A Case Study on

ACUTE GLOMERULONEPHRITIS
(AGN)
Submitted By:
Doron, Ronnie
Gaviola, Riva
Kangleon, Cheyenne
Lim, Desiree
Odon, Divina

Submitted To:
Laarni Batestil, RM
Introduction
Introduction
Acute glomerulonephritis refers to a specific set of renal
diseases in which an immunologic mechanism triggers
inflammation and proliferation of glomerular tissue that
can result in damage to the basement membrane,
mesangium, or capillary endothelium. Acute nephritic
syndrome is a group of disorders that cause
inflammation of the internal kidney structures
(specifically, the glomeruli). In acute glomerulonephritis,
the kidneys are normal in size or enlarged and
edematous, and the surface of the kidney may show
punctate hemorrhages.
Acute glomerulonephritis is defined as the sudden o
nset of hematuria,proteinuria, and red blood cell
casts. This clinical picture is often accompanied by
hypertension, edema, and impaired renal function.
As will be discussed, acute glomerulonephritis can
be due to a primary renal or systemic disease.
Symptoms of acute glomerulonephritis include the following
: Hematuria is a universal finding.
Gross hematuria is reported in 30% of pediatric patients.
Edema (peripheral or peri-orbital) is reported in
approximately 85% of pediatric patients; edema may be
mild (involving only the face) to severe, bordering on a
nephrotic appearance. Headache may occur secondary
to hypertension; confusion
secondary to malignant hypertension may be seen in as m
any as 5% of patients. Shortness of
breath or dyspnea on exertion secondary to
heart failure or pulmonary edema, and possible flank pain
secondary to stretching of the renal capsule. Hypertension
is seen in as many as 80% of affected patients.
Hematuria, either macroscopic (gross) or microscopic, may be
noted. Skin rashes (malar rash frequently seen with lupus nephritis) ma
y be observed. Abnormal neurologic examination or altered level of
consciousness occurring because of malignant hypertension or
hypertensive encephalopathy. Arthritis may be noted.
The most common cause is post infectious Streptococcus species (
group A. beta-hemolytic).
Two types have been described
as (1) attributed to serotype 12,poststreptococcal
nephritis due to an upper respiratory infection
occurring primarily in the winter months, and (2)
attributed to serotype 49, post streptococcal nephritis
due to a skin infection.
Sporadic cases of acute nephritis often progress to a c
hronic form.
This
progression occurs in as many as 30% of adult patient
s and 10% of pediatric patients.
Glomerulonephritis is the most common cause of
chronic renal failure (25%). 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. Most cases occur in patients aged 5-
15 years. Only 10% occur inpatients older than 40
years. Acute nephritis may occur at any age,
including infancy.
Objectives
 General Objectives:

 After the case presentation the listeners will be able to gain adequate knowledge
about acute glomerulonephritis, its signs and symptoms, illness process, and clinical
manifestations and will be able to discuss the possible medical and nursing
assessment and what interventions can be applied.
Specific Objectives
After the comprehensive discussion, other students present during the case presentation will be able to:
 Identify factors contributing to the presence of illness
 Establish clients past and present illness history
 Define and discuss glomerulonephritis
 Identify signs and symptoms of glomerulonephritis
 Identify and prioritize client’s needs
 Study the anatomy and physiology of the urinary system and trace pathophysiology of
glumerulonephritis
 Correlate the factors contributing to the actual manifestation of the disease to the traced
pathophysiology
 Identify medical management and its significance
 Identify nursing managements and responsibilities
 Perform medication and drug study to ensure appropriate to ensure appropriate nursing
responsibilities
 Formulate and develop nursing care plan
Nursing Health
History
BIOGRAPHIC DATA
 Name: MM
 Age: 3 years old
 Sex: Female
 Civil Status: Single
 Nationality: Filipino
 Religion: Roman Catholic
 Birthdate: June 27, 2015
 Address: Maria Clara, Maasin, Southern Leyte
 Admission: January 16,2019 @ 6:10 PM
 Admitting Physician: Dr. Orais
 Admitting Diagnosis: Acute Glomerulonephritis
History of Present illness

