I.

Introduction
Acute glomerulonephritis (AGN) is a type of renal disease which indicates the inflammation of glomerulus and nephrons most commonly at the age of 2-15 years old. Each kidney is composed of about 1 million microscopic filtering "screens" known as glomeruli that selectively remove uremic waste products. Any disruptions to this process results to the inflammation of the kidney. There are many diseases that cause an active inflammation within the glomeruli. Some of these diseases are systemic and some occur solely in the glomeruli. Most often, the inflammation that triggers the disease stems from an immune response to a specific bacterium called Streptococcus. Typically, the body launches this immune response when the bacteria attack the lungs or, less commonly, the skin. When there is active inflammation within the kidney, scar tissue may replace normal, functional kidney tissue and cause irreversible renal impairment. This inefficient functioning results in blood and protein appearing in the urine, and the accumulation of excess fluid in the body. Swelling results when protein is lost from the blood stream. Acute glomerulonephritis may be associated with the development of high blood pressure, interstitial inflammation and acute kidney failure. A number of types of glomerulonephritis exist, each of which has different causes, outcomes if not treated, and responses to treatments. Some types of glomerulonephritis lead to kidney failure, which is treated with either kidney transplantation or dialysis. Other types of glomerulonephritis lead to protein loss in the urine, which can cause edema formation, cholesterol disorders, malnutrition, and increased susceptibility to infection. Because many types of glomerulonephritis respond poorly to existing treatment regimens, new and improved treatment options are needed. A new treatment option receiving increased attention worldwide, is mycophenolate mofetil (MMF). MMF is widely used by people with an organ transplant because it is very effective in preventing rejection of the transplanted organ. MMF is an oral medication that is converted by the body to an active compound, mycophenolic acid (MPA). MPA has specific effects on lymphocytes, white blood cells that mediate many of the effects of glomerulonephritis on the kidney. . It inhibits proliferation of immune cells involved in glomerulonephritis, specifically B and T lymphocytes; inhibiting adhesion and migration of inflammatory cells to

blood vessels; and induction of programmed cell death of inflammatory cells. Furthermore, MMF is likely to be highly specific for immune cells, thereby limiting its side effects. It is widely acknowledged that the incidence of AGN has decreased in the past three decades. Nevertheless, AGN remains a common disease in many rural and Aboriginal communities with low socioeconomic status. Such is the case in Australia and in Valencia, Venezuela, where the disease causes 70% of the hospital admissions in a pediatric nephrology service. In India, glomerulonephritis represent 73% of the acute glomerulonephridities affecting the elderly. 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. 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 also.

1. Cattran DC. Invited lecture: Role of mycophenolate mofetil in the treatment of glomerulonephritis. J Am Soc Nephrol. 2002;13:75P. 2. Chen X, Chen P, Cai G, et al. A randomized control study of mycophenolate mofetil treatment in severe IgA nephropathy. J Am Soc Nephrol. 2002;13:14A. Abstract FFC065.

Objectives
Cognitive: Affective:

Psychomotor:

II. Nursing History

A. Demographic Data Sherlock is a 10-year old boy with Half- Filipino and Half-German nationality. He was born on December 6, 2002 on a small town in Germany. At the age of 1, he came home to the Philippines. He spent his growing years with his parents, grandmother and his

younger sibling. In 2006, his father died of stroke at the age of 40. At present, together with his mom and younger sibling, they reside in one of the Subdivisions in Angeles City. Sherlock is currently in the second grade at Apung Gidang Elementary School. He speaks fluently in Tagalog and Bisaya. Last June 26, 2013, the patient was admitted to Angeles Medical Center at around 8:00 in the evening with a chief complaint of blurring of vision and difficulty of breathing. B. Socio-economic, Cultural and Environmental Factors Sherlock was baptized under the Roman Catholic Church. His mother is a native Bisaya while his father is a pure German. When it comes to economic indices, Sherlocks mom stands as the breadwinner of the family. According to the SO, his father used to serve the German Military in the past. But after his demise, his mother took in charge of all the responsibilities including providing all their necessities. Today, his mother works as a businesswoman and sells make-up as the companys foremost product. She earns roughly P25, 000.00 a month. Most of their expenditures mainly include food, electric and water bill, education, and daily allowances respectively. During the interview, the family described their community as a peaceful one. It is a newly established subdivision wherein its free from all kinds of pollution. The neighborhoods are not congested and no nearby factories can be seen along the way. Adjacent to their community are some fast food chains, convenience stores and the Ospital ning Angeles. Whenever someone gets sick, the family immediately seeks for medical help to the hospital. They do not subscribe to herbolaryos and the like practice. C. History of Past Illness Sherlock had his complete immunizations namely BCG, DPT, Hepa-B, MMR before his first birthday. When he was a child, he experienced common childhood illnesses like colds, fever, diarrhea, chicken pox, mumps and measles. The signs and symptoms were managed through seeking medical help in the local community. The doctor usually prescribes them some medications, which the SO failed to recall. Sherlock never had any

history of injuries, accidents and operations but stated that he was hospitalized when he was 1 year old. He was admitted at Holy family hospital with the chief complaint of vomiting. The treatment included some medications and on the third day he became fine and was discharged. The patient denied any allergies to food, environment and medications. One medication that the patient is taking on a daily basis are multivitamins. D. History of Present Illness Three days prior to admission, the patient felt uneasy and experienced vomiting, blurring of vision, headache and pain being felt on his nape. The next day, he suffered from chest pain and shortly after that, he had difficulty breathing. The symptoms occurred on an intermittent interval. The pain was described as excruciating wherein the patient was not able to walk anymore. The condition is aggravated during exertion and alleviated when sitting or lying in supine position. On June 26, 2013, the family decided to bring him to Angeles Medical Center. The doctor advised them to have Sherlock admitted for observation and laboratory procedures. E. Lifestyle A typical day for the client is to wake up at 6:30 am to take a bath, eat breakfast and prepare for school. He leaves the house at exactly 7:30 am and travels to school through public transportation with his maid. His class ends at 3 oclock in the afternoon. Sherlock usually spends his spare time playing outside with friends. He loves biking and playing basketball which are also his means of exercise. By 6 oclock in the evening he will go home to have dinner and watch television afterwards. His usual bedtime is at 8 oclock. Routinely, he sleeps for about 10 hours. The patient denied difficulty falling asleep or sleeping. Feels well rested when he arises in the morning. He never used sleep medications otherwise.

Sherlock doesnt follow any strict diet. His mother does mostly the food preparation. She buys vegetables and meat at Pampang wet market or sometimes at SM hypermarket. For breakfast, he eats toasted bread, hotdogs and drinks water. His lunch would include fish, vegetables and a small serving of rice. Typical dinner consists of meat, chicken or monggo and a small serving of rice. The patient does not smoke neither drinks alcohol.

In terms of instrumental activities of daily living, the patient is very dependent to his mother. The mother usually does all the housekeeping, laundry, shopping for groceries and clothing, food preparation and handling of finances.