An g e le s Univ er sit y F oundat ion

C olle ge Of N ur s ing

CASE STUDY:
ACUTE GLOMERULONEPHRITIS

Subm itte d b y:
Ari e z, Ave l a i ne
Ma l i g , Ro ma ni ca
Sa n gg a la n g , Ca rla Rh u vi e Ja n e
Su a re z, R ei ze l D a wn
BSN III 1 8
GR OU P 7 2

Subm itte d to:

Ms. Me l i ssa An n S. Pon ce , RN

Au g u st 0 4 , 2 0 07
I. INTRODUCTION

The kidneys are organs that filter wastes (such as urea) from the blood
and excrete them, along with water, as urine. The medical field that studies the
kidneys and diseases of the kidney is called nephrology. The prefix nephro-
meaning kidney is from the Ancient Greek word nephros; the adjective renal
meaning related to the kidney is from Latin rns, meaning kidneys.
(http://en.wikipedia.org/wiki/Kidneys)

Glomerulonephritis, also known as glomerular nephritis and abbreviated

GN', is a primary or secondary immune-mediated 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 one 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 cancers.
(http;//en.wikipedia.org/wiki/Glomerulonephritis)

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. (http://www.nephrologychannel.com/agn/)
 The researchers chose Acute Glumerulonephritis as a case study because
it is now one of the most common diseases occurring in children ages 2yrs. old
and above. The researchers believe that being aware and understanding the
disease condition would be very beneficial to the researchers because this would
help them gain courage and be able to deal with the disease. Being
knowledgeable with the disease may help and lead the researchers to act more
responsibly and confidently when they encounter such disease condition
because they know and have an idea of the possible cause and management
and treatment of the disease.
II. NURSING ASSESSMENT

1. PERSONAL DATA:

Active Boy is a 4 year old child who resides at Marisol, Angeles City. He is
the 2nd child among three children of Mr. Active and Mrs. Active. Their family is
affiliated with Iglesia Ni Cristo. Active Boy is a Filipino Citizen and was born on
February 09, 2003 at Ospital Ning Angeles (ONA), Angeles City. He was
admitted in a secondary level government hospital situated at Pampanga on July
20, 2007 at exactly 4pm in the afternoon with an admitting diagnosis of Acute
Glomerulonephritis (AGN).

2. PERTINENT FAMILY HISTORY:

The group asked Mrs. Active if there is another family member or relative
who had or has AGN besides to active boy. Mrs. Active replied, ala man
megkasakit a makanyan kareng pamilya mi, kareng atlu kung anak, yamu ing
me-ospital a makanyan. The group asked again Mrs. Active if there is a common
disease in their family. Mrs. Active replied, king side mi sakit na ing mitatas a
prisyun, kaybat king side na ning asawa ku naman i tatang mika sakit ya na
albuminuria.
 PATERNAL MATERNAL
Active Activ Active Activ
Lolo 1 e Lolo 2 (+) e
Deceased Lola Deceased Lola
1 2
Deceased

Mr. Active Mrs. Active

Active
Active Ate Activ Bunso
e Boy
(AGN)

Figure II-a. Genogram of Active Family

Active Boy belongs to a nuclear type of family composed of father, mother
and his two siblings. Mrs. Active delivered her 3 children in spontaneous normal
delivery at Ospital Ning Angeles (ONA). The eldest among their children is Active
Ate born on June 27, 1997, followed by Active boy on February 09, 2003 and the
youngest is Active Bunso born on August 21, 2004. They rent their house free,
which is a semi-concrete type of housing, consisting of 2 bedrooms and 1
bathroom. Mr. Active works as a tricycle driver in Marisol and earns
approximately P200/day while Mrs. Active is a plain housewife. According to Mrs.
Active, the income of her husband is not sufficient for their everyday needs.
 The family believes in hilot when one of the members of their family
suffers from pain but when it becomes severe, they seek consultation to the
doctors and midwives.

3. PERSONAL HISTORY
a. Pre-natal (Practices/Habits during pregnancy):
Mrs. Active followed the standard check ups for a pregnant
woman wherein in her 6 months of pregnancy, she comes every 4
weeks or monthly check ups in the health center. While in her 7 to 8
months of pregnancy, she comes every 2 weeks or every other
week in the health center and in her 9 th month of pregnancy, she
comes to the health center once a week.

b. Birth:
Active Boy was born on February 09, 2003 at Ospital Ning
Angeles in a spontaneous normal delivery with a 39 wks age of
gestation by Mrs. Active.

c. Feeding:
According to Mrs. Active, Active boy was a bottle-fed baby
for 2 years because he doesnt want to suck the nipple of Mrs.
Active.

d. Growth and Development:

JEAN PIAGET

PREOPERATIONAL STAGE (from about two to seven years

old)

The 2nd stage of Piagets Cognitive Stage, wherein during this stage the
child learns to use symbols, such as words or mental images, to think about
things that are not present and to help them solve simple problems. Wherein the
children can talk things that are not physically present, he can represent things
by drawing and can pretend, for example he can pretend to block as a car where
although he uses and manipulates symbols in speech and play. And also in this
stage there is two limitations which is the Conservation and Egocentric Thinking
wherein the Conservation is the fact that the amount of substance remains the
same even though its shapes changes wherein there is tall thin glass of milk
holds the same amount of milk as a short and wide glass.

It is also the same thing that Boy Active tends to have an imagination that
he is Superman and he is gonna save the world while holding and playing his
Superman toy and also in this same stage he elicited the Egocentric Thinking
wherein when his mother is talking to somebody he make a way just to get her
mothers attention like calling her then when he already get her mothers
attention he tends not to say anything to her.

SIGMUND FREUD

PHALLIC STAGE (Early Childhood 3 6 years)

In this stage this last from about age three to six and is time when the
infants pleasure seeking is centered on the genitals and during this stage the
child will compete with the parent of the same sex (his father or mother) for the
affection and pleasure of the parent of the opposite sex (his mother or father).
Problems in resolving in this competition may result in feelings of inferiority for
men and of having something to prove for women.

In this stage though that he is not fond playing his genitals on the time that
we are in the duty hours, he elicited the affection and pleasure for her mother like
whenever her mother was not around because he has to buy something at the
outside of the ward he started to look for her and sometimes he cry whenever he
didnt see her mother.

ERIK ERIKSON

INITIATIVE vs GUILT (Early childhood 3 5 years)

In this stage the child has developed a number of cognitive and social
skills he is expected to use to meet challenges in his small world. And some
these challenges involve assuming responsibilty and making plan and initiate
new things. However, if they discourage initiative , he may feel uncomfortable or
guilty and may develop a feeling of being unable to plan his future.

On this stage of Initiative vs. Guilt he elicit this stage thru means of
drinking the medication pills on his own as said by his mother because we saw
her mother buying a pills for his hypertension then when his got back into the
ward we saw the med into a capsule form wherein her mother said that hindi
siya mahirap painumin ng gamot lalo pag ganito matapang nga siya pag ganito
yung iinumin niya.

LAWRENCE KOHLBERG

PRECONVENTIONAL LEVEL (LEVEL I)

The pre-conventional level of moral reasoning is especially common in

children, although adults can also exhibit this level of reasoning. Reasoners in
the pre-conventional level judge the morality of an action by its direct
consequences. The pre-conventional level consists of the first and second stages
of moral development, and are purely concerned with the self in an egocentric
manner.
 In Stage one, individuals focus on the direct consequences that their
actions will have for themselves. For example, an action is perceived as morally
wrong if the person who commits it gets punished. The worse the punishment for
the act is, the more 'bad' the act is perceived to be. In addition, there is no
recognition that others' points of view are any different from one's own view. This
stage may be viewed as a kind of authoritarianism.

Stage two espouses the what's in it for me position, right behavior being defined
by what is in one's own best interest. Stage two reasoning shows a limited
interest in the needs of others, but only to a point where it might further one's
own interests, such as you scratch my back, and I'll scratch yours. In stage two
concern for others is not based on loyalty or intrinsic respect. Lacking a
perspective of society in the pre-conventional level, this should not be confused
with social contract (stage five), as all actions are performed to serve one's own
needs or interests. For the stage two theorist, the perspective of the world is
often seen as morally relative.

On the Stage one of Preconventional level which is the Punishment

Obedient Orientation wherein he elicited that when her mother will going to give
him a food and told him to behave he tend to do so but it also happen that when
he experience nose bleed her mother told him that he was so hyperactive tend
her mother shouted at him and all he could to is crying out loud.

While on the Second Stage of Preconventional Level which is the

Personal Reward Orientation wherein he told his mother that when he is already
recovered from his illness he wants a new clothes then her mother answered him
back that oo ibibili kita, kaya magpagaling ka na"
 e. Immunization Status:
Active Boy had his immunization complete based on the Expanded
Immunization Program (EPI) of DOH. He received 1 dose of BCG, 3
doses of DPT, 3 doses of OPV, 3 doses of HEPA B and 1 dose of Measles
vaccine.

4. HISTORY OF PAST ILLNESS:

According to Mrs. Active, this is the 2 nd time of hospitalization of active boy.

First when he was one year old, he was diagnosed of blood infection and
admitted to Ospital ning Angeles (ONA). The group asked Mrs. Active if she can
remember what drug was given to Active Boy to kill the microorganisms which
caused his infection.

5. HISTORY OF PRESENT ILLNESS:

According to the mother, she decided to bring Active Boy to the hospital
specifically, Ospital ning Angeles because Active Boy is having an edematous
face. He was admitted to ONA Last July 20, 2007. Upon admission, Active boy
was subjected to have Urinalysis. The doctor also asked the patient to undergo
hematology too at the same day. Active Boy also had fever and hypertension.
This is the reason why the doctor ordered to monitor his blood pressure. The
result of his diagnostic procedure is that he is positive of albuminuria. He was
also diagnosed of having Acute Glumerulonephritis. Active boy has a cola
colored urine containing large amount of protein and increased values of BUN
and serum creatinine.
6. PHYSICAL EXAMINATION:

July 20, 2007 (Upon Admission)

Vital Signs
T= 36.5
PR= 100bpm
RR= 30bpm
BP= 110/90 mmHg.

Head:
with facial edema
no lump
no mass
no lesion or scar noted
Hair:
semi bald
thin, straight, black in color
evenly distributed
with no dandruff or lice noted

Eyes:
anicteric sclera
pale palpebral conjunctiva
positive periorbital conjunctiva
pupils equally round and reactive to light accommodation
(PERRLA)

Ears:
no mass
no lump
 symmetrical and properly aligned with the eyes
no ear discharge noted
no lesion noted
Nose:
no lesions noted
no nasal discharge noted
with nasal flaring
Mouth:
pale circum oral pallor
with pinkish gums
dry lips
with dental caries noted
Tongue:
pink in color with some white coating noted
Skin:
dark complexion with good skin turgor
no lesion or rashes noted
Neck:
no lesion
no tenderness noted
with palpable carotid pulse
Chest:
with symmetrical chest expansion
Abdomen:
abdomen distended
Upper Extremities:
no lesion or scars noted
with long dirty fingernails
Lower Extremities;
no lesions or scars noted
 with long dirty toenails

July 26, 2007 (THRUSDAY)

Vital Signs:
T= 38.4
PR= 94bpm
RR= 20bpm
BP= 120/100 mmHg.

Head:
no lump
no mass
no lesion or scar noted
Hair:
semi bald
thin, straight, black in color
evenly distributed
with no dandruff or lice noted
Eyes:
anicteric sclerae
pale palpebral conjunctiva
positive periorbital conjunctiva
pupils equally round and reactive to light accommodation
(PERRLA)
Ears:
no mass
no lump
symmetrical and properly aligned with the eyes
no ear discharge noted
no lesion noted
 Nose:
no lesions noted
no nasal discharge noted
with nasal flaring
Mouth:
pale circum oral pallor
with pinkish gums
dry lips
with dental caries noted
Tongue:
pink in color with some white coating noted
Skin:
dark complexion with good skin turgor
no lesion or rashes noted
Neck:
no lesion
no tenderness noted
with palpable carotid pulse
Chest:
with symmetrical chest expansion
Abdomen:
abdomen distended
Upper Extremities:
no lesion or scars noted
with long dirty fingernails
Lower Extremities;
no lesions or scars noted
 with long dirty toenails

July 27, 2007 (FRIDAY)

Vital Signs:
T= 37.6
PR= 71bpm
RR= 34bpm
BP= 110/80 mmHg.

Head:
no lump
no mass
no lesion or scar noted
Hair:
semi bald
thin, straight, black in color
evenly distributed
with no dandruff or lice noted

Eyes:
anicteric sclerae
pale palpebral conjunctiva
positive periorbital conjunctiva
pupils equally round and reactive to light accommodation
(PERRLA)
Ears:
no mass
no lump
 symmetrical and properly aligned with the eyes
no ear discharge noted
no lesion noted
Nose:
no lesions noted
no nasal discharge noted
with nasal flaring
Mouth:
pale circum oral pallor
with pinkish gums
dry lips
with dental caries noted
Tongue:
pink in color with some white coating noted
Skin:
dark complexion with good skin turgor
no lesion or rashes noted
Neck:
no lesion
no tenderness noted
with palpable carotid pulse
Chest:
with symmetrical chest expansion
Abdomen:
abdomen distended
Upper Extremities:
no lesion or scars noted
with long dirty fingernails
Lower Extremities;
no lesions or scars noted
with long dirty toenails
III. ANATOMY AND PHYSIOLOGY:

Renal System
The kidneys are essentially regulatory organs which maintain the volume
and composition of body fluid by filtration of the blood and selective reabsorption
or secretion of filtered solutes.

The kidneys are retroperitoneal organs (ie located behind the peritoneum)
situated on the posterior wall of the abdomen on each side of the vertebral
column, at about the level of the twelfth rib. The left kidney is lightly higher in the
abdomen than the right, due to the presence of the liver pushing the right kidney
down.

The kidneys take their blood supply directly from the aorta via the renal
arteries; blood is returned to the inferior vena cava via the renal veins. Urine (the
filtered product containing waste materials and water) excreted from the kidneys
passes down the fibromuscular ureters and collects in the bladder. The bladder
muscle (the detrusor muscle) is capable of distending to accept urine without
increasing the pressure inside; this means that large volumes can be collected
(700-1000ml) without high-pressure damage to the renal system occuring.
When urine is passed, the urethral sphincter at the base of the bladder relaxes,
the detrusor contracts, and urine is voided via the urethra.

Structure of the kidney:

On sectioning, the kidney has a pale outer region- the cortex- and a darker inner
region- the medulla.The medulla is divided into 8-18 conical regions, called the
renal pyramids; the base of each pyramid starts at the corticomedullary border,
and the apex ends in the renal papilla which merges to form the renal pelvis and
then on to form the ureter. In humans, the renal pelvis is divided into two or three
spaces -the major calyces- which in turn divide into further minor calyces. The
walls of the calyces, pelvis and ureters are lined with smooth muscle that can
contract to force urine towards the bladder by peristalisis.

The cortex and the medulla are made up of nephrons; these are the functional
units of the kidney, and each kidney contains about 1.3 million of them.
The nephron is the unit of the kidney responsible for ultrafiltration of the blood
and reabsorption or excretion of products in the subsequent filtrate. Each
nephron is made up of:.

A filtering unit- the glomerulus. 125ml/min of filtrate is formed by the

kidneys as blood is filtered through this sieve-like structure. This filtration
is uncontrolled.

Glomerulus - As blood passes through the glomerulus from the afferent

arteriole, the plasma is filtered through a very fine physical mesh created
by podocyte cells. This filtration process is entirely pressure- and
osmotically- driven, with no active transport involved at this stage.
 The proximal convoluted tubule. Controlled absorption of glucose, sodium,
and other solutes goes on in this region.

Proximal Convulated Tubule The proximal tubule carries out much of the
active reabsorption of solutes present in the filtrate. The lumen of the
tubule has many microvilli which dramatically increase the area available
for membrane transfer. The cells are also packed with mitochondria
supplying energy for the active transport processes; it has been calculated
that about 50% of the kidney's energy needs go on the active transport of
sodium back out of the filtrate in the proximal tubule.

The loop of Henle. This region is responsible for concentration and dilution
of urine by utilising a counter-current multiplying mechanism- basically, it is
water-impermeable but can pump sodium out, which in turn affects the
osmolarity of the surrounding tissues and will affect the subsequent
movement of water in or out of the water-permeable collecting duct.
 Loop of Henle The loop of Henle has a flat thin lining epithelium with little
specialization of the cytoplasm. It acts to create an osmotic gradient in the
surrounding tissues, allowing concentration of the urine as it passes
through the medulla.

The distal convoluted tubule. This region is responsible, along with the
collecting duct that it joins, for absorbing water back into the body- simple
maths will tell you that the kidney doesn't produce 125ml of urine every
minute. 99% of the water is normally reabsorbed, leaving highly
concentrated urine to flow into the collecting duct and then into the renal
pelvis.

Distal Convulated Tubule Many distal convoluted tubules join to a central

collecting duct; these, in turn, merge together until they emerge at the
renal papilla and the highly concentrated urine is released into the
calyces.
 PATHOPHYSIOLOGY OF AGN:

Antigen (Group A beta hemolytic streptococcus)

Antigen Antibody product

Deposition of antigen antibody complex glomerulus

Increased productionof epithelial cells lining the glomerulus

Leukocyte infiltration of the glomerulus

Thickening of the glomerular filtration membrane

Scarring and loss of glomerular filtration

membrane

Decreased glomerular filtration rate

(GFR)
 Primary glomerulonephritis and primary glomerular disease are disorders
in which the glomerulus is the predominant or sole tissue involved (Mulzahn &
Butera, 2006). Examples of primary disease are postinfectious
glomerulonephritis, rapidly progressive glomerulonephritis, membrane
proliferative glomerulonephritis and membranous glomerulonephritis.
Postinfectious causes are group A betahemolytic streptococcal infection of the
throat that precedes the onset of glomerulonephritis by 2 to 3 weeks (refer to the
figure above). It may also follow impetigo (infection of the skin)and acute viral
infections (upper respiratory tract infections, mumps, varicella zoster virus,
Epstein Bar virus, hepatitis B and human immunodeficiency virusor HIV
infection ). In some patients, antigens outside the body (eg. Medications, foreign
serum) initiate the process, resulting in antigen antibody complexes being
deposited in the glomeruli. In other patients, the kidney tissue itself serves as
inciting antigen.

CLINICAL MANIFESTATIONS

The primary presenting features of acute glomerulonephritis are

hematuria, edema, azotemia (concentration of urea and other nitrogenous
wastes in the blood). And proteinuria (<3.0 g of proteinuria per day). (Hricik, Miller
and Sedor, 2003). The hematuria maybe microscopic (identifiable only through
microscopic examination) or macroscopic (visible to the eye). The urine may
appear cola colored because of the red blood cells (RBCs) and protien plugs
or casts; RBC casts indicate glomerular injury. Glomerulonephritis may be mild
and the hematuria discovered incidentally through a routine microscopic
urinalysis or the disease maybe severe, with acute renal failure (ARF) and
oliguria.
 Some degree of edema and hypertension is present in most patients.
Marked proteinuria due to the increased permeability of the glomerular
membrane may be also occur, with associated pitting edema,
hypoalbuminuria,hyperlipidemia and fatty casts in the urine. Blood Urea Nitrogen
(BUN) and serum creatinine levels may increase as urine output decreases. In
addtion, anemia maybe present.

In the more severe form of the disease, patients also complain of

headache, malaise and flank pain. Elderly patients may experience circulatory
overload or dyspnea, engorged neck vein, cardiomegaly and pulmonary edema.
Atypical symptoms include confusion,somnolence and seizures which are often
confused with the symptoms of the primary neurologic disorder.

COMPLICATIONS:

Complications of acute glomerulonephritis include hypertensive

encephalopathy, heat failure, and pulmonary edema. Hypertensive
encephalopathy is a medical emergency and theraphy is directing toward
reducing the blood pressure without impairing the renal functions. This can occur
in acute glomerulonephritis or preeclampsia with chronic hypertension of greater
than 140/90 mmHg (Brady and Wilcox, 2003). Rapidly progressive
glomerulonephritis is characterized by a rapid decline in renal function. Without
treatment end stage renal failure (ESRD) develops in a matter of weeks or
months. Signs and symptoms are similar to those of acute glomerulonephritis
(hematuria and protienuria), but the course of the disease is more severe and
rapid. Cresent shaped cells accumulate in Bowmans space, disrupting the
filtering surface. Plasma exchange (plasmapheresis) and treatment with high
dose corticosteroids and cytotoxic agents have been used to reduce the
inflammatory response. Dialysis is initiated in acute glomerulonephritis if signs
and symptoms of uremia is severe. The prognosis for patients with acute
glomerulonephritis is favorable and approximately 60% recover completely.
IV. THE PATIENTS ILLNESS:
SYNTHESIS OF THE DISEASE:

1. Definition of the disease

Patients with acute nephritis often have a history of a streptococcal

infection such as strep throat a few weeks before the onset of nephritis. The
disease is characterized by fatigue, appetite loss, facial puffiness, abdominal
or flank pain, and scanty, smoky, dark urine.
Glomerulonephritis, another common kidney disease, is characterized by
inflammation of some of the kidney's glomeruli. This condition may occur
when the bodys immune system is impaired. Antibodies and other
substances form large particles in the bloodstream that become trapped in
the glomeruli. This causes inflammation and prevents the glomeruli from
working properly. Symptoms may include blood in the urine, swelling of body
tissues, and the presence of protein in the urine, as determined by laboratory
tests. Glomerulonephritis often clears up without treatment. When treatment
is necessary, it may include a special diet, immunosuppressant drugs, or
plasmapheresis, a procedure that removes the portion of the blood that
contains antibodies.

2. Predisposing / Precipitating Factors

3. Signs and Symptoms

Symptoms may include:

blood in the urine
swelling of body tissues
 the presence of protein in the urine
Onset of edema reported in approximately 85% of pediatric
patients; mild-to-severe symptoms, from involving only the face to
bordering on a nephrotic appearance
Possible headache occurring secondary to hypertension
Pharyngitis
Respiratory infection
Scarlet fever
Weight gain
Abdominal pain
Anorexia
Back pain
Pallor
Impetigo

4. Health Promotion and Preventing Aspects of the Disease

Early penicillin therapy does not prevent development of acute poststreptococcal

glomerulonephritis. While antibiotic therapy should be administered to abolish the
streptococcal infection, no evidence indicates that such therapy influences the
course of glomerulonephritis. Some clinicians have justified penicillin prophylaxis
in populations at risk during epidemics and in siblings of index cases; however,
epidemiologic evidence does not favor such use.
2. Actual SOAPIERs

July 21, 2007

S=
O= Received pt. in sitting position, awake, conscious and coherent with IV out,
with moderate facial edema; with vital signs recorded as follows: T= 37.1; PR=
82bpm; RR= 28bpm; BP= 110/90 mmHg.

A= Fluid volume excess r/t failure of regulatory mechanism AEB facial edema.
P= After 4 of nsg. intervention, SO will verbalize understanding health teaching
on contributing factors.

I=
Established rapport
Monitored vital signs
Recorded urine output and fluid intake
Provided health teachings to SO about the appropriate diet for the patient.
Explained to the SO the importance of decrease intake of salty foods and
fluid restriction.
Facilitated Tepid Sponge Bath (TSV) and instructed SO of TSB.
Provided well ventilated environment
Provided comfort measures
Kept back dry

E= Goal met AEB SO can verbalize understanding fluid restriction and decrease
intake of salty foods.
July 26, 2007

S=
O= Received pt. in lying on supine position, awake, conscious and coherent
with on going IVF # 4 D5. 0.3 NaCl 500 mL x KVO, infusing well in right hand @
450 cc; with vital signs recorded as follows: T= 38.4; PR= 94bpm; RR= 20bpm;
BP= 120/100 mmHg.

A= Hyperthermia r/t inflammatory process.

P= After 4 of nsg. intervention, patients temperature will be decrease from
38.4C to 73C.

I=
Established rapport
Monitored vital signs especially temperature
Monitored urine output and fluid intake
Provided health teachings to SO about the appropriate diet for the patient.
Explained to the SO the importance of decrease intake of salty foods and
fuild restriction.
IVF dislodge and removed

E= Goal met AEB patients temperature decreased from 38.4C to 37C.

2. DISCHARGE PLANNING

a. General Condition of Client upon Discharge:

After 10 day of being confined in the hospital diagnosed of having acute

glomerulo nephritis (AGN). The patient is walking quietly with head flexed down
upon discharged and was reminded by the doctor about his diet the student
nurse romanica approached the patient and reminded him about not to make
tiring activities such as running and biking. The patients blood pressure was
stable 2 days before discharged still blood pressure is the problem of the patient
and if diet and activities of the patient is not controlled the patient might be
confined due to hypertension.

b. METHOD:

M - Instructed patient to take the following medications prescribed by Dra.

Pantig:
sangobion syrup - 1 tspn once a day
sumapen syrup 2 tspns 3x a day
Lasix 40 grms tablet - 1 tab 2xday
E - Encouraged the patient to ambulate.
T - Instructed patient to take the medications given by the doctor.
H Instructed patient to do proper hand washing to prevent having certain
diseases.
O Instructed patient for follow up check-up to Dra. Limjoco on July 30,
2007 at 12:00 pm to 2:00 pm at Garcia Medical Center.
D Instructed patient to have his diet in low salt, low fat and
VII. CONCLUSION AND RECOMMENDATION

Glomerulonephritis, also known as glomerular nephritis and

abbreviated GN', is a primary or secondary immune-mediated 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 one which
are intrinsic to the kidney, whilst secondary causes are associated with certain
infections such as bacterial or parasitic pathogens, drugs, systemic disorders or
cancers.

Many people with glomerulonephritis have no symptoms. When symptoms occur,

they are often flu-like, such as general fatigue, nausea, vomiting, loss of appetite,
fever, and abdominal and joint pain. These types of general symptoms can
continue for up to one month before symptoms of kidney failure appear. Patients
whose kidneys are failing will produce only small amounts of urine and have
swelling (edema) from fluid build-up. Symptoms of acute glomerulonephritis
usually occur around two to three weeks after a streptococcal infection and begin
with swelling. They can progress to high blood pressure, visual disturbances,
shortness of breath, blood in the urine, and a reduction in urine production.
Chronic glomerulonephritis develops so gradually that it is often not discovered
until a routine physical exam. As this condition progresses, it causes high blood
pressure, swelling, and other symptoms of kidney failure.
Through this case study, the group should be able to learn and understand the
disease Glomerulonephritis and therefore give us knowledge in proper
management, prevention and treatment of the said disease condition. As a
student nurse, it is very important to know many things or information including
the said disease condition. After the hardships of completing this case study, a
reward of self-fulfillment and credential to our knowledge and skills has been
added to us being student nurses as well as professionals in the near future.