I.

INTRODUCTION

a. Current trends about the disease condition

Acute pyelonephritis can occur at any age. In neonates it is 1.5 times more common in
boys and tends to be associated with abnormalities of the renal tract. Uncircumcised boys tend to
have a higher incidence than circumcised boys. Beyond that age girls have a 10-fold higher
incidence. In adult life it reflects the incidence of urinary tract infection (UTI) in that it is much
more common in young women. Over 65 the incidence in men rises to match that of women.
Glomerulonephritis (GN) comprises 25-30% of all cases of end-stage renal disease (ESRD).
About one fourth of patients present with acute nephritis syndrome. Most cases that progress do
so relatively quickly, and end-stage renal failure may occur within weeks or months of acute
nephritic syndrome onset.Geographic and seasonal variations in the prevalence of
poststreptococcal glomerulonephritis (PSGN) are more marked for pharyngeally associated GN
than for cutaneously associated disease. PGN has no predilection for any racial or ethnic group.
A higher incidence (related to poor hygiene) may be observed in some socioeconomic
group.Acute GN predominantly affects males (2:1 male-to-female ratio). PGN can occur at any
age but usually develops in children. Outbreaks of PSGN are common in children aged 6-10
years.

Acute glomerulonephritis refers to a specific set of renal diseases in which an

immunologic mechanism triggers inflammation and proliferation of glomerular tissue that can
result in damage to the basement membrane, mesangium, or capillary endothelium. Hippocrates
originally described the manifestation of back pain and hematuria, which lead to oliguria or
anuria. With the development of the microscope, Langhans was later able to describe these
pathophysiologic glomerular changes.Most original research focuses on the poststreptococcal
patient. Acute glomerulonephritis is defined as the sudden onset of hematuria, proteinuria, and
red blood cell casts. This clinical picture is often accompanied by hypertension, edema, and
impaired renal function. Acute glomerulonephritis can be due to a primary renal or systemic
disease. Glomerulonephritis represents 10-15% of glomerular diseases. Variable incidence has
been reported due in part to the subclinical nature of the disease in more than one half the
affected population. Despite sporadic outbreaks, incidence of poststreptococcal
glomerulonephritis has fallen over the last few decades. Factors responsible for this decline may
include better health care delivery and improved socioeconomic conditions. With some
exceptions, a reduction in the incidence of poststreptococcal glomerulonephritis has occurred in
most western countries. It remains much more common in regions such as Africa, the Caribbean,
India, Pakistan, Malaysia, Papua New Guinea, and South America. Immunoglobulin A (IgA)
nephropathy glomerulonephritis (ie, Berger disease) is the most common cause of
glomerulonephritis worldwide. Most epidemic cases follow a course ending in complete patient
recovery (as many as 100%). Sporadic cases of acute nephritis often progress to a chronic form.
This progression occurs in as many as 30% of adult patients and 10% of pediatric patients.
Glomerulonephritis is the most common cause of chronic renal failure (25%). The mortality rate
of acute glomerulonephritis in the most commonly affected age group, pediatric patients, has
been reported at 0-7% .A male-to-female ratio of 2:1 has been reported.Most cases occur in
patients aged 5-15 years and only 10% occur in patients older than 40 years. Acute nephritis may
occur at any age, including infancy.

b. Reasons of choosing such case for presentation

The group chose this study out of curiosity as it was our first time to encounter such case
and because of that, the group was interested in it. We were willing to undergo new experiences
which would bring new learnings for the group as most of us have not been exposed yet to the
Pediatric ward. Another reason was that it was one of the suggestions of our clinical instructor to
be used in making case study.

c.Importance of the case study

This case study will help the group in understanding the disease process of the patient.
This would also help the group in identifying the primary needs of the patient with acute GN and
acute PN. By identifying such needs and health problems of the patient associated with the
disease and understanding why such needs and health problems arise the group can now
formulate an individualized care plan for the patient that would address these needs and
problems effectively. Effective management of the problems identified will help the patient to
recover faster and maintain a holistic sense of wellness even while in the hospital.
This case study would also equip the group with knowledge, skills and attitude on how to
manage future patients with the same or similar disease.

d. Objectives (Nurse Centered)

- To gain new information about the patient’s disease and its etiology, pathophysiology,
clinical manifestations as well as the standard medical and nursing management so that we may
apply this newly-acquired knowledge to our patient as well as similar situations in the future.
- To learn new clinical skills as well as sharpen our current clinical skills required in the
management of the patient with acute GN and acute PN.
- To develop our sense of unselfish love and empathy in rendering nursing care to our
patient so that we may be able to serve future clients with a higher level of holistic understanding
as well as individualized care.

b. NURSING PROCESS

A.ASSESSMENT
1. PERSONAL DATA
A. Demographic Data
Name: Boy X
Age: 5 y/o
Sex: Male
Religious Affiliation: Catholic
Role position of the family: Second son
Address: Brgy. Mangga, Capas Tarlac City
Date of Birth: February 21, 2003
Nationality: Filipino
 Health care Financing: Father
Usual source of medical care: Doctor

