Glomerulonephritis is a type of kidney disease that damages the kidneys' ability to remove waste and excess fluids.

Also called glomerular disease, glomerulonephritis can be acute a sudden attack of inflammation or chronic coming on gradually. Most original research focuses on the poststreptococcal patient. Acute glomerulonephritis (AGN; also called Glomerular Disease) is an inflammation of the glomeruli, bundles of tiny vessels inside the kidneys, which predominantly affects children aging two to twelve. The damaged glomeruli cannot effectively filter waste products and excess water from the bloodstream to make urine. The kidneys appear enlarged, fatty, and congested. Around two to three weeks after a streptococcal infection, symptoms of Acute Glomerulonephritis may occur and begin with swelling. This could progress to an increase in blood pressure, visual disturbances, shortness of breath, blood in the urine, and a reduction of urine production. II. NURSING ASSESSMENT A. PERSONAL DATA The patient, Christy, is a 4-year old little girl who was born on May 11, 2007. According to Mrs. Tita, who is the auntie of Christy and the researchers informant, Christy is the fourth child of Mr. and Mrs. U, the parents of Christy. She also has three older sisters and 2 younger siblings. Christy resides in Mt. View, Balibago, Angeles City, Pampanga. This is also the place where she was born and spent her first four years of life. She is born Filipino, and her religion is Roman Catholic. Around 11:30pm, January 1, 2012, she was admitted to a secondary hospital in Angeles City with chief complaint of hematuria, fever and vomiting. She was diagnosed Acute glomerulonephritis and was brought for confinement to the pedia ward of the said hospital. After 5 days of confinement, she was discharged last January 5, 2012. GROWTH AND DEVELOPMENT Sigmund Freuds Psychoanalytic Theory. In this theory, the development of a child is described as being a series of psychosexual stages in which the childs interests become focused on a particular body site. Since Christy is now 4 years old, she is in the Phallic stage. In this stage, a child learns sexual identity through awareness of genital area, and children play with their bodies largely out of curiosity. Also, this phase is where the Oedipus/Electra complex. The researchers observed that Ana often would ask if her father would come to see or to stay with her in the hospital. Erik Eriksons Psychosocial Development. This theory considers the importance of culture and society in personality development. Moreover, the successful resolution of each conflict, or accomplishment of the developmental task of that stage, allows the individual to go on the next phase of development. Christy is on stage of Initiative versus Guilt. In here, the child learns to do things and find doing these things desirable. The crisis at this time, according to E. Erikson, is the development of selfconcept. She solves problems in accordance to her consciousness and she knows and wants to solve her little problems by her own. She also likes to explore new places and do activities involving water like helping her mother at home in washing dishes although she does not know how to do it properly. However, during her hospitalization, she relied totally on her auntie when it comes to food choices or other little decisions which she can solve in her non-illness state. Her enthusiasm when it comes to exploring new places or new things was lessened during her illness state. She wanted to stay in bed most of the time. Cognitive development of Piaget. According to his theory, to progress from one period to the next, the child recognizes his or her think process to bring them closer to reality. Christy is now on her Preoperational thought. A child still has an immature perception and is often influenced by role fantasy. They do not understand relationships and they learn through trial and error. She likes being read stories about animals and children; she believes that her dreams are real as day-time events; and she also believes that her wishes will come true and that they are real. Kohlbergs theory of Moral Development helps to identify how a child might feel about an illness, whether the child can be depended on to carry out self-care activities, or whether the child has

internalized standards of conduct so he or she does not cheat when away from external control. Christy is in the Preconventional stage. During this stage, a child tends to do good out of self-interest rather than out of true intent to do good or because of strong spiritual motivation. The moral behavior developed in this stage is taking turns at play or sharing. She offered a slice of apple to the other patient beside her when Mrs. Tita was feeding her. Furthermore, she usually imitates what she sees. 5. HISTORY OF PRESENT ILLNESS The common foods eaten by Christy are junk foods that are rich in sodium or salt content, such as Tempura, Lala crackers, chips, and so on. She also prefers to drink carbonated drinks like colas or Sprite, and she has minimal water intake amounting to 15-30mL per day, as cited by Mrs. Tita. She urinates at a maximum of 3 times a day. She also likes to play outside the house. Sometimes, she is not able to take a shower at night and even brush her teeth before going to bed. A week prior to admission, Christy experienced fever of 40C with cough at night. She also experienced fever the same high grade fever the following nights. In the next day, she was rushed to the OPD of the same hospital and was given with antibiotic and antipyretic. 1 day prior to admission, she experienced vomiting and fever. She was given with paracetamol and was relieved. 3 hours prior to admission, she experienced hematuria which prompted the family to bring her again to the hospital. At January 1, 2012, 11:30pm, she was admitted in the pedia ward of the secondary hospital with a diagnosis of acute glumerulonephristis. B. Synthesis of the Disease (Patient based) 1. Definition of the Disease Christy was diagnosed with acute glomerulonephritis (AGN) which refers to a syndrome of disorders characterized by an abrupt onset of hematuria and proteinuria in conjunction with azotemia and renal sodium and water retention. There are several etiologies that can be linked to the development of AGN. In the patients case, it is the High Sodium diet (junk foods and carbonated drinks) triggers the occurrence of acute glumerulonephritis. 2. Non-modifiable and Modifiable Factors Non-modifiable y Age. Christy is four years old. The age bracket for children at risk of developing AGN is two to twelve.

Modifiable y Diet: Increase sodium and fat intake. Sodium consumption can be an important factor in the development of hypertension. Excessive amounts of salt encourage increased release of natriuretic hormone that may indirectly increase blood pressure. Sodium loading also stimulates the vasopressor mechanisms within the central nervous system. Furthermore, this kind of diet increases sodium and water retention in the blood which in turn increases peripheral vascular resistance resulting to decrease in renal perfusion. On the other hand, high fat diet promotes accumulation of fats in the blood vessels that narrows the lumen leading also to decrease perfusion in the kidneys. Christy likes to eat foods that are rich in sodium particularly junk foods. y Decreased knowledge/awareness. Acute glomerulonephritis usually occur because of untreated or undetected infections. This failure often results from lack of knowledge or awareness about the disease condition, the proper management for its alleviation or even the possible complications that may arise. On the case of the patient, her significant others have not done any management in order to treat the throat infection she experienced which is regarded to be one of the main factors why she developed AGN. y Low socioeconomic status. This may contribute to the disease because low income results to poor choice of food or diet which is usually high in salt and fat. More so, because of insufficient earnings, there will be prioritization as to where the money of the family goes. Most of the time, health care costs are compromised which makes them unable to access health care services or to avail essential and prescribed treatments.

3. Signs and Symptoms  Urinary changes  Proteinuria or Albuminuria. (01-03-2012) Proteinuria or albuminuria results from the increased permeability of the glomerular wall which then allows the passage of substances that were previously restricted to enter the glomerular space. Hence, proteins come with the urine and give it a cloudy or turbid appearance.  Hematuria. (01-01-12 to 01-03-12) This is also due to the increased permeability of the glomerular wall leading to passage of Red blood cells that are normally restricted to enter the glomerular space. Hematuria can be gross or microscopic and is usually revealed by reddish or tea-colored urine.  Oliguria. (01-01-12) Because proteins which play important role in the oncotic pressure are excreted, there will be shifting of fluids from the intravascular to the interstitial spaces resulting to fluid retention. This then will cause a decrease in blood volume (hypovolemia). In hypovolemia, there is a reduction in blood supply and therefore perfusion in the different parts of the body. Low renal perfusion means that there will be less amount of blood being filtered which in turn results to less urine output or oliguria. Hematologic changes  Normocytic, Normochromic anemia; Decreased Hemoglobin; Decreased hematocrit. (01-0112) Due to the increased permeability of the glomerular wall, Red blood cells are able to pass through the glomerular wall. This results to decrease in number of erythrocytes in the blood leading to anemia, low hemoglobin and low hematocrit.  Leukocytosis. (01-01-12) During inflammatory process, the body tries to boost the production of white blood cells in order to eliminate infection. Cardiovascular changes  Hypertension. Because of decreased renal perfusion along with decreased glomerular filtration rate, the Renin-angiotensin-aldosterone system was stimulated. In here, Angitensiotensin II, a vasoconstrictor, is formed from the conversion of Angiotensin I by Angiotensin-Converting Enzyme. Vasoconstriction increases peripheral vascular resistance which results to Hypertension. Respiratory changes  Tachypnea. Because of hypertension, the body tissues do not receive enough oxygen. With this, the respiratory system tries to compensate by increasing the rate of respiration. Integumentary changes  Edema. The loss of plasma proteins in the urine caused a decrease in the oncotic pressure which eventually resulted to shifting of fluids from the intravascular to the interstitial spaces. More so, the activation of renin-angiotensin-aldosterone system brought by decreased renal perfusion contributed to the fluid retention as because aldosterone secretion was stimulated. Neuromuscular changes  Weakness. Normocytic, normochromic anemia may develop due to the significant loss of erythrocytes in the urine. With this, there will be reduced perfusion to the body tissues. The patient typically experience weakness or easy fatigability. Others  Fever. During inflammation, there is an increased production of white blood cells in the body. With this, the release of pyrogens will be stimulated which in turn affects the brains hypothalamus thermoregulation center to increase the production and conservation heat. Hyperthermia or fever results.

