward. The medical technologist performs the
procedure. And to have the correct result.
 Analysis of the Result:
Increased creatinine and BUN levels in the blood of the patient means that the kidneys are not working well.
But BUN elevated can be due to dehydration. Thus nurses must encourage the patient in increasing his/ her
fluid intake and encourage also a low- protein diet to the patient and eat more foods that are fiber rich. The
patient also has an Abnormal serum albumin level that may be a sign of not functioning well liver or
kidney. This could be mean that the patient have a nutritional deficiency. To sum it up, The Nurse must
consider the BUN level, and creatinine along wit patient`s vital signs, intake and output, weight, skin turgor
as potential indicators

4. Name of Laboratory Examination: CHEST X-RAY and Ordered: July 19, 2021 and was Performed:
July 19, 2021. A chest X-ray uses very small amounts of radiation (electromagnetic waves) to create
images of the structures inside your chest, including your heart, lungs, airways, and bones. The purpose
of the study is to determine if fluid had already settled into the lungs. It is a diagnostic radiology
procedure used to examine chest structures, useful for diagnosing conditions like kidney failure.
And the result is normal.

Nursing Responsibilities Rationale

Verify doctor’s order at the same times verify patients
explain to parents or significant others about the
procedure.
Remove all metallic objects.
There is no preparation requires such as fasting.
Encourage the patient’s to hold his or her breath.
Provide appropriate clothing.
Provide comfort
Instruct patient to cooperate during the procedure.
To prevent error.
to gain cooperation with the patient
Items such as jewelry, pins, buttons can
hinder the visualization of the chest.
Fasting and or medication is not required
unless directed by health care provider.
Holding one’s breath after inhaling enables the
lung, kidney, and heart to be seen more clearly
in the x-ray.
Patients are instructed to remove clothing
from the waist up and put on an X-ray gown to
wear during the procedure.
if the test is facilitated at the bedside,
reposition the patient properly.
The patient is asked to remain still because
any movement will affect the clarity of the
image.

Analysis of the Result:

There is a normal lung fields, cardiac size, mediastinal structures, thoracic spine, ribs and diaphragm of the
patient. Microorganism settled to the glumerulus and make of antigen complex and destroy now the
glumerulus which gives now the conditions of swelling, inflammation of the glomerulus does the
appearance now is asymmetrical with the other kidney. Possible complications of glomerulonephritis
include: Acute kidney failure.

5. Name of Laboratory Examination: KIDNEY, UETER, BLADDER ULTRASOUND (KUB UZT and
Ordered: July 19, 2021 and was Performed: July 19, 2021. KUB refers to a diagnostic medical imaging
technique of the abdomen and stands for Kidneys, Ureters, and Bladder, Ureters only show if they are
abnormally distended. It is done to look for changes in the bladder wall and to look for changes in the
kidney size or structure. The purpose is also to look for stones in the urinary tract and to evaluate reasons
 why patients have recurrent kidney infection. This will identify the cause of renal or pelvic pain. Result:
Asymmetrically enlarged and echogenic right kidney with a region of relative decreased
vascularity in the upper pole.

Nursing Responsibilities Rational

e
Verify doctor orders at the same time verifying to prevent error
the patient
perform hand hygiene before having contact with the To effectively remove microorganisms from
patient hands, preventing infection and to reduces the
risk of transmitting pathogens from one
area of the body
Instruct the patient to drink a pint of water in During this period, the bladder is not empty
the hour before the scan
Instruct the patient to remove any clothing, jewelry or To prevent interfere with the scan
other objects (the patient will be
given a gown to wear)
Request laboratory procedure the medical technologist performs the
procedure.
Strict monitor intake and output accurately accurate measurement of intake and output
helps assess fluid balance
If the bladder is examined, the healthcare provider asked Additional scans will be made of the empty
patient to empty bladder after bladder.
scans if the full bladder have completed.
Analysis of the Result:
KUB UTZ was ordered because the physician or the doctor detects an evidence of damage in the
kidney. This test will verify or visualized the size, location, and shape of the kidney and other related
structures. Through this test it will detect and verify the diagnosis of the physician that the patient was
having or experiencing infection within or around the kidneys. Thus, the patient means that has a urinary
track infection. Nurses must administer antibiotics as ordered and encourage to increase fluid intake.

MEDICAL DIAGNOSIS:
ACUTE GLUMERULONEPHRITIS WITH UTI: The signs and symptoms manifested by Donald Jan are
the following:hematuria, proteinuria, generalized edema and abdominal pain. These manifestations signals the
medical practitioner to order the following diagnostic and laboratory examinations: ASO LA, CBC, BUN,
Creatinine, C3, Lipid profile in AM, Albumin, CXR 9AM and KUB UTZ. These medical examination
confirms that the patient has a problem in the glomerulus.
Thus, Dr. Cha Risma with a medical diagnosis of Acute Glomerulonephritis with UTI.

