CHAPTER I INTRODUCTION Vasculitis is an inflammation of the blood vessels.

It happens when the body's immune system attacks the blood vessel by mistake. The cause is often unknown. Vasculitis can affect arteries, veins and capillaries. Arteries are vessels that carry blood from the heart to the body's organs. Veins are the vessels that carry blood back to the heart. Capillaries are tiny blood vessels that connect the small arteries and veins. HenochSchnlein purpura (HSP, also known as anaphylactoid purpura, purpura rheumatic, and SchnleinHenoch purpura) is a disease of the skin and other organs that most commonly affects children. In the skin, the disease causes palpable purpura (small hemorrhages); often with joint and abdominal pain. With kidney involvement, there may be a loss of small amounts of blood and protein in the urine, but this usually goes unnoticed; in a small proportion of cases, the kidney involvement proceeds to chronic kidney disease. HSP is often preceded by an infection, such as pharyngitis. HSP is a systemic vasculitis (inflammation of blood vessels) and is characterized by deposition of immune complexes containing the antibody IgA; the exact cause for this phenomenon is unknown. It usually resolves within several weeks and requires no treatment apart from symptom control, but may relapse in a third of the cases and cause irreversible kidney damage in about one in a hundred cases. (Rapini, 2007) Although no one really knows what causes HSP, doctors do know that it occurs when the body's immune system doesn't function as it should. A protein called

immunoglobulin A (IgA), a type of antibody, is deposited into the blood vessels and seems to be connected to their inflammation.

It is unclear why this immune reaction occurs, but in many cases, it seems to be triggered by a bacterial or viral infection of the upper respiratory tract (sinuses, throat, or lungs). Although less common, other triggers have been identified, such as certain medicines, food reactions, insect bites, and vaccinations.

HSP cannot be passed from one person to another.

Purpura, arthritis and abdominal pain are known as the "classic triad" of Henoch Schnlein purpura. Purpura occur in all cases, joint pains and arthritis in 80%, and abdominal pain in 62%. Some includegastrointestinal hemorrhage as a fourth criterion; this occurs in 33% of cases, sometimes, but not necessarily always, due to intussusception. The purpura typically appear on the legs and buttocks, but may also be seen on the arms, face and trunk. The abdominal pain is colicky in character, and may be accompanied by nausea, vomiting, constipation or diarrhea. There may be blood or mucus in the stools. The joints involved tend to be the ankles, knees, and elbows, but arthritis in the hands and feet is possible; the arthritis is nonerosive and hence causes no permanent deformity. Forty percent have evidence ofkidney involvement, mainly in the form of hematuria (blood in the urine), but only a quarter will have this in sufficient quantities to be noticeable without laboratory tests. Problems in other organs, such as thecentral nervous system (brain and spinal cord) and lungs may occur, but is much less common than in the skin, bowel and kidneys.

Of the 40% of patients who develop kidney involvement, almost all have evidence (visible or on urinalysis) of blood in the urine. More than half also haveproteinuria (protein in the urine), which in one eighth is severe enough to cause nephrotic syndrome (generalised swelling due to low protein content of the blood). While abnormalities on urinalysis may continue for a long time, only 1% of all HSP patients develop chronic kidney disease. Hypertension (high blood pressure) may occur. Protein loss and high blood pressure, as well as the features on biopsy of the kidney if performed, may predict progression to advanced kidney disease. Adults are more likely than children to develop advanced kidney disease. (Longo et. Al, 2011) Henoch-Schonlein purpura usually improves on its own within a few weeks, usually no more than eight weeks, with no lasting ill effects. Treatment is usually aimed at relieving discomfort and preventing complications. Most often, this means: Bed rest, Plenty of fluids, Taking acetaminophen (Tylenol, others) or nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others)

In certain circumstances, children and young adults with Henoch-Schonlein purpura may require hospitalization. This is likely if they have: Trouble staying well hydrated, Severe abdominal pain or gastrointestinal bleeding, Joint symptoms that make movement difficult, Extensive ulceration of the skin, Serious kidney problems, which may be treated with immunosuppressive drugs

The use of powerful corticosteroids in treating or preventing complications of Henoch-Schonlein purpura is controversial. It's most often used to treat severe gastrointestinal symptoms. Because these drugs can have serious side effects and their

usefulness isn't clear, be sure to discuss the risks and benefits with your doctor or paediatrician.

