ACUTE

GLOMERULONEPHRITIS
 OBJECTIVES
GENERAL
The general objective of thiscase presentations to foster and
develop knowledgeand
skills in providing care and management fora patient with acute
glomerulonephritis.
SPECIFIC
To defineacute glomerulonephritis
To know the clinical manifestations, nursing management and
interventions for patientswho have this disease.
To know the different medication that needs to be taken including
its side effect which can be harmful the patient.
To be able to obtain, document and present a comprehensive
medical history.
 To apply necessary skills in providing care for a client with
acute glomerulonephritis.
To learn how to establish rapport with the client and
significant others.
To be able to recognize the importance of patient and
familial preference when selecting among treatment option.
 INTRODUCTION

Acute glomerulonephritis (AGN) is active inflammation in the glomeruli. Each kidney is

composed of about 1 million microscopic filtering "screens" known as glomeruli that
selectively remove uremic waste products. The inflammatory process usually begins with an
infection or injury (e.g., burn, trauma), then the protective immune system fights off the
infection, scar tissue forms, and the process is complete.
There are many diseases that cause an active inflammation within the glomeruli. Some of
these diseases are systemic (i.e., other parts of the body are involved at the same time) and
some occur solely in the glomeruli. When there is active inflammation within the kidney, scar
tissue may replace normal, functional kidney tissue and cause irreversible renal impairment.
The severity and extent of glomerular damagefocal (confined) or
diffuse(widespread)determines how the disease is manifested. Glomerular damage can
appear as subacute renal failure, progressive chronic renal failure (CRF); orsimply a urinary
abnormality such as hematuria (blood in the urine) or proteinuria(excess protein in the urine).
 EPIDEMIOLOGY

Over the last 2-3 decades, the incident of acute

glomerulonephritis has declined in the United Sates as
well as in other countries, such as Japan, Central
Europe, and Great Britain. The estimated worldwide
burden of AGNs is approximately 472,000 cases per
year, with approximately 404,000 cases being reported
in children and 456,000 cases occurring in less
developed countries. AGN associated with skin
infections is most common in tropical areas where
pyoderma is endemic, while pharyngitis-associated AGN
predominates in temperate climates. (WHO, 2011)
 PATIENTS PROFILE
Patients Name: L.P
Age: 5 years old
Gender: Female
Address: Pasig City
Civil Status: Single
Religion: Roman Catholic
Date of Birth: April 17, 2011
Date of Admission: January 27, 2017
Nationality: Filipino
Initial Diagnosis: AGE with moderate signs of dehydration, AVI:
R/I UTI
Final Diagnosis: Acute Glomerulonephritis
Chief Complain: Fever
Present History:
5 days PTA, patients experienced headache associated with undocumented fever.
Non associated symptoms of vomiting, chills, with good appetite and activity.
Patient was given Biogesic and temporary relief noted. No onset done.
3 days PTA, still with persistence of symptoms now with abdominal pain, loss of
appetite and no bowel movements for 3 days, patient bought to consult at AFPMC,
CBC & UA was done which lead to the diagnosis of UTI. Patient was sent home and
given Amoxicillin but was not given.
2 days PTA, patients still has persistence of symptoms with fever max of 39C,
patient was given paracetamol suppository given every 4 hours which the mother
claimed to be effective for 1hour of temporary relief.
1 day PTA, still with persistence of symptoms, now with reddish pigmentation on the
neck and hands. Patient was given paracetamol suppository and was brought to
consult in our constitution thus admission.
Past History:
(+) Bronchial Asthma
(+) hospitalization d/t asthma
PHYSICAL ASSESSMENT
Family History:

(-) Dm
(-) HPN
(-) Cancer

Natal History:
Born to a G2P1 mother, full term via NSD in a V. Luna assisted by
an OB-Gyne with a birth weight of 3.1 kg. No feto-maternal
complications noted. Patient pass out meconium within 24 hrs of
life. Patient was disacharged as well baby.
General Symptomatology loss weight gain
Integumentary No itchiness
Head and Neck No stiffness
Eyes
Ears No ear discharge
Nose No nasal discharge
Mouth and Throat No sore throat
Respiratory No fast breathing
Cardiovascular No fast heart rate
Digestive (+) Constipation
Genitourinary No dysuria
Musculoskeletal No myalgia
Endocrine No palpitation
Nervous No tremors
General Irritability, not in cardio respiratory distress
Vital Signs HR: 142 RR: 22cpm Temp: 39.8C SPO2: 98%

Anthropometrics Wt. 35.5kg Ht. 36ft Inaccessible Water loss.

