CASE STUDY

Acute Poststreptococcal Glomerulonephritis

Patient Profile NAME: Age: Sex: Birthdate: Religion: Nationality: Day admitted: Baby T.V 5 y/o Female 08-19-2007 Catholic Filipino February 14, 2010

Primary language: Tagalog

A. Chief concern (narrative of present illness) 2 weeks PTA hindi ko alam nagkaroon pala siya ng tonsillitis, nakakakain pa naman kasi siya ng hindi dumadaing as verbalized by the mother. Client urinates once a day, edematous and was experiencing difficulty of breathing secondary to FLU. The child was brought to a health institution for check up. Series of diagnostic exams were taken and ruled out presumptive Urinary tract infection. The physician prescribed antibiotics and vitamins. 1 week PTA the mother decided to have second opinion by another health institution but still ruled out UTI. Initial symptoms still exists and prescribed meds are being taken. On the day of admission came to the emergency room with a chief complaint of facial swelling. Laboratory exams were done, client was diagnosed with Acute glomerulonephritis and was advised to be admitted. B. Vital Signs (taken 02-18-2010) T: 36.2c C. Past history 1. Perinatal and birth history P: 90bpm R: 18bpm BP: 100/70

CASE STUDY
Acute Poststreptococcal Glomerulonephritis

G3P3, non-hypertensive, non-diabetic, non-asthmatic mother delivery via normal spontaneous delivery with no fetomaternal complications 2. Diet history

Breastfed for 6 months, eats whatever the mother offers such as chicken, veggies and fried fishes or any kind of dishes. likes eating junk foods,

3. Immunizations The client completed her immunizations before 1 year old and therefore considered as Fully immunized child (FIC) 4. Developmental milestones 6 months sobrang daldal niya nun verbalized by the mother 7 months first eruption of deciduous teeth 1 y/o walks without support 4 y/o starts studying; nursery Gordons Functional Health Pattern A. Functional Health Pattern Assessment Client is admitted due to the ruled out diagnosis of AGN. This is her first time and it was explained to her properly why based on her age. Home medications were given upon first check up, all are taken orally and client has no allergic reactions to any drugs. B. Nutritional and Metabolic Pattern Family eats thrice a day and usually the client eats first. Among her favorite foods are chicken and veggies of any type. Client doesnt like orange juice and prefers to drink milk or water. Right now, the childs appetite has been slightly affected because of dietary restrictions. She doesnt experience any gum and dental problems.

CASE STUDY
Acute Poststreptococcal Glomerulonephritis

C. Elimination Pattern Client is toilet trained and defecated once or twice a day, usually daytime. Has no problems with urination and wears diapers during night time. No reported changes. D. Sleep-Rest Pattern Client sleeps 8hours during the night and 2 to 3 hours after lunch. She sleeps together with her parents in one room with lights off. No experienced sleep disturbances during the clients stay in the ward but she started to snore upon the first day of confinement. No problems reported. E. Activity-Exercise Patterns Client goes to school in the morning and usually watches cartoons during noon time. There are also some restrictions in the type of TV shows being watched. Needs assistance in performing personal hygiene and grooming, e.g brushing teeth, taking a bath, combing hair etc. Feeding: 2 Bathing/ hygiene: 2 Dressing / grooming: 2 Toileting: 2 F. Cognitive-Perceptual Pattern No hearing difficulty, vision problems and no learning disabilities. Currently enrolled as a nursery student and participates actively in school. She knows how to identify basic colors and shows interest in drawing. G. Self Perception-Self Concept Pattern The child takes time to adjust to people whom she met for the first time. Client is a bit of shy, cries when being teased by older brothers and recently having trauma with the series of laboratory procedures being undergone.

CASE STUDY
Acute Poststreptococcal Glomerulonephritis

H. Role Relationship Pattern The mother is the primary care giver and is a housewife. Father works as a family driver. The clients hospitalization affects the family budget. Client doesnt have any speech or hearing problem.
I.

Coping Stress Tolerance Pattern Client has no temper tantrums. And is an accident prone just like children of her age.

J. Value-Religion Pattern Clients family is a Roman Catholic and do religious practices like praying before meal or bed time.

CASE STUDY
Acute Poststreptococcal Glomerulonephritis

DIAGNOSTIC EXAMINATIONS February 14, 2010 MACROSCOPIC Color Transparency Specific gravity pH (reaction) Albumin Glucose CHEMISTRY Blood Bilirubin Urobilinogen Ketone Nitrate Leukocyte Pus cells Red cells Epithelial cells Mucus threads Bacteria February 14, 2010 Creatinine: Sodium: Potassium: ASO TITER: Hematology Hgb: Hgt: RBC count: MCV: MCH: 41 MMOL / L 139 MMOL /L 5.1 MMOL /L Positive Results 9.2 27.8 3.65 76.2 25.2 reference value 11.00-16.00 g/dl 31.00-43.00 % 3.90-5.30 x 106 / L 80.00-100.00 fl 27.00-31.00 pg Light yellow Slightly turbid 1.020 6.0 Trace Negative 3+ Negative Normal Negative Negative Trace 2-4 / HPF TNTC Rare Rare Rare February 17, 2010 Yellow Turbid 1.010 7.0 +1 (--) +3 (-) (-) (-) (-) +2 15-20 / HPF TNTC Rare Rare Few

CASE STUDY
Acute Poststreptococcal Glomerulonephritis

MCHC: Platelets: WBC count: Eosinophil: Neutrophil: Lymphocyte: Monocyte: RDW February 15, 2010 ULTRASOUND

