Acute glomerulonephritis is an immune complex disease caused by antigen-antibody reactions following a streptococcal infection. It commonly affects school-aged children and presents with decreased urine output, bloody or brown urine, edema, and sometimes hypertension. The disease is self-limiting and typically resolves within 2-3 weeks with supportive care such as antibiotics, antihypertensives, and fluid management. Nursing care involves monitoring for complications, enforcing diet and fluid restrictions, providing diversional activities, and educating families.
Nephrotic syndrome is a kidney disorder that causes your body to pass too much protein in your urine. Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood.
Glomerulonephritis is inflammation of the tiny filters in your kidneys (glomeruli). Glomeruli remove excess fluid, electrolytes and waste from your bloodstream and pass them into your urine.
kindly check this slide for nephrotic syndrome. in this slide i covered all the points regarding this topic.
if any suggestion give comment on this topic
https://youtu.be/2Y8JNkiU29s This is the link for video lecture for the same topic. It is available in easy and comfortable language.
The Nephrotic Syndrome is a clinical state characterized by-
Proteinuria
Hypoalbuminemia
Hyperlipidemia and
Oedema.
It is a primary glomerular disease.
THIS SLIDE IS PREPARED BY SURESH KUMAR FOR MY STUDENT SUPPORT SYSTEM TO WATCH THIS VIDEO VISIT YOUTUBE CHANNEL- Important links-
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Hydrocephalus
introduction
Hydrocephalus, also known years ago as “water on the brain”, is a condition where the circulation system of the body’s cerebrospinal fluid (CSF) is not functioning properly. The CSF accumulates in the brain and causes intracranial pressure. A shunt is usually placed to equalize the flow of CSF, which requires surgery. The diagnosis and surgery can be very frightening for the parents as well as the child
definition
Hydrocephalus is a condition characterized by an excess of cerebrospinal fluid (CSF) within the ventricular and subarachnoid spaces of the cranial cavity
INCIDENCE
It is found in 1-3 of every 1000 born children in world wide
Classification
Non communicating. In the non communicating type of congenital hydrocephalus, an obstruction occurs in the free circulation of CSF.
Communicating. In the communicating type of hydrocephalus, no obstruction of the free flow of the CSF exists between the ventricles and the spinal theca; rather, the condition is caused by defective absorption of CSF, thus causing increased pressure on the brain or spinal cord.
CAUSES
Obstruction. The most common problem is a partial obstruction of the normal flow of CSF, either from one ventricle to another or from the ventricles to other spaces around the brain.
Poor absorption. Less common is a problem with the mechanisms that enable the blood vessels to absorb CSF; this is often related to inflammation of brain tissues from disease or injury.
Overproduction. Rarely, the mechanisms for producing CSF create more than normal and more quickly than it can be absorbed.
PATHOPHYSIOLOGY
CLINICAL MANIFESTATION
Poor feeding. The infant with hydrocephalus has trouble in feeding due to the difficulty of his condition.
Large head. An excessively large head at birth is suggestive of hydrocephalus.
Bulging of the anterior fontanelles. The anterior fontanelle becomes tense and bulging, the skull enlarges in all diameters, and the scalp becomes shiny and its veins dilate.
Setting sun sign. If pressure continues to increase without intervention, the eyes appear to be pushed downward slightly with the sclera visible above the iris- the so-called setting sun sign.
High-pitched cry. The intracranial pressure may increase and the infant’s cry could become high-pitched.
Irritability. Irritability is also caused by an increase in the intracranial pressure.
Projectile vomiting. An increase in the intracranial pressure can cause projectile vomiting
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conclusions
Chronic glomerulonephritis is a kidney disorder caused by slow, cumulative damage and scarring of the tiny blood filters in the kidneys. These filters, known as glomeruli, remove waste products from the blood.
Nephrotic syndrome is a kidney disorder that causes your body to pass too much protein in your urine. Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood.
Glomerulonephritis is inflammation of the tiny filters in your kidneys (glomeruli). Glomeruli remove excess fluid, electrolytes and waste from your bloodstream and pass them into your urine.
kindly check this slide for nephrotic syndrome. in this slide i covered all the points regarding this topic.
if any suggestion give comment on this topic
https://youtu.be/2Y8JNkiU29s This is the link for video lecture for the same topic. It is available in easy and comfortable language.
The Nephrotic Syndrome is a clinical state characterized by-
Proteinuria
Hypoalbuminemia
Hyperlipidemia and
Oedema.
It is a primary glomerular disease.
THIS SLIDE IS PREPARED BY SURESH KUMAR FOR MY STUDENT SUPPORT SYSTEM TO WATCH THIS VIDEO VISIT YOUTUBE CHANNEL- Important links-
youtube channel
https://www.youtube.com/c/MYSTUDENTSUPPORTSYSTEM
facebook profile- https://www.facebook.com/suresh.kr.lrhs/
FACEBOOK PAGE- https://www.facebook.com/My-Student-Support-System-101733164924592
facebook group NURSING NOTES- https://www.facebook.com/groups/241390897133057/
FOR MAKING EASY NOTES YOU CAN ALSO VISIT MY BLOG –
BLOGGER- https://mynursingstudents.blogspot.com/
Instagram- https://www.instagram.com/mystudentsupportsystem_nursing/
Twitter- https://twitter.com/student_system?s=08
#glomerulonephritis,#congenitalanomalies,#childhealthnursing#anm,#gnm,#bscnursing
Hydrocephalus
introduction
Hydrocephalus, also known years ago as “water on the brain”, is a condition where the circulation system of the body’s cerebrospinal fluid (CSF) is not functioning properly. The CSF accumulates in the brain and causes intracranial pressure. A shunt is usually placed to equalize the flow of CSF, which requires surgery. The diagnosis and surgery can be very frightening for the parents as well as the child
definition
Hydrocephalus is a condition characterized by an excess of cerebrospinal fluid (CSF) within the ventricular and subarachnoid spaces of the cranial cavity
INCIDENCE
It is found in 1-3 of every 1000 born children in world wide
Classification
Non communicating. In the non communicating type of congenital hydrocephalus, an obstruction occurs in the free circulation of CSF.
Communicating. In the communicating type of hydrocephalus, no obstruction of the free flow of the CSF exists between the ventricles and the spinal theca; rather, the condition is caused by defective absorption of CSF, thus causing increased pressure on the brain or spinal cord.
CAUSES
Obstruction. The most common problem is a partial obstruction of the normal flow of CSF, either from one ventricle to another or from the ventricles to other spaces around the brain.
Poor absorption. Less common is a problem with the mechanisms that enable the blood vessels to absorb CSF; this is often related to inflammation of brain tissues from disease or injury.
Overproduction. Rarely, the mechanisms for producing CSF create more than normal and more quickly than it can be absorbed.
PATHOPHYSIOLOGY
CLINICAL MANIFESTATION
Poor feeding. The infant with hydrocephalus has trouble in feeding due to the difficulty of his condition.
Large head. An excessively large head at birth is suggestive of hydrocephalus.
Bulging of the anterior fontanelles. The anterior fontanelle becomes tense and bulging, the skull enlarges in all diameters, and the scalp becomes shiny and its veins dilate.
Setting sun sign. If pressure continues to increase without intervention, the eyes appear to be pushed downward slightly with the sclera visible above the iris- the so-called setting sun sign.
High-pitched cry. The intracranial pressure may increase and the infant’s cry could become high-pitched.
Irritability. Irritability is also caused by an increase in the intracranial pressure.
Projectile vomiting. An increase in the intracranial pressure can cause projectile vomiting
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,
,
,
,
,
,
,
conclusions
Chronic glomerulonephritis is a kidney disorder caused by slow, cumulative damage and scarring of the tiny blood filters in the kidneys. These filters, known as glomeruli, remove waste products from the blood.
Now a days TBM is super most disease in Indian children.
Tuberculous meningitis (TBM) is difficult to diagnose, and a high index of suspicion is needed to make an early diagnosis.
Nephritis is a inflammation of kidney .
It is classified into various types like lupus nephritis ,interstitial nephritis , glomerulonephritis ,pyelonephritis.
Lupus nephritis is an inflammation of kidney due to autoimmune disorder named as lupus .
It is inflammation of lower urinary tract .
Case Report : Integrating Review Inflammation and Commorbid diseasesSoroy Lardo
Diabetes is associated with atherosclerosis and COPD contributed to the chronic inflammation within the systemic vascular. Management of CVI with diabetes and COPD requires multi-disciplinary approach
acute glomerulonephritis in pediatrics by ritu gahlawatRitu Gahlawat
Case Scenario
A child 14 yrs. old, was apparently normal one week back, when he developed puffiness around the eye and face from last 7 days, insidious in onset, gradually progressive, from the peri-orbital region to the whole of face, more during morning hours and then decreases as the day progresses.
Then mother noticed swelling of bilateral lower limbs from 5 days, insidious in onset, gradually progressed from feet to half of the lower limb, more during morning hours and decreases as the day progresses.
Then he started to develop headache, insidious in onset, gradually progressive, more in the occipital region, not associated with vomiting, blurring vision, confusion, altered sensorium, seizures.
This was followed by cola coloured urine from four days, sudden onset, present throughout the urinary stream, not precipitated by any food item, no history of pain during micturition, fever, urgency, increased frequency of micturition, regular drug intake, associated with decreased urine output present from past one week initially used to pass 7-8 times/day and now only 3-4 times/day.
History of fever with sore throat present 3 weeks back, which resolved on its own in 3-4 days.
Introduction
Acute glomerulonephritis is a common disease in children and it is one of the diseases that are presented commonly with hematuria which means red urine (blood in urine).
Acute Glomerulo Nephritis in all probabilities results secondary to a proceeding streptococcal (beta-haemolytic type 2) infection of throat or skin.
A history of upper respiratory infection.
Acute glomerulonephritis is an immune-mediated inflammatory disease of the capillary loops in the renal glomeruli. The antigen-antibody complex deposition within the glomeruli results in glomerular injury which is manifested as hematuria, oliguria, Edema and hypertension.
More common in male than females.
Most common in preschool and early school age children with a peak age of onset of 6-7 years.
On average responsible for 2 to 4% of pediatric admission in India.
Accounts for about 90% of renal diseases in childhood.
Varies with the prevalence of nephritogenic strains of streptococci and the likelihood of cross-infection.
Presumed cause: antigen-antibody reaction secondary to an infection in the body.
Initial infection:
Usually either an upper respiratory infection or a skin infection, usually one to 3 weeks before the onset of symptoms.
Most frequent causative agent- nephritogenic strains of group- A beta- hemolytic streptococcus (type 2), acute post- streptococcal glomerulonephritis is the most common.
Most cases are post infectious and have been associated with pneumococcal, viral infection, acute post streptococcal glomerulonephritis is the most common of the post infectious renal disease in childhood, streptococcal pharyngitis is more common in the winter.
Urinary symptoms:
Decreased urine output
Bloody or brown- colored urine
Malaise
Mild headache
GIdisturbance
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Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
2. ACUTE GLOMERULO NEPHRITIS
Definition: -
It is an immune complex disease due to antigen
antibody reaction following hemolytic streptococca
infection.
Incidence: -
- School age children.
- Rare in younger children than the age 2.
- More frequently in males than in females.
Etiology: -
- Antigen antibody reaction secondary to an
infection ( Haemolytic streptococcal infection).
- Recurrent URTI.
3. Pathophysiology: -
Antigen groups A beta hemolytic streptococcus.
Antigen antibody product.
Deposition of antigen-antibody complex in glomerulus.
Increased production of epithelial cells lining the glomerulus.
Leukocytes infiltrate the glomerulus
Thickening of the glomerulus filtration membrane.
Scarring and loss of glomerulus filtration membrane.
Decreased glomerulus filtration rate.
4. Clinical manifestation: -
Onset: -
1.Usually 10 to 20 days after acute pharynges. In
streptococcal skin infection, the latency period may be
as 6 weeks.
2.May be abrupt & severe or mild and detected only
laboratory measures.
Signs & symptoms: -
1.Urinary symptoms: -
a) Decreased urine output.
b) Bloody or brown colored urine.
2.Edema: -
a).Present in most patients.
b).Usually mild.
5. a) Commonly manifested by periorbital oedema in the morning
b) May appear only as rapid weight gain.
c) Generalized and influenced by posture may be present.