420 Total Fertility Rate. 933
Skin Reddish pigmentation in the neck and
mandible
HEENT: Swelling of eyelids, malting, dry lips.
Chest/Lungs Symmetrical chest expansion, no retraction,
clear breath sound.
Heart A dynamic pericardium normal rate, regular
rhythm, no murmur
Abdomen No lesion
Genitalia Grossly female genitalia
Extremities Grossly normal extremities, full equal pulse, no
cyanosis
Cerebrum Awake, conscious, GCS 15
Cerebellum Steady gait, no ataxia
Cranial Nerve
I: Olfactory can smell
II: Optic Pupils round equally reactive to light and
accommodation
III:Occulomotor Intact EOM
IV:Trochlear
VI:Abducens
V: Trigeminal Intact facial sensation
VII: Facial No facial asymmetry
VIII: Vestibulocochlear Can hear
IX, X: Glossopharyngeal, Vagus (+) Gag reflex
XI: Spinal Accessory Can shrug shoulders
XII: Hypoglossal No tongue deviation
GORDONS HEALTH STUDY
CATEGORY BEFORE HOSPITALIZATION
HEALTH PERCEPTION >Patient is healthy.
NUTRITIONAL METABOLIC >she eats 3 times a day
>She eat whatever food is
served.
ELIMINATION >Patient voids at least 3-4
times a day.
>She defecates once a day.
ACTIVITIES-EXERCISE >Energetic Sobrang malikot
as verbalized by the mother
COGNITIVE- PERCEPTUAL >The patient is oriented to
time, place and person.
SLEEP REST >She sleep late at night
>She sleeps almost 8 hours
daily.
SELF-PERCEPTION/SELF- >She use too socialize and
CONCEPT mingle to other.
>She always think of a playing
a game.
SEXUALITY REPRODUCTIVE Not Applicable
VALUES-BELIEFS >The patient is Roman Catholic >She still believe in God.
DURING HOSPITALIZATION
>She is not aware of her health
condition.
>She start to take prescribed
medication
>Theres an IV line that hooked
in her.
>Low salt
>Eats whatever the hospital
provides.
>She defecates once a day.
>She voids 3 times a day with
minimal amount.
>Decrease energy matamlay
na siya as verbalized by the
mother.
>She sleeps most of the time.
>The patient still oriented to
time, place and person.
>The patient sometimes lack
of sleep because of changing IV
bottle.
>She is not socialize to others.
Not Applicable
ROLE RELATIONSHIP >She lives with her family >The patient is confined at
>She is good and hospital and her
disciplined daughter. grandmother and mother
is her companion.
ANATOMY AND PHYSIOLOGY
 The kidneys are two bean-shaped organs, each about the size of a fist. They
are located just below the rib cage, one on each side of the spine.
Every day, the two kidneys filter about 120 to 150 quarts of blood to produce
about 1 to 2 quarts of urine, composed of wastes and extra fluid. The urine
flows from the kidneys to the bladder through two thin tubes of muscle
called ureters, one on each side of the bladder. The bladder stores urine. The
muscles of the bladder wall remain relaxed while the bladder fills with urine.
As the bladder fills to capacity, signals sent to the brain tell a person to find
a toilet soon. When the bladder empties, urine flows out of the body through
a tube called the urethra, located at the bottom of the bladder. In men, the
urethra is long, while in women it is short.
The kidneys are important because they keep the composition, or makeup,
of the blood stable, which lets the body function. They;
prevent the buildup of wastes and extra fluid in the body
keep levels of electrolytes stable, such as sodium, potassium, and phosphate
make hormones that help
regulate blood pressure
make red blood cells
bones stay strong
HOW THE KIDNEYS WORK?
The kidneys purify toxic metabolic waste products from the blood in
several hundred thousand functionally independent units called
nephrons. Each nephron filters a small amount of blood. The nephron
includes a filter, called the glomerulus, and a tubule. The nephrons
work through a two-step process.
The tubular epithelial cells reabsorb water, small proteins, amino
acids, carbohydrates and electrolytes, thereby regulating plasma
osmolality, extracellular volume, blood pressure and acidbase and
electrolyte balance.
The glomerulus lets fluid and waste products pass through it;
however, it prevents blood cells and large molecules, mostly proteins,
from passing. If the glomerulus is unable to prevent or filter blood
cells and large particles incorrectly, then it leads to a problem called
glomerulus nephritis and even kidney failure. The filtered fluid
then passes through the tubule, which sends needed minerals back
to the bloodstream and removes wastes. The final product becomes
urine.
PATHOPHYSIOLOGY DIAGRAM OF ACUTE GLOMERULO-NEPHRITIS
Non-Modifiable Risk Factors
Modifiable Risk Factors
Gender poor
personal hygiene
Aged 5-11 years old
 Antigen-antibody reaction

Insoluble immune complexes developed and become entrapped to glomerular tissue.