4. Health Promotion and Preventive Aspects of the Disease Sufficient health teachings to Christys SO could cause an increase in knowledge or awareness about AGN. Also, the factors that have contributed to the development of the disease condition may have been reduced too. She could have changes in lifestyle, primarily by eating nutritious foods instead of junk foods and fresh foods instead of the canned and preserved ones.

CONCLUSION Acute glomerulonephritis refers to a specific set of renal diseases in which an immunologic mechanism triggers inflammation and proliferation of glomerular tissue. Hippocrates originally described the manifestation of back pain and hematuria, which lead to oliguria or anuria. With the development of the microscope, Langhans was able to describe the corresponding glomerular changes. Most original research focuses on the poststreptococcal patient. Acute glomerulonephritis is currently described as a clinical syndrome that frequently manifests as a sudden onset of hematuria, proteinuria, and red cell casts. This clinical picture often is accompanied by hypertension, edema, and impaired renal function. As a student nurses, they should be knowledgeable enough regarding the diseases. However, learning through lectures and theories is not enough to completely understand these diseases. Through interaction, knowledge acquired from theories was much appreciated by the students since he/she can actually assess the patients condition. With enough information and enhance skills, she/he may be able to handle future situations and patients suffering from the mentioned condition.

7. DIAGNOSTIC AND LABORATORY PROCEDURES Blood Chemistry Diagnostic or Laboratory Procedures Creatinine

Date Ordered, Date Results

Indications or Purposes

Results

Normal Values

Analysis and Interpretation

Date Ordered: January 1, 2012

Date Results in: January 2, 2012

This is to reveal if there is alteration with the excretory function of the pt.s kidney and it suggests its chronicity since it tends to rise in the later part of the disease condition.

143 mmol/l

62-106 mmol/l

The result is above the normal range. It suggests that the condition has worsen since elevation in the creatinine level indicates chronicity of the condition.

Diagnostic or Laboratory Procedures Urinalysis

Date Ordered, Date Results 1st Date Ordered: January 1, 2012 Date Results in: January 1, 2012

Indications or Purposes

Results

Normal Values

Analysis and Interpretation

Urinalysis is done to check for early signs of glomerulonephritis. It may also be used to monitor and further evaluate the condition of the patients kidney since she had teacolored urine.