2. Hypertension: -
a) Present in more than 50% of patients.
b) Usually mild.
c) Rise in BP may be sudden.
d) Usually appear during the first 4-5 days of the illness.
3. Malaise
4. Mild headache.
5. GI disturbances, especially anorexia and vomiting.
6. Fever may or may not be present.
7. Children look pale, lethargic, and irritable.
6. Diagnostic evaluation: -
1.Urinalysis: -
a) Decreased output (oliguria) – may approach in
anuria.
b) Gross hematuria. (Microscopic)
c) Specific gravity- moderately elevated.
d) Proteinuria may be mild to severe.
e) Microscopic- red blood cells, leucocytes epithelial
cells & caste.
f). Flow urinary sodium
7. 1. BUN: -creatinine - usually mildly to moderately
elevated in 50% patients.
2. Antistreptolysin titer is elevated.
3. Antidnase B (ADB) titer- elevated.
4. Erythrocyte sedimentation rate also elevated.
5. Complement C3 &C4 depressed.
6. Serum albumin test.
7. Electrocardiography.
8. Chest X-ray- pulmonary congestion, cardio
enlargement during the edematous phase.
8. Treatment: -
• There is no specific treatment AGN.
• It is self-limiting and patients recover within two to
three weeks.
• Death may be due to complications.
Supportive treatment: -
• Antibiotics e.g. Penicillin may be given to treat the
infection. Give antihypertensive drugs.
• Give magnesium sulphate to reduce the cerebral
oedema & enchaphalopathy.
• Sedatives give to reduce the restlessness.
• Cardiac failure means give digitalis.
• If end stage means advice for dialysis
9. Nursing management: -
• Give complete bed rest.
• Check the vital signs to detect early signs of
complications such as the deviation in the pulse may
indicate cardiac failure.
• Headache, convulsions & behavioral changes may
be indicative of hypertensive enchephalopathy.
• Follow the strict intake & output chart .
• Check the weight daily, oedema. & appearance of
the urine is must.
• Nutrition should be planned according to the blood
reports in the specific stage.
10. • Mild cases: - salt restricted regular food may be
allowed.
• Salty food items should be avoided in early phase of
oliguria.
• Food should contain low proteins, high CHO &
vitamin supplement.
• Small frequent feeding should be given.
• Fluid should be supplied according to the
prescription.
• Parents should be explained about the accurate fluid
intake.
• Second phase: -Diuresis starts the normal food with
the adequate fluid can be given as the blood reports
improve.
• Give play therapy.
11. Parental advice: -
• Parental should be taught about the early signs of
complications and importance of early treatment.
• Proper care of the skin and timely treatment of the
skin lesions should be explained.
• Prompt care of the respiratory problems should be
insisted .
• Parents should be instructed about the follow up
visits.
Complications: -
• Hypertensive enchaplopathy.
• Heart failure
• Uremia
• Anemia
• Hypertension
12. Nursing diagnosis: -
• Impaired urinary elimination related to glomerular
dysfunction.
• Excess fluid volume related to impaired renal function.
• Deficient diversional activity related to focus on fluid &
salt restriction.
• Deficient knowledge regarding AGN & its
management.
Nursing interventions:-
Promoting normal urine output:
1.Monitor daily intake out put chart .
2.Test & record urine for hematuria and proteinuria as
directed & note color of urine.
3.Monitor daily weights.
13. Reducing excess fluid volume: -
• Promote a no salt diet during acute phase.
• Restrict the fluids.
• Check the BP as ordered & needed.
Promoting divers ional activity: -
1.Explain fluid restriction of at an age appropriate level
& direct the child’s focus away from restrictions.
2.Provide the child with divers ional activity & play
therapy.
• Encourage activity as tolerated
14. Providing information: -
1.Explain all aspects of the diagnostic tests & treatment in
terms the farming can understand.
2.Explain the purpose of all medications & the restricted diet.
3.Give good home environment.
4. Arrange for appointments for continued medical supervision
& initiate referrals when appropriate.
5. Encourage family participation in the child’s care.
Health education: -
• Reinforce medical explanation of the disease process.
• Reinforce activity recommendation usually not restricted.
• Explain about the prevention of recurrent respiratory tract
infection.
• Regular checkup.