Destruction and inflammation of kidneys Fever

Damaged on glomerular basement membrane

Increased permeability

Leakage of protein Proteinuria

Protein and RBCs going to interstitial space

Periorbital edema
 LABORATORY
EXAMINATIONS
 Hematology Normal Value Results: Interpretation &
01/27/17 Analysis
Hgb 130-160 gm/L 114 This indicates that there is
less oxygen in the blood and
a possibility of deficiency of
iron in the body.

Hct 0.37-0.49 0.355

RBC 4.5-6.2 x 10^12/L 4.59
WBC 4.0-11.0 x 10^9/L 8.1 .
Neutrophils 0.55-0.65 0.71 An increase of Segmenters
is an indication of the
presence of an infection

Lymphocyte 0.25-0.35 0.25

Eosinophil 0.02-0.04 0.01 The body is sending more
and more white blood cells
to fight off infections.

Monocyte 0.03-0.06 0.04

Basophil 0.00-0.01 0.01
MCV 78-102fl 77.31
MCH 39-35 pg 24.83 LowMCHmay indicate
microcytic anemia

MCHC 32-36 g/dL 32.11

RDW 11.0-15.0 12.18

Platelet count 150-400 x 10^9L 188.2
 Hematology Normal Value Results: Interpretation &
1/28/17 Analysis
Hgb 130-150 gm/L 99.50 This indicates that there is
less oxygen in theblood
and a possibility of
deficiency of ironin the
body.
Hct 0.37-0.49 0.309
RBC 4.5-6.2 x 10^12/L 3.98
WBC 4.0-11.0 x 10^9/L 15.4 An increase in WBC count
may indicate the presence
of a viral infection or
anacute infection
Neutrophils 0.55-0.65 0.76 An increase of Segmenters
is an indication of the
presence of an infection
Lymphocyte 0.25-0.35 0.18 Decreased lymphocytes
indicate the possibility
ofpresence of sepsis

Eosinophil 0.02-0.04 0.02

Monocyte 0.03-0.06 0.03
Basophil 0.00-0.01 0.01
MCV 78-102fl 77.58
MCH 39-35 pg 24.99 LowMCHmay indicate
microcytic anemia
MCHC 32-36 g/dL 32.11
RDW 11.0-15.0 12.47
Platelet count 150-400 x 10^9L 170.83
 Hematology Normal Value Results: Interpretation &
01/29/17 Analysis
Hgb 130-150 gm/L 98.00 This indicates that there is
less oxygen in theblood
and a possibility of
deficiency of ironin the body.
Hct 0.37-0.49 0.307
RBC 4.5-6.2 x 10^12/L 3.88
WBC 4.0-11.0 x 10^9/L 22.4 An increase in WBC count
may indicate the presence
of a viral infection or
anacute infection.
Neutrophils 0.55-0.65 0.68 An increase of Segmenters
is an indication of the
presence of an infection
Lymphocyte 0.25-0.35 0.26 Decreased lymphocytes
indicate the possibility
ofpresence of sepsis