PURPOSE AND OBJECTIVES This case study aims to present the nursing care of Pediatric client diagnosed with HenochSchnlein purpura. Specifically, this case study seeks to achieve the following objectives: 1. Identify the factors that led to the development of the problem which is Henoch Schnlein purpura. 2. Identify the immature physiologic functioning of each body and its significance to nursing care of pediatrics. 3. Analyze the relationship of factors that leading to the development of the HenochSchnlein purpura. 4. Discuss the relevant interventions that were utilized to resolve the problem.

SIGNIFICANCE OF THE STUDY The results of this case study are intended to give benefit to the following people concerned: To the Client. Being the primary source of quality nursing care, the outcome of this case study will initiate an alternative therapeutic approach in rendering care with her present condition.

To the Family with Similar Case. This case study will help in improving their awareness as each in the family constituents. It also aims to help them identify and understand the causes of such illness and somehow intends to initiate points to consider as to looking after their sick child with HenochSchnlein purpura. This case acknowledges each intervention utilized and/or shall be utilized for the patient. The family would have a better background of what the patient will be experiencing and whatever care needed for the patient. It also would somehow allow significant others to accept whatever event or condition the family will confront in the near future, allowing them to cope in a more challenging and therapeutic manner. To the Health Care Providers. This study will make them aware of the specific information about the clients conditions and actions/ interventions will be done base on the condition or illness experiencing by the client. To the Student Nurses. This study may serve to provide learning experience and relevant information regarding effective nursing care and management as well as the variation in the strategy and techniques of handling clients with similar case. This may also serve as a basis of information regarding an actual learning condition allowing and inspiring the student nurses to embrace the challenges of clinical experience in a pediatric unit. To the Future Researchers. This study will serve as a reference for clinical condition with HenochSchnlein purpura and this may serve as a basic guide in meeting a better care plan and may give a better baseline data of HenochSchnlein purpura in an actual application

SCOPE AND LIMITATION This is a case study, which focuses on the care of a pediatric client with Henoch Schnlein purpura. The patient receiving the focus of care is C.M.V.O., a 14 year old female. The researchers utilized the retrospective A type of approach for this study because we had an interaction with the patient and gathered data from the medical records wherein actual and potential problems were identified. The scope of this study was focus in meeting the needs of the pediatric client with HenochSchnlein purpura. Assessment was done to determine the possible nursing diagnosis that would fit to the clients condition. The researchers were able to plan a possible nursing intervention that could help to promote high level of wellness of the client. The study was done through a face to face contact and assessment of the client in between the time of 0600H-1400H date of July 04, 2013. At the 3rd floor of a tertiary hospital in Makati. Information was collected through the clients medical record, interview using forms, observations and interaction of the researcher and client itself and its family. The data gathered from the patient was handled with confidentiality. The limitations of the study was that the client was only handled for 3 days, thus further assessment before the contact of the researchers were only from medical records like chart and clients verbalizations. BACKGROUND OF THE STUDY This study was done during the 1st rotation of the researchers in the first semester of school year 2013-2014 in a certain tertiary hospital located at Makati City. The eightstorey tertiary hospital was said to be exclusive for the residents of Makati. It is situated

just within the baranggay of its district. The place where the study was conducted is at the Pediatrics ward. The Pediatrics ward is located at the third floor of the new building and is divided into two: the main and the annex. The Pediatrics ward Annex is where the client was confined. It is composed of 5 wards and 1 Pediatric Intensive Care Unit. Each ward has 10 beds, in each bed has its own portable suction machines and oxygen. The patient was handled by a nursing student from Makati Medical Center College of Nursing. Under the supervision of their clinical instructor, Ms. E.G. during the 1st rotation last July 04, 2013 during AM shifts 0600H to 1400H. The researcher selected the patient because the researcher found it interesting and challenging to make a study about HenochSchnlein purpura.