1 week PTA patient had skin lesions on both

lower extremities.
3 days PTA she had recurrent fever
1 day PTA she +1 bipedal edema, hematuria,
peri - orbital swelling upon waking up
Past Health History
 The patient has no known concurrent condition and doesn’t take any maintenance medication. She
has no known drug or food allergies. Her mother also claimed that she was afflicted with common
childhood illnesses like cough & colds and fever and completed all the immunizations.
 Surgical Health History

The patient has not undergone any previous surgical operations neither experienced
any previous injury that required any surgical management.
 Family Health History

Paternal Side Maternal Side

86 73 79 79
HPN HPN A/W HPN

51 54 55 31 29 56 50
A/W A/W HPN HPN HPN Kidney A/W
Failure

3 mos. 9 12
A/W A/W A/W

Legend:
Deceased HPN -
Male Hypertension
A/W – Alive and
Female Well
Interpretation:

 As seen in the Genogram hypertension

runs on both paternal and maternal side
of patient’s family. There is a reported link
to the patients condition which can be
traced to her maternal side. Her uncle
died of Kidney Failure.
Physical Assessment
IntegumentarY

 Skin –Skin is light in color. With insect bites located on right lower extremities and skin
lesions on both lower extremities. Skin color is consistent with the rest of the body.
 Hair – Hair is thick; evenly distributed; unkempt; without any infestation; with slight
odor; body hair is evenly distributed across the body
 Nails – patient’s nail has a convex shape; firmly attached to nail beds; approproiately
cut; without presence of dirt; with capillary refill time of 1 – 2 seconds
 Head

 Head and Face

Hair is evenly distributed with fine texture. Shape is symmetrical; no masses and
tenderness noted during palpation. No deformities noted.
Eyes and Ears

 Eyes are symmetrical. Color vision intact, equal parallel alignment. Eyelids was noted
with no lesions, eyelashes evenly distributed. Peri-orbital edema noted on both sides.
Ears are symmetrical bilaterally. No redness and lesions, ear canal was light in color
and patent. Nose located in midline, symmetrical and no deviation, no nasal
tenderness or deformities. Nares patent. Sinuses clear.
Mouth

 Mouth – lips slightly pink, dry and intact. Oral mucosa pink, no lesions noted. Tongue is
pink, no lesions and involuntary movement noted. Tonsils are not swollen with grade
of 1 during inspection. Without dental carries noted.
 Neck

 Neck is symmetrical, no masses noted. Bilaterally positioned in the midline of both

shoulders, with full range of motion. Lymph nodes are not palpable.
 Heart

 No abnormal heart sounds heared upon auscultation. With heart rate of 64 bpm.
Regular in rhythm
 Abdomen

 Umbilicus inverted in midline, no lesions and tenderness noted

 Genitourinary

 Able to urinate frequently without pain but presence of blood was noted. Cloudy and yellowish
in color.
Gordon’s Functional
Health Pattern
Health Perception – Health
Management Pattern
 Before Hospitalization
 The mother makes sure that his child is always free from diseases and illnesses.
She perceived health as something that should not be taken for granted.
Whenever her daughter gets sick, she would buy OTC drugs like paracetamol in
the nearby store.
 During Hospitalizations
 His uncle looks after him and follows all the Doctor’s order. Her mother is unable
to constantly take care of her because she has just gave birth three months ago.
Her family is concerned about her daughter’s current situation, and she is curious
about how long will she be hospitalized.
Nutritional/ Metabolic Pattern

 Before Hospitalization
 Patient is not a picky eater. The child eats thrice a day and takes her snacks in
the morning and afternoon. Her mother claims that her daughter has good
eating habits. The patient likes to eat junk foods and softdrinks.

 During Hospitalizations
 Mother claims that patient has decreased appetite due to her illness. And eats
what the physician orders her to eat. Her mother is concerned about her
daughter’s nutrition so she always make sure that she eats on time.
 Elimination Pattern

 Before Hospitalization
 Patient experienced no problems with urination and defecation. Urinates 3x and defecates
1x daily. 3 days prior to admission, patient experienced hematuria and oliguria.
 During Hospitalizations
 Due to her illness, patient is still able to urinate frequently without pain but presence of blood
is noted on her urine. There is decrease in the urine ouput and frequency. Defecates
regularly.
 Activity/ Exercise Pattern