Eosinophil 0.02-0.04 0.02

Monocyte 0.03-0.06 0.04
Basophil 0.00-0.01 0.01
MCV 78-102fl 79.22
MCH 39-35 pg 25.25 LowMCHmay indicate
microcytic anemia
MCHC 32-36 g/dL 31.87
RDW 11.0-15.0 13.01
Platelet count 130-400 x 10^9L 162.92
 Hematology Normal Value Results: Interpretation &
01/30/17 Analysis
Hgb 130-150 gm/L 104.00 This indicates that there is
less oxygen in the blood
and a possibility of
deficiency of iron in the
body.
Hct 0.37-0.49 0.325
RBC 4.5-6.2 x 10^12/L 4.17
WBC 4.0-11.0 x 10^9/L 24.4 An increase in WBC count
may indicate the presence
of a viral infection or
anacute infection.
Neutrophils 0.55-0.65 0.73 An increase of Segmenters
is an indication of the
presence of an infection
Lymphocyte 0.25-0.35 0.21 Decreased lymphocytes
indicate the possibility
ofpresence of sepsis
Eosinophil 0.02-0.04 0.01
Monocyte 0.03-0.06 0.04
Basophil 0.00-0.01 0.01
MCV 78-102fl 78.01
MCH 39-35 pg 24.94 LowMCHmay indicate
microcytic anemia
MCHC 32-36 g/dL 31.97 LowMCHmay indicate
microcytic anemia
RDW 11.0-15.0 13.06
Platelet count 130-400 x 10^9L 167.83
 Hematology Normal Value Results: Interpretation &
01/31/17 Analysis
Hgb 130-150 gm/L 100.70 This indicates that there is
less oxygen in theblood
and a possibility of
deficiency of ironin the
body
Hct 0.37-0.49 0.313
RBC 4.5-6.2 x 10^12/L 3.97
WBC 4.0-11.0 x 10^9/L 21.9 An increase in WBC count
may indicate the presence
of a viral infection or
anacute infection.
Neutrophils 0.55-0.65 0.74 An increase of
Segmenters is an
indication of the presence
of an infection
Lymphocyte 0.25-0.35 0.20 Decreased lymphocytes
indicate the possibility
ofpresence of sepsis
Eosinophil 0.02-0.04 0.02
Monocyte 0.03-0.06 0.04
Basophil 0.00-0.01 0.00
MCV 78-102fl 78.76
MCH 39-35 pg 25.36 LowMCHmay indicate
microcytic anemia
MCHC 32-36 g/dL 32.20
RDW 11.0-15.0 13.11
Platelet count 150-400 x 10^9L 164.52
 Hematology Normal Value Results: Interpretation &
02/01/17 Analysis
Hgb 130-150 gm/L 107.20 indicates anemia
Hct 0.37-0.49 0.336
RBC 4.5-6.2 x 10^12/L 4.31
WBC 4.0-11.0 x 10^9/L 16.8 An increase in WBC count
may indicate the presence
of a viral infection or
anacute infection.

Neutrophils 0.55-0.65 0.76 An increase of Segmenters

is an indication of the
presence of an infection
Lymphocyte 0.25-0.35 0.18 Decreased lymphocytes
indicate the possibility
ofpresence of sepsis

Eosinophil 0.02-0.04 0.02

Monocyte 0.03-0.06 0.03
Basophil 0.00-0.01 0.01
MCV 78-102fl 78.08
MCH 39-35 pg 24.88 LowMCHmay indicate
microcytic anemia

MCHC 32-36 g/dL 31.87

RDW 11.0-15.0 13.09
Platelet count 150-400 x 10^9L 158.51
 Hematology Normal Value Results: Interpretation &
02/02/17 Analysis
Hgb 130-150 gm/L 92.70 This indicates that there is
less oxygen in theblood
and a possibility of
deficiency of ironin the body
Hct 0.37-0.49 0.294
RBC 4.5-6.2 x 10^12/L 3.77
WBC 4.0-11.0 x 10^9/L 11.2 An increase in WBC count
may indicate the presence
of a viral infection or
anacute infection.
Neutrophils 0.55-0.65 0.73 An increase of Segmenters
is an indication of the
presence of an infection
Lymphocyte 0.25-0.35 0.19 Decreased lymphocytes
indicate the possibility
ofpresence of sepsis

Eosinophil 0.02-0.04 0.01

Monocyte 0.03-0.06 0.06
Basophil 0.00-0.01 0.01
MCV 78-102fl 77.95
MCH 39-35 pg 24.58 LowMCHmay indicate
microcytic anemia
MCHC 32-36 g/dL 31.53
RDW 11.0-15.0 13.16
Platelet count 150-400 x 10^9L 162.68
 CHEMISTRY TEST
NORMAL 1/28/17 Interpretation 1/30/17 Interpretation
VALUE and Analysis and Analysis

BUN 2.5-7.2 mmol/L 3.79

Creatinine 53-106 umol/L 49.70 Indicates renal

dysfunction

SGOT/AST </ 35 U/L

SGPT/ALT </ 45 U/L
Chloride 9-107 mmol/L 110

Sodium 135-148 mmol/L 134.8

Potassium 3.5-5.3 mmol/L 4.22

Calcium 2.15-2.87 mol/L 1.78

Total Protein 64-83 g/L 52.60

Albumin 38-54 g/L 28.00 Indicates

proteinuria and
edema
Globulin 11-35 g/L 24.5
A/G Ratio 1.5:1-2.5:1 1.14
 02/04/17
Test Normal Range Results Interpretation
and Analysis

