SAINT LOUIS UNIVERSITY SCHOOL OF NURSING

F and E Assignment

SUBMITTED TO:
Maam Angiwan Instructor

SUBMITTED BY: Marion Liana M. Dayrit SLU-BSN IV-B2

November 25, 2013

A. COMPARISON OF FEATURES OF ACUTE GLOMERULONEPHRITIS AND NEPHRITIC SYNDROME

CRITERIA DESCRIPTION

ACUTE GLOMERULONEPHRITIS Inflammation of the glomerular capillaries it is a primarily disease of children older than 2 years of age

NEPHROTIC SYNDROME a group of symptoms caused by the excretion of large amount of protein in the urine due to kidney impairment altered glomerular permeability due to the fusion of glomerular membrane surfaces, causes abnormal loss of protein in the urine highest incidence at 3 years of age and occurs more often in boys than in girls three forms: a. congenital autosomal recessive disorder b. secondary progression of glomerulonephritis or in connection with systemic diseases such as sickle cell anemia or SLE c. idiopathic (primary) most common Idiopathic possibly a hypersensitivity reaction or an autoimmune process, T-lymphocyte dysfunction

ETIOLOGY

usually occurs as an immune complex disease/immune reaction after infection with nephritogenic streptococci (most commonly subtypes of group A betahemolytic streptococci In some, antigens outside the body initiate the process resulting in antigen-antibody complexes being deposited in the glomeruli. hematuria (blood in the urine)indicates glomerular injury proteinuria (primarily albumin, due to the increased permeability of the glomerular membrane) hypoalbuminemia mild anemia oliguria edema hypertension In more severe form, patient may have headache, malaise and flank pain Tenderness in the CVA( costovertebral angle) Elderly patientsdyspnea, engorged neck veins, cardiomegaly and pulmonary edema (circulatory overload) Cerebral ischemia

SIGNS AND SYMPTOMS

Proteinuria Edema (periorbital, scrotal, intestinal causing diarrhea ) Ascites Hypoalbuminemia Hyperlipidemia (high serum cholesterol and high LDLs Headache Irritability Malaise fatigue

DIAGNOSTICS

Increased erythrocyte sedimentation rate elevated urine specific gravity Rise in serum creatinine and BUN ECG changes such as T-wave inversion and prolongation of PR interval Electron microscopy and immunofluorescent analysis identify nature of the lesion Kidney biopsy for definitive diagnosis Antistreptolysin O or anti-DNase B titers elevated in post streptococcal glomerulonephritis Antibiotics (penicillin) Antihypertensives (Calciumchannel blockers Loop diuretics Furosemide (Lasix) Coricosteroids may be given to pts with progressive acute glomerulonephritis For rising phosphate and potassium levels a. Phosphate binders (aluminum hydroxide) to reduce phosphate absorption in the GI tract b. Potassium-removing resin agent (sodium polystyrene sulfonate kayexelate) Protein intake restriction (if there is renal insuffiency and nitrogen retention Sodium restriction (if pt has hypertension, edema and heart failure If heart failure occurs: (symptomatic therapy) - Semi-fowlers position - digitalization - oxygen administration Weigh daily Calculate input and output

Protein electrophoresis and immunoelectophoresis categorize type of proteinuria Needle/renal biopsy to determine presence of scarring of the glomerular membrane and document type of nephritic syndrome Anti-C1q antibodies most reliable markers for assessing disease activity in lupus nephritis

MANAGEMENT

Corticosteroids(prednisone therapy Antihypertensives (ACE inhibitors such as Captopril) Diuretics Antineoplastic agents such as cyclophosphamide (cytoxan) Immunosuppressant such as Chlorambucil(leukeran), Azathioprine (Imuran), and cyclosporine Low sodium and liberal-potassium diet to enhance sodium-potassium pump mechanism Protein intake should be about 0.8 g/kg/day, high biologic proteins such as dairy products, eggs, and meat) Supplemental potassium and foods high in potassium

B. BENIGN PROSTATIC HYPERPLASIA (BPH) CRITERIA DESCRIPTION

BENIGN PROSTATIC HYPERPLASIA Prostate gland enlarges, extending upward into the bladder and obstructing the outflow of urine by encroaching in the vesical orifice. One of the most common pathologic conditions among older men. Caused by hormones that initiate hyperplasia of supporting stromal tissue and the glandular elements in the prostate. Incomplete emptying of the bladder Acute urinary retention (more than 60 mL of urine remains in the bladder after urination) Increased frequency of urination Nocturia Urinary urgency Hesitancy in starting urination Abdominal straining with urination Decrease in the volume and force of the urinary stream Interruption of the urinary stream Dribbling (urine dribbles out after urination Azotemia ( accumulation of nitrogenous waste products Renal failure Digital rectal exam (DRE) determines the degree to which the prostate is enlarged, the presence of any bladder wall changes, and efficiency of renal function. Urinalysis and Urodynamic studies - to assess urine flow Renal function tests including Serum creatinine levels to determine presence of renal impairment for prostaticback pressure - to evaluate renal reserve Complete blood studies to correct all clotting defects TURP (Transurethral Resection of the Prostate) surgical procedure that remove portions of the prostate gland through the penis. TUIP ( Transurethral Incision of the Prostate) - Prostate surgery done to relieve moderate to severe urinary symptoms caused by prostate enlargement. Watchful waiting appropriate treatment wherein patients are monitored periodically for severity of symptoms, physical findings, laboratory tests and diagnostic urologic tests. Alpha-adrenergic receptor blockers such as Terazosin(Hytrin) relaxes the smooth muscle of the bladder neck and prostate. It helps reduce obstructive symptoms Anti-androgen agents or 5-alpha reductase inhibitors such as Finasteride (proscar) prevents conversion of testosterone to DHT (dihydrotestosterone). Decreased

ETIOLOGY

SIGNS AND SYMPTOMS

DIAGNOSTICS

MANAGEMENT

levels of DHT demonstrates suppression of glandular cell activity and decreases in prostate size Transurethral Needle Ablation uses low level radiofrequencies to produce localized heat to destroy prostate tissue while sparring the urethra, nerves, muscles and membranes. Radiofrequencies are delivered by thin needles placed into the prostate gland from a catheter. The body then reabsorbs the body tissue. Microwave thermotherapy heat is applied into the hypertrophied prostatic tissue. A transurethral probe is inserted into the urethra, and microwaves are carefully directed into the prostatic tissue. A water-cooling system helps to minimize damage to the urethra and decreases the discomfort from the procedure. The tissue becomes necrotic and sloughs off. Saw Palmetto a botanical remedy used for symptoms of mild to moderate BPH such as urinary frequency and decreased force of urine stream. It works by directly blocking the ability of DHT to stimulate prostate cell growth and should not be used with Finasteride.

C. UROLITHIASIS