Identification Data

1. Name Sanjana
2. Age 4 years
3. Sex- female
4. Ward 18
5. MRD NO. 103932
6. Unit-III
7. Education of father- graduate
8. Education of mother- 12th pass
9. Occupation of father-Private job
10. Occupation of mother- Housewife
11. Income of father- 15,000 Rs per month
12. Religion-Hindu
13. Address- house no-3910, DLF phase-4, gurgaon, haryana.
14. Diagnosis-Nephrotic syndrome.
15. Date of admission-26th august 2015.
16. Date of care started- 4th September 2015.
17. Date of care ended- .9th September 2015
18. Informant- Mother
Chief Complaints1. Fever high grade x three days. Responding to treatment.
2. Decreased appetite
3. Swelling first in periorbital region. Gradually progressed in abdomen and fist.swelling more
in morning and gradually subside in day.
4. Puffiness with facial edema.
5. Abdominal pain generalized.
History of Present Illness
A female child came with complaints of fever for three days, lack of appetite, urine output
decreased, and swelling first in periorbital region. Gradually progressed in abdomen and
fist.swelling more in morning and gradually subside in day and puffiness with facial edema.
Here the child came in paediatric OPD and admitted in ward 18 for further management. Here
the investigation done and child is diagnosed with nephritic syndrome. For that treatment was
started.

History of past illness

a. Past medical history-

Child had no complaint of any past medical illness. Child had no previous episode of any
hospitalization.
b. Past surgical historyChild had no previous episode of any surgery.

Birth history1. Pre-natal history:Mother had no complication in antenatal period. Mother had taken complete treatment in
antenatal period.
2. Natal history:She is full term normal vaginal delivered baby. She cried after birth and was active. She
had no complaints during her delivery, mother was also stable.
3. Post natal history:Mother and child were healthy after the delivery and had no complication after the
delivery.
Developmental Milestone
Child has achieved the entire milestone and child is normal in activities as per her age.
Like:At 3 months- neck holding in prone position and making sound.
At 5 month- sitting with support and speak mono syllabus word
At 8 month- sitting without support
At 9 month- standing with support and speak bi syllabus words
At 12 month- standing without support and speak two words with meaning
At 24 month- climbing upstairs and forms simple sentence
At 36 month- riding tricycle and can tell a story.
Immunization history Child had completed all the immunization from a government dispensary.

At birth
At 6th week

At 10th week
At 14th week
At 9th month-15 month
At 16-24 month
At birth
At 6th week

At 10th week
At 14th week
At 9th month-15 month
At 16-24 month

BCG
OPV
BCG(if not given)

Single
Zero
Single

DPT-1
OPV-1
DPT-2
OPV-2
DPT-3
OPV-3
Measles
MMR
VT-A
DPT
OPV

First
First
Second
Second
Third
Third
Single

BCG
OPV
BCG(if not given)

Single
Zero
Single

DPT-1
OPV-1
DPT-2
OPV-2
DPT-3
OPV-3
Measles
MMR
VT-A
DPT
OPV

First
First
Second
Second
Third
Third
Single

Booster
Booster

Booster
Booster

Family health historyType: Nuclear family

Family size: 4
Adults: 2
hansraj , 30 yrs., male

sanjana, 4yr,female

geeta , 28yrs female

rohan, 4 month, male

Family compositionName

Age

Hansraj

Relationshi
p to patient
Father

Geeta

Mother

Rohan

Yonger
brother

Sex

Educatio
n
Graduate

Occupatio
n
Pvt. job

28yrs. Femal
e

Graduate

Housewife

4
mont
h

30yrs. Male

Male

Health status
Father is free from
any complication like
diabetes,
hypertension, asthma
and any other
complication.
Mother is free from
any complication like
diabetes,
hypertension, asthma
and any other
complication.
Brother is healthy and
free from any illness.

Family members are healthy with no disorder such as cancer, diabetes, hypertension, tuberculosis
or any allergy etc.
Socio economic backgroundLiving locality: Urban
Housing facility: Own house
Type of House: Concrete
Number of room: 4 rooms
Ventilation: Adequate
Water supply: Delhi Jal Board
Drainage system: Closed drainage system
Social status: Poor Socio Economic Status
Personal historya) Personal habitsThere is no substance use history in family or by patient herself.
b) Diet
Child is non-vegeterian.
c) SleepUsually child sleeps for 6-8hrs per day. Day sleep was less then night.
d) Elimination-

Bowel habits- child used to eat properly at home but used to like street food.
Bladder habits- child used to urinate 5-6 times a day.
e) Activities of daily livingIn premorbid condition child was very active but for last 1 month she used to get easily tired
after some activity. Child is weak and lethargic not so active because of the disease
condition.
f) Drug history
Child has no allergy or complication because of any medication.
g) AllergyChild had no history of any allergy.
Physical examination
a. General appearance NourishmentChild is malnourished. But due to edema she was looking fluffy.
Body buildModerate built.
Hygiene and groomingChild is clean and hygiene was maintained by the mother well.
ActivityChild is dull. Low activity and lethargic due to disease condition.
HealthChild is not healthy.
PostureChild had normal posture.
MovementChild had co-ordinated movement.
b. Vital signs Temperature
99.6 degree farenhight
Pulse
90/mt
Respiration26/mt
c. Anthropometric measurement
Abdominal girth- 30 cm
Mid arm circumference-14 cm
Height 110 cm
Weight 20 kg
Head to toe examinationA. Skin-

Child is wheetish in color. Normal and moisture present, no dryness or wrinkling present. Warm
temperature of skin. No macule, papules, vesicles or wound present. Turgo delayed
Discoloration, absent, no cyanosis, pallor or any increased pigmentation present.
B. Head
Shape is Normal cephalic, no complication like hydrocephalic, micro cephalic or macro
cephalic present, Scalp is Clean with no dandruff or pendiculi. Face is Normal symmetric,
pale, flushed, puffiness present especially in periorbital region.
Subjective symptomsMother had complaint about facial edema.
C. Hair
Distribution is Hair was silky, evenly distributed no complication like thin hair, lice, nits,
excessive hair or brittleness present. Texture Brittle in texture .Colour is Brown. Grooming;
Child was well groomed.
Subjective symptomsMother had no chief complaint regarding hair.
D. Eyes
Eye brows; Hairs are equally distributed and symmetrical. Eye lashes; Equally distributed.
Eye lids; Skin intact, no complication like lesion, etropion, entropion, redness or no
drooping of eyelids. Pupils; Black in colour. Colour Normal no cloudiness or redness. Size;
Normal 3-7 mm in diameter. Shape; Eyes are round no complication. Reaction to light;
Pupils were equally reacting to light and accommodation. Corneal reflex-; Corneal reflex
was present. Conjunctiva; Normal, no pallor, yellowish or purulent discharge present.
Sclera; pallor in colour .Lens; Transparent, no opaqueness present. Vision; Vision was
normal as child was responding to stimulus. Extra ocular muscle test; Normal, no
nystagmus or squint eye present. But peri orbital edema present which was excessive that
child was not able to open her eyes properly.
Subjective symptomsMother explained complaint regarding eyes puffiness.
E. Ear Position; Normal in position, no complication or low set ears.Cerumen; No cerumen
present. Otorrhoea; absent, no complication like purulent, serous or blood. Hearing;
present, as child was responding to stimulus. Response to normal voice tone; Normal.
Watch tick test; Normal .Turning fork test (weber test); Sound heard in both ears.
Rinne test; Normal
Subjective symptomsNo complaints by mother regarding ears. No complaints, like otalgia or tinnitus.
F. Nose-

External nose; Nose is symmetric, no discharge or crust present. Nasal septum;Nasal

septum is in midline no deviation present. Patency of nasal cavity Nasal cavity is
patent as air moves freely, no obstruction or polyp present. Frontal and maxillary
sinuses; Normal, no sinusitis. Smell sense Normal

G. Mouth and pharynx

Outer lips; Pink, no pale or ability to purse lips. Inner lips; Pink, no complication like
moist, excessive dryness, pale, leukoplakia or ulceration. Teeth; No teeth. Gums; Pink
no complication like bleeding or pus. Tongue; Central position, no complication like
deviated from center, rough, dry tongue, lesions or ulcerations. Movement; Moves
freely, no complication like tenderness or restricted mobility. Palate; Light pink,
smooth soft palate and lighter pink hard palate. Tonsils; Smooth, pink and not
enlarged. Odour of mouth; No foul smelling. Pharynx; Gag reflex present, no
complication like dysphagia, odynophagia or throat pain. Voice; Clear, no
complication like hard, aphonia or dysphonia.
Subjective symptoms
No complaints by mother regarding mouth and pharynx.
H. Neck Range of motion; Possible movement, no complication like painful or absent. Thyroid
gland; Normal not enlarged. Trachea; Midline and normal shape, no complication
displacement. Lymph nodes; not present Jugular veins; Non-distended.
I. Chest Shape and size; Barrel chest, transverse diameter. Expansion of chest; Expansion of
chest is symmetrical. Palpation; on palpation there were no nodes present. Tactile
fremitus; Symmetrical. Thoracic excursion; resonance present. Auscultation apical
pulse; 92/ mt. Breath sound; no abnormal broncho vesicular sound present along with
crackles, stridor, wheezing, crept and rhonchi sound. Cough; present. Sputum;Absent.
Subjective symptomsChild had no complaint regarding respiratory system.
HeartNo S1, S2 heard with murmur or gallop sound present.
J. Breast and axilla Symmetry; Symmetrical in shape and size with no complication. Areola and nipple;
Normal pinkish in color, normal in shape, no complication like inverted, retracted and
dimpling. Discharge; absent .Lesions/masses; Absent, no ulceration, nodes, swelling,
moving painful and tender. Auxiliary nodes; Non palpable nodes, no complication
like palpable nodes. Hair distribution; No hair present.
K. Abdomen

Inspection; Cylindrical in shape and abdominal distension present. No skin rash, scar,
hernia, any infection in umbilicus. Ascitis present. Palpation; Liver is palpable, spleen
is palpable no tenderness or any mass. Percussion; Fluid was detected.. Auscultation;
Normal bowel sound heard. Abdominal girth; 30cm. inguinal lymph nodes; No
enlarged lymph nodes present. Appetite; Child demand feed.
Subjective symptomsMother had complaint child was apparently well but for 1 weak she started having
abdominal pain which was reduced after treatment but onset was present. Child
was started having periorbital edema with puffiness over eyes but now it has
started generalizing specially abdominal.
L. Upper extremities Symmetry; Symmetrical in shape and size. Range of motion; Range of motion is
normal. Peripheral pulse; Brachial and radial pulses are normal. Reflexes; All
reflexes of upper extremity biceps, triceps and brachioradialis reflex are normal.
Oedema/swelling; edema or swelling present. Cyanosis;Absent but on admission
peripheral cyanosis present..Joints; No swelling, tenderness or crepitus present.
Deformity;No congenital deformity like polydactyl or syndactyl present.
M. Lower extremities
Symmetery; Normal in shape and size.Toe nails;Capillary refill time is more than 1.5
sec. Range of motion;Range of motion is normal.Peripheral pulses;Normal.
Reflexes;All reflexes are normal means patellar, ankle jerk and planter reflexes are
normal.Edema; edema present. Cyanosis;No discoloration or cyanosis
present.Joints;No stiffness, swelling, tenderness or crepitus present. Deformity; No
congenital deformity present like talipes equinovarus or talipes equinovalfum absent.
Subjective symptomsMother had no complaint like flexion, extension, abduction, adduction or any
internal rotation of extremity present.
N. Nails Shape; Normal convex curve shape no clubbing present.Texture;Normal smooth, no
brittleness, excessive thickening or thinning present.Nail bed colour;Pink in
colour.Tissues surrounding nails;Intact epidermis, no paronvchia.

O. Genital and rectum Hemorrhoids; Not present. No abnormal structure present. No heniation present but
labia majora swelling present but child had no complaint of any burning micturation.
Conclusion:Child is malnourished . skin is soft and clean. Child is having generalized edema which was
more in facial region and periorbital region. Child was having ascitis also. Child is lethargic but

conscious. Appetite of the child is low because of disease condition. Child is undergoing
management of nephritic syndoem.

Lab investigation:1. Chest Xray on 26th august 2015:Xray shows pleural effusion with no cardio megaly.
2. Ultrasound of abdomen 28th august2015:Ultrasound reported that gall bladder is contracted. Livre palpable with 6-9 cm. mild free
fluid in abdomen. Urinary bladder is minimally distended. Kidneys are normal in size.
3. Lab investigationTest
A. Haematology :
Haemoglobin
Red blood cells
Platelet
White blood cells
Hematocrit
MCV
MCH
MCHC
Mon
LYM
NE
EO
BA
B. Prothrombin time:PTT
PT control
APTT
INR
C. serum electrolytes:
Sodium
Potassium
Chloride
Blood urea
Creatinine
Uric acid
D. blood group
E. serum protein:

Patient value
10.4 gm/dl
3.44 milli /cumm
1.20 lacs/cumm
16.7/cumm
30.5%
89 fl
30.3pg
36.6 gm/dl
12.4%
56.1%
28.6%
2.7%
0.2%

24 sec
13.0
45
1.45
138 meq/lt
3.7 meq/lt
102 meq/lt
78 mg/dl
0.3 mg/dl
11 mg/dl
AB +ve

Normal value

Remarks

 Albumin
globulin
F. serum cholesterol
G. urine test:
pus cell
epithelial cell
albumin

1.4
2.3
452 mg/dl
8-10 /HPF
1.2/HPV
++

Medication:Name of drug
INJ.Monocef
Tab.predinosone
Tab.lasix
Syp.digene

Dosage
1 GM
5 mg
40mg
5 ml

Route
IV
Oral
Oral
Oral

Frequency
BD
TDS
OD
BD

Assessment of patient.
1. Child is conscious and active.
2. Child is lethargic.
3. Child is taking orally less.
4. Child had pain in abdomen.
5. Child is having periorbital edema along with facial puffiness.

Action
Antibiotic
corticosteroid
Loop diuretic
Antacaid

6. Child is having lack of appetite.

7. Child is having frequent episode of fever
8. Child is having cough.
9. Child is on fluid restriction.
10. Child parents had lack of knowledge about disease condition.

Needs of patient:1.
2.
3.
4.
5.
6.
7.

Abdominal pain should be reduced.

Daily assessment of urine albumin should be done.
Child should be given frequent diet.
Strict intake output charting should be made.
Child should be prevented from nosocomial infection.
Fluid and electrolyte balance should be maintained.
Parents should be educated about treatment of nephritic syndrome.

Summary:A female child came with complaints of fever for three days, lack of appetite, urine output
decreased, and swelling first in periorbital region. Gradually progressed in abdomen and fist.
swelling more in morning and gradually subside in day and puffiness with facial edema.
Child is lethargic and after all due investigation it was found that child is having nephritic
syndrome and in ultrasound mild free fluid present which was in query of Kochs which was rule
out after that now child is under treatment of nephrotic syndrome. Child is on corticosteroid and
loop diuretics. Child is responding well for treatment.

Prognosis:Child prognosis is good as abdominal pain is resolved and fever frequency has reduced. After
one weak of treatment puffiness of face has reduced so well.