 Before Hospitalization
 Patient plays with his friends at home and loves watching videos on her cellphone. She takes
a walk with his uncle regularly as a form of exercise. A day before admission, patient
experienced weakness and usually lies on bed and ambulates only when needed. Her
ADL’s were altered due to her condition.
 During hospitalization :
 She walks in the hallway of the hospital as a form of exercise. She is accompanied by
his uncle on walking at the hospital premises. She usually seek help from her uncle
when ambulating.
 Sleep – Rest Pattern

 Before Hospitalization
 Prior to admission the patient’s sleep wasn’t compromised but her mother states that the
occasional pain from her lesions is often the cause of her waking up in the middle of the night but
she can still go back to her sleep, as pain subsides. According to her uncle, she usually falls asleep
between 8-9 pm and wake up around 5 am. On the afternoon she takes some nap. Not until 3
days prior to admission, the patient experienced difficulty sleeping due to the pain along with her
fever. She is unable to rest during the day due to the discomfort she felt.
 During hospitalization
 The patient’s sleep is still interrupted due to same reason and routine procedures done by nurses.
She is not taking any medication for sleep. She sleeps around 8pm and wakes up at 6am as
verbalized by her uncle.
 Cognitive – Perceptual Pattern

 Before Hospitalization
 Prior to admission, patient has no auditory and visual impairment. She is not using any
hearing or optical devices. She has no difficulties in learning and no changes in memory
recently but she is complaining of pain.
 During Hospitalization
 There are still no cognitive impairment noted. Body weakness is still present but converses
with you whenever you ask her something.
 Role – Relationship Pattern

 Before Hospitalization
 Patient is well supported by her family. Her mother stays by her side more often provided her
comfort and reassurance.
 During Hospitalizations
 Her family continues to support her and is concerned about her full recovery. She is getting
enough attention she needs.
 Coping – Stress Pattern

 Before Hospitalization
 Since patient is only 3 years old she still relies on her family all the time. She is helped and
guided by her family members in terms coping with problems and stressors around her
 During Hospitalizations
 Patient still relies on her family, nothing has changed . Her family supports and motivates her.
They never give up on her, they follow the physicians order to help her in the recovery
process.
 Value – Belief Pattern

 Before Hospitalization
 The patient is Roman Catholic she was taught by her mother to pray to MAMA MARY in
times of need. They go to church every Sunday and they pray at their house every day.
 During Hospitalizations
 Her parents still maintains their faith and continues to pray for their child’s health. They are
seeking help to God for her recovery and nothing has changed in their faith.
Developmental
Task
 erik Erickson’s Psychosocial Theory
Age Stage Basic Actual
3 years old Autonomy vs. Shame and Erickson’s Psychosocial Theory Our client is a 3 year old female who
shows emotional instability and tries to
Doubt At this point in development, children
begin asserting her independence by
are just starting to gain a little
walking away from her mother,
independence. They are starting to
picking which toy to play with, and
perform basic actions on their own
making choices about what she likes
and making simple decisions about
to wear, to eat, etc.
what they prefer. By allowing kids to
make choices and gain control,
parents and caregivers can help
children develop a sense a
autonomy.
Preoperational stage [2-7 years old]
Piaget’s cognitive Development The child start relating to other children and
people, especially peers among her age. She
Schooling generally starts at 3 years-
also developed curiosity about things she
old which brings about an important
likes to learn.
social change and cause significant
social development.
 kohlBErG’s dEVEloPMEntal Theory
Age Stage Defintion Actual
3 years old Level I (Pre-conventional Morality) This stage is based on avoiding The client is a 3 year old, and her
punishements, a focus on the actions are motivated by the
Obedience and Punishment
consequences of actions, rather than reward she gets by doing such.
intentions: intrinsic difference to An example is she finishes her
authoriry food as instructed by her mother
for an exchange of having to
play with her cousins after
feeding.

