OLIVAREZ COLLEGE PARANAQUEDr. A. Santos Ave., Sucat, Parañaque

College of Health Related Sciences – Nursing Department

Case Study of a Client with a diagnosis of

Acute glomerulonephritis

CASE PRESENTATION

BS NURSING IV SECTION A, Group 2

1ST SEM - CLASS 2010-2011

Submitted to:

Ms. Acosta, RN

Introduction

Background of the study

Acute glomerulonephritis (AGN) is active inflammation in the glomeruli. Each kidney is composed of about 1 million microscopic filtering

"screens" known as glomeruli that selectively remove uremic waste products. The inflammatory process usually begins with an infection or injury

(e.g., burn, trauma), then the protective immune system fights off the infection, scar tissue forms, and the process is complete.

There are many diseases that cause an active inflammation within the glomeruli. Some of these diseases are systemic (other parts of the body

are involved at the same time) and some occur solely in the glomeruli. When there is active inflammation within the kidney, scar tissue may replace

normal, functional kidney tissue and cause irreversible renal impairment.

The severity and extent of glomerular damage—focal (confined) or diffuse (widespread)—determines how the disease is manifested.

Glomerular damage can appear as subacute renal failure, progressive chronic renal failure (CRF); or simply a urinary abnormality such as hematuria

(blood in the urine) or proteinuria (excess protein in the urine).

Case Abstract

This was a case of E.D., 6 year old male born on November 8, 2003 residing at Muntinlupa City was admitted at Ospital ng Muntinlupa on

August 24, 2010 at 8:15am with a chief complaint of Tea Colored Urine. He arrived at the hospital awake, conscious and coherent with admitting

diagnosis of Acute Glomerulonephritis.

Patient had high fever, sore throat, tonsillitis and facial edema12 days prior to confinement.

Vital Signs taken and recorded upon admission; BP 135/85 mmHg, T: 37oC, RR: 30, PR 100 bpm and Laboratory test; Urinalysis, Hematology, Blood Chemistry and ASO titer was done. Catheter was inserted upon admission. Furosemide, Nipedipine and Penicillin was given.

OBJECTIVES:

A. General Objectives

This study aims to convey familiarity and provide effective nursing care to a patient with admitting diagnosis of Acute Glomerulonephritis ,

through understanding the patient history, disease process and management.

B. Specific Objectives

At the end of the session, the students will be able to:

1. Present a thorough assessment regarding Acute Glomerulonephritis, through Nursing Health History, Maternal History, Physical

Assessment, and the interpretation of the laboratory examinations done on the patient.

2. Discuss the anatomy and physiology of Urinary system, pathophysiology of the patient’s condition, usual clinical manifestations and

possible complications of the condition.

3. Enumerate the necessary medications needed and be familiar to its mode of action.

4. Formulate a workable nursing care plan on the subjective and objective cues gathered through nurse-patient interaction to be able to help

the patient towards wellness.

PATIENT'S PROFILE

 

A. Biographical Data

Date: September 1, 2010 Clinical Area: 2nd Floor Pedia Ward; OSMUN

Name E.D.

Address Muntinlupa City

Date of Birth November 8, 2003

Age 6 years old

Sex Male

Civil Status N/A

Nationality Filipino

Religious Preferences Roman Catholic

Place of Birth Muntinlupa City

Educational

Attainment

Grade 1

Occupation N/A

Language Spoken Filipino

Health Care Financing None

Date of Admission August 24, 2010

Admitting Diagnosis Acute Glomerulonephritis

Admitting Physician Dr. Patdu, Dr. Zabian, Dr. Juntin

B. Chief Complaint

Patient had fever, facial edema and tea colored urine.

Vital Signs upon admission are as follows: (August 24, 2010)

T = 37˚C PR = 100 bpm BP = 135/85mmHg RR = 30 cpm Wt= 17.5 kg Ht=113cm Head Circumference: 51cm Chest: 56cm Abdomen: 55cm

NURSING HEALTH HISTORY

A. History of Present Illness

Patient was diagnosed of Acute Glomerulonephritis and was treated with Furosemide, Nipedipine and Penicillin. Twelve (12) days prior to

consultation client experienced fever, facial edema and tea colored urine and Five (5) days PTC OPD consultation done.

B.   Past History

  Patient has no previous hospitalization and surgeries. Patient was not taking any medication. He has no known food and drug allergies.

                 

C. Family History

Patient has no family history of kidney-related diseases.

Father has Hypertension

Physical Assessment

Date: September 1, 2010 Clinical Area: 2nd Floor Pedia Ward; OSMUN

Vital Signs

T = 36.4˚C PR = 89 bpm BP = 110/70mmHg RR = 28 cpm

Anthropometric Measurements:

Height: 113 cm Weight: 17.5 kg Chest Circumference: 56 cm Abdominal Circumference: 55 cm

Head Circumference: 51cm

GENERAL SURVEY TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

General AppearanceInspectionPalpation

Auscultation

() no sign of distress( ) With sign of distress( ) Cardio Respiratory( ) pain

Normal

Level of consciousnessInspection

() Conscious ( ) Drowsy( ) Comatose ( ) Others Normal

Coherence Inspection() Coherent( ) Incoherent( ) Others

Normal

OrientationInspection

( )Oriented( ) Disoriented Time ____ Place ____Person_______

Normal

DevelopmentInspection

() Endomorph / Well developed( ) Mesomorph / Fairly developed( )Ectomorph / Poorly developed() Looks According to Age( ) Appears older/ younger than stated age

Normal

NutritionInspection

() Well Nourished( ) Obese( ) Cachexic

Normal

Emotional StateInspection

() Calm ( ) Tense( )Worried ( ) Restless( ) Others _____________________

Normal

IISKIN TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

General ColorInspection

( ) Pinkish ( ) Pallor( ) Jaundice () Flushed( ) Cyanotic ( ) Others _________

Normal

Texture InspectionPalpation

( ) Smooth ( ) Rough ( ) Others _________________

Normal

Turgor InspectionPalpation

() Good( ) Fair( ) Poor

Normal

Temperature InspectionPalpation

( ) Warm( ) Cool( ) Others______________

Normal

Moisture InspectionPalpation

( ) Dry( ) Wet( ) Clammy() Oily

Normal

III

HEAD TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

Configuration InspectionPalpation

() Normocephalic( ) Masses( ) Other

Normal

Fontanelles InspectionPalpation

( ) Closed( ) Open( )Sunken( )Bulging

Normal

HairInspectionPalpation

( ) Fine( ) Coarse( ) Dry( ) Normal / Even Distribution( ) Alopecia

Normal

Scalp Inspection

( ) Clean( ) Dandruff( ) Lice( ) Wounds / Scars / Lesions

Normal

Lids Inspection( ) Symmetrical( ) R/L Edema / Swelling( ) R/L Ptosis

Normal

Periorbital region Inspection( ) Edema( ) Sunken( ) Discoloration

Normal

ConjunctivaInspection

( ) Pink( ) Pale( ) Lesion( )Discharge

Normal

Sclera Inspection

() Anecteric( ) Subicteric( ) Eteric( ) Hemorrhage

Normal

Cornea and Lens Inspection

( ) Smooth ( ) Clear( ) Lesion ( ) Opacity( ) Arcus Senilia

Normal

Pupil Size Inspection( ) Equal( ) UnequalR: _____mm L: _____mm

Normal

Reaction to Light Inspection

R: ( ) Brisk L: ( ) Brisk ( ) Sluggish ( ) Sluggish ( ) Fixed ( ) Fixed

Normal

Reaction to Accommodation

Inspection () Uniform constriction ( ) Unequal constriction Normal

Convergence Inspection () Intact

( )Others __________ Normal

Visual acuity Inspection () Gross Normally( ) Farsighted

Normal

( ) Nearsighted

IVEARS TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

External PinnaeInspection () Normoset

() Symmetrical( ) Gross Abnormality( ) Tenderness

Normal

External Canal Inspection ( ) Impact Cerumen Normal

Discharge Inspection

( ) Foul smelling( ) Serous( ) Purulent( ) Mucoid

Normal

Gross Hearing Inspection () Symmetrical ( ) R / L Deafness Normal

VNOSE TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

Nasolabial FoldInspectionPalpation

( ) Symmetrical( ) R / L Shallow nasal fold

Normal

Septum Inspection( ) Midline( ) Deviated( ) Perforation

Normal

MucosaInspection ( ) Pinkish

( ) Pale ( ) Reddish

Normal

Discharge Inspection ( ) Serous

( ) Mucoid( ) Purulent( ) Bloody

Normal

PatencyInspection ( ) Both Parent

( ) R / L Obstructed exhalation

Normal

Gross Smell Inspection () Symmetric

( ) R/L Olfactory Deficiency

Normal

Sinuses () Non tender( ) Tender

Normal

VIMOUTH TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

Lips Inspection

( ) Pinkish( ) Cyanosis( ) Dryness / Crackles( ) Lesion

Normal

Tongue Inspection ( ) Midline

( ) R/ L Deviation( ) Atrophy( ) Fasciculation

Normal

Teeth

Inspection ( ) Complete( ) Missing teeth( ) Carries( ) Denture( ) Braces / RetainersSpecify ______________

Normal

Gums Inspection ( ) Pinkish

( ) Pallor( ) Bleeding

Normal

Mucosa Inspection () Pinkish

( ) Pallor ( ) Cyanotic

Normal

Speech

Inspection () Intact( ) Slurred( )Aphasic( ) Others _____________

Normal

VIIPHARYNX TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

UvulaInspection () Midline

( ) R / L Deviation Normal

MucosaInspection () Pinkish

( ) Pallor( ) Reddish

Normal

TonsilsInspection () Not Inflamed

( ) R / L Inflamed( ) R / L With exudates

Normal

VIIINECK TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

Trachea InspectionPalpation

() Midline( ) R / L Divation Normal

Cervical lymph nodes InspectionPalpation

() Non palpable( ) Palpable( ) Tender

Normal

Thyroid InspectionPalpation

( ) Non palpable( ) Enlarge Normal

Others InspectionPalpation

( ) Normal ROM( ) Neck rigidity( ) Neck vein engorgement visible Upright( ) Masses

Normal

IXCHEST AND LUNGS TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

Inspiration / Exhalation Ratio

InspectionAuscultation Normal

Breathing Pattern Inspection

( ) Regular (Eupnea)( ) Effortless( ) Hyperpnea( ) Tachypnea( ) Dsypnea( ) Uses of accessory muscle( ) Other ___________

Normal

Shape of Chest:

Anterior – Posterior – Lateral Ratio

InspectionInspection

AP __2-1_________ L ____________( ) Barrel chest( ) Funnel( ) Pigeon( ) Others _______________

Normal

Lung ExpansionInspection () Symmetrical

( ) R/ L Decreased / Lag Normal

Vocal/ Tactile Fremitus Auscultation() Symmetrical( ) Decreased / Increased at _____

Normal

Percussion

( ) Resonant at ______________( ) Dullness at _______________( ) Hyper-resonant at _________( ) Liver Dullness at __________( ) Spleen Dullness at ________

Normal

Breath Sounds ( ) Bronchial at ______________() Bronchovesicular at ________( ) Vesicular at ______________( ) Crackles at ______________( ) Wheezing at _____________( ) Pleural friction rub _________

Normal

XHEART TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

Precordial Auscultation

() Flat( ) Bulging( ) Tenderness

Normal

( ) Heavy( ) Thrill( ) Normo-dynamic pre cordium

Point of Maximum Impulse AuscultationAt _________________________Apical beat at ________________

Normal

Heart Sounds Auscultation

() Distinct( ) Regular( ) Faint( ) IrregularS1 __________ S2 at the baseS1 __________ S2 at the apexOthers: ( ) S3 ( ) S4 ( ) Murmurs best heard at ____________

Normal

XIIBREAST AND

AXILLAE TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

Size Inspection () Equal ( ) Unequal

Normal

Shape Inspection () Symmetric

( ) Asymmetric Normal

Color

Inspection () Pinkish( ) Straic( ) Blue Hue( ) Increased vein engorgement

Normal

Surface

InspectionPalpation

() Smooth( ) Retraction( ) Dimpling( ) Edema( ) Lesions( ) Tenderness( ) Masses at ____________( ) Others at _____________

Normal

XIIABDOMEN TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

General Inspection( ) Specific vein( ) Straic( ) Scars / Lesions

Normal

Configuration InspectionPalpation

() Symmetrical( ) Asymmetrical( ) Flat() Globular( ) Protuberal( ) Scaphoid

Normal

Bowel Sounds Auscultation()Normoactive( ) Hyperactive( ) Hypoactive( ) Absent

Normal

Percussion() Tymphanic( ) Hyperthmphanic( ) Fluid wave( ) Shifting dullness

Normal

Palpation() Muscle guarding( ) Direct tenderness( ) Indirect tenderness

Normal

Tenderness() Organomely( ) Liver( ) Spleen

Normal

XIIIGENITO-URINARY

(EXTERNAL GENITALIA)

TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

Male: Penis Inspection

( ) Discharge( ) Nodules / Growth or lesion( ) Tenderness

Normal

ScrotumInspection

() Equal shape with lower than __left___( ) Non Tender( ) R / L Enlargement

Normal

( ) Tenderness( ) Nodules / Growth / Lesion( ) Others( ) Hernia( ) Hdyrocelle

XIVBACK AND

EXTREMITIES TECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

Extremities: Peripheral Pulses

InspectionPalpation

() Symmetrical() Regular( ) Absent( ) Warm( ) Faint( ) Weak( ) Strong( ) Pounding

Normal

Nails and Nail Beds Inspection

() Pinkish( ) Pallor( ) Cyanosis( ) Inflammation( ) Clubbing( ) Delayed capillary refill( ) Blanching

Normal

Range of Motion Inspection

Palpation

() Full() Symmetrical( ) Decreased ROM upon __________( ) Tenderness / Pain( ) Joint swelling

Normal

Muscle Tone and strength Inspection

() Equally strong() Symmetrical in muscle size( ) R / L; Upper / Lower weakness( ) Atrophy

Normal

SpineInspection

() Midline ( ) Kyposis ( ) Lordosis ( ) Scoliosis

Normal

Others ( ) CVA TendernessNormal

Gait Inspection

() Coordinated() Smooth( ) Uncoordinated( ) Staggering( ) Shuffling( ) Stumbling

Normal

XVNEUROLOGICAL

ASSESSMENTTECHNIQUE USED ACTUAL FINDING SIGNIFICANCE

Motor Response (Adult) Inspection

() 6 Obeys command( ) 5 Localized pain( ) 4 Flexion-Withdrawal( ) 3 Flexion Abnormal( ) 2 Extension( ) 1 No response

Normal

Eyes Open Inspection

() 4 Spontaneous( ) 3 To verbal command( ) 2 To pain( ) 1 No response

Normal

Verbal Response

() 5 Oriented and Converses( ) 4 Disoriented and Converses( ) 3 Inappropriate word( ) 2 Incomprehensible sound( ) 1 No response

Normal

Motor Response (Pedia)

() 6 Normal spontaneous movement( ) 5 Withdrawal to touch( ) 4 Withdrawal to pain( ) 3 Flexion-abnormal( ) 2 Extension-abnormal( ) 1 No response

Normal

Eyes Open() 4 Spontaneous( ) 3 To verbal command( ) 2 To pain( ) 1 No response

Normal

Verbal Response

() 5 Coos Babbles( ) 4 Irritable Cry( ) 3 Cries to pain( ) 2 Moves to pain( ) 1 No response

Normal

REVIEW OF SYSTEMS

BRIEF ANATOMY AND PHYSIOLOGY of SYSTEMS and BODY MECHANISM INVOLVED IN THE CASE.

Human Kidney Anatomy

The kidneys are bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage, one on each side of the spine. The kidneys are sophisticated reprocessing machines. Every day, a person’s kidneys process about 200 quarts of blood to sift out about 2 quarts of waste products and extra water. The wastes and extra water become urine, which flows to the bladder through tubes called ureters. The bladder stores urine until releasing it through urination.

The kidneys remove wastes and water from the blood to form urine. Urine flows from the kidneys to the bladder through the ureters.

Wastes in the blood come from the normal breakdown of active tissues, such as muscles, and from food. The body uses food for energy and self-repairs. After the body has taken what it needs from food, wastes are sent to the blood. If the kidneys did not remove them, these wastes would build up in the blood and damage the body.

The actual removal of wastes occurs in tiny units inside the kidneys called nephrons. Each kidney has about a million nephrons. In the nephron, a glomerulus—which is a tiny blood vessel, or capillary—intertwines with a tiny urine-collecting tube called a tubule. The glomerulus acts as a filtering unit, or sieve, and keeps normal proteins and cells in the bloodstream, allowing extra fluid and wastes to pass through. A complicated chemical exchange takes place, as waste materials and water leave the blood and enter the urinary system.

In the nephron (left), tiny blood vessels intertwine with urine-collecting tubes. Each kidney contains about 1 million nephrons.

At first, the tubules receive a combination of waste materials and chemicals the body can still use. The kidneys measure out chemicals like sodium, phosphorus, and potassium and release them back to the blood to return to the body. In this way, the kidneys regulate the body’s level of these substances. The right balance is necessary for life.

In addition to removing wastes, the kidneys release three important hormones:

erythropoietin, or EPO, which stimulates the bone marrow to make red blood cells renin, which regulates blood pressure calcitriol, the active form of vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body

Nephron

Is the basic structural and functional unit of the kidney. Its chief function is to regulate the concentration of water and soluble substances like sodium salts by filtering the blood, reabsorbing what is needed and excreting the rest as urine. A nephron eliminates wastes from the body, regulates blood volume and blood pressure, controls levels of electrolytes and metabolites, and regulates blood pH. Its functions are vital to life and are regulated by the endocrine system by hormones such as antidiuretic hormone, aldosterone, and parathyroid hormone. In humans, a normal kidney contains 800,000 to one million nephrons. Types of nephrons Two general classes of nephrons are cortical nephrons and juxtamedullary nephrons, both of which are classified according to the location of their associated renal corpuscle. Cortical nephrons have their renal corpuscle in the superficial renal cortex, while the renal corpuscles of juxtamedullary nephrons are located near the renal medulla. The nomenclature for cortical nephrons varies, with some sources distinguishing between superficial cortical nephrons and midcortical nephrons.

The Glomerulus

The glomerulus is the main filter of the nephron and is located within the Bowman's capsule. The glomerulus resembles a twisted mass of tiny tubes through which the blood passes. The glomerulus is semipermeable, allowing water and soluble wastes to pass through and be excreted out of the Bowman's capsule as urine. The filtered blood passes out of the glomerulus into the efferent arteriole to be returned through the medullary plexus to the intralobular vein.

Bowman's Capsule

The Bowman's capsule contains the primary filtering device of the nephron, the glomerulus. Blood is transported into the Bowman's capsule from the afferent

arteriole (branching off of the interlobular artery). Within the capsule, the blood is filtered through the glomerulus and then passes out via the efferent arteriole.

Meanwhile, the filtered water and aqueous wastes are passed out of the Bowman's capsule into the proximal convoluted tubule.

PATHOPHYSIOLOGY

Acute Glumerulonephritis (patient based)

Etiologic Agent : Bacteria

Group A beta-hemolytic Streptococcus

Predisposing Factor (Non-modifiable)

Age, and Gender

Predisposing Factor (Modifiable)

Immune deficiency, Awareness and Knowledge of Mother, Nutrition of Baby

Post-infection of Etiologic Agent

Etiologic Agent travel to the kidney via the Bloodstream

Patient History:

Patient had High fever, sore throat and tonsillitis

12 days PTC.

Immune system response, sending antibody to counter act antigen

Antigen-antibody complexes deposition on the glomerular capillary wall.

Activation of biochemical mediators of inflammation; leukocytes and fibrin; neutrophils and monocytes – releases

lysosomal enzymes.

Lysosomal enzymes damages the glomerular wall

Glomerular proliferation and damage

Proliferation of extra-cellular matrix

Tension builds within the rigid medullary cavity

Decrease glomerular filtrationCapillary damage Increased vasopressor activity

Increase in aldosteroneRelease of protein and RBC to the urine Vasoconstriction

Signs and symptoms:

Proteinuria and Hematuria.

Chief Complaint:

Tea colored Urine

Losses oncotic pressure

Sodium retention

Water retention

Signs and symptoms:

Hypertension (Client’s Bp is 135/85 mmHg)

Signs and symptoms:

Edema

Diagnostic Procedure:

Urinalysis, Hematology, Blood Chemistry and ASO titer.

Hematology reveals decreased in level of hemoglobin (110 g/L), increase in both WBC count (15.6 x 109 L), and neutrophils (0.84%)

Urinalysis reveals increase in Ph is acidic (Ph 5), protein (+2), RBC (TNTC), and pus cells (TNTC).

ASO Titer is elevated (>400 IU/ML)

Blood chemistry reveals elevated BUN (14.6 mmol/L)

Diagnosis: Acute Glumerulonephritis

Disease and Treatment Definition

Glomerulonephritis, also known as glomerular nephritis, abbreviated GN, is a renal disease characterized by inflammation of the glomeruli, or small blood vessels in the kidneys.It may present with isolated hematuria and/or proteinuria (blood resp. protein in the urine); or as a nephrotic syndrome, a nephritic syndrome, acute renal failure, or chronic renal failure. They are categorised into several different pathological patterns, which are broadly grouped into non-proliferative or proliferative types. Diagnosing the pattern of GN is important because the outcome and treatment differs in different types. Primary causes are ones which are intrinsic to the kidney, whilst secondary causes are associated with certain infections (bacterial, viral or parasitic pathogens), drugs, systemic disorders (SLE, vasculitis) or diabetes.  

Treatment

 Treatment varies depending on the cause of the disorder, and the type and severity of symptoms. High blood pressure may be difficult to control, and it is generally the most important aspect of treatment.Medicines that may be prescribed include:

Blood pressure medications are often needed to control high blood pressure. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are most commonly prescribed.

Corticosteroids may relieve symptoms in some cases. Medications that suppress the immune system may also be prescribed, depending on the cause of the condition.

A procedure called plasmapheresis may be used for some cases of glomerulonephritis due to immune-related causes. The fluid part of the blood containing antibodies is removed and replaced with intravenous fluids or donated plasma (without antibodies). Removing antibodies may reduce inflammation in the kidney tissues.Dietary restrictions on salt, fluids, proteinprotein, and other substances may be recommended to Persons with this condition should be closely watched for signs that they are developing kidney failure. Dialysis or a kidney transplant may eventually be necessary.

LABORATORY AND DIAGNOSTIC PROCEDURES

LABORATORY AND DIAGNOSTIC

PROCEDURESNORMAL VALUES RESULT OR FINDINGS

SIGNIFICANCE OF THE RESULT IN RELATION TO THE DISEASE

PROCESSUrinalysis

Color

Appearance

PH

Specific gravity

Protein

Yellow

Clear

7.35 -7.45

1.002-1.030

negative-trace

Amber

Turbid

5

1.025

+2

may be caused by excessive cellular material or protein in the urine or may develop from crystallization or precipitation of salts upon standing at room temperature or in the refrigerator which is usually of no significance.

Respiratory acidosis is a medical condition in which decreased respiration (hypoventilation) causes increased blood carbon dioxide and decreased pH

Normal

If there is protein in urine, there is something wrong with the filtration process in the kidneys. Normally, proteins molecules that are too large to enter the filtrate in the nephron of the kidney. If protein were to make it into the filtrate, then the kidneys are taking too much out of the blood and that could be disasterous.

Sugar

Puss Cells

RBC

Epithelial Cells

Bacteria

Mucous thread

Crystals

A. Urates

Miscelaneous

negative

0-2/HPF

Few

Negative

Negative

Too numerous to count

Too numerous to count

Few

Moderate

Moderate

Moderate

Normal

Indicates infection

Increased RBC in urine is termed hematuria, which can be due to hemorrhage, inflammation, necrosis, trauma or neoplasia somewhere along the urinary tract

Normal

Mucus is a frequent finding of the urinary sediment. The exact function of mucus is unknown.

Its an insignificant finding. Many times amorphous urates form as a result of the refrigeration process of urine when it is being processed. It has no clinical significance

ASO titer

HEMATOLOGY

Hemoglobin

Hematocrit

WBC

Neutrophils

Eosinophils

Lymphocytes

<200 IU/ml

13.2-16.2 gm/dL (Male)

31-43% (Child)

4.1-10.9x103/µL

2.5-7.5 x 10 9 /L

0-7%

20-40

>400IU/ml

11.0

0.33

15.6

0.84

0.06

0.10

Normal

Decrease may be in indicator of dietary deficiency, hemorrhage, lymphoma, anemia or sickle cell anemia

Normal

Elevated WBC can be an indication of infection, inflammation, trauma, and stress or tissue necrosis

Neutropenic patients are more susceptible to infections and less successful in fighting them off.

Normal

A decreased lymphocyte count of less than 500 places a patient at very high risk of infection, particularly viral infections. It is important when the lymphocyte count is low to implement measures to protect the patient from infection.

ESR

RBC

Platelet count

Clinical Chemistry

BUN

0-15 mm/hr

4.3-6.2x106/µL (Male)

150,000-400,000 cumm

2.86-8.93

117

3.86

395,000 cumm

14.6

A very high ESR usually has an obvious cause, such as a marked increase in globulins that can be due to a severe infection.

Anemia is a decrease in normal number RBCs or less than the normal quantity of hemoglobin in the blood.

Normal

When the kidneys aren't functioning as well as they should urea can build up in the blood causing an elevated BUN level

DRUG STUDY

NAME OF DRUG

CLASSIFICATION DOSAGE FREQUENCY

ROUTE

INDICATION MECHANISM OF ACTION

ADVERSE REACTION NURSING RESPONSIBILITY

FUROSEMIDE

(LASIX)

Loop diuretic Decrease plasma volume and edema by causing diuresis.

Increases excretion of water by interfering

with chloride-binding cotransport system,

inhibiting sodium and chloride reabsorption in

ascending loop of Henle and distal renal

tubule.

Fluid and electrolyte imbalance. Rashes,

photosensitivity, nausea, diarrhoea, blurred vision,

dizziness, headache, hypotension. Bone marrow depression (rare), hepatic

dysfunction. Hyperglycaemia,

glycosuria, ototoxicity

Perform frequent serum electrolyte monitoring.

Monitor patients fluid intake and output

NAME OF DRUG

CLASSIFICATION DOSAGE FREQUENCY

ROUTE

INDICATION MECHANISM OF ACTION

ADVERSE REACTION NURSING RESPONSIBILITY

NIFEDIPINE Anti-hypertensive

Calcium-Channel

blocker

90 mg OD It decreases BP caused by fluid retention due to

infection of glomerulus.

It blocks the slow

calcium channels

thus preventing the

flow of calcium ions

into the cell. It

produces peripheral

and coronary

vasodilatation,

peripheral

resistance and BP,

increases coronary

blood flow and

causes reflex

tachycardia.

Peripheral edema, hypotension,

palpitations, tachycardia, flushing,

dizziness, headache, nausea,

increased micturition frequency,

mental depression, visual

disturbances, tremor, impotence,

fever, paradoxical increase in

ischaemic chest pain during

initiation of treatment

WOF hypotension and bradycardia.

NAME OF DRUG

CLASSIFICATION DOSAGE FREQUENCY

ROUTE

INDICATION MECHANISM OF ACTION

ADVERSE REACTION NURSING RESPONSIBILITY

PENICILLIN V Antibiotic 50 mg TID IV Used to control local symptoms and to prevent spread of infection to close contacts.

Penicillin V works by binding to specific penicillin-binding proteins in bacterial cell walls and blocking the final cross-linking step in the synthesis of bacterial cell walls. This induces autolysis of the bactertial cells by autolysins.

Nausea, vomiting, epigastric distress, diarrhea, and black hairy tongue.

The hypersensitivity reactions reported are skin eruptions (maculopapular to exfoliative dermatitis), urticaria and other serum sicknesslike reactions, laryngeal edema, and anaphylaxis.

Fever and eosinophilia may frequently be the only reaction

observed.

NURSING CARE PLAN

Problem and Cues Nursing Diagnosis Planning Intervention Rationale Evaluation

Final Evaluation of the Client

Evaluation of learning Experience