B. Environmental Status:

Their house structures are made of concrete and wooden materials which
was build within a compound with their relatives. They have 2 bed rooms and
their appliances are arranged properly in their divider as verbalized by the father.
They have water pump which their particular source of water for bathing,
cleaning cooking etc. but not a source of water to drink because the family usually
bought mineral water for their source

C. Personal Habits:

He went to school every morning from 7:30 am to 11:30 am and play with his
uncle every afternoon. He usually eat variety of vegetables like “sayote, papaya,
carrots, kalabasa” as verbalized by her mother, which are good for his heath. He
loves to play holen and watched television. He usually play a long period of time
outside with his friends

D. Social:
He is the second son of Mr. and Mrs. Mejares and a pre-school student.

E. Psychological:
He loves to play outside with his friend so when his mother unable to permit
him to go and to play outside he usually cries and make himself busy inside the
house by playing in the room alone.

2. FAMILY HISTORY OF PAST ILLNESS

3. HISTORY OF PAST ILLNESSS

According to the mother the patient has asthma which started when he was 3
months old. Since then everytime the patient experiences the symptoms of asthma they
take salbutamol with the use of nebulizer to alleviate symptoms and improves airway
function. The patient’s asthma is usually triggered due to the weather changes, it usually
occurs during summer season or hot weather as the mother stated. When the patient has
fever, cough and colds the mother used OTC drugs like paracetamol for the patient
condition. The patient had not experience other childhood illnesses. Boy X has completed
his childhood immunizations. The patient has no allergies to drugs, animals, or insects,
and was never hospitalized due to serious illness.
4. HISTORY OF PRESENT ILLNESS
5. PHYSICAL ASSESSMENT
Date examined: Thursday, September 4, 2008

Time examined: 6:30 pm – 7:00 pm

Area / Region Findings Normal Findings Interpretatio Pathophysiology
n/Analysis

1. Vital Signs

1.1 Temperature 37.8 o C (L axilla) 35.4o C – 37.4o C (axillary) Abnormal There can be many causes of
1
(Hyperther hyperthermia (including
mia) infection), which results
from the body’s increased
basal metabolic rate.

1.2 Pulse (Right

radial pulse)

1.2.a Rate
110 bpm Normal
3-6 years old: 100-110
bpm 1
1.2.b Rhythm
Pulse is regular with Normal
even intervals between
each beat Normal pulse rhythm
should be regular with
equal intervals between
pulses. 1
1.2.c Volume
Pulse is graded as Normal
+2/+3 which can be The pulse volume is
felt using moderate usually the same with each
amount of pressure. beat. A normal pulse
volume can be felt with a
moderate amount of
pressure and obliterated
with greater pressure. A
weak or thread pulse as
well as a bounding pulse
should not be observed. 1
Hypoxia and metabolic
acidosis are common causes
1.3 Respiration of tachypnea. The body
38 bpm 3-6 years old: 19-25 bpm 1 compensates to provide
1.3.a Rate itself with more oxygen and
Abnormal eliminate hydrogen ions
(tachypnea) when metabolism is
increased
 6. DIAGNOSTIC AND LABORATORY PROCEDURES

Diagnostic/ Date ordered & Indication/s or Results/s Normal Values( Analysis

Laboratory Date Results in Purpose/s units used in the Interpretation of
Procedure Hospital) Results

Hematology Date ordered >specimens of venous >WBC 32.1 >4.1 – 10.9 G/L >mid cells may include
august 30, 2008 blood are taken for a G/L less frequent occurring
CBC(complete blood >0.6 – 4.1 10.0- and rare cells
Date result in: test), which includes >LYM 2.3 R2 50.5 % L collarating to
August 30, 2008 hemoglobin and 7.1 % L monocytes, eosinophils,
>1.0-1.8 0.1-24.0
hematocritt basophils, blasts and
Time:1:25 pm >MID 1.2 3.7
measurements, >2.0-7.8 37.0-92.0 other precursor white
%M
erythrocyte(RBI) count
 leukocyte(WBC) >GRAN 28.6 >4.20-6.30 T/L cells.
count, red blood 89.2 % G
cell(RBC) indices and >1.20-1.80 g/L
differential white cell >RBC 3.69 T/L
>.370-.510 L/L
count. Increase in RBC
>HGB 98 g/L
count may be >80.0-97.0 F/L
indicative of >HCT.276 L/L
dehydration and >26.0-32.0
decrease with anemia. >MCV 74.8 F/L
White blood cell count >350-360 g/L
determines the no. of >HCH 26.6
>140-440 g/L
circulating WBC’s of
>MCHC 355.
whole blood. High
g/L
WBC counts are often
seen in the presence of >PLT 253g/L
a bacterial infection, by
contrast, WBC counts
may be low if a viral
infection is present.

