I.

INTRODUCTION

HENOCH-SCHNLEIN PURPURA or HSP (pronounced as heh-nok shoon-line purr-puh-ruh), also called allergic purpura or anaphylactoid purpura -- is a condition that causes small blood vessels, or capillaries, to become swollen and irritated. This inflammation, called vasculitis, usually occurs in the skin, intestines, and kidneys. Inflamed blood vessels in the skin can leak red blood cells, causing a characteristic rash called purpura. Vessels in the intestines and kidneys also can swell and leak. The disorder was named after two German physicians, Eduard Henoch and Johann Schnlein, who first described the disease in the 1800s. HSP occurs much more often in kids than in adults, usually happening between ages 2 and 11. It is one of the most common forms of vasculitis in children, and boys get it about twice as often as girls. A protein called immunoglobulin A (IgA) is deposited into the blood vessels and sets off an immune reaction. In most cases, HSP occurs after a child has had a bacterial or viral infection of the upper respiratory tract (sinuses, throat, or lungs). But certain medicines, food reactions, insect bites, and vaccinations also may cause it. Common signs and symptoms of HSP include: Purpura, the raised, reddish purple rash/ pinpoint red dots (petechiae), bruises, or sometimes blisters which are prominent on the legs and buttocks, can also appear on other parts of the body, such as the elbows, arms, face, and trunk. Joint pain and inflammation can happen before the rash appears. They most commonly affect large joints, such as the knees, ankles, and elbows, but the hands and feet can be affected. Stomach pain usually starts a week after the rash appears. Pain is intermittent and can be accompanied by nausea, vomiting, or diarrhea. Blood in the stool (caused by leaky blood vessels), which may not be visible. Small amounts of blood or protein might be found in the urine, which occasionally can be bloody. Fever and headache may also be present. Diagnosis can be made through throat culture, urinalysis, blood tests for inflammation and kidney function, biopsy of the skin, and less commonly kidneys (used to demonstrate vasculitis). Special staining techniques (direct immunofluorescence) of the biopsy specimen can be used to document antibody deposits of IgA in the blood vessels of involved tissue. The treatment of HSP is directed toward the most significant area of involvement.

II. NURSING HEALTH HISTORY BIOGRAPHIC DATA Name: Patient Y Address: Brgy. 1 Salug Catbalogan, Samar Age: 6 y.o. Sex: Male Religion: Roman catholic PAST HISTORY: Weeks prior to the onset of signs and symptoms, Patient Y had an upper respiratory infection. Family History of Illness: Asthma and hypertension (mothers side). The patient has no known family history of Henoch Schonlein Purpura

HISTORY OF PRESENT ILLNESS: On December 30 last year, the patient suddenly ceased playing when he felt some unusualities on his stomach. It was so painful that it made him lie down on his bed and displayed a guarding action on his abdomen. Manzanilla oil was applied and he was given 1 tablet of Decycloverine 10mg, a drug for abdominal spasm. The patient also complained of joint pains and weakness on his body. According to the patients mother, rashes on both upper and lower extremities began to appear, thus the child was given another drug named Citirizine. Believing that her child was only suffering from a simple UTI, the mother decided not to take the patient to the hospital. On January 2, just this year, Patient Ys mother reported that his child had presented some swelling on the extremities. There had also been diarrhea and onset of fever with chills. He was then given Paracetamol. The patient was brought to Samar Provincial Hospital on that same day, but after his temperature dropped to normal, the mother decided to take the patient home. Moreover, because of the persistence of the signs and symptoms on the following weeks, a concerned relative advised to take the child back to the hospital. CHIEF COMPLAINT: Rashes, abdominal pain which started about a week PTA as onset of fever and abdominal pain, persistence of abdominal pain associated with purpuric rashes on both lower and and upper extremities prompted consult and admission LIFESTYLE Diet: Patient Y has no any special preferences of food, but has a large intake of junkfoods and softdrinks.

III. FOCUSED CLIENT ASSESSMENT Initial vital signs: BP: 100/80 mmhg Temp: 35C Pulse rate: 73 bpm Resp. rate: 29 cpm Skin/Mucous membrane color: Presence of purpuric rashes, dry skin, pale, Activity and Rest: Weakness General Survey: Conscious, coherent, oriented to 3 spheres

Respiration: (Subjective) kinukurian ako paghinga tapos madali ako hapuon As verbalized by the pt. masakit an akon dughan pagsige-sige akon pag-ubo. As verbalized by the pt. sige akon ubo ngan mayda plema na nagawas As verbalized by the patient. nagpapaaso ako para deri ak makurian paghinga As verbalized by the patient nagsisigarilyo ako tika han katorse anyos ako As verbalized by the patient. may asthma akoAs verbalized by the patient. (Objective) Wheezing Color:pale nail beds Safety: History of allergic reaction or sensitivity to Decycloverine.

IV. ANATOMY AND PHYSIOLOGY

The Urinary System

The function of the urinary system is to remove waste products from the blood and eliminate them from the body. The principal waste products being eliminated are water, carbon dioxide and nitrogenous wastes including area, uric acid and creatinine. Other functions of the urinary system include the regulation of the volume of body fluids, the balance of pH and the electrolyte composition of these fluids. Kidneys The kidneys are located in the back of the upper abdomen and are protected by the lower ribs and rib cartilage of the back. The kidneys are involved with a number of bodily functions which include: The filtering and excretion of unwanted waste products such as urea from the body. The maintenance of water balance. the regulation of the acid-base balance of body fluids. the production of renin, which is important in the regulation of blood pressure. The production of the hormone erythropoieten, which stimulates the production of red blood cells.

Ureters The ureters are two slender tubes that run from the sides of the kidneys to the bladder. Their function is to transport urine from the kidneys to the bladder. Bladder The bladder is a muscular organ and serves as a reservoir for urine. Located just behind the pubic bone, it can extend well up into the abdominal cavity when full. Near the outlet of the bladder is a small muscle called the internal sphincter, which contract involuntarily to prevent the emptying of the bladder. Urethra The urethra is a tube that extends from the bladder to the outside world. It is through this tube that urine is eliminated from the body. Nephron The basic unit of the kidney is the nephron. Each kidney is composed of roughly 1 million nephrons. Kidney nephrons filter the blood, reabsorbing what the body needs and excreting the rest as urine.

Urine Formation Blood is continually filtered within Bowmans capsule. Wastes and other solutes are passed into the tubule for inclusion in the urine, while large items like cells or large proteins are retained in the blood. High pressure within the glomerulus allows small solutes and water to escape from the glomerular blood flow into the space of the Bowmans capsule. The renal tubule is the second portion of the nephron, and it is specialized for absorption. It descends from the Bowmans capsule.

V. PATHOPHYSIOLOGY VI. LABORATORY ANALYSIS VII. DRUG ANALYSIS VIII. NURSING CARE PLAN IX. PROGNOSIS