NARRATIVE REPORT

By. Medina ShieIa Marie R.

BSN II - 1


November 8, 2011
Tuesday
We had our first duty at pedia ward under the supervision of our clinical
instructor Ms. Jesusa Cristina Oredina, RN we started our duty by having
orientation about the different area found at pedia ward, also Ms. Oredina
discussed to us the different basic things that we need to do specially in taking
vital signs of the patient. Also we met our Head Nurse Ms. Grace Teves. After
the orientation we go to our respective patient to do morning care, also we
regulate their V fluid based on the doctor's order. learned a lot when
experienced my duty at pedia ward like taking vital signs to a pedia patient /O
taken and how to compute the V regulation. Before the end of our shift we
record all the vital signs of our patient including their intake and output.


November 14, 2011
Monday
We started our duty by listening to the staff regarding to the endorsement of
patient to the next shift and during rounds we followed the staff while they check
all the V fluids of the patients. After we get our patient assignment we go to
their room to do morning care, and check their V fluid for its regulation. We get
the vital signs based on the doctor's order. Our Clinical nstructor discussed of
how to fill up the kardex form of our patient. We record all the vital signs of our
patient also their intake and output.





November 15, 2011
Tuesday
This is the last day of our duty at pedia ward, we started our duty by listening
the staff while they do the endorsement of patient to the next shift. After the
endorsement the staff will rounds to check the V fluids. When we get our patient
assignment we go to their respective room for giving the morning care. Also
Ms. Oredina discussed to us of how to make the FDAR charting based on the
patients problem, and how to make a METHOD charting for those patient who
will go home. Also our clinical instructor give us the chance to do endorsing of
patient to our head nurse, for us to know of what we are going to do when we do
the endorsement.
















NEPHROTIC SYNDROME
By. Medina, ShieIa Marie R.
t is an abnormal condition of the kidney characterized by marked
proteinuria, hypoalbuminea, and edema.
t occurs in glomerular disease and thrombosis of a renal vein and as
a complication of many systemic disease. t is a non-specific disorder
in the kidneys damaged causing them to leak large amounts of
protein from the blood into urine.
Kidneys affected by nephritic syndrome have small pores into
podocytes large enough to permit proteinuria (and subsequently
hypoalbuminea because some of the protein albumin has gone from
the blood to the urine ) but not large enough to allow cells through
(hence no hematurial). By contrast in nephritic syndrome RBC's pass
through the pores causing hematuria.
According to the nephcure most often nephritic syndrome is defined
that is primary disease that attacks the kidney's filtering system.
Some of the cases are idiophatic or unknown.
Peak incidence 2-6 years old boy
SIGNS AND SYMPTOMS
Proteinuria
Hypoalbuminea
Hyperlipidemia and edema which is generalized or also known as
anasarca.
Excess fluid in the body due to the serum hypoalbuminea.
Fluid in the peritoneal cavity causing ascites
Has foamy or frothy urine due to a lowering of the surface tension
by severe proteinuria.
Periorbital edema
PypoproLelnemla sLlmulaLes proLeln synLhesls ln llver resulLlng ln Lhe
overproducLlon of llpoproLelns
CAUSES
Primary causes of Nephrotic Syndrome are usually described by the
histology like minimal change neuropathy which is common cause of
nephritic syndrome in children and membranous glomerulous nephritis
which is main cause of nephritic syndrome in adult.

DIET
Restricts sodium intake to 1000-2000 mg daily
Avoid saturated fats such as butter cheese fried foods fatty cuts of red
meat egg yolk and poultry skin.
Monitor the fluid intake which all fluids and foods that are liquid at room
temperature.

EXAMS AND TEST
The doctor will perform a physical exam. Laboratory tests will be done to see
how well the kidneys are working. They include
Creatine - blood test
Blood urea nitrogen (BUN)
Creatinine clearance
Albumin blood test - may be low
Urinalysis - reveals large amounts of urine protein
Fats are often also present in the urine. Blood cholesterol and triglyceride levels
may increase.
Kidney biopsy may be needed .





Tests to ruIe out various causes may incIude the foIIowing:
Glucose tolerance test
Antinuclear antibody
Rheumatoid factor
Cry globulins
Complement levels
Hepatitis B and C antibodies
VDRL serology
Serum protein electrophoresis


TREATMENT
The goals of treatment are to relieve symptoms, prevent complications and delay
progressive kidney damage. Treatment of the disorder that causes the condition
is necessary to control nephrotic syndrome. Treatment may be needed for life.
Controlling blood pressure is the most important measure to delay kidney
damage. The goal is to keep blood pressure at or below 130/80 mmHg.