Urinalysis August 30, 2008 > to determine the Physical Physical

presence of examination: examination:
Results: august microorganisms, the
30, 2008 type of organism, and Color: red Color: straw, amber
the antibiotics to which transparent
the organisms are
Appearance:
sensitive. Appearance: amber transparent
turbid
> assess the color, odor
Reaction:
and consistency of the
urine and the presence Specific gravity:
of clinical signs of UTI Reaction: 6.5 1.010-1.025
(eq. frequency,
urgency, dysuria, Specific Chemical
hematuria, flank, pain, gravity: 1.025 examination
cloudy urine with foul
Chemical Albumin: ---
odor.
examination
Glucose: (-)
Albumin: +++

Glucose: (-)

Microscopic:

Pus cells: 10-15

RBC: TNTC

Bacteria: ++
 Ephithelial
cells: few

A. Urates/
phosphate: few

August 03, 2008

Physical
examination:

Color: dark
yellow

Appearance:
turbid

Reaction: 6.0

Specific
gravity: 1.015

Chemical
examination

Albumin: +++

Glucose: (-)

Microscopic:

Pus cells: 20-30

RBC: TNTC

Bacteria: few

Ephithelial
cells: rare

A. urates/
phosphate: few

Blood August 03, 2008 >specimen of venous Creatinine: >53-106 mol/L >
chemistry blood are taken for a 123.76
CBC which includes
hemoglobin and Electrolytes:
 hematocrit Sodium:138.5 >136-142
measurements,
erythrocyte (RBC) Potassium: 4.84 >3.8-5.0
count,
Chloride: 111.7 >95-103 Meg 1L
leukocyte(WBC)
county, red blood cell
(RBC) indices, and
differential white cell
count.

>CBC is one of the

most frequently
ordered blood tests, it
shows the increase, and
decrease of blood cell
count that may be
associated with
different disorders, and
also determines the
presence of bacterial
infection or viral
infection.

Nursing Responsibility for urinalysis :

 Explain to the client that the urine specimen is required, give the reason, and
explain to be used to collect. Discuss how the results will be used in planning
further care or treatments.
 Wash hands observe other appropriate infection control procedure.
 Provide client privacy.
 If uncircumcised, retract the foreskin slightly to expose the urinary meatus
 Routine urine examination is usually done on the first voided specimen in the
morning because it tends to have a higher, more uniform concentration and a
more acidic pH than specimens later in the day.
 At least 10 ml of urine is generally sufficient for a routine urinalysis.
 The specimen must be free of fecal contamination, so urine must be kept separate
from feces.
 Female client should discard the toilet tissue in the toilet or in a waste bag rather
than in the bedpan because tissue in the specimen makes laboratory specimen
makes laboratory analysis more difficult.
 Put the lid tightly on the container to prevent spillage of the urine and
contamination of other objects,
  Make sure that the specimen label and laboratory requisition carry the correct
information and attach them securely to the specimen.

Nursing responsibility for blood specimen collection:

 Place a tourniquet above the venepuncture site.
 Palpate and locate the vein. It is critical to disinfect the venepuncture site meticulously
with 10% povidone iodine or 70% isopropyl alcohol by swabbing the skin concentrically
from the centre of the venepuncture site outwards. Let the disinfectant evaporate. Do not
repalpate the vein again. Perform venepuncture.
 If withdrawing with conventional disposable syringes, withdraw 510
ml of whole blood from adults, 25ml from children and 0.52ml for infants.
 If withdrawing using vacuum systems, withdraw the desired amount of blood directly
into each
transport tube and culture bottle.
 Remove the tourniquet. Apply pressure to site until bleeding stops, and apply sticking
plaster (if
desired).
 Using aseptic technique, transfer the specimen to the relevant cap transport tubes and
culture
bottles. Secure caps tightly. Be sure to follow manufacturer’s instructions on the correct
amount and method for inoculation of blood culture bottles.
 Label the tube, including the unique patient identification number using indelible marker
pen.
 Do not recap used sharps. Discard directly into the sharps disposal container
 Complete the case investigation and the laboratory request forms using the same
identification
Number
7. ANATOMY AND PHYSIOLOGY
 EXTERNAL ANATOMY KIDNEY

They are paired that are reddish in color and resemble beans in shape.
They are about size of a close fist located at retro peritoneally ( behind and outside
peritoneal cavity) on the posterior wall of the abdomen from 12 thoracic vertebrae to
the third lumbar vertebrae in adult

The average adult kidney weighs approximately 133-170g. (4.5 oz)

and is 10-12 cm long 6 cm wide and 2.5 cm thick the right kidney is slight lower than
the left due to the location of the liver