SGOT/AGT 5 34 U/L 74.00 U/L H

SGPT/ALT 0 55 U/L 709.00U/L H

 URINALYSIS
Normal Value Specimen No. E6 Interpretation and
Analysis
Yellow Amber Yellow

Slightly Turbid Slightly Turbid

4.5-8 5.0

1.005-1.030 1.020

Negative Negative

Negative +1 due to increasedglomerular

permeability
 MICROSCOPIC

RBC 0-2

PUS CELLS 3-5 Pus cells increased

value indicates
infection

BACTERIA few

EPITHELIAL few

CELLS

CRYSTALS

AMORPHOUS URATES

MUCUS THREADS

AMORPHOUS PHOSPHATE

KETONES Negative +2
 Normal Value SPECIMEN NO: Interpretation
3 and Analysis
COLOR Yellow Amber Light Yellow
TRANSPARENCY Slightly Turbid Slightly Turbid
REACTION 4.5-8 6.0
SP GRAVITY 1.005-1.030 1.020
SUGAR Negative Negative
PROTEIN Negative +3 Due to disease of the
kidney such as
glomerulonephritis.
MICROSCOPIC
RBC 6-8/hpf Indicates possible
injury to kidney tissue
PUS CELLS 1-2/hpf Indicative ofbacterial
infection
BACTERIA
EPITHELIAL few Indicative ofnephrotic
syndrome
CELLS
CRYSTALS
AMORPHOUS URATES few
MUCUS THREADS few
AMORPHOUS PHOSPHATE
KETONES Negative
 Normal Value SPECIMEN Interpretation
NO: and Analysis
2
COLOR Yellow Amber Yellow
TRANSPARENCY Slightly Turbid Slightly Turbid
REACTION 4.5-8 6.0
SP GRAVITY 1.005-1.030 1.020
SUGAR Negative Negative
PROTEIN Negative +2 Due to disease of the
kidney such as
glomerulonephritis.
MICROSCOPIC
RBC 4-6hpf Indicates possible injury
to kidney tissue

PUS CELLS 0-2/hpf Indicative ofbacterial

infection
BACTERIA
EPITHELIAL few Indicative ofnephrotic
syndrome

CRYSTALS
AMORPHOUS URATES few
MUCUS THREADS few
AMORPHOUS PHOSPHATE
KETONES Negative +3
 02/02/17

RESULTS REFERENCE Interpretation
INTERVAL and Analysis
Color Light Yellow
Transparency CLEAR
URINE CHEMICAL
Specific Gravity 1.010 1.003-1.053
pH 7.00 5.00-7.00
Protein + NEGATIVE Due to disease of the
kidney such as
glomerulonephritis.
Glucose NEGATIVE NEGATIVE
Bilirubin NEGATIVE NEGATIVE
Blood (ERY/Hb) ++++ NEGATIVE
Leukocyte NEGATIVE NEGATVE
Nitrite NEGATIVE NEGATIVE
Urobilinogen 0.20 mg/dL <1.00
Ketone + NEGATIVE
MICROSCOPIC
RBC 1-3/hpf 0-3 Indicates possible
injury to kidney tissue
WBC 1-2/hpf 0-5 WBCsin
theurinemaymeana
UTI is present.
Epithelial Cells
Bacteria
Mucua Threads
 FECALYSIS
COLOR Yellow

CONSISTENCY Soft

RBC

PUS CELLS 2-3/hpf

MUCUS

OVA & PARASITES No ova nor parasites seen

 Hematology Normal value 02/09/17
hgb 130-160 gm/l 125.50
Hct 0.37-0.49 0.35
RBC 4.5-6.2 x 10^ 12/L 3.19
WBC 4.0-11.0 8.7
Neutrophils 0.55-0.65 0.40
Lymphocyte 0.25-0.35 0.38
Eosinophil 0.02-0.04 0.03
Monocyte 0.03-0.06 0.17
Basophil 0.00-0.01 0.02
MCV 78-102 78.18
MCH 39-54 pg 25.76
MCHC 32-36 g/Dl 32.95
RDW 11.0- 15.0 13.01
Platelet count 150-400 x 10^9L 308.30
DRUG STUDY

