cccccccccc

cccccccccccLiceo de Cagayan University

College of Nursingc
c

c
c

c
c c
c
c c
 ×
 

c
c Introduction
a.cJ
r i
 of th
Cas

b.cJbj
cti
of th
Study
c.cScop
and Limitation of th
Study

 c Ô
alth Ôistory
a.cërofil
of pati
nt
b.cë
rsonal Ô
alth Ôistory
c.cÔistory of ër
s
nt Illn
ss
d.cChi
f Complaint

 c 

lopm
ntal ata


c M
dical Manag
m
nt
a.cM
dical Jrd
rs and rational

b.crug study

c ëathophysiology ith Anatomy and ëhysiology

 c Nursing Ass
ssm
nt (Syst
m R
i
 & Nursing

Ass
ssm
nt II)

 c Nursing Manag
m
nt

a.cId
al Nursing Manag
m
nt (NCë)
b.cActual Nursing Manag
m
nt (SJAëIE)

 c R
f
rrals & Folloup

 c E aluation and Implications

c Bibliography
cc
c
c
c
c
c
c
c
c

c  c

c

cccc
c

c Acute Glomerulonephritis is the disease of the kidney in which there is an

inflammation of the glomerular capillaries. In most cases, the stimulus of the reaction is

group A streptococcal infection, which ordinarily precedes the onset of

glomerulonephritis by 2 to 3 weeks.


c
cccc

c c c

The study generally aims to investigate the condition of an adult man and further

understand the extent of the case.

Specifically, the health care provider sought to;

„c ëerform ëhysical Assessment,

„c ata Base and History taking that solidifies the present diagnosis of the client.

„c Identify the development and changes encountered by the client.

„c Identify the nursing problems which will be the basis of the care plan.
 „c evelop ëlan of the Care and Implement nursing interventions relevant and

suitable for the case.

As nursing students they will be able to improve their skills in accordance to patient¶s

needs and condition.

The purpose of the study is to gather significant data to broaden our knowledge with

regards to the condition of the patient and to improve our abilities as future health care

providers. Moreover, this case study will enable us to apply the acquired skills we

obtained in the classroom set-up.


ccc  cccc

c c c

c The study focuses only on one of the many problems of the kidney, mainly the

glomerulonephritis and its causes and effects on patients that are being diagnosed to it.

Also, the study tackles on how this problem is being acquired.

c

c!" !c! #
c

c$ %c& $c
Name : Lisdan, Elpedio N.
Wife : Lisdan, Jemma
Address : San Rafael, Talakag, Bukinon province
Civil Status : Married
Sex : Male
Age : 42 years oldc
Religion : Roman Catholic
Educational Status : Elementary level
Income : 2,000 php/month
Nationality : Filipino
ate of Admission : January 27, 2009
Time of Admission : 9:10 am
Informant : ëatient
Height : 158 centimetres
Weight : 52 kg
 $c 'c 'c  c
Temperature : 36.7 °C
ëulse Rate : 55 bpm
Respiratory rate : 20 cpm
Blood ëressure : 150/110 mmHg

Admitting iagnosis : Acute Glomerulonephritis related to nephritic

syndrome; hypertension

Attending ëhysician : r. Joseph Borong


c( $cc&$c!$c

& %c! c

c
$$' )c
*cNo known allergies on foods and drugs.c
c
 +c  c cc)c
*cëatient had not experience injuries or accident in the past.c
c
$c )c
- ëatient didn¶t receive blood in the past.c
c
( $c$c )c
- Experienced Hypertension and Kidney disorder (2006)

c
c
 $c! c
c
$$c)c
*cëatient occasionally drinks alcoholic beverages, as seldom as once in 2 months.
c
c)c
*cëatient often smokes.
c
! cc"
 )c
- Resides at San Rafael, Talakag
- Living status is just enough for their family needs

c
c
c

c c $ cc! cc&c $$c
c
c Noted to have edema; condition noted for a week ± prior to admission as onset of

fever on and off associated with dysuria ± tea colored urine.

c""&," c 
c
„c c
$ $c'cc" -c" -c

, $c $)c./cc0/)cc

Generativity vs. Self absorption or Stagnation

Now work is most crucial. Erickson observed that middle-age is when we tend to

be occupied with creative and meaningful work and with issues surrounding our family.

Also, middle adulthood is when we can expect to "be in charge," the role we've longer

envied. The significant task is to perpetuate culture and transmit values of the culture

through the family (taming the kids) and working to establish a stable environment.

Strength comes through care of others and production of something that contributes to the

betterment of society, which Erikson calls generativity, so when we're in this stage we

often fear inactivity and meaninglessness.

„c (1c&2$c'cc

$ c
c3 $c'cc

In the genital stage, as the child's energy once again focuses on his genitals,

interest turns to heterosexual relationships. The less energy the child has left invested in

unresolved psychosexual developments, the greater his capacity will be to develop

normal relationships with the opposite sex. If, however, he remains fixated, particularly

on the phalliccstage, his development will be troubled as he struggles with further

repression and defenses.

„c c!
'c
$ $c-ccc

, $c $c4.5*05c6c c

Achieving adult social and civic responsibility; Reaching and maintaining

satisfactory performance in one¶s occupational career; eveloping adult leisure time

activities; Relating oneself to one¶s spouse as a person; To accept and adjust to the

physiological changes of middle age; Adjusting to aging parents. Assisting teenage

children to become responsible and happy adults; achieving adult social and civic

responsibility.

„c & '1ccc' 

c
$ c

( $c $c' (Adolescence and adulthood)

 In this stage, intelligence is demonstrated through the logical use of symbols

related to abstract concepts. Early in the period there is a return to egocentric thought.

Many people do not think formally during adulthood.


c,"  c,  3","c

c

c, $ccc $c
c
c
Doctor¶scrderc tionec
c
57+89+5:c

mc ëlease admit „c To monitor patient¶s medical

condition and proper management.

mc TëR q 4h „c To monitor any abnormal changes

in vital signs

mc Full low salt, low fat diet „c For proper nourishment and for
prevention of disease that may lead
to severity of the condition

mc Give 1 egg white a day „c To promote good nutritional status

mc 0.9 NaCl @ KVO rate
mc Furosemide i amp q 12h x 3doses
„c To monitor body fluids & prevent
dehydration
„c For treatment of hypertension,
edema associated with CHF,
cirrhosis and renal disease

„c For treatment of lower respiratory

 mc Cefuroxime 750 mg q 8h IVTT infection, UTI & dermatologic
infection

„c First line treatment for heartburn

mc Omeprazole 20mg icap O ë.O. and short term treatment of active
duodenal ulcer

mc Captopril 25mg itab BI ë.O. „c Treatment for pulmonary

tuberculosis that is not responsible
to 1st line antituberculosis

„c For proper hydration of the patient

mc I & O q shift and carefully monitor the fluid
losses

57+8;+5:c
c
mc IVF 0.9 NaCl @ KVO rate „c To monitor body fluids & prevent
dehydration

mc Spironolactone 50mg itab TI ë.O. „c To counteract potassium loss

mc Continue meds.
mc Weight patient daily pre-breakfast
caused by other diuretics
„c To treat the disease & remove the
symptoms
„c To monitor if the symptoms are
relieved

57+8:+5:c
c
mc Continue meds.
„c To treat the disease & remove the
symptoms
mc IVF of /nm iL @ KVO rate
„c To monitor fluids

c
c
c
c
c
c
c
c
c
c
c
c
c
c
c
c
c

c'cc
3 c c $ * +c ,  cc   c *  c  'c
 cc c   c (<+c  c   c   c "+c & c
c c 2 c
'c "c

Cefuroxime 01/27/09 Antibiotic 750 mg q 8h Inhibits For lower Contra Hypersen- Assess for
(Cephalos IVTT synthesis of respiratory indicated with sitivity, hepatic or
porin ± 2nd bacterial cell infection, allergy to nephrotoxi renal
generation) wall, causing UTI & cephalosporin city, pain impairment
cell death. derma or penicillins at injection
tologic site Assess for
infection skin status