TREATMENT:

1. Dr. Cha Risma prescribed Paracetamol (Tempra) to Mr. Donald Jan last July 19, 2021.
Paracetamol is a drug belong to Antipyretic. Antipyretic work by inhibiting the enzyme
cyclooxygenase and reducing the levels of PGE(2) within the hypothalamus. It reduces the fever of
the patient. Dose/Route/Frequency: 250 mg/PAR/ q4hrs.

NURSING RESPONSIBILITIES
ACTION RATIONALE
1. Follow the 10 R’s of drug administration To ensure safety and helps avoid any medication

2 . Perform tepid sponge bath
3. eliminate excess clothing and dress the child with
lightweight clothing.
4. Take temperature readings every 4 hours, including
pulse, respiration and blood pressure.
5. Encourage to increase fluid intake.
6. Provide patient a quiet and safety environment
7. Encourage adequate rest.
8. Monitor for signs of side effects
9. Document all relevance information
errors
The giving of Tepid Sponge could be done by
wiping of warm water to all clients body. The
effect of giving Tepid Sponge are as follow:
making vasodilatation of blood vessel, pores of
skin, reduction of blood viscosity, improving
metabolism, and stimulating impulse through skin
receptor which sent to hypothalamus posterior to
decrease the body temperature. The giving of
Tepid Sponge could
reduce 1.4°C in 20min.
This allows the extra heat to escape from the
child’s body . Lighter clothing can have a cooling
effect. It’s been reported that very warm clothing
may increase a child’s body temperature even in
the case that
they are not ill.
Vital signs should be monitored in high fever as
these may indicate complications. Fever causes
an increase in the heart rate, breathing rate and
blood circulation to the skin. This is how the
body tries to
reduce the heat caused by fever.
To replace fluid loss and to reduce the viscosity of
the mucus.
To promote health and well being and enhance
recovery. It also helps improve patients
perception of healing.
To promote health, well being and for fast
recovery.
To avoid complications and for immediate care
To promote continuity of care and to prevent
doubling in administering the dose.

10. Evaluate appropriateness and accuracy of To determine the patient's outcome from drug
medication order for client. therapy

2. Dr. Cha Risma prescribed PEN-G ( Bicillin C-R) to Mr. Donald Jan last July 19, 2021. PEN-G is
a drug belong to Antibacterial. Penicillin kills susceptible bacteria by inhibiting the attachment of
the cell wall membrane. It treat the infection of the patient. Dose/Route/Frequency is
650.00U/IV/q6hrs.
NURSING RESPONSIBILITIES
ACTION RATIONALE
1. Follow the 10 R’s of drug administration To ensure safety and helps avoid any medication
errors
2. Encourage the patient to eat high-fiber foods like These can help the growth of healthy bacteria in
whole grains, beans, fruits and vegetables after the the gut. They should be eaten after taking
administration of Pen-G antibiotics but not during, as fiber may
reduce antibiotic absorption.
3. Encourage the patient to eat probiotic foods Probiotics are foods that help the growth of healthy

4. Instruct the parents to notify physician if
headache and chills appear to the patient
when taking penicillin for the treatment of
AGN
5. Monitor for electrolyte imbalance
6. Penicillin G should be administered slowly
bacteria in the gut
and may help restore the gut microbiota after taking
antibiotics.
4. To avoid severe complications to the patient’s
body
Penicillin G is usually administered as the
potassium salt and sometimes as the sodium salt of
6-phenylacetamidopenicillanic acid. This drug may
cause serious and even fatal electrolyte
disturbances,
i.e., hyperkalemia, when given intravenously in large
doses
6. To avoid electrolyte imbalance from potassium or
sodium content.

3. Dr. Cha Risma prescribed FUROSEMIDE (lasix) to Mr. Donald Jan last July 19, 2021.
Furosemide is a drug belong to diuretics. Furosemide inhibits re absorption of sodium and chloride in
the proximal and distal tubules and the thick ascending loop of Henle . It increase the urination of the
patient. Dose/Route/Frequency is 20 mg/IV/q6hrs.