Color:

Reddish

Color: Light yellow to Amber yellow

The result shows an abnormality in patients urine color, which indicates presence of blood in the patients urine since it is tea-colored (January 1, 2012). This is due to the altered glomerular function which increases membrane permeability and allow the passage of erythrocytes. The urine is cloudy which is due to the presence of albumin (+2). This is due to the loss of plasma albumin in the blood which causes the urine to become turbid. The specific gravity is within normal limit, which indicates normal concentration of urine particles. It demonstrates that the kidney has the still capability to concentrate urine since the degree of glomeruli damage is not yet severe. The result is within normal which

Transparency: Cloudy

Transparency: Clear

Specific Gravity: 1.010

Specific Gravity: 1.010-1.030

pH: 6.0

pH: 4.6-8.0

reflects that the kidney has the ability to maintain normal pH homeostasis. In addition, it proves absence of acidosis and alkalosis as because the kidneys are still able to compensate. Glucose: (-) Negative Glucose: (-) Negative The result is normal, wherein there is no presence of glucose in the urine. This reflects that the kidney has the ability to reabsorb glucose in the proximal renal tubule. Presence of albumin (+2), the main protein in the human blood, was noted. This indicates injury or changes with the glomerular membrane which results to increased permeability and therefore allowing proteins to seep out into the filtrate and then into the urine. There is fluid shifting from intravascular to interstitial spaces which causes fluid retention. There is accumulation of fluid in the facial area (December 31, 2011) and in the periorbital area (December 31-January 2, 2012). The result is abnormally elevated which shows an injury in the glomerular membrane which increases in size and allows the passage of large molecules like RBCs. This caused a decreased in the hemoglobin: 110g/dL hematocrit: 0.27 g/dL and RBCs: 3.85x 12 12/L (January 1, 2012) The urine was found to have pus cells. This result suggests infection. The patient experienced hyperthermia of 39.1 C (January 1, 2012). The result is within normal which shows an absence of tubule cell

Albumin: +2

Albumin: None

RBC: Too many to count/hpf

RBC: <2/hpf

Pus Cells: 3-6

Pus Cells: None

Epithelial cells: Few

Epithelial cells:

Few Color: Reddish Color: Light yellow to Amber yellow

injuries. The result shows an abnormality in patients urine color, which indicates presence of blood in the patients urine (January 1-3, 2012). This is due to the altered glomerular function which increases membrane permeability and allow the passage of erythrocytes. The urine is turbid which is due to the presence of albumin (+2). This is due to the loss of plasma albumin in the blood which causes the urine to become turbid. The specific gravity is within normal limit, which indicates normal concentration or urine particles. It demonstrates that the kidney has the capability to concentrate urine. The result is within normal which reflects that the kidney has the ability to maintain normal pH homeostasis. In addition, it proves absence of acidosis and alkalosis. The result is within normal, wherein there is no presence of glucose in the urine. This reflects that the kidney has the ability to reabsorb glucose in the proximal renal tubule. Presence of albumin (+2), the main protein in the human blood, was noted. This indicates injury or changes with the glomerular membrane which results to increased permeability and therefore allowing proteins to seep out into the filtrate and then into the urine. And there is loss of plasma albumin in the blood.

Transparency: Turbid

Transparency: Clear

Specific Gravity: 1.012

Specific Gravity: 1.010-1.030

pH: 6.0

pH: 4.6-8.0

2nd Date Ordered: January 3, 2012 Date Results in: January 4, 2012

Glucose: (-) Negative

Glucose: (-) Negative

Albumin: +2

Albumin: None

RBC: over 100/hpf

RBC: <2/hpf The results is abnormally elevated which shows an injury in the glomerular membrane which increases in size and allows the passage of large molecules like RBCs.

Pus Cells: 1-2 Epithelial cells: Few

Pus Cells: None The urine was found to have pus cells. This result suggests infection. Epithelial cells: Few The result is within normal which shows an absence of tubule cell injuries.

Complete Blood Count Diagnostic or Date Ordered, Date Laboratory Results Procedures Complete Blood Date Ordered: Count January 1, 2012

Indications or Purposes

Results

Normal Values

Analysis and Interpretation

Date Results in: January 1, 2012

The complete blood count is a series of tests of the peripheral blood that provide a tremendous amount of information about the hematologic system and many other organ systems. This test was ordered in order to detect any deviations which could be significant with the patients disease or could suggest development of other significant conditions that may or may not be because of the patients disease.

Hgb: 110

Hct: 0.27

RBC: 3.85

*Hemoglobin (Hgb)

This is to measure the total Hgb in the blood in the peripheral blood. It is used as a rapid indirect measurement of the red blood cell.

Hgb: 120-170g/dL

WBC: 17.6

The result is below the normal limit. It indicates that the patient does not have a sufficient volume of red blood cell. This is due to the passage of red blood cell in the urine. The patient experienced weakness (January 13, 2012). Based from the result, the hematocrit level of the patient is below the normal limit. It indicates that there is a low a concentration of red blood cells within the blood volume and due to retention of fluid, thus causing dilutional anemia. There is fluid shifting from intravascular to interstitial spaces which causes fluid retention. There is accumulation of fluid in the facial area (December 31January 3, 2012) and in the periorbital area (January 1-3, 2012).

Hematocrit (Hct)

It is an indirect measurement of red blood cell number and volume.

Hct: 0.37-0.54

Platelets: 300

Erythrocyte (RBC)

This test is to count for number of circulation of red blood in the peripheral venous blood. It determines the total number of circulating WBC per cubic mm in the blood. It is used to detect for infection and an indicator of immune function.

RBC: 4.0-5.0 x 12x12/L Lymphocytes: 0.54

The result shows below the normal level due to the continuous passage of red blood cell in the urine which is known as hematuria.

Leukocytes (WBC)

WBC: 5.10 x 10^9/L

The result is above normal limit, this indicates inflammatory process. The patient had hyperthermia of 39.1 C (January 2012).

Platelets

The platelet count is done to determine the actual count of the number of platelets (thrombocytes). This is to assess the clotting ability of the

Segmenters: 0.46

Platelets: 150-450 x 10/L

Based from the result, the platelet count of the patient is within the normal limit. It indicates that the patient has enough platelet production and is at lesser risk for bleeding. Platelets are responsible for the clotting mechanism of blood in case of injury to the body tissues.

blood.

Lymphocytes

Lymphocytes are white blood cells of the agranulocyte type, originally from stem cells, that produce antibodies and attack harmful cells. The test of lymphocyte is to evaluate chronic bacterial and acute viral infection. It is used to help diagnose conditions associated with acute and chronic inflammation, including infections.

Lymphocytes: 0.20-0.40

An increased level of lymphocytes indicate presence of immune response to combat infection.

Segmenters

Segmenters: 0.50-.0.70

Based on the result, the segmenters are below the normal range.

MEDICAL MANAGEMENT 1. Intravenous Fluids DATE ORDERED MEDICAL DATE PERFORMED MANAGEMENT DATE CHANGED or OR TREATMENT D/C D5 0.3 Nacl 500 cc x KVO Date Ordered: January 1, 2012 Date Performed: January 1-5, 2012 Date Discontinued: January 5, 2012

A.

GENERAL DESCRIPTION

INDICATIONS OR PURPOSES

CLIENTS RESPONSE TO THE TREATMENT

D5 0.3 Nacl is a D5% 0.33NACL, a hypertonic solution. A solution with a higher salt concentration than in normal cells of the body and the blood When hypertonic fluids are infused, osmosis pulls water out of the cells. This causes the cells to shrink. When they shrink at the site of IV infusion, the basement membrane of the lining of the vein is exposed.

Used only when high sodium and/or chloride content without large amount of fluid is required (e.g. electrolyte and fluid loss replaced with sodium-free fluids, excessive water intake resulting in drastic dilution of body water, emergency treatment of severe salt depletion.

The clients edema was decreased AEB from 13.5 kg to 12.9 kg.

b. Drugs Name of the drugs; Generic name and Brand name 1. Generic Name: Paracetamol

Date Ordered; Date performed; Date Changed or Date Discontinued Date Ordered: January 1, 2012 Date Performed: January 1, 3, 2012

Route, Dosage, and Frequency 135 mg IV q 4 PRN if T >37.8 C

General Action and Mechanism of Action Classification: Antipyretics Analgesic Action: Reduces fever by acting directly on the hypothalamic heatregulating center to cause vasodilation and sweating, which helps dissipate heat.