Kidney are well protected by the ribs and by the muscles of the
abdomen and back

3 LAYERS OF TISSUE SURROUNDING EACH KIDNEY

1. RENAL CAPSULE- innermost layer, it is a smooth transparent fibrous

connective tissue membrane that connects with the outermost covering of the
ureter at the hilum. It serves as a barrier against infection and trauma to the kidney

2. ADIPOSE CAPSULE- second layer it is a mass of fatty tissue that protects the
kidney from blows. It firmly holds the kidney in the abdominal activity

3. RENAL CAPSULE- outer most layer which consist of a thin of a layer of fibrous
connective tissue that also anchors the kidney to their surrounding structures and
to the abdominal wall
 INTERNAL ANATOMY OF KIDNEY

The renal parenchyma is divided into two parts the cortex and the medulla

MEDULLA

Medulla is approximately 5 cm wide which is the inner portion of the kidney. It contains
the loop of Henle, the Vasa Recta and the collecting ducts of the juxtamedullary nephrons the
collecting duct from both the juxtamedullary and the cortical nephrons connect to renal pyramids
which are triangular and are situated with base facins the concave surface of the kidney and the
point (papilla)facins the hilum/pelvis. Each kidney contains approximately 8-18 pyramids. The
pyramids drain into 4 to 13 minor calices which drain into 2 major calices that open directly into
the renal pelvis. The renal pelvis is the beginning of the collecting system and is composed of
structures that are designed to collect and transport urine. Once the urine leaves The renal pelvis,
the composition of urine does not change.

CORTEX

- It is approximately 2 cm wide, is located farthest from the center of the kidney and
around the outer most edges. It contains the nephrons.

NEPHRONS

-these are the functional units of kidney. It is microscopic renal tubule which functions as
a filter. Each kidney has 1 million nephrons, which usually allows for adequate renal function
even if the opposite kidney is damaged or becomes nonfunctional. The structures are located
within the renal parenchymas that are responsible for initial formation of urine.

2 KINDS OF NEPHRONS

a. Cortical nephrons – this makes up 80 to 85% of total number of nephrons in the kidney which
are located in the innermost part of the cortex.

b. Juxtamendullary – nephrons which make up the remaining 15 to 20% are located deeper in the
cortex. There are distinguished by long loops of Henle, which are surrounded by long capillary
loops called Vasa Recta that dip into Medulla of the Kidney.

Nephrons are made up of two basic components; a filtering element component of an

enclosed capillary network and the attach tubule. The glumerulus is a unique network of
capillaries suspended between the afferent and efferent blood vessels, which are enclosed in an
epithelial structure called Bowman’s capsule. The glumerular membrane is composed of three
filtering layers: (a) Capillary endothelium, (b) basement membrane, and (c) epithelium. This
membrane normally allows filtration of fluid and small molecules yet limits passage of larger
molecules, such as blood cells and albumin.

The tubular component of the nephrons begins in the Bowman’s capsule. The filtrate
created in the Bowman’s capsule travel first into the proximal tubule, then into loops of Henle,
distal tubule, and either the cortical or medullary collecting ducts. The structural arrangement of
the tubule allows the distal tubule to lie in close proximity to where the afferent and efferent
arteriole respectively enter and leave the glumerulus. The distal tubular cells located in this area,
known as the Macula Densa which functions with the adjacent afferent arteriole and create what
is known as juxtaglumerulus apparatus. This is the site of the renin production. Renin is a
hormone directly involved in the control of arterial blood pressure; it is essential for proper
functioning of the glumerulus.

The tubular component consists of the Bowman’s capsule, the proximal tubule, the
descending and ascending limbs of the loop of Henle, and the cortical and medullary collecting
ducts. This portion of the nephrons is responsible in making adjustments in the filtrate based on
the body’s needs. Changes are continually made as the filtrate travels through the tubules until it
enters the collecting system and is expended from the body.

BLOOD SUPPLY TO THE KIDNEY

The hilum of pelvis is the concave portion of the kidney through which are renal artery
enters and ureters and renal vein exit. The kidney received 20% to 25% of the total cardiac
output, which means that all of the body’s blood circulates through the kidneys approximately 12
times per hour. The renal artery (arising from the abdominal aorta) divided into smaller and
smaller vessels, eventually forming the afferent arterioles. Each afferent arterioles branches to
form a glumerulus, which is the capillary bed responsible for glumerular filtration
.