Monitoring and maintaining euvolemia (correct amount of fluid in the body)
Monitor urine output
Monitor the blood pressure regularly
Restricts fluid if ordered
Place the patient into fowler's position to decrease the pressure against
the diaphragm.
Provide regular diet, discourage the use of salt





CURRICULUM VITAE

Name: Medina, Shiela Marie R.
Nickname: Ella
Age 23 years old
Birthday: Sept. 26, 1988
BirthpIace Bacoor Cavite
Address: 32-C Bayanan, Bacoor Cavite
CiviI Status Single
NationaIity Filipino
ReIigion: Roman Catholic
EmaiI Address acohpoun_26@yahoo.com
Motto: " One is enough, Two is too much Three is dangerous. "
Hobbies: Watching T.V Texting, Reading Books
Ambition To be a successful Nurse someday
EducationaI Background
Primary: Bayanan Elementary School
1999-2000
Secondary General Emilio Aguinaldo National High School
2004-2005
Tertiary Bachelor of Science in Nursing
City University of Pasay
2010-present

PATIENT'S PROFILE
Patient's Name JJD
Address Pasay, City
Age 3 years old
Sex Male
ReIigion Catholic
Birthday September 25, 2008
BirthpIace Pasay, City
Attending Physician: Dr. Somogod
Chief CompIaint Peri-orbital Edema
4 days prior to admission
(+) peri-orbital edema (+) abdominal distention
(+) tea colored urine (+) colds
(-) headache (-) Loose Bowel Movement (LBM)
(-) seizure (-) allergy

5-months the patient experience Urinary Tract nfection (UT)- no medication
taken.
IMMUNIZATION HISTORY
BCG Done
OPV Done 3 times
DPT Done 3 times
MEASLES Done
HEPA-B Done 3 times

Vital Signs
BP 80/50mmHg CR 120 bpm RR 42cpm Temp36.6 C

AdmittingDiagnosis:
Nephrotic Syndrome
Medication:
Penicillin G 340,000 milk q6
Prednisone 10mg/5ml/2.5ml every other day
Enalapril 5mg tab once a day
Furosemide 14mg TV once a day

LABORATORY EXAMS
Date Nov. 11, 2011
Blood Chemistry Result Normal Value
Hemoglobin 115 140-180
Hematocrit 0.34 0.40-0.54
RBC 3.76 4.5-6.5
WBC 6.10 5-10
Neutrophils 0.69 0.55-0.65
Lymphocytes 0.31 0.25-0.35
Platelet count 252 150-400

URINALYSIS
Color Dark yellow
Characteristic Cloudy
Ph 6.0
Specific Gravity 1.020
Sugar Negative
Protein +3
Blood +3
Leukocytes Trace
Nitrite Negative
Pus cells 6-8 hpf
RBC Too numerous to count
Mucus thread Few
Epithelial cells Few
Bacteria Moderate
Urates phosphate Few

EXPECTATION
By. Medina, ShieIa Marie R.
Honestly don't have any expectation from our head nurse Ms. Grace Teves,
because we are not aware that we are having a head nurse but we are thankful
that she is our head nurse because she is very helful she shared to us her
knowledge regarding in different procedures. She teach us a lot specially in
Doing the V regulation properly.
also want to thank Ms. Grace Teves for her effort of teaching us because
know that she is a very busy student and inspite of her busy schedule she exert
extra time to explain some ideas and knowledge that we are not yet learned.
must say that all the ideas and knowledge that she share to us will help us a
lot in our next duty even in our future profession.















EVALUATION
By. Medina ShieIa Marie R.
AREA Pedia Ward, 3
rd
Floor Pasay City General Hospital
My evaluation in the pedia ward, when the time that im not yet experience my
duty at pedia ward for me this is one of the toxic area in the hospital because
every children has a low immune system specially if they are sick are prone to
any illness. But when got finally do my duty at padia ward must say that this is
a toxic but exciting ward because learned a lot from this area and understand
that we must give effort and knowledge in every procedure that we do because
life of the patient is very important also the are is clean and well ventilated.

STAFF NURSES Pedia Ward
My evaluation to all the staff in pedia ward they are so kind and very
approachable to us. want to thank them for giving us a chance to do some basic
procedure because we learned a lot from doing it.

CLINICAL INSTRUCTOR Ms. Jesusa Cristina Oredina RN, MANc
My evaluation to our Clinical nstructor Ms.Jesusa Cristina Oredina, RN feel
that she is very strict but when we finally meet her when we start our duty at
pedia ward i understand that her characteristic of being strict has a reason,
because we learned a lot from her specially to the things that we need to know
everytime that we gathered our duty at pedia ward.
want to thank our Clinical nstructor for her effort of teaching us regarding to
the procedure that she explained to us because it will help us a lot for our duty in
other area.

HEAD NURSE: Ms. Grace S. Teves BSN V-2
My evaluation to our Head Nurse Ms. Grace Teves she is very kind and
approachable to us because she always help us in our activities in duty and she
teach us about the different things that we need to know for us to learn the
different procedure that the nurse do in pedia ward.


HOW DO I SEE MYSELF 5 YEARS FROM NOW
By. Medina, ShieIa Marie R.
BSN II - 1
see myself 5 years from now think i am a registered nurse already , who
works in the community as a community health nurse, because this is the field of
nursing 'd like to belong. n my own perception the true meaning of being a
nurse is by helping the others even though if they do not have enough money for
them to sustain their health needs, that's why 'd like to be a community nurse
someday. Also want to help those elders who's not capable enough to cater
their self.