INTRODUCTION: My client name is Baby Vanshika 10 years old.

She is admitted in this

hospital with the complaint of decrease renal function, hematuria, and edema.

Demographic Data

 Name of the Patient - Baby Vanshika

 Father’s Name - Mr.ArunSahu

 Mother’s Name - Mrs.Vandana

 Age / Sex - 10yrs / Female

 Opd / Ipd No- 39756 / 65234

 Date of Admission -

 Mode of Delivery - Hospital Delivery

 Chief Complaints - My Patient Had Been Admitted with a Complaint Of

decrease renal function, hematuria And Edema.

 Diagnosis - Acute and chronic kidney failure

 Date Of Care Started -

 Date Of Care Ended -

Personal History

Personal Hygiene - Oral Hygiene Is Good. Patient Takes Bath once Daily

Bowel& Bladder Pattern - Irregular, Hematuria Urine Frequency Is 1-2 Times Per Day.

Sleep & Rest Pattern - Irregular & Inadequate

Hobbies - My Patient Have Hobbies Like Watching Television

Family History

S.No Name Of Age Sex Relation Occupation Education Health

Family With Status
Member Patient
1 Baby 10yrs Female Self - 5th Class Unhealthy
Vanshika
2 Mr.ArunSahu 31yrs Male Father Labor 5th Class Healthy

3 Mrs.Vandana 28yrs Female Mother Housewife 7th Class Healthy

Family Tree:-

Father (31 Years) Mother (28 Years)

Patient (10 Years)

Family Medical History

My Patient’s Family Has No Specific Hereditory Diseases like Hypertension, Diabetes

Mellitus, Cancer Etc.There Is No Family History of Communicable Diseases like
Tuberculosis, Aids Etc.

Present medical history -My Patient Had Been Admitted with a Complaint Of decrease
renal function, hematuria And Edema.

Socio Economic History

Type Of Family - Nuclear Family

Housing - Pacca Concrete House

Income - 3000/- Per Month

Earning Person Of Family - Mr.Arun Sahu (Patient’s Father)

Electricity - Available

Surgical history –

 No surgery perfomed.

Past medical history –

 Patient was admitted in hospital before 1months with the complain of fever and
cough.

Past surgical history –

 No history of surgical procedure.

Prenatal History

Prenatal Visits - 2 Times

Gestational Age - Full Term

Immunization of Mother - Tetanus Vaccination Taken At 7th Month of Pregnancy

Mother Had No Other Diseases During Pregnancy.She Was Not Taking Any Type Of Drugs

Except Folic Acid And Iron Tablets During Pregnancy Period.

Natal History

Type Of Delivery - Normal Delivery

Immediate Cry - Baby Cried Immediately After Birth

Apgar Score - Parents Have No Knowledge

Birth Weight - 2.5kg

Initiation Of Breast Feeding - Baby Had First Breast Feeding Within 1 Hour.
Post Natal History

After Delivery Both Baby And Mother Had No Complications.

Past Medical History

My Patient Had Past Medical History Of Weight Gain, Ascitis And Generalised Edema.

Past Surgical History

My Patient Has No Past Surgical History Due To Any Significant Diseases.

Present Medical History

My Patient Admitted to Hospital with Complaint Of hematuria, hypertension And Edema.

Nutritional History

My Patient Takes Meals 3 Times A Day.She Is Both Vegetarian And Non-Vegetarian.

Immunization History

S.No. Age Vaccine Remark

1. At birth BCG , OPV - 0 dose Received

2. At 6 weeks BCG (if not given ) Received

OPV – 1 ,Hep B – 1 ,DPT – 1

3. At 10 weeks DPT – 2 ,Hep B – 2 ,OPV – 2 Received

4. At 14 weeks DPT – 3 ,OPV – 3 ,Hep B – 3 Received

5. 9 month Measles , vit. A. – 1 dose Received

6. 16 – 24 month DPT – 1st booster ,OPV – booster Received

Measles – 2nd , Vit. A. – 2nd

7. 5 year DPT Booster 2nd Received

History of allergies –

 No any history of allergy.

Psychosocial history –

a. Behavioural history

 History of nail biting – no

 History of thumb sucking – no

 Pica – no

b. Play activity

 Type of play – play with doll

 Reaction towards play – happy

c. Relationship with family and friends – patient relationship with family is good and

normal.

 School performance – normal

 Hobbies – painting

d. Activities of daily living

My patient sleep 10 hrs and arise at 8am daily.

e. Bladder habbits – abnormal

f. Bowel habbits –abnormal

g. Nutritional history –

 Duration of breast feeding – 6month

 Time of weaning – start from 8 month

 History of bottle feeding – 1 year

  Time when additional food started – 8month

Physical Examination

Anthropometric Measurement

Height - 55cm

Weight - 61kg

General Appearance

Activity - Less Active

Complexion - Fair and pale

Level of Consciousness - Conscious

Head To Foot Examination

Head

Hair - Black

Scalp - Soft

Skull – Round Shape

Birth Injury - Absent

Face

Edema - Edema Is Present On Face

Eye

Sclera - White in Colour

Conjunctiva – yellow

Pupil – Black Colour

Eye Brow – Hair’s Equally Distributed

Ear

Pinna – Curved
Cartilage – Curved

Low Set Ear – Absent

Nose

Mucous Secretion – Present

Nasal Septumderication – Absent

Flat Nasal Bridge – Absent

Mouth

Teeth - Present.All Are In Normal Condition.

Lips -Moist, Bluish Discoloration Due To Cyanosis

Tongue – Light Pinkish

Cleft Lip / Palate - Absent

Neck

Enlargement of Thyroid Gland - Absent

Enlargement Of Lymph Nodes - Absent

Movement Of Neck - Can Move In All Possible Direction

Chest

Inspection - Normal

Percussion - No Evidence Of Fluid Collection .

Palpation - No Palpable Mass Present

Auscultation -Heart Sounds Can Be Heard.

Abdomen

Inspection -edema .

Percussion - Evidence of Fluid Collection.

Palpation - No Palpable Mass Present.Liver And Spleen Are Not Palpable.

Auscultation - Peristaltic Sounds Can Be Heard

Back

Spinal Deformities - No Abnormalities Present

Spina Bifida – Absent

Extremities

Pedal Edema Is Present

Clubbing Of Fingers - absent

Polydectaly - Absent

Syndectaly - Absent

Nail - Fully Developed

Knocked Knee – Absent

Vital Signs

Temperature – 100f

Pulse - 100 Beats / Minute

Respiration - 30 Breath / Minute

DEVELOPMENT ASSESSMENT

S.NO. Major milestones Normal age Achieved at which month

During infancy

1 Social smile 2 month 1.5 month

2 Head raised 3 month 3 month

Turn over 5-8 month 7 month

3
Seat with support 5 month 6 month
4
 Seat without support 8 month 8 month
5
Stood with support 9 month 9month
6

Stood without support 12 month 12 month

7 Walked with support 10 month 10 month

8 Walked without support 13 month 12 month

9 First tooth 5-7 month 7 month

First words 3 month Ma,ma

10
During toddler and pre –school
11
Brushes teeth 3 year 3 year

Washes 5 year 5 year

1
Dresses 4-5 year 4 year
2
Feeds 15 month 15 month
3
Talk in sentences 24 month 26 month

4 Bowel control 2 year 2 year

5 Bladder control 3-5 year 3 year

Growth and development – according to age

I. Physical growth and development

 Gross motor

According to book Seen in patient

 Perform trick on bicycles My patient just do cycling
 Participate in organized sports- My patients play soccer
baseball,soccer
 Throws a ball skillfully He is able to throws ball overhand
  Fine motor

According to book Seen in patient

 Uses both hand independently My patient uses both hand
 Draws a person with 18-20 parts My patient draw a person
 Dress self completely Patient select own dress and wear self
 Handles eating utensils skillfully Patient unable to use utensils in eating

II. Cognitive development

According to book Seen in patient

 Understands explanation and tries to Patient understand what I am say and follow
follow through. instructions.
 Can read simple sentences. Patient can notread sentences
 Tell the differences between right Patient able to tell right and wrong
and wrong differences
 Know what day of the week it is. Patient know about no of day and name of
day in week.

III. Psychosocial development

According to book Seen in patient

 Concerned about relationship with My patient concerned about his parents
others.
 Are impatient. They like My patient can’t wait for things they
immediate gratification and find it want.
hard to wait for things they want.
 Helping when mother is busy and My patient relationship with his cousins is
improve relationship with siblings. good.
IV. Psychosexual development

According to book Seen in patient

 Spends most of time interacting My patient baby varshika spend his time
with same sex peers. with friends.
  Engaging in hobbies and acquiring He is engaging in his hobby playing
skills. football
V. Language development

According to book Seen in patient

 Have well developed speech and My patient use correct grammar.
use correct grammar most of the
time.
 Follow suggestions better than My patient follow suggestion properly.
commands
 Begins to use shorter and more My patient use shorter sentences.
compact sentences.

Investigation

Test In Patient Normal

Haemoglobin 11gm % Male-13-18gm %

Female-11.5-16.5gm %

Wbc 11000/Cumm 4000-11000/Cumm

Lymphocyte 65% 20-45%

Monocyte 01% 1-10%

Neutrophil 55% 40-60%

Eosinophil 01% 1-6%

Basophil 0% 0-1%

Serum Albumin 2mg/Dl 3.5-5mg/Dl

Serum Creatine 2mg/Dl 0.6-1mg/Dl

Serum Cholesterol 250mg/Dl 100-160 Mg/Dl

 Medications

S.N Name Of Drug Dos Rou Ti Side Effect Nursing

o e te me Responsib
ility
1 Inj.Lasix 20 Iv Od Water And Mineral Assess For
mg Loss,MuscleCramps,Weakness, Nausea,
Dizziness And Vomiting
Headache,Hypotension. Monitor
Vital
Signs.
2 Tab.Cyclophosph 50 Oral Bd Hair Assess For
amide mg Loss,Vomiting,Diarrhoea,Mout Vomiting
h Sores And Jaundice Monitor
Vitals
Monitor
Electrolyte
AndBilliru
bin Levels
In Blood
3 Tab.Aldactone 50 Oral Od Gastro-Intestinal Assess For
mg Intolerance,Drowsiness Signs
MaculoPapular Or Ofgastro-
Erythematous Cutaneous Intestinal
Eruption Intoleranc
e
Monitor
Electrolyte
Levels.
Check For
Bleeding
 Disease Condition

Definition

Acute renal failure is traditionally defined as a rapid fall in the rate of glomerular filtration,
which manifests clinically as an abrupt and sustained increase in the serum levels of urea and
creatinine with an associated disruption of salt and water homeostasis.

This definition has several important limitations that have implications for clinical practice.
The terms “rapid,” “abrupt” and “sustained” are not defined. Acute renal failure can evolve
over hours or days, depending on the cause

Chronic renal failure is a condition involving a decrease in the kidneys' ability to filter
waste and fluid from the blood. It is chronic, meaning that the condition develops over a
long period of time and is not reversible. The condition is also commonly known as chronic
kidney disease (CKD)

Anatomy And Physiology

Kidney Nephrons Are The Functional Units Of The Kidneys.

There Are Typically Over 10,000 Kidney Nephrons In Each Of The Two Kidneys In The
Body.

Diagram Of A Kidney Nephron

There Are Two Parts Of A Kidney Nephron: The Renal Corpuscle, And The Renal Tubule.

 Renal Corpuscle

The Renal Corpuscle Is The Part Of The Kidney Nephron In Which Blood Plasma Is Filtered.

The Term "Corpuscle" Means "Tiny" Or "Small" Body. The Renal Corpuscle Of Each
Kidney Nephron Has Two Parts - They Are The Glomerulus, Which Is A Network Of Small
Blood Vessels Called Capillaries, And The Bowman's Capsule (Also Known As The
Glomerular Capsule), Which Is The Double-Walled Epithelial Cup Within Which The
Glomerulus Is Contained.

Within The Glomerulus Are Glomerular Capillaries That Are Located Between TheAfferent
Arteriole Bringing Blood Into The Glomerulus And The Efferent Arteriole Draining Blood
Away From The Glomerulus. The (Outgoing) Efferent Arteriole Has A Smaller Diameter
Than The (Incoming) Afferent Arteriole. This Difference In Arteriole Diameters Helps To
Raise The Blood Pressure In The Glomerulus.
The Area Between The Double-Walls Of The Bowman's Capsule Is Called The Capsular
Space. The Cells That Form The Outer Edges Of The Glomerulus Form Close Attachments
To The Cells Of The Inner Surface Of The Bowman's Capsule. This Combination Of Cells
Adhered To Each Other Forms A Filtration Membrane That Enables Water And Solutes
(Substances That Are Dissolved In The Water/Blood) To Pass Through The First Wall Of
The Bowman's Capsule Into The Capsular Space. This Filtration Process Is Helped By The
Raised Blood Pressure In The Glomerulus - Due To The Difference In Diameter Of The
Afferent And Efferent Arterioles.

In The Renal Corpuscle Blood Is Forced Through The Glomerular Capillaries At Higher
Pressure Than The Pressure At Which The Blood Generally Travels Around The Body (And
Also Into The Kidney Itself). Helped By The Increased Pressure In The Glomerular
Capillaries, A Filtration Process Occurs In Which Some Blood Fluid Is Forced Out Of The
Glomerulus And Into The Capsular Space Of The Bowman's Capsule.

The Fluid That Is Filtered Into The Bowman's Capsule Is Called The Glomerular Filtrate.

 Renal Tubule

The Renal Tubule Is The Part Of The Kidney Nephron Into Which The Glomerular Filtrate
Passes After It Has Reached The Bowman's Capsule. The First Part Of The Renal Tubule Is
Called The Proximal Convoluted Tubule (Pct), Which Is Shown On The Right-Hand Side Of
The Diagram Above.

The Water And Solutes That Have Passed Through The Proximal Convoluted Tubule (Pct)
Enter The Loop Of Henle, Which Consists Of Two Portions - First The Descending Limb Of
Henle, Then The Ascending Limb Of Henle. In Order To Pass Through The Loop Of Henle,
The Water (And Substances Dissolved In It) Pass From The Renal Cortex Into The Renal
Medulla, Then Back To The Renal Cortex. When This Fluid Returns To The Renal Cortex
(Via The Ascending Limb Of Henle) It Passes Into The Distal Convoluted Tubule (Dct),
Which Is Shown On The Left-Hand Side Of The Diagram Above.

The Distal Convoluted Tubules Of Many Individual Kidney Nephrons Converge Onto A
Single Collecting Duct. The Fluid That Has Passed Through The Distal Convoluted Tubules
Is Drained Into The Collecting Duct (Far Left-Hand-Side Of The Diagram Above). Many
Collecting Ducts Join Together To Form Several Hundred Papillary Ducts, There Are
Typically About 30 Papillary Ducts Per Renal Papilla (The Renal Papillae Being The Tips Of
The Renal Pyramids - Which Point Towards The Centre Of The Kidney). At Each Renal
Papilla The Contents Of The Papillary Ducts Drain Into The Minor Calces - The Channels
Through Which The Fluid Passes, Via The Major Calyx, Into The Centre Of The Kidney -
Called The Renal Pelvis.

Causes

ACCORDING TO BOOK PICTURE ACCORDING TO PATIENT

PICTURE

Under 5 yr (most commonly Congenital Absent

abnormalities)
Absent
Renal Hypoplasia

Renal Dysplasia
Absent
Obstructive Uropathy

Congenital Nephrotic Syndrome

Absent
Prune Belly Syndrome

Cortical Necrosis Absent

Polycystic Kidney Absent
Renal Vein Thrombosis Present
Hemolytic Uremic Syndrome Absent
Acquired and inherited disorders)

PATHOPISIOLOGY
Hyperfiltration Injury
 Final common pathway of glomerular destruction

Hypertrophy of remaining nephrons

Increase glomerular blood flow

↑ glomerular filtration in surviving nephrons

Progressive damage to surviving nephrons (due to elevated hydrostatic pressure / toxic effect)

↑ excretory burden on surviving Nephrons

Sclerosis of nephrons

Exerts a direct toxic effect

Infiltration of monocytes / macrophages

Enhancing glomerular sclerosis Hypertension

Signs And Symptoms

ACCORDING TO BOOK PICTURE ACCORDING TO PATIENT

PICTURE
  Dark brown-colored urine (from Present
blood and protein)
 Diminished urine output Present
 Fatigue
Present
 Lethargy
 Growth failure / short stature Present
 Failure of thrive
 Pallor Present
 Edema
 Hematuria Absent
 Proteinuria
Absent
 Polyuria
 Pale skin color Present
 Fluid accumulation in the tissues
(edema) Absent

Absent

Present

Present

Absent

Diagnosis

ACCORDING TO BOOK PICTURE ACCORDING TO PATIENT

PICTURE

 PHYSICAL EXAMINATION : Done

Pallor & sallow appearance Short
stature Bony abnormality of renal
osteodystrophy Edema Hypertension
 LABORATORY FINDINGS :
Elevated BUN and creatinin ↓ GFR Done
Hyperkalemia Hyponatremia
Acidosis Hypocalcemia
Hyperphosphatemia Elevated uric
acid * Hypoproteinemia (if
proteinuria) Normocytic,
normochromic anemia Elevated
serum cholesterol and triglyceride
 Hematuria &
Proteinuria(glomerulonephritis) Done
 Urine tests
Done
 Blood tests
 Electrocardiogram  Done
 Renal ultrasound
 Renal biopsy Done

Done

Treatment

ACCORDING TO BOOK PICTURE ACCORDING TO PATIENT

PICTURE

 Your child's age, overall health, Recorded

and medical history

 Treatment for glomerulonephritis

may include:
 Fluid restriction
 Decreased protein diet
 Decreased salt and potassium diet Done
 Medication, such as:
o Diuretics
o Blood pressure
medications
o Phosphate binders. Given
Medications to decrease
the amount of the mineral
phosphorus in the blood.
o Immunosuppressive agents
 Dialysis

No need
Nursing Management

Nursing Diagnosis

 Weakness Related To Inadequate Intake Of Nutritious Food.

 Anxiety And Fear Related To Disease Condition.
 Knowledge Deficit Related To Disease Condition.
 Activity Intolerence Related To Disease Condition.
 Risk For Infection Related To The Disease Condition.

Nursing Care Plan

Assess Nursing Goal Planning Implementatio Rational Evaluation

ment Diagnosis n
Risk Risk Baby -Hand -Hard -Hand Baby
Of Of Will Washing Washing Washing General
Infectio Infections Not -Use And Maintainin Condition
ns Related Acquire Antiseptic Gloving By g Improving
Related To Infectio Techniques All Personal As
To Disease ns - Give Stuff Hygiene Sign
Disease Condition Antibiotics Before And Of
Conditi - Maintain Handling Aseptic Infection
Personal The Baby Techniques Noted
Hygiene -Treatment Prevent As Vital
-Observe Given Secondary Signs
Or Monitor Under Infection Remained
Signs Aseptic - Antibiotic With
Of Technique. Kill Micro- Normal
Infections - Organism Range
Inj.Amikacin And Temperature
500mg Enhance 36.60c
Twice Daily. Quick Heart Rate
Baby Cord Recovery 142/
Cleaned. Minute
-Mother Respiration
40/Minute

Knowle Knowledg Both Assess Health Health Parent

dge e Father Parents Message Education Showed
Deficit Deficit And Knowledge S Increases Appreciat
 Related Mother By Included. Knowledge Ion
To Baby’s Will The -Keeping And Of
Care Have Asking Baby Helps The
After Adequat What They Clean Always Family Knowled
Hospitaliz e Know -Feeding To Ge
ation Knowle About The On Adjust Gained
Characteri dge Disease Demand With And The
zed On Baby Condition - The New Help
By Care Immunization Born Received
Parent After Of At Home During
Verbalizin Dischar The And The Time
g ge Babyon Provide Of
Indicating Discharge To Good Care Sickness
Lack Prevent From As Of Their
Of Infectious It Also Baby And
Knowledg Diseases Help Also
e On Which Them To Promised
Care Of Are Cope To
Sick Immunisable Well Continue
New -Follow With With
While At Up Less Follow
Home Clinic Problems Ups
At
Paediatric Out
Patient Clinic
After 2 Weeks

Subj Imbalance Patient -To Assess -Patient’s -To Know After These
Data- d Will Be The Condition The Interventions
My Nutrition Able To Condition Assessed Condition Patient Was
Patient Less Than Maintai Of The -Iv Fluids Of The Feeling
Compla Body n Flud Patient Administered Patient Better
ined Requirem And -To Give Iv -Health -To
About ent Electrol Fluids Education Maintain
Weakne Related yte -To Advice Given To The Fluid And
ss To Balance The Parents About Electrolyte
Obj Inadequat Relatives The Supplemen
Data- e Intake To Provide Requirement tation
On Nutritious And Sources -To
Observ Food To Of Nutritious Improve
ation I The Patient Foods The
Found Knowledge
That About
She Is Child
Seem Nutrition
To Be
Dull
Subj. Activity Client -Assess -Assessed The - Client Is Able
Data: - Intoleranc Will Be The Condition Assessment To Do Some
Client e Related Able To Condition -Assisted The Helps To Of Her Daily
 Stated To Do -Assist The Client In Plan The Activities
That He Confinem Some Of Client In Activities Of Proper
Is ent To Her Activities Daily Living. Care.
Having Bed As Daily Of Daily -Promoteed -To
Not Manifeste Activity Living. Ambulation Promote
Able d By As -Promote -Changeed Participatio
To Do Observati Evidenc Ambulatio Position -It
Her on. ed By n Timely Promotes
Activiti Verbaliz -Change -Encouraged Circulation
es. ation Position Client .
Obj. Timely Participation -Promotes
Data: - -Encourage In Daily Circulation
Client Client Activities -
Is Not Participatio Encourage
Able n In Daily d Client
To Do Activities For
Activiti Participatio
es Of n.
Daily
Living.

On Fear & Client -Assess -Assessed The - Patient’s And

Observ Anxiety Will Be The Condition Assessment Parent’s Fear
ation Related Relieved Condition -Provided Helps To And Anxiety
Patient To From -Provide Psychological Plan Care Reduced
And Disease Fear & Psychologi Support. Properly.
Parents Condition Anxiety cal -Clarified All -To
Were As As Support. Doubts. Relieve
Frighte Manifeste Evidenc -Clarify All Explain Fear.
ned & d By ed By Doubts. About -To Reduce
Tensed Observati Verbaliz Explain Disease Fear
on & ation About Condition In -To
Verbalizat Disease Detail. Promote
ion Condition Knowledge
In Detail.

Theory Application

As My Patient Is Only 10 Year Old, She Cannot Care For Herself.Considering Her Disease
Condition And Age I Am Choosing Orem’s Self Care Deficit Theory.

Orem’s Self-Care Deficit Nursing Theory

The Self-Care Deficit Nursing Theory Is A Grand Nursing Theory That Was Developed
Between 1959 And 2001 By Dorothea Orem. It Is Also Known As The Orem Model Of
Nursing. It Is Particularly Used In Rehabilitation And Primary Care Settings Where The
Patient Is Encouraged To Be As Independent As Possible.

Central Philosophy

The Nursing Theory Is Based Upon The Philosophy That All "Patients Wish To Care For
Themselves". They Can Recover More Quickly And Holistically If They Are Allowed To
Perform Their Own Self-Cares To The Best Of Their Ability.

Self-Care Requisites

Self-Care Requisites Are Groups Of Needs Or Requirements That Orem Identified. They Are
Classified As Either:

 Universal Self-Care Requisites - Those Needs That All People Have

 Developmental Self-Care Requisites - 1. Maturational: Progress Toward Higher Level
Of Maturation. 2. Situational: Prevention Of Deleterious Effects Related To
Development.
 Health Deviation Requisites - Those Needs That Arise As A Result Of A Patient's
Condition

Self-Care Deficits

When An Individual Is Very Unable To Meet Their Own Self-Care Requisites, A "Self-Care
Deficit" Occurs. It Is The Job Of The Registered Nurse To Determine These Deficits, And
Define A Support Modality.

Support Modalities

Nurses Are Encouraged To Rate Their Patient's Dependencies Or Each Of The Self-Care
Deficits On The Following Scale:

 Total Compensation
 Partial Compensation
 Educative/Supportive

Universal Self-Care Requisites (Scrs)

The Universal Self-Care Requisites That All Or Health Are:

 Air
 Water
  Food
 Elimination
 Activity And Rest
 Solitude And Social Interaction
 Hazard Prevention
 Promotion Of Normality

The Nurse Is Encouraged To Assign A Support Modality To Each Of The Self-Care

Requisites.

Health Education

1. Adviced The Patient And Relatives About Importance Of Personal Hygiene.

2. Advice Client’s Relative To Give Nutritious Diet Having Low Sodium And Liberal
Pottassium.
3. Health Education Given To The Parents About Nutritious Food.
4. Instructions Given ToNthe Parents About The Right Time Of Immunization.
5. Advised The Parents To Inform Physician If Any Complication Occurs.
6. Advices Client’s Attendant Or Relative The Techniques To Clam The Agitated
Client.
7. Advice Client’s Relatives For Follow Up Care
 Bibliography

1.Dorothy R Marlow & Barbara A Redding;

The Text Book Of Pediatric Nursing;6thEdition;Page No:500-502.

2.Achar’s;

The Text Book Of Pediatrics;4thEdition;Page No:154-157.

3.Jaypees;Nurse’s Dictionary;3rdEdition;Page No:54.

4.Brunner AndSuddharth’s;

Text Book Of Medical Surgical Nursing;10thEdition;Page No:1540-1542.

 Ritee college of nursing
Clinical presentation on acute and chronic failure