Generic Brand Classifica Actual Action Rational Side Nursing
name name tion dose e effect consider
ation
Ampicillin Ampicillin Novo- Antibiotic 700mg tiv Bactericidal Used in the CNS: lethargy
-Allergies to
sodium ampicillin Penicillin q6 after action against treatment GU: nephritis
penicillin,
(CAN), ANST sensitive of Hematology:renal
Principen, organisms; respiratory leukopenia disorders,
Ampicin inhibit synthesis tract, CBC, LFTs,
of bacterial cell urinary renal
wall causing cell tract and function
death. gastro tests, serum
Intestinal electrolytes,
infections, Hct,
septicemia urinalysis
and -Inspect skin
endocarditis daily for
rash.
ceftriaxon Ceftriaxone Rocephin Antibiotic 1.4g tiv q8 Bactericidal: Used in the CNS: lethargy -Hepatic and
e sodium Cephalospori hours ANST inhibits treatment GU: renal
n synthesis of of urinary nephrotoxicit impairment
(third bacterial cell tract y Renal
generation) wall, causing infection. Hematologic: function
death. decreased test, skin
WBC count, status, LFTs,
decreased sensitivity
platelets, tests.
decreased -Monitor
Hct ceftriaxone
blood levels
in patients
with severe
renal
impairment
cetirizine Cetirizine Zyrtec Antihistami 5mg/ml Potent Used for CNS: -Allergy to
Hcl Reactine ne at histamine renal somnolence histamine,
(CAN) bedtime (H1) receptor dysfunctio , sedation bladder
BID antagonist, n CV: edema neck
inhibits obstructio
histamine n.
release and -Monitor
eosinophil skin color,
chemotaxis renal
during function
inflammation, tests.
leading to -Report
reduced difficulty
swelling and of
decreased breathing.
inflammatory
response.
glycerin glycerin Colace Hyperosmola 1-1.7g Elevates the Used to GU: Hypersensiti
suppository r rectally osmolarity of clear increased vity to
, laxative once. the glomerular edematous urination glycerin,
Osmoglyn, Ophthalmic filtrate, thereby cornea Others: edema,
Sani- supp, hyper hindering the Ocular pain pupillary
Fleet osmolar reabsorption of and irritation. reflexes.
babylax preparation water and Monitor
Osmotic leading to a urinary
diuretic. loss of water, output
sodium, and pattern,
chloride; serum
creates an electrolytes,
osmotic urinalysis.
gradient in the Headache
eye between and blurred
plasma and vision.
ocular fluids,
paracet Paracet Biogesi Non- 250mg/ The Used Thrombo -Monitor
amol amol, c, narcotic 5ml q6 mechanism for - CBC,
Acetami Panadol analgesic PRN of action is treating cytopeni liver and
no , , associated modera a, renal
phen Tylenol Antipyret with te to Leukope function
ic inhibition severe nia, s.
of pain, Drowsine -Assess
prostaglan fever, ss for fecal
din arthritis occult
synthesis, pain blood
the and and
predomina muscle nephriti
nt ache. s.
influence -Report
on the pain
thermoreg that
ulation persists
center in for more
the than 3-5
hypothala days.
mus, -
enhances Phenma
heat cetin
transfer. may
cause
urine to
 COURSE IN THE WARD
January 27, 2017 (NO DUTY)
Received patient conscious and coherent with fever and no cough and colds. Patient has a weak faces
and loses good appetite. Vital sign taken and recorded. Patient body temperature after checking was
38.2C. Not distress and pink palpebral was observed.
January 28, 2017 (NO DUTY)
For continuity of care same patient, the patient has macculopapule rash on mouth, extremities no signs
of fever, chilling, bleeding and DOB. Physical assessment done Anterior posterior, normal rate regular
rhythm. (-) murmurs, Saturated Calomel Electrodes, (-) reactions. Capillary Blood Sugar , soft Normal
Active Sounds and non-tender. Patient also lack of sleep and non-cooperative and not in distress.
January 29, 2017 (NO DUTY)
Patient was (+) fever, (+) macculopapule rash. Difficulty of breathing, (+) periorbital edema. Decrease
appetite and activity. She was asleep, non-cooperative and not in distress. And, Nasal Respiratory
Resistance, (-) murmur. Saturated Calomel Electrodes (-) reaction.
January 30, 2017 (NO DUTY)
Patient was (+) for fever and chills. Her appetite and physical activities were decreased. Signs of
bleeding and abdominal pain was negative. She was examined while sleeping, there was no cardio
pulmonary distress, skin was warm to touch and good anger.
January 31,2017 (NO DUTY)
Patient was (+) for fever, periorbital swelling. She was conscious coherent and not in distress.
Symmetrical chest expansion, clear breath sound, full and equal pulse.
February 1, 2017 (NO DUTY)
Nursing care done, for continuity of care same patient, Vital signs are monitored and recorded due to
medicine given. The patient has normal Blood pressure 110/60, pulse rate 94 and temperature 37.7C but
(+) on edema on eyelids R/L. Full equal pulses, symmetric chest expansion no reaction and breath sounds.
February 2, 2017 (ON DUTY)
Patient is conscious and coherent and in cardiorespiratory distress, Anicteric, pink palpebral conjunctiva,
has signs of periorbital edema. Symmetrical chest expansion, normal breath sounds, precordium, negative
from murmurs, flabby abdomen, soft and non-full and equal pulses. (-) edema and (-) vomiting was
observed. Patient has normal vital sign. BP 90/60, Temperature 37.2, PR 98. Appetite id now on fair to good
as well as her activity.
February 4, 2017 (ON DUTY)
Patient was (-) for fever, (+) edema, no bleeding and no abdominal pain. Vital signs: BP 90/60, CR 71,
RR 36, TEMP. 36.3. She was conscious coherent, not in distress.
February 6, 2017 (NO DUTY)
Patient had no complain, assessment was done. She was (-) for fever and no eye contact but she was
awake. There was decrease facial edema. Vital signs: BP 90/60, CR 82. She has a good appetite and in
good condition.
February 7,2017 (NO DUTY)
Patient was conscious coherent with good appetite and good in activity. Assessment and vital signs
were recorded. She was (-) for fever, edema and seizures and also the pink palpebral conjunctiva and
dynamic precordium was clear, breath sounds with normal rate.
 February 11,2017 (0N DUTY)
Patient was (-) for fever, edema, bleeding, vomiting. She had good activity and appetite. She was
conscious coherent, not in stress. Vital signs: BP 90/60, CR 119, RR 28. Pink palpebral sclera. Symmetrical
chest expansion, clear breath sound.
February 12, 2017 (No Duty)
Patient was (-) fever, vomiting, headache and pain. Good oral intake, Conscious coherent and not in
distress. Vital signs: BP: 110/60 CR: 90 RR: 23 Temperature: 36.3. Pink palpebral conjunctiva anicteric
sclera. Angina Pectoris, Nasal Respiratory Resistant (-) murmur. Her abdomen was soft and non-distended.
February 13, 2017 (No Duty)
Patient was (-) for seizure, vomiting, and fever. She was conscious coherent and not in distress. Vital
signs: CR 92, RR 24, TEMP. 36.5. She had Pink palpebral conjunctiva and anicteric sclera. Saturated
Calomel Electrodes (-) reaction, clear breath sounds. A dynamic precordium normal rate, irregular rhythm
murmur.
February 14, 2017 (No Duty)
Patient was (-) for vomiting, fever. She had a good activity and good appetite. She was a conscious
coherent and not in distress. Vital signs: CR 90, RR 25, TEMP 36.7. She had Pink palpebral conjunctiva
anicteric symmetrical chest expansion and clear breath sounds. She had (-) No Apparent Distress and (-)
Canine Leukocyte adhesion Defficiency.
February 15, 2017 (No Duty)
Patient was (-) fever, seizure, pain and (+) scalp itchiness. She was conscious coherent and not in
distress. She had Saturated Calomel Electrodes and (-) reaction. Angina Pectoris Nasal Respiratory
Resistant (-) murmur full and not equal pulses
 NURSING CARE PLAN (1)
Assessment Diagnosis Background Planning Intervention Rationale Evaluation
knowledge
Subjective: Hyperthermia Infectious Agents After 4hrs of nursing - Monitor clients - Assist in After 4hrs of
Mainit ang anak related to (Pyrogens) intervention the temperature and determining the nursing
ko as verbalized secondary patient will maintain note for presence of diagnosis. interventions the
by the patients infection core temperature chills/ profuse Room temperature patient was able to
mother Monocytes within normal range. diaphoresis; also should be changed maintain core
note for degree and to maintain near temperature to the
Objectve: pattern of normal normal range.
(+) fever Pyrogenic cytokines occurrence. temperature. The goal was met.
(+) periorbital
edema - Monitor the - To obtain baseline
-warm to touch Anterior temperature of the data.
VS : Hypothalamus environment.
- Temp: 38.2
- PR: 113 -Monitor the vital -Can help reduce
- RR: 24 Elevated signs fever
thermoregulatory set
point -Provide tepid - Water regulates
sponge bath body temperature.
-Providing health
Increased -Encourage client to teachings to client
Conservation increase fluid intake could help client
cope with disease
-Educate client of condition and
Increased heat signs and symptoms could help prevent
production of hyperthermia further
complications of
hyperthermia
FEVER Dependent:
- Administer -Antipyretics acts
antipyretics as on the
prescribed by the hypothalamus,
physician. reducing
hyperthermia
 NURSING CARE PLAN (2)
Assessment Diagnosis Background Planning Intervention Rationale Evaluation
Knowledge
Subjective: Fluid volume After 7 days of >Establish >To gain trust After 7 days of
Nagmamanas excess related to Renal Failure nursing rapport to the patient. nursing
yung paligid ng decrease interventions, interventions,
mata ng anak ko golumerular patient will able >Monitor the >To obtain the goal was met
as verbalized by filtration to maintain fluid vital signs. baseline data. the patient
the patients secondary to Loss of albumin volume, normal maintained fluid
mother. glomerular VS, and free from >Asses patients volume, the puffy
inflammation. signs of appetite eyelids easily
Objective: periorbital edema. >To prevent gone and went to
-(+) Periorbital Reduction in colloidal >Record the fluid overload back to normal
edema osmotic pressure amount of fluid and, free from
-puffy eyelids intake. periorbital
-Reddish in >To monitor edema.
palpebral fluid retention
conjuctiva Edema and evaluate
>Record I&O degree of
Temp: 38.2C accurately and excess .
BP: 90/60 calculate fluid
CR: 113 volume. >Weight gain
RR: 24 indicates fluid
>Restrict retention or
sodium and fluid edema.
intake.