NURSING RESPONSIBILITIES
ACTION
1. Follow the 10R’s of drug administration
2. Assess fluid status. Monitor daily weight, intake and output
ratios, amount and location of edema, lung sounds, skin
turgor, and mucous membranes. Notify health care
professional if thirst, dry mouth, lethargy, weakness,
hypotension, or oliguria occurs.
3. Monitor BP and pulse before and during administration.
4. Instruct patient to take Vitamin C
5. Advice guardians to assist the child getting out of bed
slowly, allow his/her feet to rest on the floor for a few minutes lightheadedness, and fainting when getting
before standing up.
11. Provide patient a quiet and safety environment
12. Encourage adequate rest.
RATIONALE
To ensure safety and helps avoid any
medication errors
Careful monitoring of the patient's clinical
condition, daily weight, fluids intake, and
urine output, electrolytes, i.e., potassium
and magnesium, kidney function
monitoring with serum creatinine and
serum blood urea nitrogen level is vital to
monitor the response to furosemide. If
indicated as diuresis with furosemide,
replete electrolytes lead to electrolyte
depletion and adjust the dose or even hold
off on furosemide if
laboratory work shows sign of kidney
dysfunction.
Furosemide reduces BP in hypertensives as
well as in normotensives due to increase
production of urine in able to excrete excess
sodium and water. To monitor the patients
response to treatment
To help boost immune system
Furosemide may cause dizziness,
up too quickly from a lying position to
prevent falls.
To promote health and well being and
enhance recovery. It also helps improve
patients perception of healing.
To promote health, well being and for
 fast recovery.
13. Monitor for signs of side effects To avoid complications and for
immediate care
14. Document all relevance information To promote continuity of care and to
prevent doubling in administering the
dose.

15. Evaluate appropriateness and accuracy of medication To determine the patient's outcome from
order for client. drug therapy

NURSING DIAGNOSIS AND RESPONSIBILITIES:

ND: Hyperthermia related to the release of streptococccus pyogenes secondary to Acute
glomerulonephritis as manifested by BT of 37.8 ℃.

OUTCOME IDENTIFICATION:Within 30 minutes of rendering nursing interventions the client

will be able to demonstrate signs of relief as manifested by BT within normalrange of 36.5-37.5
℃.

INTERVENTIONS
1 .Administer antipyretic drugs as indicated.
2. Perform tepid sponge bath
RATIONALE
To reduce body temperature.
The giving of Tepid Sponge could be done by wiping
of warm water to all clients body. The effect of
giving Tepid Sponge are as follow: making
vasodilatation of blood vessel, pores of skin,
reduction of blood viscosity, improving metabolism,
and stimulating impulse through skin receptor which
sent to hypothalamus posterior to decrease the body
temperature. The giving of
Tepid Sponge could reduce 1.4°C in 20min.

3. eliminate excess clothing and dress the child
with lightweight clothing.
This allows the extra heat to escape from the child’s
body . Lighter clothing can have a cooling effect. It’s
been reported that very warm clothing may increase
a child’s body temperature even in
the case that they are not ill.

4. Take temperature readings every 4 hours,
including pulse, respiration and blood
pressure.
Vital signs should be monitored in high fever as these
may indicate complications. Fever causes an increase
in the heart rate, breathing rate and blood circulation to
the skin. This is how the body tries to
reduce the heat caused by fever.

5.Provide a quiet environment and comfort To promote health and well being and enhance
measures. recovery. It also helps improve patients perception
of healing.
 6. Encourage deep breathing exercises and To lessen sense of anxiety and associated muscle
some diversional activities
7. Maintain bed rest.
ND: Excessive Fluid Volume related to accumulation of fluids in the body as manifested by
generalized edema.
OUTCOME IDENTIFICATION: Within 2 hours of rendering nursing interventions the client will
be able to demonstrate signs of relief as manifested by decreased pre-orbital and bipedal edema.
INTERVENTIONS
1.) Administer diuretics as prescribed
2.) Monitor Vital signs every 4 hours, notify
any significant changes
3.) Auscultate breath sounds for the presence of
crackles. Observe for increased work of
breathing, cough and nasal flaring
4.) Weight the child on the same scale at the
same time daily. Monitor intake and output
accurately
5.) Measure and record abdominal girth daily
6.) Instruct parents to maintain fluid
restrictions as indicated
7.) Assist or encourage the child to do position
changes every 2 hours
8.) Elevate edematous body part while the
child is in bed or sitting in a chair
9.) Explain to the child and family about acute
glomerulonephritis, including it's signs and
symptoms diagnostic and management
10.) Refer to a dietitian for a consultation to
develop a meal plan low in sodium, potassium,
and protein that includes preferred foods as
allowed
tension
To reduce metabolic demands/oxygen
consumption.
RATIONALE
Decreases plasma volume and edema
by causing diuresis
to provide baseline information for
monitoring changes and evaluating
the
effectiveness of therapy
- crackles upon auscultation indicates a
fluid accumulation resulting in
pulmonary congestion
- weight gain results from fluid
retention, accurate measurement of
intake and output helps assess fluid
balance
- Edema normally observed in the abdomen
which may increase as the condition
progresses
- The amount of fluid allowed to take
depends on the level of kidney function
- frequent position change lessens pressure
on body parts and prevents the
accumulation of
fluid in the dependent areas
- to help move fluid away from
dependent body parts through activity
- to provides an understanding of the
disease which increases compliance with
the treatment regimen
- a proper diet plays a Vital part in
controlling the symptoms, maintaining
Nutrition and in the management of the
disease.
 ND: Imbalanced Nutrition: Less than body requirements related to inability to
ingest or digest food or inability to absorb nutrients due to alteration of
health as manifested by body weight of 29 kgs.

