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Acute glomerulonephritis
Table of contents
I. Introductiona. Overview of the Caseb. Objective of the Studyc. Scope and Limitation of the Study
II.Health Historya. Profile of patientb. Personal Health Historyc. History of Present Illnessd. Chief Complaint
III. Developmental Data
IV. Medical Managementa. Medical Orders and rationale
b. Drug study
V. Pathophysiology with Anatomy and Physiology
VI. Nursing Assessment (System Review &Nursing Assessment II)
VII. Nursing Managementa. Ideal Nursing Management (NCP)
b. Actual Nursing Management (SOAPIE)
VIII. Referrals & Follow-up
IX. Evaluation and Implications
X.Bibliography
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I. INTRODUCTION
A. Overview of the Case
Acute Glomerulonephritis is the disease of the kidney in which there is an
inflammation of the glomerular capillaries. In most cases, the stimulus of the reaction is
group A streptococcal infection, which ordinarily precedes the onset of
glomerulonephritis by 2 to 3 weeks.
B. Objective of the Study
The study generally aims to investigate the condition of an adult man and further
understand the extent of the case.
Specifically, the health care provider sought to;
Perform Physical Assessment,
Data Base and History taking that solidifies the present diagnosis of the client.
Identify the development and changes encountered by the client.
Identify the nursing problems which will be the basis of the care plan.
Develop Plan of the Care and Implement nursing interventions relevant and
suitable for the case.
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As nursing students they will be able to improve their skills in accordance to patients
needs and condition.
The purpose of the study is to gather significant data to broaden our knowledge with
regards to the condition of the patient and to improve our abilities as future health care
providers. Moreover, this case study will enable us to apply the acquired skills we
obtained in the classroom set-up.
C. Scope and Limitation of the Study
The study focuses only on one of the many problems of the kidney, mainly the
glomerulonephritis and its causes and effects on patients that are being diagnosed to it.
Also, the study tackles on how this problem is being acquired.
II. HEALTH HISTORY
A. Clients Profile Name : Lisdan, Elpedio N.Wife : Lisdan, JemmaAddress : San Rafael, Talakag, Bukinon provinceCivil Status : MarriedSex : MaleAge : 42 years oldReligion : Roman Catholic
Educational Status : Elementary levelIncome : 2,000 php/monthNationality : FilipinoDate of Admission : January 27, 2009Time of Admission : 9:10 amInformant : PatientHeight : 158 centimetresWeight : 52 kg
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Vital Signs during AssessmentTemperature : 36.7 CPulse Rate : 55 bpmRespiratory rate : 20 cpmBlood Pressure : 150/110 mmHg
Admitting Diagnosis : Acute Glomerulonephritis related to nephriticsyndrome; hypertension
Attending Physician : Dr. Joseph Borong
B. Family and Personal Health
Patients History
Allergies:
-No known allergies on foods and drugs.
Injuries/ Accident in the past:
- Patient had not experience injuries or accident in the past.
Blood Transfusion:
- Patient didnt receive blood in the past.
Family health history:- Experienced Hypertension and Kidney disorder (2006)
Social History
Alcohol use:
- Patient occasionally drinks alcoholic beverages, as seldom as once in 2 months.
Tobacco use:
- Patient often smokes.
Home and Environment:
- Resides at San Rafael, Talakag- Living status is just enough for their family needs
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C. Chief Complaint and History of Present Illness
Noted to have edema; condition noted for a week prior to admission as onset of
fever on and off associated with dysuria tea colored urine.
III. DEVELOPMENTAL DATA
The Developmental Stages of Erik Erickson
Middle Adulthood: 35 to 65:
Generativity vs. Self absorption or Stagnation
Now work is most crucial. Erickson observed that middle-age is when we tend to
be occupied with creative and meaningful work and with issues surrounding our family.
Also, middle adulthood is when we can expect to "be in charge," the role we've longer
envied. The significant task is to perpetuate culture and transmit values of the culturethrough the family (taming the kids) and working to establish a stable environment.
Strength comes through care of others and production of something that contributes to the
betterment of society, which Erikson calls generativity, so when we're in this stage we
often fear inactivity and meaninglessness.
Freud's Psychosexual Stages of Development
The Genital Stage
In the genital stage, as the child's energy once again focuses on his genitals,
interest turns to heterosexual relationships. The less energy the child has left
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invested in unresolved psychosexual developments, the greater his capacity will be
to develop normal relationships with the opposite sex. If, however, he remains
fixated, particularly on the phallicstage, his development will be troubled as he
struggles with further repression and defenses.
Robert Havighurst Developmental Task Theory
Middle Adulthood (30-60 years)
Achieving adult social and civic responsibility; Reaching and maintaining
satisfactory performance in ones occupational career; Developing adult leisure time
activities; Relating oneself to ones spouse as a person; To accept and adjust to the
physiological changes of middle age; Adjusting to aging parents. Assisting teenage
children to become responsible and happy adults; achieving adult social and civic
responsibility.
Piaget's Theory of Cognitive Development
Formal operational stage (Adolescence and adulthood)
In this stage, intelligence is demonstrated through the logical use of symbols
related to abstract concepts. Early in the period there is a return to egocentric thought.
Many people do not think formally during adulthood.
IV. MEDICAL MANAGEMENT
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A. Medical Orders and Rationale
Doctors Order Rationale
01/27/09
Please admit
TPR q 4h
Full low salt, low fat diet
Give 1 egg white a day
0.9 NaCl @ KVO rate
Furosemide i amp q 12h x 3doses
Cefuroxime 750 mg q 8h IVTT
Omeprazole 20mg icap OD P.O.
Captopril 25mg itab BID P.O.
I & O q shift
01/28/09
To monitor patients medicalcondition and proper management.
To monitor any abnormal changesin vital signs
For proper nourishment and forprevention of disease that may leadto severity of the condition
To promote good nutritional status
To monitor body fluids & preventdehydration
For treatment of hypertension,edema associated with CHF,cirrhosis and renal disease
For treatment of lower respiratoryinfection, UTI & dermatologicinfection
First line treatment for heartburn
and short term treatment of activeduodenal ulcer
Treatment for pulmonarytuberculosis that is not responsibleto 1st line antituberculosis
For proper hydration of the patientand carefully monitor the fluidlosses
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IVF 0.9 NaCl @ KVO rate
Spironolactone 50mg itab TID P.O.
Continue meds.
Weight patient daily pre-breakfast
01/29/09
Continue meds.
IVF of D5nm iL @ KVO rate
To monitor body fluids & preventdehydration
To counteract potassium losscaused by other diuretics
To treat the disease & remove thesymptoms
To monitor if the symptoms arerelieved
To treat the disease & remove the
symptoms
To monitor fluids
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B. Drug StudyGeneric
Name of
Ordered
Drug
Date
Ordered
Classi-
fication
Dose/
Frequency/
Route
Mechanism
of Action
Specific
Indication
Contra-
indication
Side
Effects/
Toxic
Effects
Nursing
Precaution
Cefuroxime 01/27/09 Antibiotic
(Cephalosporin 2nd
generation)
750 mg q 8h
IVTT
Inhibits
synthesis ofbacterialcell wall,
causing celldeath.
For lower
respiratoryinfection,UTI &dermatologic
infection
Contra
indicated withallergy tocephalosporinor penicillins
Hypersen-
sitivity,nephrotoxicity, pain
atinjection
site
Assess for
hepatic orrenalimpairment
Assess forskin status
Check forsensitivity
tests
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Generic
Name of
Ordered
Drug
Date
Ordered
Classi-
fication
Dose/
Frequency/
Route
Mechanism
of Action
Specific
Indication
Contra-
indication
Side
Effects/
Toxic
Effects
Nursing
Precaution
Furosemide 01/27/09 LoopDiuretic
Amp of 12h x 3doses
Inhibitsreabsoption
of Na andCl from theproximaland distal
tubules andascendinglimb of the
loop ofHenle,
leading to aNa-reach
diuresis
Hyperten-sion, Edema
associatedwith CHF,cirrhosisand renaldisease
Contraindicates allergy to
furosemide;anuria,hepatic coma
Polyuna,Nocturia,
Rash,Anemia,Musclespasms,Cardiac
arrythmias
Assess forallergy to
furosemide
Assess forskin color,lesions andedemaCBC,seriumelectrolytes
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Generic
Name of
Ordered
Drug
Date
Ordered
Classi-
fication
Dose/
Frequency/
Route
Mechanism
of Action
Specific
Indication
Contra-
indication
Side
Effects/
Toxic
Effects
Nursing
Precaution
Omeprazole 01/27/09 Antisecretorydrug;
ProtonPump
Inhibitor
20mg icap ODP.O.
Gastric acidpump
inhibitor:Supresses
gastric acidsecretion by
specificinhibition ofhydrogen-K ATPaseenzymessystem atsecretorysurface of
the gastricparietal
cells.
First linetreatment
forheartburnand short
termtreatment of
activeduodenal
ulcer
Contra-indicated with
hyper-sensitivity to
omeprazole orits
component.Use
cautiouslypregnancylactation
Rash,alopecia,nausea,
vomitingEpistasis,
fever
Assess forhypersensiti
vity toomeprazole
Assess forskin lesionsAssess for
urinaryoutput
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Generic
Name ofOrdered
Drug
Date
Ordered
Classi-
fication
Dose/
Frequency/Route
Mechanism
of Action
Specific
Indication
Contra-
indication
Side
Effects/Toxic
Effects
Nursing
Precaution
Captropil 01/27/09 ACEinhibito
r
25mg itabBID P.O.
PolypeptideAntibactic;
againstMycobacter
iumtuberculosis
Treatmenthyper-tension
Contra-indicatedallergy to
capreomycin;pre-existing
auditoryimpairment
Polyuria,Tachy-cardia,
proteinuriacough
dry mouth
Assess forallergy tocaptropil
Assess forskin colorand lesions
For CBCand
differential
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Generic
Name of
Ordered
Drug
Date
Ordered
Classi-
fication
Dose/
Frequency/
Route
Mechanism
of Action
Specific
Indication
Contra-
indication
Side
Effects/
Toxic
Effects
Nursing
Precaution
Spirono-lactone
01/28/09 Diuretics
50mg itab TIDP.O.
Cause lossof sodium
bicarbonateand calciumwhilesaving
potassiumand
hydrogenions
Tocounteract
potassiumloss causedby otherdiuretics
Hyper-sensitivity;
Hyperkalemia
ClumsyHeadache
Dyscrasias
Monitorintake &
output
Dailyweightduringtherapy
Monitor BPbeforeadminis-
tering
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V. PATHOPHYSIOLOGY
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VI. ASSESSMENT EENT:
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[ ] impaired vision [ ] blind
[ ] pain [ ] reddened [ ] drainage
[ ] gums [ ] hard of hearing
[ ] deaf [ ] burning [x] edema
[ ] lesion [ ] teeth [ ] no problem
RESPIRATORY:
[ ] asymmetric [ ] tachypnea
[ ] apnea [ ] rales [x] cough
[ ] barrel chest [ ] bradypnea
[ ] shallow [ ] rhonchi [x] sputum
[ ] diminished [ ] dyspnea
[ ] orthopnea [ ] labored [ ] wheezing
[ ] pain [ ] cyanotic [ ] no problem
CARDIO VASCULAR:
[ ] arrhythmia [ ] tachycardia [ ] numbness
[ ] diminished pulses [ ] edema [ ] fatigue
[ ] irregular [ ] bradycardia [ ] murmur
[ ] tingling [ ] absent pulses [x] pain
[ ] no problem
GASTRO INTESTINAL TRACT:
[ ] obese [ ] distension [ ] mass
[ ] dysphagia [ ] rigidly [ ] pain
[x] no problem
GENITO URINARY and GYNE:
[x] pain [x] urine color [ ] vaginal bleeding
[ ] hermaturia [ ] discharge [ ] nocturia
[ ] no problem
NEUROLOGICAL:
[ ] paralysis [ ] stuporous [ ] unsteady
[ ] seizures [ ] lethargic [ ] comatose
[ ] vertigo [ ] tremors [ ] confused
[ ] vision [ ] grip [x] no problem
MUSCULOSKELETAL:
[ ] appliance [ ] stiffness [ ] itching
[ ] petechiae [ ] hot [ ] drainage
[ ] prosthesis [ ] swelling [ ] lesion
[ ] poor turgor [ ] cool [ ] deformity
[ ] wound [ ] rash [ ] skin color
[ ] flushed [ ] atrophy [x] pain
[ ] ecchymosis [ ] diaphoretic [ ] moist
[ ] no problem
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NURSING ASSESSMENT IISUBJECTIVE OBJECTIVE
COMMUNICATION:
[ ]Hearing Loss Comments: wala[ ]Visual Changes man wala[x] Denied gihapon
As verbalized bythe husband
[ ] Glasses [ ] Language[ ] Contact lens [ ] Hearing Aide
R LPupil Size: 3-5 mm [ ] Speech difficultiesReaction: PERRLA
OXYGENATION:[ ] dyspnea Comments: Nah![ ] smoking history gapanigarilyo
Oftentimes mana siya -giubo[x] cough pd siya karon oh.[x] sputum As verbalized by[ ] denied the wife
Respiratory: [x] regular [ ] irregularDescribe: regular breathing but associated with
pain
Right: Right lung is symmetrical to left lung.Left: Left lung is symmetrical to right lung.
CIRCULATION:[ ] chest pain Comments: Sakit![x] leg pain bug-at[x] numbness of extremities nanghubag na[ ] denied man gni ako
mga tiil Asverbalized bythe patient
Heart Rhythm [x]regular [ ] irregularAnkle Edema: present in lower extremitiesPulse Carotid Radial DP Femoral
Right: 62 65 60 not assessedLeft: 62 65 60 not assessed
Comments: Pulse sites are palpable and its rate arewithin normal range.
NUTRITION:
Diet: DAT but decreased fluid intake[ ] N [ ] V Comments: WalaCharacter manperma-[ ] recent charge nente nay gana
in weight, appetite As verbalized[ ] swallowing by the patient
Difficulty[x] denied
[ ] dentures [x] none
Full Partial With PatientUpper [] [ ] [ ]
Lower [] [ ] [ ]
ELIMINATION:Usual bowel pattern [ ] urinary frequency
Once a day once daily[ ] constipation [ ] urgency
Remedy [x] dysuria[ ] hematuria
January 27, 2009 [ ] incontinenceDate of last BM [ ] polyuria
[ ] diarrhea character [ ] foly in place[ ] denied
Comments: urinate once Bowel Sounds:daily due to pain Audible soundsand excrete small Abdominal Distention:amount. Present [ ] Yes [x] No
Urine (color,consistency, odor)tea color of urine,inconsistent
MANAGEMENT OF HEALTH &ILLNESS:[x] alcohol [ ] denied
(amount, frequency)Occasionally once in 2 months
[ ] SBE Last Pap Smear: N/ALMP:
Briefly describe the patients ability tofollow treatments (diet, meds, etc.) forchronic health problems (if present):
The patient is properly following her medications
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SUBJECTIVESKIN INTEGRITY:[ ] dry Comments: wala man[ ] itching - nanghupong
[x] other - edematous lang ko as[ ] denied verbalized by the
Patient.
ACTIVITY/SAFETY:
[ ] convulsions Comments: dili man[ ] dizziness hinuon, bug-at lang[ ] limited motion of joints gyud ako tiil
Kay nanghupongNaman kaya
Limitation in man hinuon nako.ability to as verbalized by the
[ ] ambulate patient
[ ] bathe self[ ] other[x] denied
COMFORT/SLEEP/AWAKE:
[ ] pain Comments: ok(location, raman hinuonFrequency, As verbalizedRemedies) by the patient.
[ ] nocturia[ ] sleep difficulties[x] denied
COPING:Occupation : FarmerMembers of household:
6Most supportive person:
Wife
SPECIAL
PATIENT
INFORMAT
ION_______________ Daily weight
_____________ __ PT/OT________________________________ BP q shift_______________ Irradiation
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_______________ Neuro VS______________ Urine test_______________
_______________ CVP/SG.Reading
______________________ 24 hour urinecollection
Date
Ordered
Diagnostic/laboratory
exams
Date done Date
ordered
I.V.
Fluids/Blood
Date disc.
01/27/09 CBC 01/27/09 01/27/09 0.9 Nacl iL@ KVO rate
01/27/09 Urinalysis
VII. NURSING MANAGEMENT
A. Ideal Nursing Management
Nursing Diagnosis:
Excessive fluid volume related to glomerulonephritis
INTERVENTIONS RAT
Monitor intake and output To check fluid balance
Observe for fever To check for infection
Elevate edematous extremities, change position frequently To reduce tissue pressu
After elevating, place in semi-fowlers position To facilitate movementrespiratory effort
Provide quiet environment To promote ventilation
Administer furosemide I amp of 12h as prescribed by the For the treatment for e
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physician
Nursing Diagnosis:
Ineffective airway clearance related to productive cough
INTERVENTIONS RAT
Assess the airway patency To check the effectivit
management
Elevate the head part of the bed/change position q 2h To enhance drainage o
segments
Encourage deep-breathing and coughing exercise To mobilize secretions
Monitored the fluid intake To help liquefy secreti
Instruct to have proper clothing, not too tight and not too
loose
To provide warm body
Nursing Diagnosis:
Acute pain related to edema
INTERVENTIONS RAT
Monitor vital signs Because vital signs are
Acknowledge patients verbalization of pain & allow him todescribe it
Pain is subjective expecan felt about it
Perform pain assessment each time occurs To rule out worsening complication
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Elevate edematous extremities, change position frequently To reduce tissue pressu
Provide quiet environment
To promote ventilation
Administer Spironolactone 50mg itab TID P.O. asprescribed by the physician
For the treatment for e
B. Actual Nursing Management
S Bug-at lang akong tiil kay nanghupong naman ko.As verbalized by the patient
O
Edema Oliguria Restlessness
A Fluid volume excess related to Glomerulonephritis
P
Long term:At the end of 2 days, pt. will be able to lessen or diminished the
symptoms of glomerulonephritis that produces excessive fluid.
Short term:
At the end of 8 hours, the pt. will be able to reduce the excessivefluid volume.
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I
1) Monitor vital signs especially temperature To check & assess for infection since the pt. has a higher risk2) Monitor intake & output To monitor & check fluid volume & prevent dehydration
3) Elevate the edematous extremities To reduce tissue pressure & risk in skin breakdown4) Place in a semi-fowlers position, change position frequently To facilitate movement of diaphragm & improve respiratory
effort5) Administer furosemide 1 ampule every 12h as prescribed by the
physician For the treatment of edema
E At the end of 8 hrs, the pt reduces the excess fluid in his body thru
excretion of stored fluids.
HEALTH TEACHINGS
Name of Patient: Gloria Yabo
MEDICATIONSEncourage to follow the dosages and proper timing of hismeds. Such as the Furosemide 1 ampule every 12hours x3doses, Omeprazole 20mg 1capsule once a day, Captopril25mg 1tablet twice a day, & Spironolactone 50mg 1 tabletthrice a day. As prescribed by his physician.
EXERCISEEncourage bed rest and frequent changes of position, earlyambulation, and deep breathing exercise.
TREATMENT
Encourage/instruct to keep the edematous extremities toelevate as often; limit of water intake; monitor intake andoutput; provide warm environment; provide egg white aday; weight the pt. daily, at the same time.
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OUT-PATIENT(Check-up)
Encourage pt. that when his discharged, he must have aregular check-up to his physician until its needed. Toevaluate the progress of his condition.
DIET Instruct to limit intake of salty & fatty foodsandenrich/increase the intake of foods rich in potassium such asbananas
VIII. REFERRALS AND FOLLOW-UP
Since the patient is suffering from Acute Glomerulonephritis, it is advised for him
to stay in the hospital for a better and thorough management regarding on her condition.
Acute Glomerulonephritis are very critical in a mans condition that is why the patient
needs an urgent hospital service for him to be monitored every now and then.
If the doctor has already approved the release or discharge of the patient from the
hospital, the patient is highly advised to have a regular check-up on her personal
physician to take out the risk from the said ailment.
If the patient will again suffer the Acute Glomerulonephritis, it is best for him to
be admitted to a tertiary-leveled hospital for better monitoring of his critical condition,
knowing that even a single mistake worsen his condition.
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IX. EVALUATION AND IMPLICATIONS
After conducting this care study, I was able to appreciate more the
essence of utilizing the nursing process in the care and management of my
patient. It was indeed a tough job on conducting this study yet, it gave me a
big impact regarding how useful it is in my chosen profession. Nursing really
demands a tender loving care attitude. It demands patience and it is calling
that cannot be merely taken for granted.
Moreover, this care study taught us to stand on our own by not depending
on others just to make this. This provides us, the students, a big learning
regarding on how well we take care of or patients in the real clinical setting.
Most of all, this study teaches the students to provide clients care more
efficiently and competently to achieve an effective and quality nursing care.
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X. BIBLIOGRAPHY
Doenges, Marilyn E. et.al Nurses Pocket Guide:Diagnoses, Interventions and Rationale. 9th edition
pages 278-279, 472-477, 576-578 F. A Davis Company
Philadelphia, 2004.
Lippincott Williams & Wilkins, Manual of NursingPractice, 8th edition, volume 1.
Deglin, et al. Daviss Drug Guide for nurses, 9th edition.
Smeltzer, Suzanne C. et al. Textbook of Medical-Surgical Nursing, 11th edition, volume 2.
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