College of Our Lady of Mt.

Carmel
Bachelor of Science in Nursing Department

COLLEGE DEPARTMENT
College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing
S.Y 2023-2024

MEDICAL SURGICAL NURSING

NCM 112 (RLE)
Case Study and Analysis

Submitted by:
De Jesus, Fatima Kate M.
Tan, Paulen Joy G.
Villanueva, Rhynah Francheska S.
BSN 2

Submitted to:
Mr. Mikel Renz Cariño, RN

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 College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing Department

Introduction

This nursing case study aims to provide a comprehensive understanding of Acute Glomerulonephritis by
delving into its various aspects, including its pathophysiology, risk factors, clinical presentation, diagnostic
methods, and management strategies. Through the exploration of our patient’s journey, we will shed light
on the intricate nature of this life-threatening condition and highlight the importance of early recognition
and intervention.

1. Patient Data: Past Patient History, Medical History

1.1 Past Patient History

On September 8, 2023 Mr. Villegas, a 6-year-old male and his mother, arrives at the Emergency
Department (ED) with complaints of bloody urination (tea colored) that began approximately 3 days prior
to admission. Patient has a history of fever without any accompanying other symptoms.

Five hours prior to confinement, patient went to Bulaon district hospital and was advised for admission but
due to unavailability of room, the patient transferred to Our Lady of Mt. Carmel Medical Center caused by
persistence of tea colored urine and facial edema.

1.2 Medical history

The patient has complete immunization and has unremarkable medical history. The patient is not on any
maintenance medication. His diet is fond on soft drinks and junk food. Upon admission, patient urinalysis
result was reddish brown, turbid 5.5, 1.010, 3+ protein, - glucose, - ketone, 6-8 wbc, too many count rbc,
and few bacteria.

2. History of Present Illness: Chief Complaints, Presenting Signs and Symptoms

2.1 Chief complaints

Bloody urination

2.2 Presenting signs and symptoms

3 days prior to admission, the patient developed a colored urine accompanied by low frequency in
urination. 2 days prior to admission, the patient shows positive sign of periorbital and facial edema, and
episodes of headache. Few days PTA, persistence of above mentioned symptoms prompted consult at
Bulaon district and was advised to transfer at OLMCMC institution.
Persistent sign and symptoms on admission: facial and periorbital edema and decreased urination.
Physical examination on admission: BP: 140/90 HR: 127 RR: 24 Temp: 37.2
Clinical impresssion: To consider Acute Glomerulonephritis (AGN)

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 College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing Department

3. Brief Discussion of the Medical Condition, Usual Treatment Modalities, Medications, and
Therapies

3.1 Medical Condition

Glomerulonephritis is an inflammation of the tiny filters in the kidneys known as glomeruli. Urine is the
body's method of excreting waste and excess fluid from the circulation that glomeruli remove.
Glomerulonephritis, whether acute or chronic, can develop rapidly. This can be an independent condition or
a complication of another illness, such lupus or diabetes. The kidneys can get damaged by glomerulonephritis-
related inflammation that is severe or persistent.

Glomerulonephritis signs and symptoms may include:

 Pink or cola-colored urine from red blood cells in your urine (hematuria)
 Foamy or bubbly urine due to excess protein in the urine (proteinuria)
 High blood pressure (hypertension)
 Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen
 Urinating less than usual
 Nausea and vomiting
 Muscle cramps
 Fatigue
 Jaundice

Glomerulonephritis can be brought on by numerous circumstances. Sometimes an illness is passed down

through families, while other times the reason is unknown. The following conditions are among the causes of
glomeruli inflammation; Infecction, Auto-immune disease, Vasculitis, and Sclerotic condition.
3.2 Usual Treatment Modalities
Treatment of glomerulonephritis and patient prognosis are determined by: whether the patient has an acute or
chronic form of the disease; the underlying cause; and the kind and severity of signs and symptoms.
Sometimes, treating the underlying cause, like taking medication to manage high blood pressure, is all that’s
necessary. If the cause is due to infection, antibiotics can treat the infection.
At other times, the healthcare provider may recommend:

 Changes to diet so that patient eat less protein and salt, which put extra strain on kidneys.
 Immunosuppressants, if a problem with immune system causes glomerulonephritis.
 Medicine to lower blood pressure, such as angiotensin-converting enzyme (ACE) inhibitors or
angiotensin blockers (ARB).
 Corticosteroids to decrease inflammation.
 Dialysis, which helps clean blood, remove extra fluid and control blood pressure.
 Diuretics (water pills) to reduce swelling and remove excess fluid from your body.
 Plasmapheresis, a special process that filters protein from your blood.

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 College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing Department

3.3 Medications and Therapies

Antibiotics
 Antibiotics may be prescribed by our doctors to treat bacterial infections in patient with
glomerulonephritis. Acute glomerulonephritis induced by a bacterial infection usually resolves
following antibiotic therapy.

Blood Pressure Medications

 In order to manage hypertension in glomerulonephritis patients, a physician may prescribe blood
pressure medications such angiotensin-converting-enzyme inhibitors, calcium channel blockers, and
beta blockers.Diuretics may also be prescribed to help the kidneys eliminate excess water and sodium,
which can narrow blood vessels and cause further kidney damage. Many of these medications are
available in liquid form, which are often easier for young children to take.

Corticosteroids
 Corticosteroids, such as prednisone, are powerful medications that control inflammation and swelling
by suppressing the immune system. These medications, which can be given by mouth or through a
vein with intravenous (IV) infusion, may be used for a short period of time to manage more severe
symptoms.High doses of steroids can block the absorption of vitamin D and calcium, which can lead
to bone loss. They can also cause weight gain. Doctors can prescribe dietary supplements to manage
these side effects.

Immunosuppressant Medications
 Doctors may use immunosuppressant medications, such as cyclophosphamide, to treat children with
severe glomerulonephritis caused by the autoimmune disease lupus. This treatment, which is given
once a month via IV infusion, can continue for months or longer, depending on the severity of your
child’s symptoms.Immunosuppressive medications can prevent bone marrow, the spongy tissue inside
bones, from making new blood cells, which can increase the risk of infection. As a result, our doctors
recommend that your child wash his or her hands frequently and stay up to date on vaccinations to
avoid bacterial or viral infections.

Targeted Therapies.
 Diet. For the treatment of signs and symptoms of fluid retention (such as edema and pulmonary
edema), sodium and fluid restriction should be suggested; protein restriction for patients with
azotemia should be suggested if there is no sign of malnutrition.
 Activity. The patient should stay in bed until the circulatory congestion and indications of glomerular
inflammation go away because extended inactivity doesn't help the patient's recuperation.
 Long-term monitoring. Few chronic effects have been seen in long-term examinations of children with
AGN.

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 College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing Department

4. Client-centered Pathophysiology

5. Diagnostics

6. Treatment Plan

7. SOAPIE
Subjective Objective Assesment Planning Intervention Evaluation

8. Conclusion

9. Sources / Citations

10. Learning Derived

11. Curriculum Vitae

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