OUTCOME IDENTIFICATION: Within 3 days of rendering nursing intervention the

patient will be able to have body weight within 20% of ideal body weight.

INTERVENTIONS
1. Document actual weight using weighing scale; do
not estimate.
2. Ascertain healthy body weight for age and
height. Refer to a dietitian for complete nutrition
assessment and methods for nutritional support.
RATIONALE
These anthropomorphic assessments are vital that
they need to be accurate. These will be used
as basis for caloric and nutrient
requirements.
Experts like a dietitian can determine nitrogen
balance as a measure of the nutritional status of
the patient. A negative nitrogen balance may
mean protein malnutrition. The dietitian can also
determine the patient’s daily requirements of
specific nutrients to promote sufficient nutritional
intake.

3. Provide a pleasant environment. A pleasing atmosphere helps in decreasing stress

4. Promote proper positioning.
5. Provide good oral hygiene and dentition.
6. If patient lacks strength, schedule rest periods
before meals and open packages and cut up food
for patient.
7. Provide companionship during mealtime.
8. Consider the use of seasoning for patients with
changes in their sense of taste; if not contraindicated.
9. Once discharged, help the patient and family identify area Change is difficult. Multiple changes may
to change that will make the greatest contribution
to improved nutrition.
10. Adapt modification to their current practices.
and is more favorable for eating.
Elevating the head of bed 30 degrees aids in
swallowing and reduces risk for aspiration
with eating.
Oral hygiene has a positive effect on appetite
and on the taste of food. Dentures need to be
clean, fit comfortably, and be in the patient’s
mouth to
encourage eating.
Nursing assistance with activities of daily
living (ADLs) will conserve the patient’s
energy for activities the patient values.
Patients who take longer than one hour to
complete a meal may
require assistance.
Attention to the social perspectives of eating
is important in both hospital and home
settings.
Seasoning may improve the flavor of the foods
and attract eating.
be overwhelming.
Accepting the patient’s or family’s preferences
shows respect for their culture.

REFERENCES:
 https://nurseslabs.com/excess-fluid-volume/
 https://nurseslabs.com/hyperthermia/ https://nurseslabs.com/?s=imbalanced+nutrition+less+than+body+requirements
 https://rnspeak.com/paracetamol-biogesic-drug-study/ http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/P
 024.html
 https://www.rxlist.com/penicillin-g-potassium-drug.htm
 https://www.rxlist.com/lasix-drug.htm#:~:text=Lasix%20is%20a%20prescription%20medicine,of%20drugs%20called%20Diuretics%2C%20Loop
 https://www.drugguide.com/ddo/view/Davis-Drug-Guide/51345/all/furosemide
 https://labtestsonline.org/tests/complete-blood-count-cbc
 https://stanfordhealthcare.org/medical-tests/b/blood-test/types/blood-chemistry-study.html~:text=A%20blood%20chemistry%20study%20is,or
%20tissue%20that%20makes%20it. https://www.nurseslearning.com/courses/nrp/labtest/course/section4/index.htm
 https://my.clevelandclinic.org/health/diagnostics/10228-chest-x-ray#:~:text=A%20chest%20X%2Dray%20uses,within%20one%20to%20two%20days.
 https://www.mayoclinic.org/tests-procedures/chest-x-rays/about/pac-20393494
 https://www.radiologyinfo.org/en/info/chestrad
 https://www.news-medical.net/health/KUB-Radiography.aspx#:~:text=KUB%20stands%20for%20kidney%2C%20ureter,downwards%20to%20the%20pu
bic%20symphysis.
 https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425086/all/Kidney__Ureter and_Bladder_Study
https://nursingcrib.com/medical-laboratory-diagnostic-test/preparing-for-kub-kidneys-ureters-bladder/