UNIVERSIDAD DE MANILA

Arroceros St., Corner Palma St.,

Mehan Garden, Manila

ACUTE GLOMERULONEPHRITIS
(AGN)

In Partial Fulfillment of the Requirement

For the subject Related Learning Experience

Submitted to:

Isabela Demillo, RN
Clinical Instructtor

Submitted by:

Kristine Pangindian
Nr-42
INTRODUCTION

Acute Glomerulonephritis (AGN) is an inflammation of the internal kidney structures

(glomeruli). Glomeruli itself has functions to help filter waste and fluids from the blood.
This disease leads to proliferative and inflammatory changes within glomerular structure,
as well as, destruction, inflammation and sclerosis of the glomeruli of both kidneys.

A thorough history should focus on the identification of an underlying systemic disease (if
any) or recent infection. Most often, the patient is a boy, aged 2-14 years, who suddenly
develops puffiness of the eyelids and facial edema in the setting of a poststreptococcal
infection. The urine is dark and scanty, and the blood pressure may be elevated. Onset
of symptoms is usually abrupt. Nonspecific symptoms include weakness, fever,
abdominal pain, and malaise. Symptoms of acute glomerulonephritis include the
following: Hematuria (a universal finding, even if it is microscopic. Gross hematuria is
reported in 30% of pediatric patients.), Oliguria, Edema (peripheral or per orbital is
reported in approximately 85% of pediatric patients; edema may be mild (involving only
the face) to severe, bordering on a nephrotic appearance.), Headache (may occur
secondary to hypertension; confusion secondary to malignant hypertension may be seen
in as many as 5% of patients.), Shortness of breath or dyspnea on exertion secondary to
heart failure or pulmonary edema (usually uncommon, particularly in children.), possible
flank pain secondary to stretching of the renal capsule, decreased urinary output,
anorexia, pallor, irritability and lethargy, proteinuria, azotemia, increased blood urea
nitrogen and creatinine levels and Antistreptolysin O titer.

ASSESSMENT
General Data
Name: Canlos Pinca Jr.
Age: 13 y/o
Gender: Male
Address: 551 Pampanga Streer Tondo Manila
Date of Birth: Febuary 2, 1997
Civil Status: Single
Religion: Roman Catholic
Nationality: Filipino
Dialect: Tagalog
Date of Admission: September 16, 2010
Diagnosis: t/c AGN

Chief Complaint
-facial edema

History of Present Illness

-The client was brought to the hospital due to facial edema. Four months prior to
admission, onset of edema with no other associated symptoms noted. Two months prior
to admission, persistence of facial edema associated with pallor. A month prior to
admission, pain in the abdomen and pallor and decreased urine output (2 time per day)
was noted which prompted patient to seek medical consultation.

Family History of Past Illness

-Asthma (father)
-AGN, UTI (mother)

Vital Signs
BP: 130/100 mmHg
Temperature: 37.1
Heart rate: 70 bpm
Respiratory rate:32 cpm
PHYSICAL EXAMINATION
-(+) per orbital edema
-(+) scabs both hands
-(+) bipedal edema
-(+) abdominal pain

Gordon’s Functional Health Pattern

Nutrition

During pre-hospitalization, the client used to eat junk foods which

are high sodium.
 During hospitalization, Patient X was on a low salt diet. He
consumed whole share with good appetite. The client seldom drinks water
and was not taking in any vitamins. The client is not hooked in any
intravenous fluid.

Elimination Pattern

Pre-hospitalization, Patient X defecates once to twice daily with

formed, brownish stool and soft in consistency. No discomfort felt during
defecation but during hospitalization, the client has difficulty in defecating,
thus, making him at risk to have constipation.

Pre-hospitalization, a month before the admission to the hospital,

client has difficulty urinating thus, decreasing the urinary frequency from
6-8 times to 3 times per day. It’s dark yellow in color.

Activity -Exercise Pattern (pre – hospitalization)

Patient X is incorporating his exercise when walking going to

school every morning and he’s going home from the school. Playing is his
leisure activity together with few of his friends.

Activity-Exercise Pattern (while confined)

Describe the patient’s functional abilities

Feeding: independent

Bathing: independent
 Toileting: independent

Bed mobility: independent

Dressing: independent

Grooming: dependent

General mobility: independent

ROM: independent

Ambulation: independent

The patient can do independently all activity- exercise but then, it

is limited and controlled due to disease condition and client prefer to stay
in the bed than ambulating. Toileting was done in the bedside only like
urinating except defecating and don’t take a bath during hospitalization
rather, his mother cleans wipe out dirt in the body which made him
dependent in Grooming.

Cognitive-Perceptual Pattern
Patient X understands and speaks Tagalog language. Patient is an
elementary student without any learning difficulties.

Sleep -Rest Pattern

Pre-hospitalization, Patient X usually sleeps for 8-9 hours. He
doesn’t have any sleep disturbances but while confine, he verbalized
problem of sleeping disturbances at night.
 Self-perception and Self-concept Pattern
Patient X says that he is a good and jolly person.

Role-Relationship Pattern
His family specifically his mother and sister are the one who
helped him during hospitalization. His father and other members in the
family are not around because it requires money in order for them to visit
at the hospital.

Coping -stress Tolerance Pattern

Patient X seldom experience any stress, but whenever he has, he
subject his self in sleeping.

Value -Belief Pattern

Patient X is a Roman Catholic. Seldom goes to church. The client
also prays frequently as part of his religious practices.

ANATOMY AND PHYSIOLOGY

KIDNEY

The kidneys are a pair of bean-shaped organs that lie on either side of the spine in the
lower middle of the back. Each kidney weighs about ¼ pound and contains
approximately one million filtering units called nephrons. Each nephron is made of a
glomerulus and a tubule. The glomerulus is a miniature filtering or sieving device while
the tubule is a tiny tube like structure attached to the glomerulus.
The kidneys are connected to the urinary bladder by tubes called ureters. Urine is stored
in the urinary bladder until the bladder is emptied by urinating. The bladder is connected
to the outside of the body by another tube like structure called the urethra.

The main function of the kidneys is to remove waste products and excess water from the
blood. The kidneys process about 200 liters of blood every day and produce about two
liters of urine. The waste products are generated from normal metabolic processes
including the breakdown of active tissues, ingested foods, and other substances. The
kidneys allow consumption of a variety of foods, drugs, vitamins and supplements,
additives, and excess fluids without worry that toxic by-products will build up to harmful
levels. The kidney also plays a major role in regulating levels of various minerals such as
calcium, sodium, and potassium in the blood.

* As the first step in filtration, blood is delivered into the glomeruli by microscopic leaky
blood vessels called capillaries. Here, blood is filtered of waste products and fluid while
red blood cells, proteins, and large molecules are retained in the capillaries. In addition
to wastes, some useful substances are also filtered out. The filtrate collects in a sac
called Bowman's capsule.

* The tubules are the next step in the filtration process. The tubules are lined with
highly functional cells which process the filtrate, reabsorbing water and chemicals useful
to the body while secreting some additional waste products into the tubule.

The kidneys also produce certain hormones that have important functions in the body,
including the following:

* Active form of vitamin D (calcitriol or 1,25 dihydroxy-vitamin D), which regulates

absorption of calcium and phosphorus from foods, promoting formation of strong bone.

* Erythropoietin (EPO), which stimulates the bone marrow to produce red blood cells.

* Renin, which regulates blood volume and blood pressure.

PATHOPHYSIOLOGY

Predisposing factors Precipitating factors

Age: 5-10 y/o B hemolytic streptococci
Gender: Male Post infection
 Poor intake of vit. rich food
Post-streptococcal infection
(group-A, beta hemolytic)
⇓
Microorganism circulate in the bloodstream
⇓
Deposition of antigen-antibody complex glomerulus
⇓
Acute inflammation and damage within the nephrons including the glomerulus
⇓
Proliferation of endothelial cell lining of the glomerular capillary
⇓
Leukocyte infiltration of the glomerulus
⇓
Thickening of the glomerular filtration membrane
⇓
Scarring and loss of glomerular filtration membrane
⇓
↓ Glomerular filtration rate
⇓
Facial edema
Abdominal pain
Increase BP
Decrease RBC
Weight loss
Dyspnea
⇓
ACUTE GLOMERULONEPHRITIS
DISCHARGE PLANNING/ HEALTH TEACHINGS
MEDICATIONS
• Explain to the patient and family members the importance of taking
medicines.
• Discuss to the patient and family the dosage, frequency and adverse
effects of
the drugs.
.
Economic status
• Explain to significant others that the rehabilitation may be prolonged
to be able
for the family to prepare financial needs
• Inform the patient to avail to some government programs such as
Philhealth.

Treatment
• Tell the patient that he should have self-monitoring by checking his
vital signs
and weighing regularly.
• . Encourage/instruct to keep the edematous extremities to
elevate as often
• Limit of water intake; monitor intake and output
• Provide warm environment

HEALTH TEACHINGS
• Instruct the patient to take medications religiously.
• Improve nutritional status.
• Importance of proper hygiene for comfort.

OUT-PATIENT
• The patient could avail his medication from government hospitals
that he could
get some benefits.
• He will also be able to avail the services offered by the barangay
health center
and and at the “Botika ng barangay”.
• Instruct patient to seek regular medical check-up
DIET
• Eat five or more servings of vegetables and fruit daily.
• Intake of fluids 8-10 glasses a day to avoid constipation and to
maintain skin
turgor.
• Instruct patient to eat low fat and low sodium foods that will help not
worsen condition that is ordered by the physician.