>To monitor
>Explain to the kidney function.
mother the
consequence of
fluid retention >Understanding
promotes
patient and
 NURSING CARE PLAN (3)
Assessment Diagnosis Background Planning Intervention Rationale Evaluation
knowledge
Subjective: Imbalance General body After 7-14 days Established To facilitate After 7-14 days of
Matamlay at Nutrition: Less weakness related of nursing rapport cooperation as well nursing intervention,
mahina siyang than body to Acute intervention the as to gain patients the patient
kumain as requirements Glomerulonephriti patient will trust. manifested increase
verbalized by the related to dietary s manifest in appetite and mood
mother. restriction as increase in Daily physical To assess weight improvement and
evidence by Poor appetite and appetite, mood and weight gain or weight loss. weight improvement
Objective: decrease desire desire to eat and improvement monitoring from 33kg to 35.5kg
-Weakness to eat. drink and weight Goal was met.
-Patient improvement Assess To provide foods
untouched to her Decrease intake of between 33kg nutritional that will increase
food. food and fluids to 35.5kg status her appetite.
-150ml water
intake Nutrition To maintain fluid
-wt 33kg imbalance Increase fluids balance.
Temp: 38.2C per doctors
BP: 90/60 order.
CR: 113
RR: 24 Assess and To prevent
encourage dehydration and
the patient to nutritional deficit.
increase fluid
and increase
food intake.

Provide low
salt diet. To prevent further
water retention due
to acute
glomerulonephritis
RECOMMENDATION
MEDICATION -explain to the mother of the patient and family
members the importance of taking medicines

> Ampicillin - tiv q6 after ANST
> ceftriaxone - IVq 12 hours.
> cetirizine - at bedtime
>Paracetamol - q6 PRN
> glycerin Given once
EXERCISES -Advise the mother of the client to have an exercise to
her child such as walking.

-As time and experiences increases the client can
move to higher intensity exercise.

>Advice the mother of the patient to have or maintain
safe and clean environment
TREATMENT -Ensure follow up and self-care.

-Advice the mother or significant others to take in time
prescribe medicines specially in kidney function.

-Advise the mother of the patient to limit water
intake; that she drink and monitor output.

Health Teachings >Describe to the family of the patient the signs and
symptoms to be reported immediately(Blood in the
urine, foamy urine, swelling and swelling on her face.
> Advise significant others to immediately consult her
physician if signs and symptoms of the diseases occurs
persist.

OUTPATIENT Encourage the mother of the patient that
(CHECK UP) when her child discharged, she need to
have a regular checkup, to her physician
until is needed. To check regularly her
condition.
DIET -limit the amount of protein, potassium, and salt
that be eaten of her child.

-eat healthy foods and get plenty of exercise.

- eat low fat and low sodium foods that will help not
worsen hercondition.

Spiritual >Advise relatives or significant others to provide

moral support and widen theirunderstanding.
>Tell to the significant other to pray for the
client to help with the recovery.
>and also Instruct the patient to pray for her
fast recovery and guidance.
THANKYOU!!