Check for
sensitivity
tests

c
 3 c c $ * +c ,  cc   c *  c  'c
 cc c   c (<+c  c   c   c "+c & c
c c 2 c
'c "c
c
Furosemide 01/27/09 Loop Amp of 12h Inhibits Hyperten- Contraindicates ëolyuna, Assess for
iuretic x 3 doses reabsoption of sion, allergy to Nocturia, allergy to
Na and Cl from Edema furosemide; Rash, furosemide
the proximal and associated anuria, hepatic Anemia,
distal tubules with CHF, coma Muscle Assess for
and ascending cirrhosis spasms, skin color,
limb of the loop and renal Cardiac lesions and
of Henle, disease arrythmias edema
leading to a Na- CBC,
reach diuresis serium
electrolytes

c
c
c
c
 3 c c $ * +c ,  cc   c *  c  'c
 cc c   c (<+c  c   c   c "+c & c
c c 2 c
'c "c
c
Omeprazole 01/27/09 Antisecre 20mg icap Gastric acid First line Contra- Rash, Assess for
tory drug; O ë.O. pump inhibitor: treatment indicated with alopecia, hypersensit
ëroton Supresses for hyper- nausea, ivity to
ëump gastric acid heartburn sensitivity to vomiting omeprazole
Inhibitor secretion by and short omeprazole or Epistasis,
specific term its component. fever Assess for
inhibition of treatment Use cautiously skin lesions
hydrogen- K of active pregnancy Assess for
ATëase duodenal lactation urinary
enzymes system ulcer output
at secretory
surface of the
gastric parietal
cells.
c
3 c c $ * +c ,  cc   c *  c  'c
 cc c   c (<+c  c   c   c "+c & c
c c 2 c
'c "c

Captropil 01/27/09 ACE 25mg itab ëolypeptide Treatment Contra- ëolyuria, Assess for
inhibitor BI ë.O. Antibactic; hyper- indicated Tachy- allergy to
against tension allergy to cardia, captropil
Mycobacterium capreomycin; proteinuria
tuberculosis pre-existing cough Assess for
auditory dry mouth skin color
impairment and lesions

For CBC
and
differential
 3 c c $ * +c ,  cc   c *  c  'c
 cc c   c (<+c  c   c   c "+c & c
c c 2 c
'c "c

Spirono- 01/28/09 iuretics 50mg itab Cause loss of To Hyper- Clumsy Monitor
lactone TI ë.O. sodium counteract sensitivity; Headache intake &
bicarbonate and potassium Hyperkalemia yscrasias output
calcium while loss
saving caused by aily
potassium and other weight
hydrogen ions diuretics during
therapy

Monitor
Bë before
adminis-
tering

c

c& !&!# 3#cc
c
c
c ëost-streptococcal infection
c (group-A, beta hemolytic)
c
c
c
Release of material from the organism,
c
into the circulation (antigen)
c
c
c
Formation of antibody
c
c
c
c
Immune complex reaction in the
c
glomerular capillary
c
c
c
c
Inflammatory response
c
c
ëroliferation of epithelialccells lining
glomerolus & cells between
c
endothelium & epithelium of capillary
membrane c
c
c
c
Swelling capillary membrane &
infiltration with leukocytes
c
c
c
Ĺ ëermeability of base membrane
c
c
c
 c
c
c of the
Occlusion of the capillaries
glomeruli vasospasm ofc afferent
ventrioles
c
c
c
Glomerular filtration c rate
c
c
c
Ļ Ability to form filtrate from
glomeeruli plasmacflow
c
c
Retention of H8O & Na; hypovolemia;
c
circulatory congestion
c
c
c
Edema c
Hypertension
Ļ urinary output c
Urine dark in colorc
Anorexia c
Irritability lethargy
c
c
c
"cc
3,"* c
"&! c c
c
c
c
c
c
c
c

c ","c
c
"")c
3" c  #cc3#")c
w ] impaired vision w ] blind
wx] pain wx] urine color w ] vaginal bleeding
w ] pain w ] reddened w ] drainage
w ] hermaturia w ] discharge w ] nocturia
w ] gums w ] hard of hearing
w ] no problem
w ] deaf w ] burning wx] edema
c
w ] lesion w ] teeth w ] no problem
"3  )c
c
w ] paralysis w ] stuporous w ] unsteady
"&  #)c
w ] seizures w ] lethargic w ] comatose
w ] asymmetric w ] tachypnea
w ] vertigo w ] tremors w ] confused
w ] apnea w ] rales wx] cough
w ] vision w ] grip wx] no problem
w ] barrel chest w ] bradypnea
c
w ] shallow w ] rhonchi wx] sputum
,="" )c
w ] diminished w ] dyspnea
w ] appliance w ] stiffness w ] itching
w ] orthopnea w ] labored w ] wheezing
w ] petechiae w ] hot w ] drainage
w ] pain w ] cyanotic w ] no problem
w ] prosthesis w ] swelling w ] lesion
c
w ] poor turgor w ] cool w ] deformity
  c  )c
w ] wound w ] rash w ] skin color
w ] arrhythmia w ] tachycardia w ] numbness
w ] flushed w ] atrophy wx] pain
w ] diminished pulses w ] edema w ] fatigue
w ] ecchymosis w ] diaphoretic w ] moist
w ] irregular w ] bradycardia w ] murmur
w ] no problem
w ] tingling w ] absent pulses wx] pain

w ] no problem c
c c c c c
3 c "  c )c c c c c c
w ] obese w ] distension w ] mass c c c c
w ] dysphagia w ] rigidly w ] pain c
wx] no problem
 dysuria

Infusion site

Edema wit pain

in both
extremities
  3c ","c c
>" "c >" "c
,,   )c
w ] Hearing Loss  )c³wala w ] Glasses w ] Language
w ] Visual Changes man ± wala w ] Contact lens w ] Hearing Aide
wx] enied gihapon´
As verbalized by R L
the husband ëupil Size: 3-5 mm w ] Speech difficulties
Reaction: ëERRLA
?#3"  )c
w ] dyspnea  )c³Nah! Respiratory: wx] regular w ] irregular
w ] smoking history gapanigarilyo escribe: regular breathing but associated with
Oftentimes mana siya -giubo pain
wx] cough pd siya karon oh.¶
wx] sputum As verbalized by Right: Right lung is symmetrical to left lung.
w ] denied the wife Left: Left lung is symmetrical to right lung.
   )c Heart Rhythm wx]regular w ] irregular
w ] chest pain  ) ³Sakit! Ankle Edema: present in lower extremities
wx] leg pain bug-at« ëulse Carotid Radial ë Femoral
wx] numbness of extremities nanghubag na Right: 62 65 60 not assessed
w ] denied man gni ako Left: 62 65 60 not assessed
mga tiil´ As
verbalized by Comments: ëulse sites are palpable and its rate are
the patient within normal range.
  )c
iet: AT but decreased fluid intake w ] dentures wx] none
w ]N w ]V  ) ³Wala
Character man«perma- Full ëartial With ëatient
w ] recent charge nente nay gana´ Upper w ] w ] w ]
in weight, appetite As verbalized
w ] swallowing by the patient Lower w ] w ] w ]
ifficulty
wx] denied
" ,   )c
Usual bowel pattern w ] urinary frequency  )ccurinate oncecccccBowel Sounds:
Once a day once daily daily due to pain Audible sounds
w ] constipation w ] urgency and excrete small Abdominal istention:
Remedy wx] dysuria amount. ëresent w ] Yes wx] No
w ] hematuria Urine (color,
January 27, 2009 w ] incontinence consistency, odor)
ate of last BM w ] polyuria tea color of urine,
inconsistent
w ] diarrhea character w ] foly in place
w ] denied
,  3","c(c!" !c@c
")c
wx] alcohol w ] denied Briefly describe the patient¶s ability to
(amount, frequency) follow treatments (diet, meds, etc.) for
Occasionally ± once in 2 months
chronic health problems (if present):
w ] SBE Last ëap Smear: N/A
LMë:c The patient is properly following her medications
c
 >" "c >" "c
= c "3 #)c
w ] dry  )c³ wala manc w ] dry wx] cold w ] pale
w ] itching - nanghupong w ] flushed w ] warm
wx] other - edematous lang ko´ as w ] moist w ] cyanotic
w ] denied verbalized by the
ëatient. * rashes, ulcers, decubitus (describe size,
location, drainage): No presence of any ulcers,
decubitus or rashes.

c   #+ ("#)c c
w ] convulsions  )c³ dili man w ] LOC and orientation: Oriented to time and
w ] dizziness hinuon, bug-at lang space
w ] limited motion of joints gyud ako tiil Gait: w ] walker w ] cane w ]
Kay nanghupong other
Naman ± kaya
Limitation in man hinuon nako.´ wx] steady w ] unsteady
ability to as verbalized by the w ] sensory and motor losses in face or
w ] ambulate patient extremities
w ] bathe self None
w ] other
wx] denied w ] ROM limitations: patient can performed
c range
of motionc
,(+""&+ A =")c c
w ] pain  )c³okc w ] facial grimaces
(location, raman hinuon´ w ] guarding
Frequency, As verbalized w ] other signs of pain
Remedies) by the patient. Edema on both extremities
w ] nocturia
w ] sleep difficulties w ] siderail release form signed (60 + years)
wx] denied None c
c
c& 3)c
Occupation : Farmer Observed non-verbal behavior
Members of household: None
6
Most supportive person: The person and his phone number that can be
Wife reached any time

&" c&  "c (,  

_______________ aily weight _______________ ëT/OT _________________
_______________ Bë q shift _______________ Irradiation
_______________ Neuro VS ______________ Urine test _______________
_______________ CVë/SG. Reading ________ ______________ 24 hour urine collectionc
c  ' +$c cc c

c c 
c
c 2 c c ($ +$c

01/27/09 CBC 01/27/09 01/27/09 0.9 Nacl iL

@ KVO rate

01/27/09 Urinalysis

c
c

c 3c,  3","c

c $c 'c,' c
 'c ' )cc
mc "2
c$ c
$ c$cc'$ $  c

"" c    "c

„c Monitor intake and output „c To check fluid balance and prevent dehydration

„c Observe for fever „c To check for infection since the patient has a greater risk

„c Elevate edematous extremities, change position frequently „c To reduce tissue pressure and risk of skin breakdown

„c After elevating, place in semi-fowlers position „c To facilitate movement of diaphragm, thus improving
respiratory effort

„c ërovide quiet environment „c To promote ventilation and limits external stimuli

„c Administer furosemide I amp of 12h as prescribed by the „c For the treatment for edema

physician

c
 'c ' )cc
mc 
c c$c$cc
c'c

"" c    "c

„c Assess the airway patency „c To check the effectivity of the airway & to plan for further

management

„c Elevate the head part of the bed/change position q 2h „c To enhance drainage of/ventilation to different lung

segments

„c Encourage deep-breathing and coughing exercise „c To mobilize secretions

„c Monitored the fluid intake „c To help liquefy secretions and not to severe the edema

„c Instruct to have proper clothing, not too tight and not too „c To provide warm body/environment

loose

c
c
c
 'c ' )ccc
mc c c$cc cc
"" c    "c

„c Monitor vital signs „c Because vital signs are altered in acute pain experienced

„c Acknowledge patient¶s verbalization of pain & allow him „c ëain is subjective experience of a person that no other one
to describe it can felt about it

„c ëerform pain assessment each time occurs „c To rule out worsening of underlying condition/developing
complication

„c Elevate edematous extremities, change position frequently „c To reduce tissue pressure and risk of skin breakdown

„c ërovide quiet environment „c To promote ventilation and limits external stimuli

„c Administer Spironolactone 50mg itab TI ë.O. as „c For the treatment for edema
prescribed by the physician

c $c 'c,' c

c c
c B'*c$'c-'c $c-c''c c-
Cc
c
$ Dccc 

c
c „c Edema
c „c Oliguria
„c Restlessness

c c
c c
($ c
$ c2c$cc3$ $  c
c

c
c Long term:
At the end of 2 days, pt. will be able to lessen or diminished the
c
symptoms of glomerulonephritis that produces excessive fluid.
&c
Short term:
At the end of 8 hours, the pt. will be able to reduce the excessive
fluid volume.

c
c 1)c Monitor vital signs especially temperature
mc To check & assess for infection since the pt. has a higher
c
risk
c 2)c Monitor intake & output
c mc To monitor & check fluid volume & prevent dehydration
3)c Elevate the edematous extremities
mc To reduce tissue pressure & risk in skin breakdown
4)c ëlace in a semi-fowlers position, change position frequently
mc To facilitate movement of diaphragm & improve
respiratory effort
5)c Administer furosemide 1 ampule every 12h as prescribed by the
physician
mc For the treatment of edema

c
"c At the end of 8 hrs, the pt reduces the excess fluid in his body thru
excretion of stored fluids.
 !" !c" ! 3c
c

 cc& )c3$ c#c

Encourage to follow the dosages and proper timing of his

MEICATIONS meds. Such as the Furosemide 1 ampule every 12hours x
3doses, Omeprazole 20mg 1capsule once a day, Captopril
25mg 1tablet twice a day, & Spironolactone 50mg 1 tablet
thrice a day. As prescribed by his physician.

Encourage bed rest and frequent changes of position, early

EXERCISE ambulation, and deep breathing exercise.

Encourage/instruct to keep the edematous extremities to

elevate as often; limit of water intake; monitor intake and
TREATMENT output; provide warm environment; provide egg white a
day; weight the pt. daily, at the same time.

OUT-ëATIENT Encourage pt. that when his discharged, he must have a

(Check-up) regular check-up to his physician until it¶s needed. To
evaluate the progress of his condition.

Instruct to limit intake of salty & fatty foodsand

IET enrich/increase the intake of foods rich in potassium such as
bananas«

c
c
c
c
c

c"(" c c(A*&c
c c c c c c c c c c c

c Since the patient is suffering from Acute Glomerulonephritis, it is advised for him

to stay in the hospital for a better and thorough management regarding on her condition.

Acute Glomerulonephritis are very critical in a man¶s condition that is why the patient

needs an urgent hospital service for him to be monitored every now and then. c

If the doctor has already approved the release or discharge of the patient from the

hospital, the patient is highly advised to have a regular check-up on her personal

physician to take out the risk from the said ailment.

If the patient will again suffer the Acute Glomerulonephritis, it is best for him to

be admitted to a tertiary-leveled hospital for better monitoring of his critical condition,

knowing that even a single mistake worsen his condition.

c
c
c
c
c
c
c
c
c
 ?
c"   c c ,&   c
c

c  
c 
c c  c c  c c c 
c c c

 c 
c 


c c  
c  c
c c c c c 
c c


cc c
cc ccc 
c
c  cc
cccc


c
c
cc 
c
c
c
cc c

c 
cc

 c c c 

c c 
 c c  c 
c c
c
c 
c

ccccc
cc

c
cc  c c cc cc cccc
c

c  c  c c c 

c 
c 
 c c c   c c 
c 
c


c c c c c c c 
cc 
 c
c cc 

c 
c

 c 
c c 
c  c  c c   c c 
c 
 c c c





cccc
cc


cc 
c 
cc

c
c
c
c
c
c
c
c
c
c
?
c  3 &!#c
c
ßcoenges, Marilyn E. et.al Nurses ëocket Guide:
iagnoses, Interventions and Rationale. 9th
edition pages 278-279, 472-477, 576-578 F. A
avis Company ëhiladelphia, 2004.

ßcLippincott Williams & Wilkins, Manual of

Nursing ëractice, 8th edition, volume 1.

ßceglin, et al. avis¶s rug Guide for nurses, 9th

edition.

ßcSmeltzer, Suzanne C. et al. Textbook of Medical-

Surgical Nursing, 11th edition, volume 2.