She obeys her mother’s

command because she fears
being punished.
 siGMund FrEud’s PsychosExual Theory
Stage
3 years old Phallic stage 3- to5 year old child
Basic Actual
Freud’s Psychosexual Development The client is the 3rd among her
Theory siblings. As of now it is not
bothersome for our client to not
The phallic stage 3- to5 year old child is
engage on his sexual drives.
focused on the erogenous stimulation
of the genital area, the pines and She is always seen to be close
vagina specially. In the phallic stage with his father and shares quality
gratification begins with masturbation. time and bonds with him most of
The need for satisfaction soon turns time.
toward our parents, typically the parent
She spends most of the time with
of the opposite sex. As sexual
his father. At times when she cries
satisfaction expands, a child finds
and needs someone, she calls for
himself within the realm of one of
his father’s attention and is often
Freud’s most controversial and strange
given the care she needs .
contributions to the study of
personality, the Oedipus complex,
which essentially states that a male
child sees his own mother as a sexual
partner with his own father of course.
Definition of Terms
 Definition of Terms

Acute Glomerulonephritis is active inflammation in the

glomeruli. There are many diseases that cause an active
inflammation within the glomeruli. Some of this diseases
are systemic (i.e., other parts of the body are involved at
the same time ) and some occur solely in the glomeruli.
The acute disease may be caused by infections such as
strep throat. It may also be caused by other illnesses,
including lupus, Goodpasture's syndrome, Wegener's
disease, and polyarteritis nodosa. Early diagnosis and
prompt treatment are important to prevent kidney
failure.
 Definition of Terms

The GLOMEROLUS is the tuft of small blood vessel

called capillaries located within bowman’s capsule
within the kidney. Glomerular mesangial cells
structurally support the tufts. Blood enters the
capillaries of the glomerulus by a single arteriole
called an afferent arteriole and leaves by an
efferent arteriole.
 Definition of Terms

HEMATURIA is the presence of blood in a person’s

urine.
Anatomy and
Physiology
The glomerulus and its surrounding Bowman's capsule constitute a
renal corpuscle, the basic filtration unit of the kidney. The rate at which
blood is filtered through all of the glomeruli, and thus the measure
of the overall renal function, isthe glomerular filtration rate (GFR).
Etiology
Predisposing Factors Rationale Actual

HIV/ HEPATITIS VIRAL INFECTION  Having a condition which weakens the

immune system and increases the risk of
chronic infection, and can be a risk
factor of glomerulonephritis.

 An excess of antibodies are produced /

BACTERIAL INFECTION i.e, STREP THROAT to fight the infection. This may cause an
inflammation when they settle in the
kidneys

Systemic lupus erythematous (SLE or lupus)  This is a chronic disease causing an

inflammatory response in different parts
of the body, including the kidneys
Precipitating Factors Rationale Actual

Post infection  It is the result of an infection of a /

completely different area, such as the

skin or throat. The infection causes
filters in the kidneys to become
swollen. This makes the kidneys less
able to filter and remove wastes.
Symptomatology
SYMPTOMS ACTUAL RATIONALE

EDEMA / Extra fluids and salt build up in the body

which causes swelling in the extremities
and other parts of the body
HYPERTENSION / Conditions likely to cause scarring of the
glomeruli. (High blood pressure). This can
damage your kidneys and impair their
ability to function normally.
Glomerulonephritis can also lead to high
blood pressure because it reduces
kidney function and can influence how
your kidneys handle sodium

PROTEINURIA Glomerulonephritis may be caused by

(foamy urine due to excess protein)
HEMATURIA
(pink or cola colored urine from red blood cells)
problems with the body's immune
system. Often, the exact cause of this
condition is idiopathic. Damage to the
glomeruli causes blood and protein to
be lost in the urine
/ Characterized by a thin glomerular
basement membrane and small pores in
the podocytes of the glomerulus, large
enough to permit proteins and red
blood cells to pass into the urine
(yielding proteinuria and hematuria).
OLIGURIA / There is low urine
output due to the
accumulation of fluids
to the extremities
resulting to edema.
Pathophysiology
Predisposing Factors Precipitating Factors

Contact with streptococcus

A (beta-hemolytic)

Poor body hygiene would

result to overwhelming of Rashes
the causative agent in the
skin

Bacteria goes inside the

body

Bacteria goes into the blood

circulation

Multiple Organ Damage

Bacteria enters into the
multiple organs
Septicemia
Bacteria enters
the kidney
DEATH
 Overwhelming
of bacteria

Increased production of
epithelial cells lining in the
glomerolus
Leukocytes
infiltrates the
glomerolus
inflammation Protenuria
Hematuria
Thickening of
glomerular filtration Oliguria
membrane
Scarring and loss of
glomerular filtration
membrane