8. PATHOPHYSIOLOGY

i BOOK BASED
ANTIGEN (GROUP A BETA-HEMOLYTIC
STREPTOCOCCUS)

ANTIGEN – ANTIBODY
PRODUCT

DEPOSITION OF ANTIGEN-ANTIBODY COMPLEX IN

GLOMERULUS

INCREASE PRODUCTION OF EPITTHELIAL CELLS LINING THE

GLOMERULUS

LEUKOCYTE INFILTRATION OF THE

GLOMERULUS

THICKENING OF THE GLOMERULAR FILTRATION MEMBRANE

SCARRING AND LOSS OF GLOMERULAR

FILTRATION MEMBRANE

MANIFESTATION
DECREASE GLOMERULAR FILTRATION RATE
(BFR)
ACUTE ONSET OF EDEMA
OLIGURIA
PROTENURIA
ANEMIA
COCOA COLORED URINE
WITH RED BLOOD CELLS
CAST (HEMATURIA)
HYPERTENSION
HEADACHE
FEVER
NAUSEA AND VOMITING
PATHOPHYSIOLOGY

ii CLIENT CENTERED
ANTIGEN (GROUP A BETA-HEMOLYTIC STREPTOCOCCUS)

ANTIGEN – ANTIBODY PRODUCT

DEPOSITION OF ANTIGEN-ANTIBODY COMPLEX IN GLOMERULUS

INCREASE PRODUCTION OF EPITTHELIAL CELLS LINING THE

A
GLOMERULUS

LEUKOCYTE INFILTRATION OF THE

GLOMERULUS

THICKENING OF THE GLOMERULAR FILTRATION

MEMBRANE

DECREASE
SCARRING
GLOMERULAR
AND LOSSFILTRATION
OF
 MANIFESTATION

EDEMA(facial and
bipedal) 08/30/08
HEMATURIA
08/30/08
HEADACHE 08/30/08
FEVER08/30/08
09/04/08
09/05/08
NAUSEA AND
VOMITING

B. IMPLEMENTATION
I. DRUGS
GENERIC DATE ROUTE OF GEN. ACTION INDICATION/S
NAME: ORDERED ADMINISTRATION MECHANISM PURPOSES
CEFUROXIME 8/30/08 DOSAGE AND OF ACTION >Pharyngitis tonsillitis
12:50 pm FREQUENCY OF infection of urinary and
BRAND DATE TAKEN ADMINISTRATION Chemical lower respiratory tract
NAME: / GIVEN Effect: Inhibits and skin structure
Ceftin, Kefurox 8/30/08 Cefuroxime 650 mg cell wall infections. Susceptible
Zinacef 9:00pm I.V q 8 hours synthesis are Streptococcus
8/31/08 promoting pneumonia, S pyogens,
Pharmacologic 6:00 am osmotic Staphyloccus aureus,
class: second- 2:00pm instability: Escherichia coli
generation 10:00 pm usually > Secondary bacterial
cephalosporin 9/01/08 bactericidal infection of acute
6:00 am bronchitis
Therapeutic 2:00 pm Therapeutic
Class: antibiotic 10:00 pm Effect:
9/02/08 Hinders or kills
6:00 am susceptible
2:00 pm bacteria
10:00 pm including many
9/02/08 gram-positive
6:00 am organisms and
2:00 pm enteric gram-
10:00 pm negative bacilli
9/03/08
6:00 am
2:00 pm
10:00 pm
9/04/08
6:00 am
2:00 pm
10:00 pm
DATE
CHANGED
9/05/08

NURSING RESPONSIBILITIES:
BEFORE ADMINISTRATION
1. Explain to the patient and family on what is the effect of drug and its action

2. Assess patients infection before therapy

3. Before giving first dose do sensitivity test

4. Before giving the first dose , ask patient about previous reaction to cephalosporins or
penicillin

AFTER ADMINISTRATION

1. Be alert for adverse reaction and drug interaction

2. If adverse GI reaction occur, monitor patients hydration

3. Tell patient/ significant others to report adverse effect seen and experience

4. Assess patients infection after the therapy

GENERIC DATE ROUTE OF GEN. ACTION INDICATION/S
NAME: ORDERED ADMINISTRATION MECHANISM PURPOSES
FUROSEMIDE 8/30/08 DOSAGE AND OF ACTION >Edema
12:50 pm FREQUENCY OF
BRAND DATE TAKEN ADMINISTRATION Chemical
NAME: / GIVEN Effect: Inhibits
Apo-furosemide 8/30/08 Furosemide 19 mg sodium and
, Furoside, 2:00 pm I.V q 6 hours chloride
Lasix, Lasix 7:00 pm reabsorption at
Special, 8/31/08 proximal and
Novosemide, 12:00 am distal tubules
Uritol 12:00pm and ascending
9/01/08 loop Henle
Pharmacologic 2:00 pm
class: Loop 10:00 pm Therapeutic
diuretic 9/02/08 Effect:
6:00 am Promotes water
Therapeutic 2:00 pm and sodium
class: diuretic 9/03/08 excretion
6:00am
6:00 pm

DATE
CHANGED
09/03/08
10:00 am Furosemide IVP OD

09/04/08
10:10 am D/C Furosemide
NURSING RESPONSIBILITIES

BEFORE ADMINISTRATION:

1. Explain to the patient and family on what is the effect of drug and its action
2. Assess patients underlying condition before administration
3. Monitor weight peripheral edema breath sounds blood pressure fluid intake and output
and electrolyte glucose BUN
AFTER ADMINISTRATION:

1. Be alert for adverse reaction and drug interaction

2. Tell patient/ significant others to report adverse effect seen and experience
 3. Monitor weight peripheral edema breath sounds blood pressure fluid intake and output
and electrolyte glucose BUN

GENERIC DATE ROUTE OF GEN. ACTION INDICATION/S

NAME ORDERED ADMINISTRATIO MECHANISM OF PURPOSES
ACETAMINOPHEN 8/30/08 N DOSAGE AND ACTION >Mild fever or
(APAP, 12:50 pm FREQUENCY OF pain
PARACETAMOL) DATE ADMINISTRATIO Chemical Effect: May
TAKEN / N produce analgesic
BRAND NAME GIVEN effects by blocking pain
Abenol Acephen, 8/30 /08 Paracetamol 190 impulses by inhibiting
Aceta Anacin Apacef 7:00 pm mg IVP q 4 hours prostaglandin or pain
Dymadon Genapapp receptors sentisizers.
Childrens Elexir DATE May relieve fever by
CHANGED acting in hypothalamic
Pharmacologic class: 08/05/08 heat- regulating center.
para- aminophenol
derivatie Therapeutic Effect:
Relieves pain and
Therapeutic class: reduces fever
nonopioda nalgesic,
antipyretic
NURSING RESPONSIBILITIES

BEFORE ADMINISTRATION:

1. Explain to the patient and family on what is the effect of drug and its action
2. Assess patient temperature before the therapy

AFTER ADMINISTRATION:

1. Assess patient temperature after the therapy

2. Be alert for adverse reaction and drug interaction
3. Tell patient/ significant others to report adverse effect seen and experience

GENERIC DATE ROUTE OF GEN. ACTION INDICATION/S

NAME ORDERED ADMINISTRATI MECHANISM OF PURPOSES
Amoxicillin 8/05/08 ON DOSAGE ACTION
with 10:00 am AND Infections of the organs
clavulanic FREQUENCY OF Amoxicillin + potassium associated with
acid or DATE ADMINISTRATI clavunate is usually breathing, including
Amoxicillin+ TAKEN / ON bactericidal in action. nasal passages, sinuses,
clavulanate GIVEN Concurrent administration windpipe and lungs
8/05 /08 Oral route 1 tsp of clavulanic acid does not (respiratory tract)
BRAND 11:00 am 3x a day for 7 days alter the mechanism of
NAME action of amoxicillin.
Co- amoxiclav However because
Clavulanic acid has a high
affinity for and binds to
certain β lactamases that
generally in activate
Amoxicillin by
hydrolizing its β lactam
ring, concurrent
administration of the drug
with amoxicillin results in
a synergistic bactericidal
effect. This synergisms
expands Amoxicillin’s
spectrum of activity
against many strains of β-
lactamase-producing
bacteria resistant to
amoxicillin alone

NURSING RESPOSIBILITIES
BEFORE ADMINISTRATION

1. Assess if the patient has penicillin hypersensivity and cross sensitivity with other β
lactam antibiotic e.g cephalosporin
2. Preparation of the medication
>Direction of Reconstitution
To make up to &0 ml first shake the bottle to loosen powder. Then ad 58 ml water
and shake well.
3. Explain to the patient and family on what is the effect of drug and its action
4. Shake well before the patient take the first dose
5. Administer medication at the start of a meal to minimize potential gastrointestinal
intolerance and to optimize drug’s absorption
AFTER ADMINISTRATION
1. Be alert for adverse reaction and drug interaction
2. Advice the patient to drink plenty of water to ensure proper ate of hydration and adequate
urinary output
3. Advice the parents to maintain the take of medication at regular intervals
4. Advice the parents to refrigerate the medication to maintain effectiveness

GENERIC DATE ROUTE OF GEN. ACTION INDICATION/S

NAME ORDERED ADMINISTRATI MECHANISM OF PURPOSES
Carbocisteine 8/05/08 ON DOSAGE ACTION
10:00 am AND Artificial airway
BRAND FREQUENCY OF Carbocisteine is a opening in the neck
NAME DATE ADMINISTRATI mucolytic medicine which (tracheostomy)
Emyxer TAKEN / ON breaks down some of the Chronic obstructive
GIVEN chemical bonds in mucus. pulmonary disease
8/05 /08 Oral route 1 tsp This makes the mucus less
11:00 am 3x a day thick and sticky (viscous)
and thus easier to cough
up
NURSING RESPONSIBILITIES:
BEFORE ADMINISTRATION
1. Explain to the patient and family on what is the effect of drug and its action
2. Assess if the patient has known sensitivity to drug
3. Shake well before the patient take the first dose
AFTER ADMINISTRATION
1. Be alert for adverse reaction and drug interaction

GENERIC DATE ROUTE OF GEN. ACTION INDICATION/S

NAME ORDERED ADMINISTRATI MECHANISM OF PURPOSES
PHENYL 8/05/08 ON DOSAGE ACTION
PROPANOLAMI 10:00 am AND used to treat the
NE FREQUENCY It works by constricting congestion
DATE OF (shrinking) blood vessels associated with
BRAND NAME TAKEN / ADMINISTRATI (veins and arteries) in allergies, hay fever,
Coway, GIVEN ON your body. Constriction sinus irritation, and
8/05 /08 of blood vessels in your the common cold.
11:00 am Oral route 1 tsp sinuses, nose, and chest
3x a day allows drainage of those
areas, which decreases
congestion
NURSING RESPONSIBILITIES:
BEFORE ADMINISTRATION
1. Assess if the patient has the following condition;
• high blood pressure;
• any type of heart disease, hardening of the arteries, or
irregular heartbeat;
• thyroid problems;
• diabetes;
• glaucoma or increased pressure in your eye;
• an enlarged prostate or difficulty urinating; or
 • liver or kidney disease.
You may not be able to take phenylpropanolamine, or you may require a lower dose or special
monitoring during treatment if you have any of the conditions listed above.
2. Explain to the patient and family on what is the effect of drug and its action
3. Shake well before the patient take the first dose

AFTER ADMINISTRATION
1. Be alert for adverse reaction and drug interaction
2. Advice to store the medication on a less light and heat exposure place

II. DIET

TYPE OF DATE GENERAL INDICATION/S SPECIFIC FOODS TAKEN

DIET: ORDERED: DESCRIPTION OR PURPOSES

Diet as August 30, the customary Diet as tolerated September 4

Tolerated 2008 amount and is ordered when
(DAT) kind of food client’s appetite, Breakfast:
and drink taken ability to eat and 1 hotdog
DATE by a person tolerance for
STARTED: from day to certain foods Lunch:
day; more may change.
2 hotdogs
narrowly, a diet
planned to meet half rice
August 30,2008
specific
requirements of Dinner:
the individual,
Half rice and vegetable
including or
excluding September 5
certain foods
dietary Breakfast:

1 egg

arozcaldo

I glass of Milo
 III ACTIVITY/EXERCISE
1. For patient risk for impaired skin integrity r/t the presence of edema.
A. Change the child’s position at least every 2 hours. Changing the position keeps pressure sores
from appearing.
B. Give bath daily and cleanse skin as needed. Attention to hygiene deters skin breakdown.
C. Use lotion over areas of dry skin. Lotion help and moisture to the skin to decrease the chance
of skin breakdown.
D. Use a support pillow under any edematous extremity. Support pillow will increase circulation
and decrease pressure points that might lead to skin breakdown.
2. For patient experiencing fatigue r/t infectious process.
A. Assess the child for signs of fatigue such as excessive sleepiness, yawning, or inability to
help with activities of daily living. A child may show signs of fatigue in subtle ways such as
sleeping more than usual, yawning, or reluctance to help with bath or feeding activities.
B. Ask the child what he wants to play with or what activities he wishes to engage in today. A
child of 5 years usually wants to play no matter how sick he is. If he has some choice he may
play more than if he was told what to do.
C. Observe the child’s activity to do activities even if these are bed games. Observation will
indicate the child’s tolerance of an activity and level of fatigue.
D. Rest periods during activities are important because the child will fatigue easily.
3. For patient who has pain r/t presence of infection and edema.
A. Assess the child for signs of pain such as grimacing, crying, staying quiet, verbal complaints
of pain, or reluctance to move. Assessment of child’s pain level allows for easily intervention
to make the child, more comfortable.
B. Gently move or reposition the child every 2 hours if he is to remain in a bed or chair position.
Moving the child gently promotes circulation of the blood, lessens chance of pain, and helps
comfort the child.
C. Position an edematous extremity on a support pillow. Supporting a swollen leg or arm will
help decrease the pain.
 D EVALUATION
A. EVALUATION

DAILY PROGRAM ADMISSION 1ST DISCHARGE DATE

DATE:8/30/08 DATE:9/04/08
NURSING PROBLEM
1.Ineffective airway
clearance
2 fever
3. poor hygiene
VITAL SIGNS Temp=38.9 Temp=37.8 Temp=39.1 10:00 am
RR=40 RR=38 38.3 10:30 am
PR=108 PR=110 RR=40 6:00 am
Bp=110/80 Bp=110/80 26 10:30 am
PR= 140 6:00 am
106 10:30
Bp=110/70 6:00 am
100/70 10:30 am
DIAGNOSTIC/LAB Hematology Serum
PROCEDURES U/A Creatinine
Serum electrolyte U/A
Creatine
C3
HSO
MEDICAL
MANAGEMENT
DRUGS Cefuroxime 650 IVP Cefuroxime PHENYL
q8 650 IVP q 8 PROPANOLAMINE1 tsp 3x
Paracetamol 190 g Paracetamol a day
IVP q 4 +≥ 37.8 C 190 g IVP q 4 Carbocisteine 1 tsp 3x a day
Furoxemide 19 mg +≥ 37.8 C Co-amoxiclav
IVP q 6 1 tsp 3x a day
D/C
Furosemide
DIET DAT DAT DAT
CONTROLLED
LIQUID INTAKE
TO 300 ml
ACTIVITY/EXERCISE A. Gently move or Bedrest • Assess the child for
reposition the signs of fatigue such as
child every 2 excessive sleepiness,
hours if he is to yawning, or inability to
remain in a bed help with activities of
or chair position. daily living. A child
Moving the child may show signs of
 gently promotes fatigue in subtle ways
circulation of the such as sleeping more
blood, lessens than usual, yawning, or
chance of pain, reluctance to help with
and helps bath or feeding
comfort the activities.
child. • Ask the child what he
B. Position an wants to play with or
edematous what activities he
extremity on a wishes to engage in
support pillow. today. A child of 5
Supporting a years usually wants to
swollen leg or play no matter how sick
arm will help he is. If he has some
decrease the choice he may play
pain. more than if he was
told what to do.
• Observe the child’s
activity to do activities
even if these are bed
games. Observation
will indicate the child’s
tolerance of an activity
and level of fatigue.
• Rest periods during
activities are important

2.DISCHARGE SUMMARY

M: Take home medication instructed to the patient mother as follows:

Coamixilae (Amocram) 150 g/mL 1 tsp 3x a day for 7 days

Carbocisteine syrup ( emyxer) 1 tsp 3x a day

Phenypropanolamine (coway) 1 tsp 3x a day

E: Advised the mother to let his child continue his usual daily activities as tolerated

T: Ø

H: The following are advised to the patient’s mother:

  Increase the patients fluid intake to prevent dehydration
 Watch her child carefully for symptoms of asthma to prevent further complications
 Don’t let her child to stay outside on hot environment for long period of time.
O: Scheduled for OPD check up on September 08, 2008 at Tarlac provincial hospital

D:

 Advised the mother to give her child nutritious food like fruits and vegetables to sustain
the needed nutrients of the body.
 Advised the mother not to let her child to eat junk foods.

III CONCLUSION

IV RECOMMENDATION

Patient education is directed toward maintaining kidney function and preventing

complications. Fluid and diet restrictions must be reviewed with the patient, such as avoiding
dietary protein when renal insufficiency and nitrogen retention (elevated BUN) develop, and
sodium when the patient has hypertension, edema and heart failure. The importance of follow-up
evaluations of blood pressure, urinalysis for protein and serum BUN and creatinine levels to
determine if the disease has progressed is stressed to the patient. A referral for home care may be
indicated, a visit from a home care nurse provides an opportunity for careful assessment of the
patient’s progress and detection of early signs and symptoms of renal insufficiency. Void every 2-
3 hours during the day and completely empty the bladder. This prevents over distention of the
bladder and compromised blood supply to the bladder wall. With regards to hygiene, shower
rather than bathe in tub because bacteria in the bath water may enter the urethra. After each
bowel movement, clean urethral meatus. Indicate that strenuous exercise should be avoided
because exercise can induce proteinuria, hematuria, and cylindruria (renal cylinders or casts in
the urine). Some recommend other nutritional approaches such as consuming cranberry juice,
blueberry juice, and fermented milk products containing probiotic bacteria, have been shown to
inhibit adherence of bacteria to the epithelial cells of the urinary tract

V. BIBLIOGRAPHY

Website
2
New international Child Growth Standards for infants and young children (2006) by the World
Health Organization (retrieved from: http://www.who.int/growthref/en/)
http://www.drugs.com/mtm/phenylpropanolamine.html
 http://www.chem-online.org/generic-pharmaceutical.htm
http://en.wikipedia.org/wiki/Carbocisteine
http://en.wikipedia.org/wiki/Co-amoxiclav
(http://www.emedicine.com/med/topic879.htm)
http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm
http://www.patient.co.uk/showdoc/40024643/)
Book:
1
Health Assessment & Physical Examination (3rd Edition) by Mary Ellen Zator Estes
Pediatric Nursing (Caring for children and their families)by Nicki L Potts and Barbara L
Mandleco

Tarlac State University

College of Nursing
Lucinda Campus, Tarlac City
A.Y. 2008 – 2009

A Case Study on
“Acute Glomerulonephritis and Acute Pyelonephritis”

Submitted by:
Canlas, Mylene
Casilang, Freda
Cayabyab, Jodi
Cayabyab, Shiela
Daguro Wella
Espinosa, Rachel
Dijamco, Arcen
Dizon, Robert
Escalona, Hesusito
Galeon, Paolo
 Group A2

Submitted to:
Mr. Apollo G Facun RN,MSN