Indication or Purpose

Client Response to Medication The patients body temperature decreased from 39.1 C to 36.8 C

For body temperature of more than or equal to 37.8 C.

Brand Name: Tempra

Name of the drugs; Generic name and Brand name 2. Generic Name: Cefuroxime sodium Brand Name: Zinacef

Date Ordered; Date performed; Date Changed or Date Discontinued Date Ordered: August 11, 2010 Date Performed: August 12-13, 2010

Route, Dosage, and Frequency 450 mg IV q 8

General Action and Mechanism of Action Classification: Antibiotic Second-generation cephalosporin Action: Bactericidal: Inhibits synthesis of bacterial cell wall, causing cell death.

Indication or Purpose

Client Response to Medication Patient has decreased in presenting signs and symptoms of infection such as fever, chills, nausea and vomiting. There are no hypersensitivity reaction noted.

It was given to the patient to treat infection caused by sensitive organisms.

c. Diet Type of Diet

Date Ordered; Date Changed

General Description

Indication or Purpose

Specific food taken

Client Response to DIet The patient complied with the ordered diet and there was a decreased in edema The patient complied with the ordered diet and there was a decreased in blood pressure.

Low sodium

Date Ordered: January 1, 2012 Date Performed: January 1-5, 2012

The patient should only take foods that have limited sodium content.

To reduce accumulation of fluid in the body causing edema and to decrease blood pressure.

Tinola, sopas, grapes, rice, crackers

Low fat

Date Ordered: January 1, 2012 Date Performed: January 1-5, 2012

The patient should only take foods that have limited cholesterol and high density lipoprotein content.

To prevent further in lipid and cholesterol level in the blood of the patient.

Type of Diet Limit fluid intake to 800 ml/day

Date Ordered; Date Changed Date Ordered: January 1, 2012 Date Performed: January 1-5, 2012

General Description The patient should only take fluid in limited or small amount.

Indication or Purpose This type of diet helps to reduce edema and prevent fluid retention.

Specific food taken Small amount of water, soups

Client Response to Diet The patient drinks fluid in the prescribed amount and the edema was reduced.

d. Activity or Exercise Type of Activity Complete Bed Rest Date Ordered; Date Changed Date Ordered: January 1, 2012 Date Changed: January 4, 2012 General Description Complete rest periods without any extraneous activity. May turn side to side. Indication or Purpose The patient had edema and body weakness due to continuous hematuria. Because of continuous hematuria, there is decrease red blood cell in the blood which leads to decrease perfusion in the patients body. The patient needs to be in this type of activity to prevent fatigue and conserve energy. Indication or Purpose This is to prevent respiratory complication as well as thromboembolism from immobilization, thus promoting proper circulation. Clients response to activity The patient had an adequate rest and had conserved energy.

Type of Activity Ambulation

Date Ordered; Date Changed Date Ordered: January 4, 2012

General Description The patient may sit on the side of the bed and walk around the room.

Clients response to activity The patient was able to resume activities of daily living gradually.

NURSING CARE PLAN Problem No. 1: Hyperthermia

ASSESSMENT S= O= The patient manifest:  Increase in body temp. (39.1 C) Skin warm to touch With flushed skin Weakness NURSING DIAGNOSIS Hyperthermia SCIENTIFIC EXPLANATION Since acute glumerulonephritis is a post streptococcal in origin microorganisms that entered the body causes release or activation of chemical mediators that produces inflammatory response and attraction of phagocytes. The microorganisms, neutrophils and other cells release chemical called pyrogens which stimulate OBJECTIVES Short term: After 4 hours of NI, the patients temperature will decrease from 39.1 C to 37.5 C Long term: After 2 days of Nursing Interventions, the patient will be able to maintain core temperature Remove unnecessary clothing that could only aggravate heat Assist patient in doing self care activities NURSING INTERVENTIONS Assess underlying condition and body temperature Monitor and record all sources of fluid los such as urine, vomiting and diarrhea RATIONALE To obtain baseline data EXPECTED OUTCOMES Short term: The patients temperature shall have decreased from 39.1 C to 37.5 C

To monitor potential fluid and electrolyte losses and imbalance

  

Decreases warmth and increase evaporative To prevent fatigue

Long term: the patient shall have maintained core temperature within normal range AEB of afebrile until the day of

The patient may manifest

Reduce

metabolic

  

Diaphoresis Chills Seizures

fever production. Pyrogens affect the body temperature regulating mechanism in the hypothalamus of the brain. As a consequence, heat production and conservation increases, fever promotes activities of the immune system, such as phagocytosis and inhibits the growth of some microorganisms.

demands or oxygen Promote adequate rest and sleep periods Provide bath tepid sponge To provide proper ventilation and promote release of heat through evaporation To offset increased oxygen demand and consumption To promote cooling surface

disharge

Loosen clothing

Provide oxygen therapy in extreme cases ordered

To lower temperature Administer ordered meds as

core

Problem No. 2: Impaired Urinary Elimination

ASSESSMENT S= O= The patient manifest        Oliguria 110 ml in 8 hours Hematuria Albuminuria (+2) Periorbital edema Facial Edema Weakness Irritability NURSING DIAGNOSIS Impaired Urinary elimination r/t compromised regulation mechanism AEB tea colored urine and decreased urine output, facial edema albuminuria, weakness 2 AGN SCIENTIFIC EXPLANATION Post infectious causes Group A beta hemolytic streptococcal infection of the throat that precedes the onset of glumerulonephritis by 2-3 weeks deposition of antibody and antigen complex in glomerulus that may lead to the thickening of the glomerular filtration membrane. The scarring and loss of glomerular filtration membrane will decreased glomerular filtration rate. The decrease in filtration rate will dec. the production of the urine output OBJECTIVES Short term: After 4 of NI the patients SO will verbalize understanding of condition and demonstrate behaviors/ techniques to prevent infection and to maintain fluid status NURSING INTERVENTIONS Identify condition that may be present such as Urinary tract infection Assist with physical examination(cough test, palpation of bladder retention) Determine clients usual daily food intake Review regimen medication RATIONALE To assess factor causative EXPECTED OUTCOMES Short term: The patient SO shall have verbalized understanding of condition and demonstrate behaviors/ techniques to prevent infection and to maintain fluid status AEB the SO assist properly in urinating

To assess contributing factor

To help determine level of DHN For drugs that can alter bladder or kidney Long term:

The patient may manifest   Incontinenc e retention

Long term: After 4 days of NI the patient will improve/ achieve elimination pattern

Review results diagnostic studies

of To identify presence/ type of elimination problem Open expression allows client to deal with feelings and begin problem solving To reduce the risk for infection

The patient shall have improve/ achieve normal elimination pattern

Encourage client to verbalize fears/ concern

Check frequently for bladder distention and observe for overflow

Problem No. 3: Fluid Volume Excess

ASSESSMENT NURSING DIAGNOSIS SCIENTIFIC EXPLANATION OBJECTIVES INTERVENTION RATIONALE EXPECTED OUTCOME S= O= patient manifest: Fluid Volume Excess related to compromised renal perfusion Glomerulonephritis is an immunologic disorder that causes inflammation and increased cells in the glomerulus. Because the primary function of the glomerulus is to filter blood, most cases result when antigenantibody complexes become trapped in -edema -poor skin turgor -dry, scaly skin -restlessness -decreased urine output the glomerulus. This entrapment causes inflammatory damage, reducing the glomerular membranes capacity for selective permeability, which results in loss of protein in the urine. The resulting hypoalbuminemia alters oncotic pressure in the vascular tree and fluid moves into interstitial spaces, causing edema. Long-term: After 3 days of NI, pt will be able to stabilize fluid volume AEB balanced I/O, VS within clients normal limits, stable weight, and free of signs and symptoms of edema. -Evaluate mental status -To check for cerebral edema - Restrict fluid/sodium intake as indicated -To reduce further edema After 3-4 hours of NI, pt will be able to demonstrate behaviors to monitor fluid status and reduce recurrence of fluid excess -Monitor I & O - To reveal alteration in fluid status Pt shall be able to stabilize fluid volume AEB balanced I/O, VS within clients normal limits, stable weight, and free of signs and symptoms of edema. Long-term: note level of consciousness - Monitor VS and - To have a baseline data and to reveal alteration Pt shall be able to demonstrate behaviors to monitor fluid status and reduce recurrence of fluid excess. Short term: Short term:

-Measure abdominal girth

-To reveal fluid status change

-To promote -Administer diuretics as ordered fluid excretion

Problem # 4: Ineffective Renal Tissue Perfusion

ASSESSMENT NURSING DIAGNOSIS SCIENTIFIC EXPLANATION PLANNING INTERVENTIONS RATIONALE EXPECTED OUTCOME

S:

O: patient manifested the following:

Ineffective renal tissue perfusion r/t decreased hgb concentration in the blood secondary to AGN

AGN usually leads to decreased hgb because of rbc exretion though urne. Decreasing the blood flow as well as to the kidneys.

Short Term:

Establish Rapport

To gain the trust of the patient

Short Term:

After 2 hours of Nursing intervention patient will identify interventions to prevent agrivation of condition

Assess patients condition

To note for abnormalities r/t condtion

After 2 hours of Nursing intervention patient shall have identify interventions to prevent agrivation of condition

>oliguria >has pale conjunctiva Long Term: >generalized pallor >weakness >irritability >Elevated creatinine level Monitor and record V/S To establish base line data Long Term: Review lab studies To assess for progress And to and to note for comparison of the present and previous state

After 4 days of nursing intervention, the patient will achieve Weight pt. weekly and improvement in in PRN tisssue perfusion AEB Best wat to assess normal vs , balance Reinforced diet as ordered hydration status intake and absence of edema Regulate IVF as ordered

After 4 days of nursing intervention, the patient shall have achieve improvement in in tissue perfusion AEB normal vs , balance intake and absence of edema

patient may manifest the following:

To prevent further agravtion of the condtion To regulate entry of fluid and to control amount of fluid through the body

Administer meds as ordered

>fever >increased vital signs >elevation of BUN >paralysis >hematuria Refer to other members of the team and collaborate to treatment regimen a ordered To provide therapeutic management For better therapeutic care management process and for efficient nursing care

Problem # 5: Altered Tissue Perfusion

NURSING DIAGNOSIS Altered tissue perfusion r/t decrease Hgb level/ concentration in the blood 2o TO AGN SCIENTIFIC EXPLANATION Pt. with kidney problems manifest anemia due to the interruption in the release of erythropoietin and enzymes responsible for RBC production

CUES S= 0= Pt. manifested >Body malaise >Pale palpebral conjunctiva >Pale skin

PLSNNING Short-term After 6 of NI pt.s SO will verbalize understanding of condition and therapy regimen

INTERVENTIONS >Establish rapport

RATIONALE >To gain pt. trust

EXPECTED OUTCOME Short-term Pt.s SO will verbalize understanding of condition and therapy regimen

>Monitor VS and note level >to have a baseline of consciousness data and to reveal alteration

Long-term >Activity intolerance >poor skin turgor >delayed capillary refill >low Hgb level >Restlessness >Irritability After 8 days of NI pt. will demonstrate increase perfusion as individually appropriate >check for calf tenderness >Elevate HOB

>To increase gravitational blood flow

Long-term Pt. will demonstrate increased perfusion as individually appropriate

>May indicate thrombus formation

>to promote relaxation

>Weakness >Fatigue >Provide quiet and restful environment >to conserve energy

The pt. may manifest the ff.: >Dry skin >Tenting of skin >Blurring of vision >Delayed wound healing >cold and clammy skin

>instruct pt. to avoid strenuous activity

>To promote RBC production

>Provide foods rich in iron and vit. C and iron

>To avoid fatigues

>Encourage to use relaxation techniques

>To promote wellness >Provide adequate rest periods

>Provide comfort and safety measures

>To promote wellness

>Administer due medications as ordered particularly ferrous sulfate.

>To promote wellness