Decrease GFR Edema Weight gain

Pulmonary Decreased
Organ Failure embolism lung expansion
 Decreased lung
expansion

Decreased
respiratory
output

Respiratory
distress

atelectasis
DEATH
Medical Management
 MEDICAL MANAGEMENT

 Treating symptoms
 Treating complications
 Treating streptococcal infection with Cefuroxime
 Treat edema with Furosemide
 Low Na, Low Protien diet to decrease edema and hypertension
 Administering Angiotensin Converting Enzyme (ACE) inhibitors and Angiotensin Receptor
Blockers, immuno-suppressants
Laboratories
 Test Patient’s Result Reference Values Interpretation
(CBC)
WBC 13.00 5.00-10.00 High
Due to the inflammatory
process needed in the
healing process and
combatting infections,
there is increased WBC
production
RBC 3.12 4.80-5.40 Low
HGB 7.90 11.50-16.50 Normal
HCT 22.10 35.00-55.00 Normal
RDW % 15.20 11.00-16.00 Normal
RDWA 49.10 30.00-150.00 Normal
MCH 24.50 25.00-35.00 Normal
MCHC 35.70 31.00-38.00 Normal
MCV 68.70 75.00-100.00 Normal
PLT 287.00 150.00-400.00 Normal
 Test Patient’s Result Reference Values Interpretation
(CBC – Differential Count)
Neutrophil 87.5 50.0 – 70.0 High
Due to the inflammatory
process needed in the
healing process and
combatting infections,
there is increased WBC
production
Lymphocyte 7.4 18.00 – 42.00 Low
Due to the inflammatory
process needed in the
healing process and
combatting infections,
there is increased WBC
production
Monocyte 4.5 2.0 – 11.0 Normal
Eosinophil 0.5 1.00 – 3.00 Normal
Basophil 0.1 0.00 – 2.00 Normal
Drug Study
Cefuroxime

 Generic Name: Cefuroxime

 Brand Name: Zinacef
 Dosage: 750 mg
 Frequency: every 8 hours
 Route: IVTT
 Therapeutic Class: Antibiotics
 Pharmacologic Class: 2nd Generation Cephalosporin
 M.O.A.: inhibit cell wall synthesis promoting osmotic stability, usually bactericidal
 Indications:
 Serious lower respiratory tract infection, UTI, skin and skin-structure infection, bone or joint
infection, septicaemia, meningitis and gonorrhoea
 Uncomplicated skin and skin-structure infections
 Early Lyme disease
 Impetigo
 Adverse Effects:
 CV: Phlebitis
 GI: Diarrhea, Pseudomembranous colitis, N/V, anorexia
 Hematologic: haemolytic anemia, thrombocytopenia, transient neutropenia, eosinophilia
 Skin: rashes, urticaria, induration, sterile abscesses
 Other: anaphylaxis, hypersensitivity reactions, serum sickness
 Contraindications:
 Contraindicated in patients hypersensitive to drug or other cephalosoporins
 Use cautiously with hypersensitive to penicillin, breast feeding women, colitis or renal insufficiency
 Nursing Considerations:
 Monitor for signs and symptoms of superinfection
 Tell patient to complete therapy even after he/she is feeling better
 Give PO tablets with food
 Advise patient take IV drugs to report discomfort at IV site
Paracetamol

 Generic Name: Acetaminophen/ Paracetamol

 Brand Name: Perfalgan
 Dosage: 300 mg
 Frequency: every 6 for 4 days
 Route: IVTT
 Therapeutic Class: Analgesics
 Pharmacologic Class: Para – aminopherol derivatives
 M.O.A.:
 Thought to produce analgesia by inhibiting prostaglandin and other substances that sensitize path
receptors. Drugs may relieve fever through central action in the hypothalamic heat – regulating centers
 Indications:
 Mild pain or fever

 Arthritis

 Mild to moderate fever

 Adverse Effects:
 CNS: anxiety, fatigue, headache, insomnia, pyrexia

 CV: Hypertension, hypotension, peripheral edema, tachycardia

 GI: N/V, abdominal pain, diarrhea, constipation

 GU: oliguria

 Hematologic: haemolytic anemia, leukopenia, neutropenia, pancytopenia, anemia

 Hepatic: Jaundice

 Metabolic: Hypoglycemia, hypokalemia, hypervolemia, hypomagnesemia, hypophosphatemia

