Care conference Nephrotic Syndrome....

1. CARE CONFERENCE
SRN NOORHAZAMIN

2. PATIENT BIODATA
 Mrs A
 F/46
 Med history – DM, HPT,
gastritis
 Surg history – Nil
 Family history – DM
(mother)
 Allergic – Nil
 Admission – 13/2/11 @

3. CURRENT MEDICATION
 Diamicron 80mg BD
 Lovastatin 4mg OM
 Captopril 50mg OD From
 Moduretic 1 ON GHAS
 Covasc 10mg OD
 Metformin 500mg OD

4. ON ADMISSION
 C/O leg swelling, abdominal
distended, chest tightness
& decrease urine output X
2/12.
 ▲ Nephrotic syndrome 2˚
diabetic nephropathy
 Wheelchair

5. ASSESSMENT
 VITAL SIGN :
- Temperature – 36.3 ˚C
- Pulse – 104 bpm
- Respiration - 22 bpm
- B/P - 160/100 mmHg
- Weight – 59 kg
 Conciuous, orientated, anxious

6. ACTIVITIES DAILY LIVING
 All normal except feeling chest
tightness when breathing &
looked gasping.
 Ambulate
 Self
 Side rail

7. PHYSICAL EXAMINATION
 Skin
 oedema UL & LL
 Puffiness of eyes

8. INTRODUCTION
 S/B Dr I in clinic at 1300H :-
 IV Lasix 80mg STAT & 40mg OD
 Nephrotic chart
 TDS dextrosmeter
 Restrict fluid 800ml/day
 ↑ protein, ↓ fat, ↓ sodium diet
 Daily weight
 Daily urine albumin

19. A DISORDER OF THE
GLOMERULI
 Excessive amount of protein
excreted in urine – proteinuria
 Low albumin in blood –
hypoalbuminemia
 Increase serum cholesterol &
LDL - hyperlipidemia

21. PRIMARY affect only kidney
 Chronic glomerulonephritis
 Amyloidosis of kidney
 Renal vein thrombosis

22. SECONDARY affect other
part of body
 Diabetes mellitus with intercapillary
glomerulosclerosis
 Systemic lupus erythematosus
 Multiple myeloma
 Viral infection
 Allergies or drug toxicity

24. CAN DEVELOP SUDDENLY /
GRADUALLY
 In children :
 Age 18 months – 4 years
 Affected more boys than girls
 In adult :
 Affects both sexes.

26.  Loss of appetite
 Malaise
 Puffy eyelids
 Oedema
 Abdominal discomfort
 SOB
 Irritability

27.  Muscle atrophy
 Frothy urine
 Headache
 Ascites

30.  18KS, HbA1c – 13/2/11
 U/S abdo, CXR – 13/2/11
 Urine 24hours protein – 13/2/11
 ANA, ESR, C3C4 – 14/2/11
 BUSE, creatinine, LFT – 17/2/11

31. ULTRASOUND ABDOMEN
Date ordered – 13/2/11
 Gallbladder polyps. Bilateral
grade 1 parenchymal renal
disease. Uterine fibroid 9.2 X
8.0cm.

32. CHEST X-RAY
Date ordered – 13/2/11
 Heart is mildly enlarged with
CTR 13/25.

33. ECG
Date ordered – 13/2/11
 Sinus tachycardia

34. 18KS
Date ordered – 13/2/11
 Haemoglobin 9.3g/dL
 Red cell count 3.3 10²/L
 Haematocrit (PCV) 28%
 ESR > 120mmol/hr
 Glucose 10.3mmol/L
 Creatinine 136 umol/L
 Calcium 2.00 mmol/L

35. Cont.
 Total cholesterol 8.5mmol/L
 Triglyceride 2.60mmol/L
 HDL cholesterol 1.30mmol/L
 LDL cholesterol 6.0mmol/L
 Chol/HDL chol 6.5mmol/L
 Total protein 51g/L
 Albumin 24g/L
 A/G ratio 0.9
 TSH 7.38mIU/L

36. HbA1c
Date ordered – 13/2/11
 6.6 %
(Normal range < 6.0 )

37. Anti Nuclear Antibodies
Date ordered – 14/2/11
ANA titre – 320 (RR < 80)
Comment :
Moderate ANA titres may
associated with systemic
autoimmune disease.

38. C3C4
Date ordered – 14/2/11
 Serum complement (C4) - 0.65g/L
(Normal range – 0.16-0.47 )

39. Haematology
 Hb – 9.3g/dL
Film
There is moderate normochromic
normocytic anemia. Recent
significant blood loss should be
excluded. Other possible causes
include anemia, renal or liver
disease, hypothyroidism and bone
marrow hypoplasia, infiltration or
fibrosis.

40. BUSE
Date ordered – 17/2/11
 Urea 7.4mmol/L

41. LFT
Date ordered – 17/2/11
 Total protein 51g/L
 Albumin 24g/L
 A/G ratio 0.9
 Total bilirubin 1.9
 SGOT/AST 46

42. Se Creatinine
Date ordered – 17/2/11
Creatinine 162mmol/L

44. DRUGS DATE
ORDERED
DATE
OFF
IV Lasix 80mg STAT 13/2/11 13/2/11
IV Lasix 40mg TDS 13/2/11 15/2/11
Tab Burinex 2mg OD 13/2/11 18/2/11
Tab Covasc 10mg OD 13/2/11 18/2/11
Tab Diamicron 80mg BD 13/2/11 18/2/11
Tab Stovas 40mg ON 13/2/11 18/2/11
Cap Omesec 20mg BD 13/2/11 18/2/11
Tab Rasilez 150mg OD 13/2/11 18/2/11
Tab C-Thyroxine 100mg OD 13/2/11 18/2/11
IV Lasix 80mg TDS 15/2/11 16/2/11
Tab Lasix 80mg TDS 16/2/11 18/2/11

48. NCP
 Alteration in fluid &
electrolyte related to
retention of sodium &
water.
 Alteration in breathing
pattern related to retention
of fluid in body.

49. NCP
 Alteration in nutritional status :
less than body requirement
related to loss of appetite,
altered oral mucosa & dietary
restriction.
 Knowledge deficit related to
dietary status & treatment
regime.

50. NCP
 Activity intolerance related
to fatigue and retention of
fluid.
 Low self esteem related to
changes body image and
role changes.

68.  Monitor fluid & electrolyte balance
 Reducing metabolic rate
 Promoting pulmonary function
 Preventing infection
 Providing skin care
 Promote emotional support