33.1 316 10.29 4 58 31 7 14.1

31.00-37.00 pg 150.00-400.00 x 103 / L 5.00-17.00m x 103 / L 2.00-3.00 % 25.00-43.00 % 42.00-50.00 % 4.00-5.00 % 8.50-15.00

KUB UTZ PRE and POST VOID: - Right kidney: 7.4 x 2.8 x 3.2 cm - Left kidney: 7.0 x 3.2 x 3.7 cm - Both shows increased parenchymal echogenecity - Urinary bladder is well distented - Pre void volume: 130cc - Post void shows Impression: Kidneys mild diffuse parenchymal disease consistent with AGN Urinary bladder unremarkable Xray Mild perihilar haziness with thickened minor fissure and both sulci Both bases shows minimal fuzziness Heart is slightly enlarged Diaphragm and bony thorax unremarkable

Impression: Mild perihilar pneumonia Mild pulmonary congestion

CASE STUDY
Acute Poststreptococcal Glomerulonephritis

Cardiomegaly Bilateral moderate pleural effusion February 16, 2010 C3 430 mg / L LAB RESULTS: Definition, Interpretation and Nursing Considerations URINALYSIS Definition: A urinalysis is an array of tests performed on urine and one of the most common methods of medical diagnosis. A part of a urinalysis can be performed by using urine dipsticks, in which the test results can be read as color changes. Interpretation: the urinalysis results are normal. Normal urine may vary in color from almost colorless to dark yellow. Usually, glucose, ketones, protein, and bilirubin are not detectable in urine. The following are not normally found in urine Hemoglobin, Nitrites, Red blood cells, White blood cells. Nursing Consideration: Special diets can change test results. For example, a diet low in carbohydrates and high in protein and fat can raise ketone levels in the blood which can then enter the urine. HEMATOLOGY Definition: Hematology, is the branch of internal medicine, physiology, pathology, clinical laboratory work, and pediatrics that is concerned with the study of blood, the blood-forming organs, and blood diseases. Interpretation: a low HGB indicates anemia, severe hemorrhage, hemolysis, cancer, kidney disease, and splenomegaly. A low HCT indicates anemia, normal pregnancy, hemorrhage and leukemia. A low RBC indicates anemia, which often leads to fatigue.

CASE STUDY
Acute Poststreptococcal Glomerulonephritis

MCV decreases value may indicate iron deficiency anemia and thalassemia. Decreased MCH occurs in microcytic anemia or hypochromic anemia. And the rest is normal. Nursing Consideration: should be aware of tests that do require special food restrictions. Some tests require fasting prior to the test. Be sure you inform your patient verbally and in writing. Be sure that the staff is informed of any food restrictions. It is no secret that many tests and procedures had to be canceled at the last minute because the patient ate some food. Be sure to mark the patient's chart, diet list, and put signs in their room. Many hospitals have a specific procedure to follow for NPO. Be sure to follow this procedure and follow-up on keeping them NPO, if required for testing or for the procedure. Also remember that some tests/procedures might require that the patient consume a light meal, a liquid meal, or other special diet. X-RADIATION(X-RAYS) Definition: X-radiation (composed of X-rays) is a form of electromagnetic radiation. Xrays have a wavelength in the range of 10 to 0.01 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz (3 1016 Hz to 3 1019 Hz) and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays. Interpretation: Mild perihilar pneumonia, Mild pulmonary congestion, Cardiomegaly Bilateral moderate pleural effusion Nursing Consideration: The effect of X-rays on the film depends upon three factors: PPV, the intensity of X-rays and the contrast equivalent X-ray tube voltage. ULTRASOUND Definition: Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Although this limit varies from person to person, it is approximately 20 kilohertz (20,000 hertz) in healthy, young adults and thus, 20 kHz serves as a useful lower limit in describing ultrasound.

CASE STUDY
Acute Poststreptococcal Glomerulonephritis

Interpretation: Kidneys mild diffuse parenchymal disease consistent with AGN Urinary bladder unremarkable Nursing Consideration: Patient education is an important part of preparation. Discussion and consensus of the exact treatment goals with patients and their families must be done prior to treatment. CREATININE BLOOD TEST Definition: Creatinine blood test is used along with a BUN (blood urea nitrogen) test to assess kidney function. Both are frequently ordered as part of a basic or comprehensive metabolic panel (BMP or CMP), groups of tests that are performed to evaluate the function of the bodys major organs. Interpretation: Urine that is foamy, bloody, or coffee-colored , decrease in the amount of urine, Problems urinating, such as a burning feeling or abnormal discharge during urination, or a change in the frequency of urination, especially at night , Mid-back pain (flank), below the ribs, near where the kidneys are located,High blood pressure . Nursing Consideration: Avoid Drugs that can interfere with creatinine clearance measurements include: cimetidine, trimethoprim, and nephrotoxic drugs, such as cephalosporins (e.g., cefoxitin). Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others. ASO TITER Definition: ASO titer is a blood test to measure anti-streptolysin O (ASO) antibodies. Blood is drawn from a vein, usually from the inside of the elbow or the back of the hand. The puncture site is cleaned with antiseptic. An elastic band is placed around the upper arm to apply pressure and cause the vein to swell with blood.

CASE STUDY
Acute Poststreptococcal Glomerulonephritis

Interpretation: active streptococcal infection, bacterial endocarditis, post-streptococcal glomerulonephritis, rheumatic fever, scarlet fever Nursing Consideration: The risks associated with these tests are minimal, but may include slight bleeding from the blood-drawing site, fainting or feeling lightheaded after the blood is drawn, or blood accumulating under the puncture site.

MEDICATIONS Furosemide 10mg, orally, q12h Pen G 400,000U, intravenously, q6h