 Musculoskeletal: Muscle Spasm

 Respiratory: abnormal breath sounds, dyspnea, hypoxia, atelectasis, pleural effusion, pulmonary edema

 Skin: rash, urticaria, pruritus

 Contraindications:
 Contraindicated in patients hypersensitive to drug, hepatic impairment, severe active liver
disease
 Use cautiously in patients with long term alcohol use
 Nursing Considerations:
 Give drugs without regard to meals
 Do not exceed daily dosage to 4000 mg/day
 FUROSEMIDE
 Generic Name: Furosemide
 Brand Name: Lasix
 Classification: Diuretics
 Dosage: 5mg (0.5ml)
 Frequency: Every 12 hours, Hold for BP less than 85 systolic
 Route: IV Push
 MOA: Inhibit reabsorption of sodium and water in the ascending limb of the loop of
Henle by interfering with the chloride binding.
  Indication:
 Edema due to cardiac, hepatic and renal disease
 Burns
 Mild to moderate HTN
 Hypertensive crisis
 Acute heart failure
 Reduced urinary output
 Nephrotic syndrome
 Contraindication:
 Anuria; Hepatic coma & precoma
 Severe hypokalemia & or hyponatremia
 Hypovolemia with/without hypotension
 Hypersensitivity to sulfonamides
  Side Effects/Adverse Effects:
 Low blood pressure
 Dehydration and electrolyte depletion
 Jaundice
 Tinnitus
 Photophobia
 Nausea, Diarrhea and Abdominal pain
 Nursing Considerations:
 Assess pt underlying condition before starting therapy
 Monitor for renal, cardiac, neurologic, GI manifestations of hypokalemia
 Monitor for CNS, hyperactive reflexes, depressed cardiac output, nausea and vomiting,
tachycardia
 Assess fluid volume status
 ENALAPRIL
 Generic Name: Enalapril
 Trade Name: Vasotec
 Classification: ACE inhibitors
 Route: PO
 Dose & Range: 5mg/ day increased as required by response
 10-40 mg q day in 1-2 divided doses
 MOA: ACE inhibitors block the conversion of angiotensin I to the vasoconstrictor
angiotensin II. Net result is systemic vasodilation. Indicated for treatment of hypertension.
  Indication:
 Used to treat high blood pressure, heart failure, and asymptomatic left ventricular
dysfunction.
 Contraindication:
 Increased sensitivity to drug
 Severe hypokalemia
 Hypovolemia with hypotension
 Pregnant women
 Side Effects:
 Dizziness
 Weakness
 Skin rash
 Cough
 Nursing Considerations:
 Use in precaution to patients with hypersensitivity and history of angioedema with
previous use of ace inhibitors.
 Monitor vital signs of patients with renal impairment
 Intruct patient to follow correct timing when taking the drug
 Caution patient to avoid salt substitutes containing high potassium or sodium
 Caution patient to change positions slowly to minimize hypotension, particularly after
initial dose.
 Nursing Diagnosis

1. Elevated blood pressure

2. Impaired skin integrity r/t presence of skin lesions
3. Fluid volume excess r/t sodium retention as manifested by edema in lower
extremities
4. Acute pain upon urination r/t inflammation of glomerulos
5. Hyperthermia r/t increased metabolic rate secondary to disease process
 NCP 1

 Assessment
 Subjective: “Taas man daw iyaha BP ingun ang nurse” as verbalized by the patient
 Objective:
 With Heploc @ lef arm intact and patent
 Flushed skin
 Skin warm to touch with lesions @ left lower extremities
 Facial grimace noted
 Nursing Diagnosis
 Elevated Blood Pressure
 Scientific Basis
 An increased in sodium levels in the blood which will result to vasoconstriction that would cause
thickening the passage of the blood which will result to increase of blood pressure
 Source:
 www.painscience.com
 Planning
 After 8 hours of nursing interventions the patient will be able to:
 Have normal range of blood pressure 110/80 or 80/50
 Show manifestations of decreased BP

