Documente Academic
Documente Profesional
Documente Cultură
C olle ge Of N ur s ing
CASE STUDY:
ACUTE GLOMERULONEPHRITIS
Subm itte d b y:
Ari e z, Ave l a i ne
Ma l i g , Ro ma ni ca
Sa n gg a la n g , Ca rla Rh u vi e Ja n e
Su a re z, R ei ze l D a wn
BSN III 1 8
GR OU P 7 2
Au g u st 0 4 , 2 0 07
I. INTRODUCTION
The kidneys are organs that filter wastes (such as urea) from the blood
and excrete them, along with water, as urine. The medical field that studies the
kidneys and diseases of the kidney is called nephrology. The prefix nephro-
meaning kidney is from the Ancient Greek word nephros; the adjective renal
meaning related to the kidney is from Latin rns, meaning kidneys.
(http://en.wikipedia.org/wiki/Kidneys)
1. PERSONAL DATA:
Active Boy is a 4 year old child who resides at Marisol, Angeles City. He is
the 2nd child among three children of Mr. Active and Mrs. Active. Their family is
affiliated with Iglesia Ni Cristo. Active Boy is a Filipino Citizen and was born on
February 09, 2003 at Ospital Ning Angeles (ONA), Angeles City. He was
admitted in a secondary level government hospital situated at Pampanga on July
20, 2007 at exactly 4pm in the afternoon with an admitting diagnosis of Acute
Glomerulonephritis (AGN).
The group asked Mrs. Active if there is another family member or relative
who had or has AGN besides to active boy. Mrs. Active replied, ala man
megkasakit a makanyan kareng pamilya mi, kareng atlu kung anak, yamu ing
me-ospital a makanyan. The group asked again Mrs. Active if there is a common
disease in their family. Mrs. Active replied, king side mi sakit na ing mitatas a
prisyun, kaybat king side na ning asawa ku naman i tatang mika sakit ya na
albuminuria.
PATERNAL MATERNAL
Active Activ Active Activ
Lolo 1 e Lolo 2 (+) e
Deceased Lola Deceased Lola
1 2
Deceased
Active
Active Ate Activ Bunso
e Boy
(AGN)
3. PERSONAL HISTORY
a. Pre-natal (Practices/Habits during pregnancy):
Mrs. Active followed the standard check ups for a pregnant
woman wherein in her 6 months of pregnancy, she comes every 4
weeks or monthly check ups in the health center. While in her 7 to 8
months of pregnancy, she comes every 2 weeks or every other
week in the health center and in her 9 th month of pregnancy, she
comes to the health center once a week.
b. Birth:
Active Boy was born on February 09, 2003 at Ospital Ning
Angeles in a spontaneous normal delivery with a 39 wks age of
gestation by Mrs. Active.
c. Feeding:
According to Mrs. Active, Active boy was a bottle-fed baby
for 2 years because he doesnt want to suck the nipple of Mrs.
Active.
The 2nd stage of Piagets Cognitive Stage, wherein during this stage the
child learns to use symbols, such as words or mental images, to think about
things that are not present and to help them solve simple problems. Wherein the
children can talk things that are not physically present, he can represent things
by drawing and can pretend, for example he can pretend to block as a car where
although he uses and manipulates symbols in speech and play. And also in this
stage there is two limitations which is the Conservation and Egocentric Thinking
wherein the Conservation is the fact that the amount of substance remains the
same even though its shapes changes wherein there is tall thin glass of milk
holds the same amount of milk as a short and wide glass.
It is also the same thing that Boy Active tends to have an imagination that
he is Superman and he is gonna save the world while holding and playing his
Superman toy and also in this same stage he elicited the Egocentric Thinking
wherein when his mother is talking to somebody he make a way just to get her
mothers attention like calling her then when he already get her mothers
attention he tends not to say anything to her.
SIGMUND FREUD
In this stage this last from about age three to six and is time when the
infants pleasure seeking is centered on the genitals and during this stage the
child will compete with the parent of the same sex (his father or mother) for the
affection and pleasure of the parent of the opposite sex (his mother or father).
Problems in resolving in this competition may result in feelings of inferiority for
men and of having something to prove for women.
In this stage though that he is not fond playing his genitals on the time that
we are in the duty hours, he elicited the affection and pleasure for her mother like
whenever her mother was not around because he has to buy something at the
outside of the ward he started to look for her and sometimes he cry whenever he
didnt see her mother.
ERIK ERIKSON
In this stage the child has developed a number of cognitive and social
skills he is expected to use to meet challenges in his small world. And some
these challenges involve assuming responsibilty and making plan and initiate
new things. However, if they discourage initiative , he may feel uncomfortable or
guilty and may develop a feeling of being unable to plan his future.
