General Objective: To be able to learn and understand the diseaseprocess and its corresponding nursing caremanagement to the patient having Post-infectiousGlomerulonephritis.
Specific Objective: 1. To present the patient’s profile and health history with its Gordon’s Pattern of Functioning. 2. To present and discuss about post-infectious glomerulonephritis, with its etiology and clinical manifestations 3. To present and discuss the normal anatomy and physiology of urinary system. 4. To present the Physical assessment of the patient 5. To correlate the laboratory results to theclient’s clinical manifestation.
6. To present and discuss thepathophysiology of Post-infectiousGlomerulonephritis 7. To present the nursing care plan to thepatient according to priority. 8. To present the drugs prescribed to thepatient and the nursing considerations
Glomerulonephritis is animmunologic disorder that causesinflammation and increased cells in theglomerulus.Glomerulonephrits encompasses a varietyof diseases, most of which are caused byimmunologic reaction that result inproliferative and inflammatory changes inglomerular structure. It is usuallymanifested by either a nephrotic syndromeor a nephritic syndrome.
Nephrotic syndrome is a set of clinicalmanifestations caused by protein wastingsecondary to diffuse glomerular damage.Manifestations include proteinuria (>3.5 g/day),hypoalbuminemia and edema. Nephriticsyndrome refers to set of clinical manifestationsthat includes hematuria and at least one of thefollowing: oliguria (urine output <400ml/24hour), hypertension, elevated blood ureanitrogen (BUN) level or decreased GFR.Nephritic syndrome is common with many typesof glomerulonehpritis, includingimmunoglobulin A (IgA) nephropathy andHenoch-Schönlein purpura.
Client Profile Name: Patient Z Address: Brgy. Sabang, Palompon, Leyte Religion: Roman Catholic Gender: Male Age: 6 years old Birthdate: 11-17-2005 Date of Admission: January 5, 2012 Chief Complaint: Facial Puffiness
History of Present Illness A case of Patient Z, 6 years old, living at Brgy.Sabang, Palompon, Leyte, was admitted for the firsttime at Eastern Visayas Regional Medical Center, witha chief complaint of “Ning burot man ang iyang naongog sige siya ug kahilanti” as verbalized by the motherof the client. 12 days PTA, the client had a fever, the mothergave him Paracetamol and no other interventions weredone. 11 days PTA, the client still had a fever. He alsohad an epistaxis, no management was done.
10 days PTA, the client’s fever still persisted. Healso experienced difficulty in breathing and headache.He vomited once which is approximately 300ml, hisvomitus was composed of small amount of his recentintake but most of it was saliva. He also had tea-colored urine with approximate amount of 240ml.Manifestation of the signs and symptoms promptedthem to seek medical consultation at St. Paul’sHospital. There the client was given with Co-amoxiclav (15mg/kg/day BID x 7 days) and Cetirizine(0.25mg/kg/dose OD).
5 days PTA, the client went back to St. Paul’sHospital with facial puffiness and fever. He hadanother check-up and was advised to continueprescribed medication and to have a CBC andurinalysis. 2 days PTA, the client went back to St. Paul’sHospital to get the result of CBC and urinalysis whichrevealed UTI and abnormalities on the CBC count.The doctor ordered to have the client ultrasound. 1 day PTA, the client returned to St. Paul’sHospital to have ultrasound which revealedPyelonephritis. The client was recommended to beadmitted at the EVRMC.
Past History Client didn’t have chickenpox, mumps, measles,and asthma and has no known food and drug allergies.He had a complete immunization when he was a baby.No history of surgeries, accidents, injuries, andhospitalization. He had taken medications before hewas admitted to EVRMC such as co-amoxiclav andcetirizine. Client had a complete immunization, as claimedby the mother of the client.
Developmental History At 12 months, the client can stand alone and ableto obey commands. At 15 months, the client can walkwell alone. At 2 years old, he can run well and wastoilet trained by day. At 3 ½ years old, the client canalready stand on one foot. At 4 ½ years old, the clientcan already dress by himself. At 5 years old, he canalready write alphabets and tells stories. At 6 yearsold, he can already walk heal to toe.
Maternal History The maternal history of the mother of the clientis G5 T5 P0 A0 L5 M0, had no complications duringpregnancy and deliveries. The client was delivered fullterm via NSVD at home assisted by “hilot”. Had prenatal check-ups on their Health Center atPalompon, Leyte and received 5 doses of TetanusToxoid injections on her prenatal check-ups and wasgiven FeSO4 supplements one tab once a day. She is a non-smoker, non-alcoholic drinker. Shehad no history of severe bleeding and severe vomiting.
Family History of Illness Both sides of their family have a history ofhypertension and the grandmother of the client on thematernal side who is deceased had a heart problem.No other known debilitating diseases such as DM,asthma, and allergies.
Lifestyle The client usually sleeps at eight in the eveningand wake up at six in the morning. He doesn’t havedifficulty in sleeping. They usually eat 3 meals a day.In the morning, he usually eats 3 pandesal with milo.During lunchtime, his typical meal is fish, vegetablesand rice. He can consume at least 1-2 cups of rice anddrinks approximately 1 glass of water each meal.During week days, he usually goes to school at sevenin the morning accompanied by his mother and goesback home four in the afternoon.
At school, he likes to eat junk foods and playswith his classmates during free time. On weekends, heusually takes 1 hour of nap in the afternoon and afterhis nap he usually plays outside their house with hisfriends. The client usually does his relaxation byplaying with his toys and watching TV.
Social Data The client was born on November 17, 2005, andwas born and raised in Palompon, Leyte. He is a grade1 pupil in Palompon. He lives with his family in ahouse made up of light materials with electricity andtheir water source is from NAWASA. He has 4siblings and he is the 5th child. Usually, the father ofthe client is the one who does the financial planningsince he is the only one who is working in theirfamily.
The client is much closer to his mother becauseshe is the one whom he confides to in times ofproblems. Also his mother is the one who monitorshim at home and in school and the one who takes careof him when he is sick. The family has a good relationship with eachother, but sometimes conflicts are inevitable especiallyif their family is suffering from crisis. The family hasa good relationship towards their neighbors and theyhave no conflicts with each other.
Psychologic Data The client has no history of any psychiatricillness. Patterns of Health Care Access to health care is a problem for them becauseof long periods of travel from Palompon to Tacloban.They have their health center in Palompon, Leyte, butit is inadequate to meet their needs for care. The family is supported with PHILHEALTH and ithelped them reduce payment to their bills at thehospital.
The family usually consults to a “Tambalan”before seeking consult to a doctor because of financialconstraints. They sometimes use herbal medicine suchas calamansi juice or lagundi leaves to relieve coughand colds.