 Nursing Interventions
 Established rapport
R: To gain trust and promote cooperation
 Monitored and record vital signs
R: To obtain baseline data, monitor for unusualities
 Assessed patient’s appetite
R: To prevent fluid overload and monitor intake and output
 Note amount/rate of fluid intake from all sources
R: To monitor fluid retention and evaluate degree of excess
 Compare current weight gain with admission or previous stated weight
R: To monitor excess fluids that would worsen the edema
 Reinforce low sodium , low protein diet
R: To prevent aggravating edema and hypertension
 Advised S.O to report any unusualties noted
R: To monitor possible complication
 Position patient comfortably
R: To promote relaxation and rest
 Raised side rails
R: To promote safety and prevent injuries
 Evaluation:
 The Goal was met as evidence by reaching the normal range of blood pressure.
 Assessment NCP 2
 Subjective: “Sakitan sijas ijang mga samad sa teel mam” as verbalized by the mother
 Objective:
 Disruption of skin surface @ left lower extremities
 Poor skin integrity
 Report of localized pain around the lesions
 Nursing Diagnosis:
 Impaired skin integrity r/t presence of skin lesions
 Scientific Basis: Skin is a primary defense of the body it protects the body against infections
and diseases brought about by the invasion of microbes in the body.

 Source:
 www.nurselabs.com
 Planning:
 After 4 hours of nursing interventions the S.O will be able to:
 Demonstrate behaviors or techniques to prevent skin breakdown or injury

 Nursing Interventions:
 Vital signs checked and charted
R: To assess for any systemic effects and possible complications of the
 Monitored for signs and symptoms of infection
R: To determine depth and extent of injury and identify the possible course of therapy
 Kept the area clean and dry
R: to assist the body’s natural process of repair
 Provided with wound care with use of aseptic technique
R: To prevent contamination and infection of the wound
 Provided with appropriate dressings, as indicated
R: to prevent contamination and infection of the wound
 Maintained appropriate moisture in the environment
R: Moisture potentiates skin breakdown
 Repositioned patient on a regular basis
R: To prevent formation of further skin breakdown like skin ulcers
 Encouraged early ambulation, as indicated
R: promotes circulation and prevents immobility
  Provided with range of motion exercises
R: promotes circulation and prevents immobility
 Provided with medications, as prescribed
R: To promote pharmacological management of underlying condition

 Evaluation
 Goal was met
 NCP 3

 Assessment
 Subjective: “Nanghubag lge na ija teel mam” as verbalized by the mother
 Objective:
 Presence of edema in both lower extremities
 Limited range of motion
 Nursing Diagnosis
 Fluid volume excess r/t sodium retention as manifested by presence of edema in both
lower extremities
 Scientific Basis:
 Fluid volume excess in the intravascular compartment occurs due to an increase in total body
sodium content and a consequent increase in extracellular body water.
 Source:
 www.scribd.com
 Planning:
 After 8 hours of nursing interventions the S.O will be able to:
 Verbalized understanding of the measures to prevent and lessen fluid volume excess of the
patient

 Nursing Interventions:
 Established rapport
R: to gain trust and promote cooperation
 Provided with adequate rest periods, in between activities
R: To prevent overexertion
 Provided with calm, hazard-free environment
R: To prevent further injury
 Record intake and output
R: accurate I&O is necessary for determining renal function and fluid replacements needs, reducing
risk of fluid overload
 Restrict fluids
R: fluid management is usually calculated to prevent further fluid retentinon
 Note severity of edema
R: it may indicate increased in fluid retention
 Administer diuretics as ordered
R: To excrete excess fluids
 Evaluation:
 The goal was partially met
 NCP 4
 Assessment
 Subjective: “Sakitan sija ig mangihi” as verbalized by the mother
 Objective:
 Pain scale of 6/10
 Presence of blood in urine
 Facial grimace
 Crying with guarding behavior
 Nursing Diagnosis:
 Acute pain upon urination r/t inflammation of glomerulos
 Scientific Basis:
 Due to the presence of inflammation in the glomerulus which causes obstruction in urination
which causes sharp acute pain upon urination.
 Source:
 www.scribd.com
 Planning:
 After 8 hours of nursing interventions the patient will be able to:
 Manifest behaviors of decreased pain
 Nursing Interventions:
 Provided with adequate rest periods in between activities
R: To reduce fatigue and prevent overexertion
 Provided with calm, well – ventilated environment
R: To promote rest
 Provided with therapeutic communication such as providing positive feedback
R: Helps to minimize frustration and channel energy
 Encouraged verbalization of feelings of the S.O
R: To identify areas of additional concern
 Encouraged to limit fluid intake
R: To prevent further complications of edema
 Promoted touch therapy
R: To promote non-pharmacologic pain management
 Provided with comfort measures such as straightening of bed linens
R: To promote relaxation
 Instructed significant others to never leave the patient unattended
R: to assist in activities beyond patient’s level of tolerance
  Administered medications, as prescribed
R: To promote pharmacological management of underlying condition