On this stage of Initiative vs. Guilt he elicit this stage thru means of
drinking the medication pills on his own as said by his mother because we saw
her mother buying a pills for his hypertension then when his got back into the
ward we saw the med into a capsule form wherein her mother said that hindi
siya mahirap painumin ng gamot lalo pag ganito matapang nga siya pag ganito
yung iinumin niya.
LAWRENCE KOHLBERG
Stage two espouses the what's in it for me position, right behavior being defined
by what is in one's own best interest. Stage two reasoning shows a limited
interest in the needs of others, but only to a point where it might further one's
own interests, such as you scratch my back, and I'll scratch yours. In stage two
concern for others is not based on loyalty or intrinsic respect. Lacking a
perspective of society in the pre-conventional level, this should not be confused
with social contract (stage five), as all actions are performed to serve one's own
needs or interests. For the stage two theorist, the perspective of the world is
often seen as morally relative.
According to the mother, she decided to bring Active Boy to the hospital
specifically, Ospital ning Angeles because Active Boy is having an edematous
face. He was admitted to ONA Last July 20, 2007. Upon admission, Active boy
was subjected to have Urinalysis. The doctor also asked the patient to undergo
hematology too at the same day. Active Boy also had fever and hypertension.
This is the reason why the doctor ordered to monitor his blood pressure. The
result of his diagnostic procedure is that he is positive of albuminuria. He was
also diagnosed of having Acute Glumerulonephritis. Active boy has a cola
colored urine containing large amount of protein and increased values of BUN
and serum creatinine.
6. PHYSICAL EXAMINATION:
Head:
with facial edema
no lump
no mass
no lesion or scar noted
Hair:
semi bald
thin, straight, black in color
evenly distributed
with no dandruff or lice noted
Eyes:
anicteric sclera
pale palpebral conjunctiva
positive periorbital conjunctiva
pupils equally round and reactive to light accommodation
(PERRLA)
Ears:
no mass
no lump
symmetrical and properly aligned with the eyes
no ear discharge noted
no lesion noted
Nose:
no lesions noted
no nasal discharge noted
with nasal flaring
Mouth:
pale circum oral pallor
with pinkish gums
dry lips
with dental caries noted
Tongue:
pink in color with some white coating noted
Skin:
dark complexion with good skin turgor
no lesion or rashes noted
Neck:
no lesion
no tenderness noted
with palpable carotid pulse
Chest:
with symmetrical chest expansion
Abdomen:
abdomen distended
Upper Extremities:
no lesion or scars noted
with long dirty fingernails
Lower Extremities;
no lesions or scars noted
with long dirty toenails
Head:
no lump
no mass
no lesion or scar noted
Hair:
semi bald
thin, straight, black in color
evenly distributed
with no dandruff or lice noted
Eyes:
anicteric sclerae
pale palpebral conjunctiva
positive periorbital conjunctiva
pupils equally round and reactive to light accommodation
(PERRLA)
Ears:
no mass
no lump
symmetrical and properly aligned with the eyes
no ear discharge noted
no lesion noted
Nose:
no lesions noted
no nasal discharge noted
with nasal flaring
Mouth:
pale circum oral pallor
with pinkish gums
dry lips
with dental caries noted
Tongue:
pink in color with some white coating noted
Skin:
dark complexion with good skin turgor
no lesion or rashes noted
Neck:
no lesion
no tenderness noted
with palpable carotid pulse
Chest:
with symmetrical chest expansion
Abdomen:
abdomen distended
Upper Extremities:
no lesion or scars noted
with long dirty fingernails
Lower Extremities;
no lesions or scars noted
with long dirty toenails
Head:
no lump
no mass
no lesion or scar noted
Hair:
semi bald
thin, straight, black in color
evenly distributed
with no dandruff or lice noted
Eyes:
anicteric sclerae
pale palpebral conjunctiva
positive periorbital conjunctiva
pupils equally round and reactive to light accommodation
(PERRLA)
Ears:
no mass
no lump
symmetrical and properly aligned with the eyes
no ear discharge noted
no lesion noted
Nose:
no lesions noted
no nasal discharge noted
with nasal flaring
Mouth:
pale circum oral pallor
with pinkish gums
dry lips
with dental caries noted
Tongue:
pink in color with some white coating noted
Skin:
dark complexion with good skin turgor
no lesion or rashes noted
Neck:
no lesion
no tenderness noted
with palpable carotid pulse
Chest:
with symmetrical chest expansion
Abdomen:
abdomen distended
Upper Extremities:
no lesion or scars noted
with long dirty fingernails
Lower Extremities;
no lesions or scars noted
with long dirty toenails
III. ANATOMY AND PHYSIOLOGY:
Renal System
The kidneys are essentially regulatory organs which maintain the volume
and composition of body fluid by filtration of the blood and selective reabsorption
or secretion of filtered solutes.
The kidneys are retroperitoneal organs (ie located behind the peritoneum)
situated on the posterior wall of the abdomen on each side of the vertebral
column, at about the level of the twelfth rib. The left kidney is lightly higher in the
abdomen than the right, due to the presence of the liver pushing the right kidney
down.
The kidneys take their blood supply directly from the aorta via the renal
arteries; blood is returned to the inferior vena cava via the renal veins. Urine (the
filtered product containing waste materials and water) excreted from the kidneys
passes down the fibromuscular ureters and collects in the bladder. The bladder
muscle (the detrusor muscle) is capable of distending to accept urine without
increasing the pressure inside; this means that large volumes can be collected
(700-1000ml) without high-pressure damage to the renal system occuring.
When urine is passed, the urethral sphincter at the base of the bladder relaxes,
the detrusor contracts, and urine is voided via the urethra.
On sectioning, the kidney has a pale outer region- the cortex- and a darker inner
region- the medulla.The medulla is divided into 8-18 conical regions, called the
renal pyramids; the base of each pyramid starts at the corticomedullary border,
and the apex ends in the renal papilla which merges to form the renal pelvis and
then on to form the ureter. In humans, the renal pelvis is divided into two or three
spaces -the major calyces- which in turn divide into further minor calyces. The
walls of the calyces, pelvis and ureters are lined with smooth muscle that can
contract to force urine towards the bladder by peristalisis.
The cortex and the medulla are made up of nephrons; these are the functional
units of the kidney, and each kidney contains about 1.3 million of them.
The nephron is the unit of the kidney responsible for ultrafiltration of the blood
and reabsorption or excretion of products in the subsequent filtrate. Each
nephron is made up of:.
Proximal Convulated Tubule The proximal tubule carries out much of the
active reabsorption of solutes present in the filtrate. The lumen of the
tubule has many microvilli which dramatically increase the area available
for membrane transfer. The cells are also packed with mitochondria
supplying energy for the active transport processes; it has been calculated
that about 50% of the kidney's energy needs go on the active transport of
sodium back out of the filtrate in the proximal tubule.
The loop of Henle. This region is responsible for concentration and dilution
of urine by utilising a counter-current multiplying mechanism- basically, it is
water-impermeable but can pump sodium out, which in turn affects the
osmolarity of the surrounding tissues and will affect the subsequent
movement of water in or out of the water-permeable collecting duct.
Loop of Henle The loop of Henle has a flat thin lining epithelium with little
specialization of the cytoplasm. It acts to create an osmotic gradient in the
surrounding tissues, allowing concentration of the urine as it passes
through the medulla.
The distal convoluted tubule. This region is responsible, along with the
collecting duct that it joins, for absorbing water back into the body- simple
maths will tell you that the kidney doesn't produce 125ml of urine every
minute. 99% of the water is normally reabsorbed, leaving highly
concentrated urine to flow into the collecting duct and then into the renal
pelvis.
CLINICAL MANIFESTATIONS
COMPLICATIONS:
S=
O= Received pt. in sitting position, awake, conscious and coherent with IV out,
with moderate facial edema; with vital signs recorded as follows: T= 37.1; PR=
82bpm; RR= 28bpm; BP= 110/90 mmHg.
A= Fluid volume excess r/t failure of regulatory mechanism AEB facial edema.
P= After 4 of nsg. intervention, SO will verbalize understanding health teaching
on contributing factors.
I=
Established rapport
Monitored vital signs
Recorded urine output and fluid intake
Provided health teachings to SO about the appropriate diet for the patient.
Explained to the SO the importance of decrease intake of salty foods and
fluid restriction.
Facilitated Tepid Sponge Bath (TSV) and instructed SO of TSB.
Provided well ventilated environment
Provided comfort measures
Kept back dry
E= Goal met AEB SO can verbalize understanding fluid restriction and decrease
intake of salty foods.
July 26, 2007
S=
O= Received pt. in lying on supine position, awake, conscious and coherent
with on going IVF # 4 D5. 0.3 NaCl 500 mL x KVO, infusing well in right hand @
450 cc; with vital signs recorded as follows: T= 38.4; PR= 94bpm; RR= 20bpm;
BP= 120/100 mmHg.
I=
Established rapport
Monitored vital signs especially temperature
Monitored urine output and fluid intake
Provided health teachings to SO about the appropriate diet for the patient.
Explained to the SO the importance of decrease intake of salty foods and
fuild restriction.
IVF dislodge and removed
b. METHOD: