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(Olfu) Pediatrics Case Study: Post Streptococcal Glomerulo Nephritis (PSGN)
(Olfu) Pediatrics Case Study: Post Streptococcal Glomerulo Nephritis (PSGN)
(Olfu) Pediatrics Case Study: Post Streptococcal Glomerulo Nephritis (PSGN)
Prepared By:
Group 1 BSN 2Y2-1A
Presented To:
General Objective:
This study aims to broaden the student’s knowledge about Post Streptococcal Glomerulo
Nephritis (PSGN) and it is designed to enhance the skills and attitudes in the application of
different nursing processes and management of the patient with PSGN.
Specific Objectives:
The kidneys are two organs that sits underneath the ribs in the back and which are
responsible for filtering toxins from the blood and maintaining the balance of fluid and
electrolytes. If the small filtration units of the kidney (glomeruli) become inflamed and swollen,
this called glomerulonephritis. The dead bacteria and antibodies become trapped in the filters of
the kidneys. This causes inflammation, which slows down the filters of the kidneys, making it
harder for them to make urine and get rid of the waste. These are several possible causes,
including autoimmune conditions (when the immune system begins to mistakenly attack the
healthy body tissues), following an infection, and some medical conditions, including diabetes
and some cancers.
It may occur in people of any age, but the most commonly affected group are pre-school
and school-aged pediatric patients. PSGN occurs most often in males with a male-to-female ratio
of 1.5 to 2:1
We chose this study due to rare complication in child nowadays to know related
information and knowledge about the aforementioned disease condition. This case study will
serve as a guideline for us student nurses in assessing and providing proper nursing care to
patients with the same problem or disease.
PATIENT’S PROFILE
NAME : J.S.G
AGE : 8 y/o
STATUS : Single
Family History :
Socio-Economic History :
Personal History :
Prenatal History :
Birth History :
Feeding History :
PHYSICAL ASSESSMENT
Patient JGS is a 8 years old male, with a PR of 100 BPM, O2 Sat of 97, RR 20
cycles/min, temperature of 36.5°C and a BP of 120/90 mmHg. He is awake, conscious, coherent
and not distress upon interaction.
Assessment
a. Head
Head is round in shape. Hair is short, thin and coarse, straight and evenly distributed.
Scalp is smooth and white in color, minimal lesions were noted.
b. Eyes
Her eyes are symmetrical, black in color, almond shape and anicteric sclera. Pupils
constricts when diverted to light and dilates when she gazes a far, conjuctivas are pink.
Eyelashes are equally distributed and skin around the eyes is intact.
c. Ears
Ears are clean, no ear wax noted and approximately of the same size and shape. Patient
can hear normally when spoken softly.
d. Nose
With narrow nose bridge, no discharges upon inspection. No swelling of the mucous
membrane and presence of nasal hairs were seen.
e. Mouth
She has a complete set of teeth with minimal dents noted. Oral mucosa and gingival are pink
in color, moist and there were no lesions nor inflammation noted. Tongue is pinkish and is free
of swelling and lesions. Lips are symmetrical, appear pale and dry with bits noted upon
observation.
f. Neck
Neck has strength that allows movement back and forth, left and right. Patient able to move
her neck freely.
g. Lungs and Thoracic Region
No reports of pain during the inhalation and exhalation. Absence of adventitious sounds upon
auscultation. RR is 19 cycles per minute.
h. Heart
Patient has an audible heart sound. Heart is pumping well with a pulse rate of 88 bpm.
i. Abdomen
There was a pain scale of 7/10 verbalized by the patient.
j. Upper Extremities
Fair skin in color, presence of minimal scars of wound in the arms and legs. Her skin is moist
and soft to touch
k. Lower Extremities
No edema is present in her lower extremities.
GORDON’S HEALTHSTATUS
Functional Health Before Hospitalization During Hospitalization
Pattern
A. Health She used to take herbal and She complies with the physician’s
perception and over the counter medicines and nurse’s health teachings.
health whenever she feels sick.
management
B. Nutritional and She has no known allergy. She was placed on a soft diet and
Metabolic She drinks 2,000-3,000ml experiencing weakness all
Pattern water everyday and she throughout the day.She used to to
drinks alcohol occasionally drink orange juice and milk.
and coffee in every morning
C. Elimination She defecates once daily Her output was being strictly
Pattern and urinates frequently. monitored. She did not defecate
after her surgery and her urine
output is approximately
2,500ml/day.
D. Activity- She used to do daily She can sit, stand and walk
Exercise household chores. slowly.
E. Sleep – Rest She used to sleep at 9pm She was unable to sleep at night
Pattern /and she wakes up 4am in due to painful incision and painful
the morning. urination from the catheter.
F. Cognitive- She had good sensory and She can easily comprehend
Perception auditory adequacy. No instructions and ideas.
Pattern difficulties in learning.
G. Self- Perception/ She is kind, generous and She shows respect and positive
Self- Concept affectionate attitude towards doctors and
Pattern nurses
H. Role- She has a close bond with She is being taken care of by her
Relationship her family. daughter.
Pattern
I. Sexually- She is menopause at the age She is menopause at the age of 59.
Reproductive of 59.
J. Coping/Stress She is engaging meditation She is able to manage her stress
Tolerance daily through praying with adequate rest.
before she sleeps
at night.
K. Value-Belief She is religious and have She believes in good deeds.
respect to different aspect of
cultures and she go to
church every Sunday.
ANATOMY AND PHYSIOLOGY
The kidneys are two bean shaped organs of the renal system located on the posterior wall of the
abdomen one on each side of the vertebral column at the level of the 12 th rib. The left kidney is slightly
higher than the right. Human kidneys are richly supplied with blood vessels which give them their reddish
brown color. The kidneys measure about 10cm in length and, 5cm in breadth and about 2.5 cm in
thickness.
The kidneys are protected by three specialized layers of protected tissues. The outer layer consists
mainly of connective tissue which protects the kidneys from trauma and infection. This layer is often
called the renal fascia or fibrous membrane. The technical name for this layer is the renal capsule. The
next layer (second layer from the exterior) is called the fascia and it makes a fibrous capsule around the
kidneys. This layer connects the kidneys to the abdominal wall. The inner most layer is made up of
adipose tissue and is essentially a layer of fatty tissue which forms a protective cushions, the kidney and
the renal capsule fibrous sac) surrounds the kidney and protects it from trauma and infection.
The main function of the kidney is to maintain fluids, electrolyte and pH balance of the body by
filtering ions, macromolecules, water, and nitrogenous wastes from the blood based on the body’s
condition. Waters filtered out of the blood drains from canals in the kidney into the bladder as urine.
Blockage of the drainage system can cause the kidney to become congested, stretched, and potentially
scarred. Functioning kidneys are necessary to maintain life and one measure of their function is the
glomerular filtration rate. A loss of kidney function results in the need for dialysis, which is an artificial
method of removing wastes from the blood by running the blood from the body, through an artificial
kidney, and then back into the body.
PATHOPHYSIOLOGY
POST-STREPTOCCOCAL INFECTION
(GROUP A, BETA HEMOLYTIC)
FUNCTION OF ANTIBODY
INFLAMMATORY REPONSE
PROLIFERATION OF EPITHELIAL CELLS LINING EPITHELIAL CELLS – cresent formation (when severe,
GLOMEROLUS AND ENDOTHELIAL CELLS AND Browman’s space) (usually stimulated by fibrin)
EPITHELIUM OF CAPILLARY MEMBRANE ENDOTHELIAL CELLS – capillary lumen ↓
The patient is for TAHBSO as ordered and on NPO diet. She was conscious and coherent
and instructed for total body hygiene. Informed consent for TAHBSO was secured. Fleet enema
was done by duty-nurse at 4am with informed consent. 2u PRBC properly type and cross
matched was secured. Cefuroxime 1.5gTIV after negative skin test 1hr. prior to OR and
Omeprazole 40mg NPO, Tranexamic 500mg IV every 8hrs. as LD was given by duty-nurse. She
was continued monitoring of CBG every 6hrs.on NPO and 30mins. prior to OR. Elected
TAHBSO was oriented to OR policy on NPO maintained. IM-RS and IM-endo clearance noted.
SURGICAL PROCEDURE: With informed consent for TAHBSO, @ 2pm patient to OR per
stretcher and was seen and examine. Induction of Anesthesia was done by the doctor, IFC
inserted aseptically, pelvic examination under anesthesia done, providone iodine scrub and
antiseptic used for vaginal, perineal and skin preparation, sterile drapes applied, initial count of
syringe needle was done, surgical incision started @ Midline suprapubic infraumbilical incision
and carried down to the perirtoneum, specimen exposed. TAHBSO with utero sacral suspension
done by the Doctor, specimen was obtained . Count of surgical needle and puncture acknowledge
completed by the Doctor. Binders were checked. Abdominal capes sutured until closed,
antiseptic and dressing applied. Procedure ended.
S/P TAHBSO. Patient was transferred from OR per stretcher with abdominal drain, clean and
dry and transferred to bed safely. She was conscious and coherent and advised to used abdominal
girdle and dangle her leg before going out to bed. She was also instructed to ambulate gradually
and full body hygiene was emphasized.
Patient was back to ward and monitored vitals sign with BP 110/70, PR 80, RR 18,Temp.
30, O2 99.1, Soft Abdomen with (-) Flatus. (-)BM and adequate and clear UO. IVF was given as
ordered then heplock. She was instructed for clear liquid diet. Patient was verbalized the pain
scale 6/10 and encourage her to do deep breathing and least the pain scale to 3/10. Doctor
ordered Cefuroxime 750mgIV after negative skin test q 24hrs. and then shift to Cefuroxime
500mg/tab TID for 7 days. Start Ferrous Sulphate OD, Ascorbic Acid OD, Celoxib 200mg/cup
BID once IV pain meds consumed. IFC was ordered to be removed at 2pm 1/16. Due medication
was given as ordered. CBG was monitored TID per meals. Intake and Output was also
monitored and recorded.
S/P TAHBSO. Patient still on Ward with abdominal dressing, conscious and coherent and
advised to continue use abdominal girdle , gradual ambulation, dangle her leg before going out to
bed. Full body hygiene was also emphasized to patient. IFC was removed by duty-nurse. Vital
sign was monitored q4. She was advised to eat SBF jelly and crackers, soft diet with (+) Flatus
@ 5:30pm. Encouraged to continued deep breathing exercise to least the pain from the inscision
site. Cefuroxime 500mg 1/tab BID for 7 days, Ferrous Sulfate OD, Ascorbic Acid OD,
Celocoxib 200mg/cup BID was given as ordered.
S/P TAHBSO. Patient was conscious and coherent, with abdominal dressing, with pain
noted. Vital signs was monitored with PR 88, O2 97, Temp. 36.3 C, BP 120/80. She was
advised to maintain abdominal girdle, maintained heplock, encouraged to ambulate, deep
breathing exercise. Total body hygiene was emphasized. Daily wound care was also advised and
instructed for soft diet while still waiting for BM. I and O was monitored and recorded.
DAY 4: JANUARY 18, 2019 - FRIDAY (ON DUTY)
S/P TAHBSO. Patient vital sign was monitored. She was noted for 4 days (-) BM. She
was encouraged for soft diet that high in fiber, encouraged ambulation and promote adequate
fluid intake. She was verbalized understanding of method for preventing and treating the
constipation. Doctor ordered Bisacodyl. Due medication was given as ordered and safety
precaution was advised.
S/P TAHBSO. Patient was conscious and coherent, vital sign was monitored, full body
hygiene was advised, encouraged to ambulate, safety precaution was observed. Due medication
was given as ordered.
Patient instructed to eat nutritious food. Proper wound care and total body hygiene was
emphasized. Vital sign and I&O was monitored and recorded. Due medication was given by
duty-nurse as ordered. Patient safety was ensured.
Patient was seen active and oriented. Monitored vital sign and instructed to eat nutritious
food. Emphasized medication compliance and kept rested. Intake and Output was also monitored
and recorded and conducted patient health teaching.
RECOMMENDATION SUMMARY
Medications : Ascorbic Acid 500mg 1 tab/day