 Evaluation
 The goal was met as evidence by decreased pain by letting the patient point the faces of wong
baker’s faces chart
 NCP 5
 Assessment:
 Subjective:
 “Taas lge ija hilanat mam.” as verbalized by the mother

 Objective:
 Flushed skin
 Skin warm to touched
 Febrile body temp of 38.1
 Nursing Diagnosis:
 Hyperthermia r/t increased metabolic rate secondary to disease process
 Scientific Basis:
 Fever is the bodies first response to infections
 Source:
 www.scribd.com
 Planning:
 After 4 hours of nursing interventions the patient will be able to:
 To decreased body temp and reach the normal range of 37.5

 Nursing Interventions:
 Monitored vital signs and recorded
R: To obtain baseline data
 Demonstrated proper tepid sponge bath to S.O
R: TSB lessens body temp, promotes independence
 Instructed in performance of hand washing with use of water and soap/disinfectant
R: A first line defense against health-care associated infections
 Maintained aseptic technique in performing procedures
R: To prevent infection
 Encouraged to increase oral fluid intake, as tolerated
R: To promote well – being
 Kept the area around the wound clean and dry
R: To prevent infection
 Maintained appropriate moisture in the environment
R: Moisture delays skin healing and potentiates skin breakdown
  Provided with wound care with use of aseptic technique
R: To prevent infection

 Evaluation:
 The goal was met and patient reached body temp of 36.8
Nursing Implications
Nursing research
Made to improve and develop new schemes on preventing the problem.
Much medical research on open complete fracture helps health care team to
formulate and enhance interventions which aid in good decision making.

Nursing Practice
Knowledge, skills, and ability should always be as one. It is an essential
aspect that we carry out nursing action and interventions, bearing in mind
its underlying principles and standard for the plan of care that we provide to
our patients.
Nursing Education
Knowledge about the disease process are ideas in
evaluating patients that are at risk for the possible
problem that may arise. This study aims to improve and
prevent further complications that may show the way to
worst case scenarios. As a nursing student, it is
important for us to know and understand what are the
proper actions and interventions that we can do in order
to avoid and lessen additional complications.
Journal Reading
Expanding the Domain of Postinfectious
Glomerulonephritis
 The article on infection-related glomerulonephritis (GN) by Glassock et al1
emphasizes the important differences between true “postinfectious GN,” such as
poststreptococcal GN, and infectionassociated GN, such as the IgA-dominant lesion
associated with ongoing staphylococcal infection. There is another category of GN
that we believe should also be included in the domain of “postinfectious GN,” which
is defined by the authors as including a latent period following an infection “lasting
more than several days and up to a few weeks, during which the patient returns to or
toward his or her usual state of health; and.ends with the acute onset of features of
glomerulonephritis.and often some decrease in kidney function”. 1(p826) Recent
studies suggest that infections have a much wider role in GN, not only through the
serum sickness–like mechanisms reviewed in the article from Glassock et al, but also
because they initiate an autoimmune response.
 . We have recently reviewed the multiple mechanisms by which infections likely
initiate many common types of autoimmune GN, including ANCA-associated
vasculitis, IgA nephropathy, membranoproliferative GN type 1, and lupus nephritis.2
Thus, the domain of postinfectious GN extends well beyond classical
poststreptococcal disease or entities such as IgA-dominant staphylococcus-
associated GN. We strongly endorse the goal of better understanding and treating
infection-related GN that is stated in the title of the article by Glassock et al,1 but to
achieve this, we need to extend our thinking about postinfectious GN beyond the
traditional concepts of serum sickness due to bovine serum albumin to include the
role of infections initiating GN through autoimmune mechanisms.
References
 William G. Couser, MD1 Richard J. Johnson, MD2 1 University of Washington, Woodinville,
Washington 2 University of Colorado Denver, Aurora, Colorado

 © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved